In front of the shogi board, they moved a piece with trembling hands. What the 'last game' I played at the special nursing home taught me

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Prologue—Trembling hands and the final move

They were trying to move a piece with trembling hands.

Their fingertips were unsteady. The piece they thought they had gripped would slip from their fingers. In the moment they tried to move it, their hand would hit the board, shifting other pieces that had nothing to do with the move. They would then fix them one by one with those same trembling hands. While fixing them, they would think about their next move.

There was no conversation anymore. No voice came out.

But it was painfully clear that they were desperately thinking about something with a mind that was no longer functioning as it once had.

I did not go easy on them. I couldn't. I felt that going easy on them would be the most disrespectful thing I could do.

This is the story of what was likely the last game of shogi I played with a resident during my 16 years of working at a special nursing home.

It is also the story of an event that confronted me, in the most profound way possible, with the question of what it truly means for a person to 'want to do something'.

Chapter 1—When we could play shogi and laugh together

I am in my 16th year as an occupational therapist, working as a functional training instructor at a special nursing home. I have been present at the end of life for nearly 100 people.

I didn't meet this person that long ago.

Their dementia was not that severe. They understood me well. They remembered the faces and names of the staff. They could talk about what happened yesterday clearly. That was the kind of person they were.

And, they were a Hanshin Tigers fan.

Not just an ordinary fan. They were someone who remembered the results of the previous day's game perfectly. They would talk about the game with such accuracy that it would surprise me, saying things like, 'They won yesterday' or 'That play was bad.'

I am not a Hanshin fan. But because I wanted to talk to them, I started checking the baseball results. Not just Hanshin. I started looking at the results for other teams as well. There are several baseball-loving residents at the nursing home. Since it also gave me topics to talk about with them, checking the previous day's results every morning became a habit before I knew it.

We would talk about baseball and play shogi.

When it came to shogi, they were serious. At that time, they could still form strategies and move their pieces firmly. I also played them seriously. Sometimes I would lose. After the game, we would look back on it together, saying, 'It was like this' or 'It was like that.' I quite liked that time.

A relationship where we could laugh together across a shogi board.

In a place like a special nursing home, this is by no means something to be taken for granted. Many residents have advanced dementia or cannot move their bodies as they wish, making such 'equal matches' difficult to achieve. That is precisely why the shogi I played with them was a somewhat special time for me as well.

That relationship began to crumble rapidly at a certain point.

Chapter 2: Becoming a 'troublesome person'

What happened before things fell apart?

I will write honestly. This is not a story about blaming anyone. But if I look away while writing, it would be a lie. So, I will write as honestly as I can.

After they started taking a certain medication, they began to complain of stomach pain.

And then, they started calling the care staff about every five minutes. They would press the nurse call button. The staff would come. But they couldn't quite put into words what was painful or what they wanted. The staff, unable to understand the request, would return to their next task. And then, five minutes later, the call would ring again.

They couldn't sleep at night, either.

Because they couldn't sleep, they would sit alone on the sofa in the living room. An elderly person sitting all by themselves in the dark living room in the middle of the night. From the staff's perspective, they would say, 'It's dangerous, let's go back to your room and rest.' They said this over and over again. But the person didn't want to return to their room.

Care facilities are short-staffed.

This is not just the case at that facility. Right now, care facilities all over Japan are operating under chronic staff shortages. With a small number of people, we have to look after many individuals. The time that can be spent on one person is inevitably limited.

In such a workplace, someone who 'calls every five minutes but cannot convey their needs' or 'won't return to their room no matter how many times they are told'—I don't want to write this, but I will write it honestly—became a 'high-maintenance person' or a 'troublesome person'.

The nursing side was also difficult.

That person often showed resistance to the nurses' involvement. Therefore, it was difficult for the nurses to engage with them deeply. However, they had to deal with the stomach pain and the inability to sleep. While being rejected, they still wanted to suppress the symptoms. They had no choice but to rely on medication.

From the care side, they were 'high-maintenance.' From the nursing side, they 'wouldn't let us help.'

Both sides had their own pressing circumstances. It wasn't that anyone was particularly cold-hearted. Everyone was doing their best in their respective roles, within the limits of their time and staffing.

However—as a result, it is a fact that the person gradually became someone who was looked upon with annoyance at the facility.

I want to write this clearly. Even so, there was more than one staff member who felt, 'Isn't this treatment a bit pitiful?' There were several. It was by no means the case that everyone was cold. There were definitely people who were heartbroken by it.

