With respect to Socrates, my unexamined life is not worth living. The front room is the face we show everyone but we hide our true self in the back room.
The population I serve is mostly in their 80’s or 90’s. And most have been given a diagnosis of Senile Dementia, indicating late onset, with a possible add-on of Complications from Alzheimer’s or Parkinson’s Disease. Though well-read in how to treat older adults with mood and behavior issues there is no substitute for experience.
Sitting with someone who does not remember you from last week and proceeds to tell you a story you heard before. How the interaction changes when he feels a present physical pain, allowing you to inquire about the pain, sharing how he showed you where it hurt last week, the history of the pain, the tests run, the results given finding nothing and how these doctors all have their heads up their asses to find nothing since there’s something there because he can feel and last week asked you to feel it. But most importantly, how it made him feel, not to be understood.
This can be one of more minor forms of senile dementia, despite this exchange happening several weeks in a row.
Sitting with someone who does not remember you from last week and after a few minutes does not remember you again. She lays in her hospital bed looking at a quilt on top of the hospital dresser. What is that, she asks. You tell her it’s a quilt. She verbalizes comprehension. And less than five minutes later points to the top of the hospital dresser. What is that, she asks. You tell her it’s a quilt. She verbalizes comprehension. This goes on another six times in your session. Sometimes she is disbelieving it is a quilt, mistaking it for clothes. Other times, she believes you are here to take the quilt since she no longer remembers who you are anyway. You are here since it was reported she isolates in her room and has no family or friends visiting her and may be depressed. Never underestimate the power of visitation.
This can be one of the more serious forms of senile dementia.
And finally, for the sake of brevity or late night Friday end of the week tiredness, there is an occasion you are sitting with someone and she mistakes you for an old boyfriend of hers, suddenly grabbing your hand and pulling you closer. You smile and remind her you are married while slowly pulling your hand away, while the nurse’s aide is yelling at her to find another man her own age. She looks at you, asking if you will be taking her to church to see her mother this afternoon, citing the church name and the blue dress her mother wants her to wear. You know not to address that her mother passed away in 1989. Not unless there is a therapeutic outcome to be gained from the gentle confrontation. You are fascinated at the detail of these memories, how vivid they are from probably over 60 years ago. But the most interesting aspect to come from this patient is how every single word she has ever said to you has been sung as if it were a hymn verse. “Come now, dear Roger-r-r-r- and ta-aake my hand… we’re goin’ to see my mother-r-r- and talk ‘bout the promised land!”. Only to return next week to a blank slate, no memory of who you are, the only constant is the singsong of her voice. In circumstances like these, the patient’s behavior is monitored more closely than the patient’s mood, given to unpredictable actions.
This can be dementia with delusions/hallucinations from possible Alzheimer’s complications.
To close, ( for real because I am quite sleepy) I wanted to show a few examples of people in my current world and what their here and now means to them.
The first example I gave could be someone’s grandmother, not diagnosed with dementia, but just a little forgetful and repetitive. I think it is important to note a distinction between the two.
There is a growing population, soon to mushroom as the boomers grow older, for people in nursing homes. People who until recently, held jobs, lived in their own homes, took care of their finances, ate fed and bathed themselves, had shared a life with someone, spoke with authority and were regarded as competent, intelligent adults.
They are now generally placed in the helpless, pitiful, underserved, what can be done for them category.
They used to be us.
If you listen closely, they still are.