Dementia

Thank you for the beautiful postcard. When I was first reading it, I was a little confused when you said the picture reminded you of us. I wasn't sure if you were suppose to be the one prancing through the field or if you were the other girl skipping. I can actually imagine both of those girls being me. LoL.

I had this patient today that made me really rethink about life. I've seen him before, the first time I saw him I didn't really slow down to think about things, but this time around, I thought about his situation a little more. He has dementia. He always comes with his wife and a caretaker. He's also wheelchair bound. When I first called his name, he came in with his wife first. He can barely transfer from his wheelchair to the exam chair. I'm thinking next time I might just leave him in his wheelchair. He's in his late 80's so I'm sure his wife is close to that age. She's a very nice lady. I'm assuming he's by his side all the time and constantly taking care of him and his needs. I remembered what a struggle it was the first time I tried to exam him. He was very upset, he called me names and even threatened to beat me up if I continued to examine him. Of course, this time was no different.

It was difficult enough to just transfer him to the exam chair. Once we got him onto the chair, I tried to do some preliminary testing on him. He wasn't very cooperative with all the testing. I had to mainly do objective testing. Couldn't get any subjective measurements from him. But that's expected from dementia patients. Then when some of the testing got a little more invasive, he began to fight me. He started to call me names and mimic the way I talk (in a very offensive way) and threaten me. His wife was talking to him through most of the exam, trying to explain to him what was happening, but it didn't seem like he was really understanding what she was saying. She would say one thing and he would respond with something completely off topic. To get the exam going, I tried to be a little more pushy with him and force him to be cooperative. That was a bad idea...he just got more angry and worked up. He started to threaten me more and stare at me with this look of hatred. It got really dicey when the wife got desperate and tried to strap his arms down so he wouldn't hurt me, then she asked me to use force to get my test measurements that I needed. I wasn't very comfortable with this whole situation. The patient's getting strapped down against his will and I'm going in and trying to do all this testing on him when he's resisting like their's no tomorrow. Seems kinda barbaric. But when I think about it, it's for his own good. I'm trying to monitor his conditions and make sure he stays healthy. So I went in for it, I tried my best for force him to cooperate and get the measurements that I needed. During the struggling, the patient somehow got lose and got a hold of his wife's hand. He must have been hurting her because she was constantly saying "let go, you are grabbing me too tight, let go!". I was really uncomfortable working in that type of environment. It's like watching two people wrestle and I'm trying to go in and get a blood pressure measurement or something. It's weird.

When the wife couldn't get a handle on him, she called in the caretaker to help. Middle aged woman. She seemed to calm him down a bit more. So we went at it again. The caretaker and the wife holding him down while they beckon me over to continue examining him. At one point, one of his hands got free and he punched me. It wasn't very hard, but it was enough for me to call it quits. I told them that I'm willing to try again, on another day, but I think he's had enough for today. So I kindly invited them to leave, but now the patient wouldn't leave. Remember when I said it's very hard to get him into the exam chair? Well, ending up, it's just as hard to get him back into his wheelchair. Especially when he was refusing to leave. He was confused I think. He thought he was home. He didn't want to be moved. Here I am, 45 mins into the exam (when I'm only allowed 30mins MAX), I obtained almost NO exam findings, and I have a patient that doesn't want to leave the exam room. I am basically in a bind. I can't start my exam on the next patient, this patient won't leave and I'm already super behind. Wonderful.

I don't know how, but he eventually left. They rescheduled for another day. I'm looking forward to working with him the THIRD time, which I will probably run into the same problems.

During the exam, when the patient was struggling with his wife, it all played out like a movie. Like I was in third person, watching myself from TV or something. It was weird. I know it sounds like I was having an out of body experience or something, but I wasn't. It was just all in my head. I imagined this experience like a scene out of "The Notebook" or something. Remember in the end, when the lady got Alzheimer's and she couldn't remember her husband and was going crazy and she had to be contained by the nursing home staff? Yeah, it suddenly occurred to me that this could be a scene from some romantic love story, a tragic ending scene, but certainly a scene.

