Dementia

Although these events had transpired the day before I wrote the first part of this post, the second part should make it obvious that it didn’t really happen yesterday. It’s been waiting a while to be published, in order to avoid any possible violation of privacy. While it was waiting, part two happened. And then it waited some more.

Part One

I had to have a hard talk with a patient yesterday, about the fact that he has dementia, and can no longer trust what he “knows.” He’s been angry, paranoid, and difficult his entire admission; the only way his brain could rationalize the things happening to him was to assume the people around him had all turned on him and were conspiring against him. The day before, on my orders, security had to forcibly put him back in his room when he tried to leave. Yesterday he was calmer, but still angry and thinking nobody was taking him seriously.

Later in the day I caught him in a receptive moment, or perhaps the medications I had to have forcibly administered the day before were having some delayed effect, and so I broached the dementia subject. I frankly expected another verbal/physical explosion, but instead he sat quietly and soberly in his bed and told me about the research he had done when he was given the diagnosis, and how hard it had been for him to face the future he knew was coming. I ordered cognitive testing for today. I don’t know if he will still remember our conversation by the time it has been done, but at the time, we agreed it would give him a better idea of whether to believe himself or everyone else in the current situation, and whether his insistence on going home to his (terrorized and terrified) wife has merit, or if he should perhaps consider moving into a memory care facility. He said it would be hard for him, knowing he has slipped as much as I think he probably has, but he would rather know than not know.

I can not begin to imagine how it must feel to be a highly intelligent person whose mind is slowly slipping away like last night’s dream; to have some part of yourself still intact enough to be aware of the loss, while the rest of you is feeling indignant at being treated like a crazy person. It reminds me of how I felt during the first real earthquake I experienced as an adult, and the horribly disconcerting realization that absolutely EVERYTHING I had ever depended on to be solid and supportive and dependable was betraying me, and there was nothing to hold on to, nowhere to run, nothing firm or solid or immovable anywhere in my universe.

Part Two

A few weeks later, the same patient was back in the hospital. In just that short amount of time, his cognitive decline had progressed past that “tipping point” of awareness. Now, instead of frightened and angry over what he could see slipping away from him, he had forgotten that he had ever had it at all. 

He was no longer paranoid and upset. The fear and anger was gone. In its place was kind of a mild bafflement. He sat quietly in his room, calm and serene, looking contentedly out the window, interacting pleasantly with the staff who were caring for him. When I talked to him, he told me he was working on a paper he wanted to publish. He described, at great length, the theories he was developing for classifying human emotions according to a biological taxonomic system of phylums and families.

As our conversation drew to a close, he said, “I’m sorry…I’ve forgotten your name.” He looked apologetic, explaining, “I have dementia, you know.”

“I know,” I said, “it’s okay. My name is Ruth.” His eyes took on a far away look. “Ruth,” he said contemplatively, looking off into the distance somewhere over my left shoulder. “Ruth…” he said again. “…You know, I met someone named Ruth, one time. She was tall and slender, just like you…” He gazed into space for a moment more, trying to remember, then shook his head and shrugged as the ghost of a memory drifted away. He smiled, lifting a hand in farewell, as I retreated before he could see my tears.

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