If you can learn a simple trick, Scout, you’ll get along a lot better with all kinds of folks. You never really understand a person until you consider things from his point of view…until you climb into his skin and walk around in it. –Atticus Finch in Harper Lee’s To Kill A Mockingbird.
The challenge is to consider things from a different point of view.
I spent my morning in a memory clinic. I have some choices in the current Neurology rotation I am doing, so I can pick from clinics being offered (that aren’t already occupied by other learners) to try to tailor my learning.
I chose to go to this clinic because memory issues are something that can be caused by cancer treatments I will in my future life administer. I chose to go to this clinic because memory issues are common. I chose to go to this clinic because memory issues are very personal for me. I almost went to a different clinic for the same reason.
I can walk into this clinic wearing many different pairs of shoes in my mind. These three are the most predominant.
I walk into the clinic as a part of the team.
I don’t know these people. I don’t know their past. I can’t say for sure what their future holds.
I introduce myself. He has that blank stare. The lost look that dementia brings. He is polite and shakes my hand. Smiles back at me with a big grin. I can see a stain on his shirt from breakfast. He glances around uncomfortably as I meet his wife and daughter. The daughter has a list of questions and a notepad in hand.
They sit down.
I ask what brings them in today.
He says, “a checkup.”
His daughter interjects, “He has been having trouble with his memory. His family doctor thinks he has Alzheimer’s. He repeats himself. He doesn’t remember how to get home from his walks. Mom isn’t coping well with him at home. It isn’t safe.”
His wife looks tearful and ashamed. She just nods along.
He then looks at me and asks, “Why am I here? When can I go?”
I go on to ask questions. How long has this been happening. Talk about when things started, how the progressed, about safety issues, medicatons and family history. I get to hear intimate details of their lives. I listen to their fears and hopes, their belifs and misconceptions. I listen to them bicker and laugh and cry.
I want so much to fix their hurt. All I can do is offer the help that is available, a listening ear and a friendly smile.
I supported my family members as they have gone into a clinic like this.
Unfortunately, I am aware that there is a good chance that one day I will sit on the other side of these figurative and real tables.
I will be the daughter or daughter-in-law of the person being seen in the memory clinic.
I shake the resident’s hand and sit down with my Mom and Dad.
She explains the procedure and we laugh because we know the drill.
Mom tells her, “We’ve been here before. Plus, my baby here is a doctor.”
I am embarrassed. “It never gets old,” I say and laugh.
The resident is puzzled, “You’ve been here before?”
“Oh yes, our Mothers were both through this clinic. Alzheimer’s. I guess its our turn now.”
My father sits silently, but smirks and shakes his head.
The resident looks confused at how casual we are about this.
“We have been expecting this. It is kind of our way of coping. Either way, we decided to come early. Get on medication. Plan ahead. We have done this before.” I explain.
Later in the conversation, they are doing the testing. I have given these tests more than I would have liked, but there is something different sitting behind your mother as they go through the questions.
She stumbles through serial 7s. She can’t spell world backwards, but my Dad chimes in that she is “half dyslexic,” so that is probably why. It isn’t. She knows the season because we are wearing sandals and the date because she memorized it on the way in.
She draws the clock as I cringe when she almost mixes up the hands. Almost. I sigh with relief when she gets them right.
She can’t remember the name of my youngest child. And my grandmother is still alive in a nursing home (we laugh because we joked that she would outlive us all, but in the end she didn’t). She knows they downsized and moved to an apartment near my husband and I, but can’t recall their new address.
She glances back at us for confirmation.
The resident then asks for our help in sorting out the correct information.
I take a deep breath and give the correct information. She smiles and nods alongs. Agrees and laughs at her misinformation. It is good that she is so good natured.
We smile and encourage her to continue but give eachother looks from the corner of our eyes.
Even more frightening is that one day, it might be me.
I’m sitting in an unfamiliar clinic room. Something tells me I have been there before, but I just can’t place it.
Posters all around the room show pictures of human brains and nervous systems and drug advertisements. This is my world. This is what I know.
They come back in the room. Patrick, my son, my daughter, two strangers one with a stethoscope around their neck. I don’t know these people but they seem to know me.
They pull out a test. They say it was mine.
I recognize it. An MoCA (Montreal Cognitive Assessment) test. It is completed. I must have done it earlier.
I don’t remember.
That is the frightening part. I feel like I miss more and more with each coming month and I don’t even realize it all the time any more.
The resident is explaining the meaning of the results.
I know these things. I used to do these things.
“Her level of education helps her get along. Her scores have been fairly stable. When she first presented she got a 27, then a 25 six months later. Since we switched her meds and started her on the trial drug, her score has been hovering around 23. But today, she got a 17.”
I stare at her. There has been some sort of mistake. I have Alzheimer’s, but I am medicated. I am a competent adult. I am a physician and a mother and a wife.
She continues, “After all we talked about today, it seems your wife’s condition is progressing. It is clear that she is having more difficulties with her short term memory and judgement, especially after the time she wandered out the other evening. And that fact that she is no longer able to hide things very well any more. Have you thought about what you are going to do when things get worse?”
I have. I want to be put in a nursing home. That much I know. But, things aren’t that much worse, are they? I try to remember getting lost. I try to remember what clinic we are in.
Then I realize they are all staring at me. How much time has passed?
I forgot to make my notes. I always keep notes. It is how I get by. Memory cues. I don’t know where we are in the conversation. I feel overwhelmed. I feel afraid.
My daughter takes my notebook from me and repeats what the doctor said about medication dosing and changes to my timing. She says she will make sure the blister packs get replaced.
Someone from home care is coming by tomorrow to meet with us about getting some help at home. She takes my calendar and marks that down.
Patrick is staying back to talk to the doctor. I hate it when he stays behind. I know what that means. At least, I think I do, but I can’t be sure of anything anymore.
I want to stay. I ask to stay. I demand to stay. It is my health and my body. Back when I was first diagnosed, I could manage these issues. Nobody figured it out until I was ready for them to know. Medications are better now. I am not my grandparents. I just need to take better notes or add more pills or maybe take away more pills…
They tell me it will only be a minute. I can’t understand why. I just don’t like being apart from him. He is one of the few people I know. He helps me.
My daughter tells me we will go to the Starbucks across the street for lattes while we wait.
I tell her, “That sounds great, I haven’t had one of those for years and years.”