Even so, the momentum did not stop.

And the medication to suppress the symptoms increased.

Chapter 3: The medication increased, and they became quiet

After their medication was increased, that person changed rapidly.

Their level of alertness visibly dropped.

The time they spent awake decreased. Even when I spoke to them, their reactions became slow. They no longer mentioned the previous day's game results, which they used to remember so accurately. They could no longer talk about baseball or shogi.

In terms of the staff's burden, it might have truly 'settled down.' The call button was pressed less often. They stopped wandering around the living room in the middle of the night.

But to my eyes, it did not look like they had 'settled down.'

It looked as if the very life force was quietly draining out of them.

As an occupational therapist, there is something I must write here.

We tend to think that 'fewer behavioral problems equals improvement.' Fewer calls. Less wandering. Easier to assist. From the perspective of those managing them, it looks like an 'improvement.'

But if that 'calmness' is the result of eroding their 'will to live,' can we really say it has 'improved'?

I have been carrying this question with me for a long time.

Chapter 4—The day they moved a piece with a trembling hand

One day, while they were in that state, there was a rare period when their alertness was slightly higher.

Their eyes were open. They were looking at me. They seemed to want to convey something. But it wouldn't turn into words. Even though their mouth moved, no voice came out. I didn't know what they wanted to tell me.

So, I asked them,

'Shall we play shogi?'

They—it looked like they nodded slightly.

I brought out the shogi board.

And so, we return to the scene in the prologue.

They tried to move a piece with a trembling hand. Their fingertips were unsteady. The piece slipped away. Their hand hit the board, moving other pieces that shouldn't have been touched. They corrected them with that same trembling hand.

There was no strategy to speak of. They could no longer play with the solid technique they once had. Even so, with a mind that was no longer functioning clearly, they were thinking desperately. They were trying to squeeze out the next move.

Their desperation came through.

That is why I did not hold back.

To hold back would be to treat this person as someone who 'can no longer even play shogi properly.' That would be disrespectful. This person's dementia is not that severe. They know who I am. There is no way they wouldn't notice if I went easy on them. If they noticed, it would be trampling on their pride.

So, I fought with all my might. While facing that trembling hand, I played seriously on the board.

Partway through, they resigned.

I think they could no longer continue. Both their mind and body had reached their limit.

After resigning, they smoothly raised their right hand.

And then, they looked at me.

No voice came out. But I understood.

Perhaps they wanted to say, 'Thank you.'

Even now, I cannot forget that right hand and those eyes.

Chapter 5—From there, like going down a slope

A few days after that game.

They could no longer bring food to their own mouth. Assistance became necessary for every movement.

Even when sitting in a wheelchair, they could not support their own body. They would lean forward, further and further, until they were slumped over the desk.

One day, a care worker came to me.

'Could you do some seating for them?'

Seating is a technique for adjusting one's sitting posture. It involves using cushions or other supports to help the person sit comfortably. Seeing them slumped over the desk, the staff member called me because they wanted to find a way to help them sit up. I was grateful for that sentiment.

However, I replied calmly.

'In their current state, using a U-shaped cushion or adding support cushions will only make them more uncomfortable. Let's switch to a reclining wheelchair.'

This was a technical judgment. But more than that, I had a different realization within me.

This posture wasn't leaning forward because their 'way of sitting was bad'.

This person's body was no longer able to support the very act of 'being awake'. Therefore, trying to force them to sit was, in itself, causing them suffering. It wasn't about finding ways to help them sit, but about creating an environment where they could rest their body as comfortably as possible. That was what I could do for them now.

After switching to a reclining wheelchair, they almost stopped opening their eyes.

They stopped eating, even with assistance. They could barely take in any fluids. Eventually, they began to have a persistent fever.

They visited a nearby hospital and were admitted.

What happened after that has not reached me.

Will they come back? Or... I don't know. I can only pray that they might sit in front of that shogi board one more time.

Chapter 6—What happens to a person when they lose what they want to do

I had been unable to write about this event for a long time.

It was because it was too heavy. And because I was afraid that by writing it, I might be condemning someone.

But as an occupational therapist, there is something I absolutely must convey through this event. So, I decided to write it.

It is this.

From the moment a person loses 'what they want to do', they weaken rapidly.

That person clearly had 'something they wanted to do'. Remembering the previous day's game results and talking to someone about them. Sitting across a shogi board and playing in earnest. That was what made them who they were. It was their reason for living.