At that moment, during the exam, I imagined that if there really was a movie that started out with this exact scene of this dementia patient at a clinic, then they would flash back and show how life was BEFORE the patient had dementia. It would take you all the way back to how the couple met. It would show you what their life was like together. How many children they ended up having. How happy they were together. How great the guy was to his wife. Then it would show signs of his mental decline. Little by little, the wife getting suspicious and asking the husband to go to the doctor. Then the dreadful day the couple found out that he has dementia. I imagine the couple would try to squeeze out as much time with each other as possible before the disease really wrecked havoc on the victim's mind. Little by little, he began to lose it and soon enough, he didn't know how he was and he certainly didn't know who his wife was. His wife is devastated and heartbroken. And then it would flash forward to today, this very exam I'm trying to conduct. I think it's always sad to retrace the steps of how people arrived at their tragic endings. Endings like this one, where the husband has end stage dementia and can't even recognize his wife. His wife that loves him to always be by his side and take care of all his needs. He'll never show appreciation for all she does because he won't remember it, he doesn't recognize her and most importantly, he doesn't comprehend what's going on.

Like I said, I noticed that the wife always came with the husband to the exam. She was trying very hard to help him understanding where he was and why it was important for him to cooperate. It occurred to me that when people get diagnosed with Alzheimer's or Dementia, they get sent to nursing homes because the family members find it too hard to take care of them. So they would rather hire other people to take care of them. But this wife, stayed by her husband's side. She has a caretaker, but who wouldn't? She's old and he's a handful. I don't blame her. I could tell from the way she talked to him that she really cared about him. "Billy, it's Kim, don't you remember me? We are here to help you Billy. Please let the doctor do her job. Please Billy. I don't want anything to happen to you, I want you to stay healthy. Please Billy. Please. It's Kim, don't you recognize me?"  "Get away from me! Don't touch me! Stop it! I'm going to hit you if you come any closer!"  "Billy, it's Kim, I'm not going to hurt you, please Billy, please! Let the doctor take a look!"  "I'm going to hit you! Get away! I don't know you!"  (names have been changed to protect their privacy)

I put myself in Kim's shoes for a second. How hurtful to hear those words coming from her loved one. Her husband that she takes care of everyday of her life and works so hard to keep him healthy and strong, for him to say those hurtful words, threaten to hurt her and not even recognize who she is. It must be heart breaking for her to be around someone like that everyday. Not only are the words hurtful, but I think just watching someone that you love so much become like this is very very heartbreaking. Just like at the end of The Notebook. That guy was so heartbroken that his wife didn't even recognize him and was freaking out that he was an intruder and was trying to hurt her. How terribly agonizing living life like that would be. The person you love is still physically alive and there, but his mind is gone. He's not the same person you fell in love with, and he's certainly not going to recognize you as someone that he loves and cherishes. It's like you just have this empty shell. Everyday, you watch them mentally deteriorate little by little, until they are a completely different person. You still want to love them, you still want to believe that they are the same person, but those are just lies. Poor Kim. Poor all those people out there with loved ones that have Alzheimer's or Dementia. It's a terrible disease to have.

I would hate to ever get diagnosed with that. I don't want to slowly lose my brain, lose myself, lose who I am, and be fully aware of this....well, I guess I'd only be aware until my brain doesn't even work anymore and I don't even know who I am. I would lose all my memories of my friends and family. It's so heartbreaking to even think about. I think it's actually probably worse for the people close to the person with Alzheimer's or Dementia, because they will slowly witness the person's brain dying and shutting off. The person that is losing their brain will eventually not even know what's going on. But it's those that are aware, that suffer.

Sorry, I didn't mean to rant on about such sad things. But it just really makes me think about life and how much I value all that I have. I think people can never be too grateful for everything that they are blessed with. People should be reminded more of all the great things in their life.

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So I just went home this past weekend...to find out that this coming weekend is my mom's birthday. Then the subsequent weekend is Chinese New Years! So my mom was asking if I was coming home this weekend for her birthday and I said no. I said no because if I did come home this weekend, that would mean I would have to go home THREE weekends in a ROW. And besides, there is a fun party/get together at a co-worker's this coming weekend and I was really looking forward to going. But on my drive back to my apartment here, I realized that I should cherish my time together with my family. It's like every day my mom has a birthday and it certainly would be nice to go home and celebrate with her. She would be so happy. I am still going to stick with my "I'm not coming home" story but I think I'll sneak home and surprise her. I haven't decided if that's what I'm doing yet, but I think I'm 80% sure I'll be going home this weekend. But that means I'll be SUPER tired these coming few weekends. I've been growing very tired of this drive. It's only 2.5hours but those short 2.5hours seem like an eternity for me, especially when I have to do it alone, with NO RADIO and NO CELLPHONE reception. Ugh. Oh well, I'll do it for Mommy!

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Hope you are doing well. *Big Hugs*