Last week, I wrote my first letter to officially take away someone’s license.
I had been involved with these scenarios as a med student and, as a resident, I have told people not to drive for so long after a procedure or taking a medication. But, this was a first.
We saw someone in emerg with advancing dementia. This person had gotten lost in their own neighbourhood twice and once drove 10 minutes in reverse because it was easier than getting turned around. They were being aggressive towards their spouse who kept suggesting they shouldn’t drive and they came in because there was a question if the new worsening in behavior was due to an infection. It wasn’t.
I have said before that dementias are the thing that kill me inside. I can deal with them, but I find it exceedingly tough. This from the oncologist-in-training. Most people say that cancer is one of those things they like to avoid. I don’t mind it. Not saying it is easy, but I have found ways to cope. There is hope in the grave situation. Chances for cure or quality of life. And I have ways to cope with people with dementia too. But, for whatever reason (probably because of my family) impending forgetfulness without a defined endpoint or fix is worse than possible impending death and disability for me to observe.
Any situation can have some hope. And in medicine, you learn to process those things. But, memory loss strikes a chord with me. Maybe it always will.
Back to my story…
So, after we rule out all of the reversible stuff, there is a conversation about where to manage things and about safety.
I had to tell this person they can no longer drive. This person who is the same age as my grandfather who just died. This person who has been driving their entire life. Who lives far from everything.
But, to complicate things, their judgment is poor. Their insight is absent. “I just forget a few unimportant things. Who needs to know the date or the season. That isn’t needed for driving,” they say. They blame their spouse. They yell at me. They threaten to harm themselves if they can’t drive. To destroy the car so nobody can enjoy it.
I empathize. I mean, I can’t imagine what I would do if someone told me I couldn’t drive. When I had that terrible torticollis earlier this year, I couldn’t drive for a week (something about moving one’s head that is important to the driving process) and I didn’t like it.
I empathize because my family had the discussion that when my grandfather lost his license, it would kill him. I empathize because it crushed him, even though he was so sick, to hear that he shouldn’t drive. I empathize because I have had family members get upset because I seemed to be stopping them from doing something they thought to be harmless for their own protection.
I had to explain that I will be sending a letter to the motor vehicle branch. That they can be arrested and fined if they are caught driving. That they are at risk of hurting someone, even though they would never mean to. And that if I didn’t say something, I could be fined.
I know in my head anything I say won’t make a difference. That it is still, to that person a blow out of left field. And that they will forget as soon as they leave and their poor spouse will have to deal with their anger.
I left to get something and came back. They had already forgotten I told them not to drive.
I can’t imagine what it must be like.
I wrote the letter and dropped it off with the admin assistant to be sent.
I keep thinking of that person. Their family.
My parents take care of both of their mothers. Both of whom have Alzheimer’s . They present very differently. One is relatively easy, childlike. The other is difficult and can, at times, be downright nasty. They are both (as of yesterday) in facilities to keep them safe and help with their care. Where we don’t have to worry quite as much about them getting hurt or lost.
Because really, keeping people safe is important. But, sometimes it is more of a struggle to balance the safe and happy.
When I see people coming in, especially when these changes are new, I recognize the scared looks. The uncertain questions.
I find it hard to not see it from their eyes. Maybe because I am living it from the other side (when I can be there or at least vicariously). Also maybe because I fear that one day I will be that family member or even that person.
I know it won’t be the last letter I write. Or the last person with memory deficits I see. I hope it will get easier, less personal. But at the same time, I hope I keep the empathy.