As their alertness dropped due to medication, they became unable to do those things one by one. They couldn't talk about baseball. They couldn't play shogi.

And that day, when they resigned their final game and raised their right hand. To me, that looked like the moment they said goodbye to their 'reason for living'.

From a few days after that, like sliding down a slope, they became unable to eat and stopped opening their eyes.

Of course, I do not intend to simply say this was 'the fault of the medication'. Perhaps their physical limits were already approaching. I believe various factors were overlapping.

But I have seen this many times in the field.

People who have 'something they want to do' are strong. Even if their bodies weaken somewhat, those who have the drive to say 'I want to do this' or 'I'm looking forward to that' do not collapse easily. Conversely, those who have let go of all their joys, saying 'I don't want to do anything anymore,' weaken surprisingly quickly.

The will to live and 'having something you want to do' are directly linked.

This is not just a platitude. It is a simple realization I have gained after seeing nearly 100 people off.

Chapter 7—All I could do was a mere few minutes

There is one more thing I want to write honestly.

The time I was able to spend with that person was only a few minutes out of their entire day.

Every day, whenever we met, I would greet them. We had light conversations. In the end, we even played shogi. But that was all. I could not be by their side 24 hours a day. I have my own work, and there are many other residents to care for.

That person must have been sending out an SOS the whole time. My stomach hurts. I can't sleep. Something is painful. They were seeking help the whole time, unable to put it into words effectively.

I was unable to fully grasp that.

Here, ironically, what saves me is the 'separation of tasks' from Adlerian psychology, which I have been practicing for 13 years.

There is a limit to what I can do as part of my job. The scope I can step into ends here. Beyond that lies the realm of nursing, caregiving, and medical judgment, and I cannot control everything. That is not my task.

I understand that in my head.

But—even so, I think. Every time I remember that right hand and those eyes, I want to ask myself, 'Was a few minutes really enough?'

And, I will write one more honest thing.

I do not believe that the person themselves was entirely without responsibility for the fact that they could not adjust to the environment until the end.

This might sound cold. But human interaction is always two-way. The facility had its circumstances, and the individual also had difficulties in how they interacted. It wasn't that one person was unilaterally at fault. Everyone was doing their best within their own circumstances and limitations. That slope was the result of that.

I do not want to condemn anyone.

Care staff, nurses, and doctors are all doing their jobs with their own thoughts. It is a current reality that interactions inevitably become thin when there is a shortage of staff. It is easy to criticize from the outside, saying, 'You should have interacted more properly.' But as someone standing on the front lines, I think that is wrong.

I just want to hold onto that complexity, as it is.

I cannot neatly organize it and conclude 'who is to blame.' Nor should I. I just want to keep remembering that right hand and those eyes. I believe that is the very least I can do.

Epilogue—So, while you are still healthy

Finally, there is something I want to tell you, the person reading this.

Watching that person, what I truly felt from the bottom of my heart was that you should cherish the things you 'want to do' while you are still healthy.

We tend to put off the things we 'want to do.' 'I'm busy,' 'When I have time,' 'When things settle down.' That is how we postpone the things we love and enjoy to a 'someday' that may never come.

But once your body stops moving and your mind stops working, it may be too late to try to do the things you 'want to do.'

That person wanted to play shogi until the very end. With trembling hands, they desperately moved the pieces. I believe that is proof that they did not want to let go of 'what they wanted to do' until the very last moment.

Therefore, I want to ask you this.

What is the 'thing you want to do' that you are currently putting off until 'someday'?

Will that 'someday' really come?

While your body can move, your mind can think, and you can feel that you 'love' the things you love. While you can still laugh with someone. Please, cherish that time.

Tomorrow, I will stand in the special nursing home again.

The day may come when I place a shogi board in front of someone else again. When that happens, I will probably fight with all my might again. Without holding back. Because that person taught me that doing so is the best way to respect the 'want to' of the person in front of me.

I hope to meet that right hand again someday.

Profile

16th year as an Occupational Therapist | Works in a special nursing home/unit care | Former Dementia Care Instructor and Manager | HSP/ISFJ | Playing tennis since junior high | Father of a 7-year-old daughter | 13 years of practicing Adlerian psychology | Lost weight from 106kg to 77kg | After experiencing depression and social phobia, I continue to share field-based information on how I became able to live without medication.

*This article deals with the delicate themes of end-of-life care and a person's final moments. If you are currently feeling like you 'want to disappear' or that 'living is painful,' please do not carry it alone. I hope you will reach out to someone you trust or a professional support service.

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