It was a fine Monday morning, I was on my 4th patient of the day. I looked at her chart, a 93 years old lady, in the hospital after a fall. I walked into the room and saw my patient sitting up in the bed, with a big smile on her face, looked at me and said, “it is nice to see you again handsome man!”. That certainly made me smile, but surprised at the same time. Smile because she thought I was handsome, despite me wearing a mask. Surprised because it was my first time seeing her but it seemed like she thought she had seen me before.
She was extremely pleasant. She had a confident answer for every question that I asked. However, she thought she was at her parents’ house and not in a hospital. She was not sure why she was where she was but believed her sister was coming to pick her and together they were going shopping. The sad part is that her parents had passed away a long time ago, and her sister lived thousands of miles away on the other coast of the country. But for my patient, it was all as real as it can be. She was at her parents’ waiting for her sister, and was looking forward to it.
Dementia is one of the many side effects of longevity. Now that the average life span has increased to about 80, it is common to see demented patients. In the US, about 5.7 million adults are living with dementia. A conversation with a demented patient can be very interesting. They will fool you into thinking they are having a good conversation with you, with moments that make you question if they really have dementia. However, if you dig a little deeper, you realize very soon that their brain is still able to put together coherent responses, but it is not pulling any information from its labyrinth of memory stores.
On the other hand, there was my grandmother. She was 98, but memory sharper than my 17 years old Gen Z niece. The last two years of her life, she was mostly bed bound. She was fortunate to have an army of off-springs and their off-springs that were there to help her. However she understood that her time was near. Every goodbye was a last goodbye for her. It was painful! Imagine seeing off your loved ones thinking this might be the last time you see them, and not being able to do something about it. Her very sharp memory almost felt like a curse at that time. Because she could have been happily demented, oblivious of her critical medical condition, believing she is about to go out for shopping.
I do not wish dementia on anyone. In fact, dementia is the hardest on people who love the patient than on the patients themselves. Imagine a person you love and know is slowly disappearing in front of your eyes. They are there but not there. However, imagine being old, frail and weak, not able to participate in the chores of daily life, watching others do that, must be painful. Unless you are pleasantly demented. It definitely is a trade off. Do you want to be happy but not remember it or remember everything but be constantly reminded that your time is limited?
I must add though, I also believe that with aging comes a certain maturity and acceptance of the process. I have rarely seen an elderly patient complaining about being old but I have seen countless patients who will say “I have had a good life and I am ok, no aggressive measures to save me if it’s my time”. However, the way we look at dementia may need to be changed. Sometimes I wonder if it is just nature’s defense mechanism, to make you forget all the things you are attached to and make it easy for you to say goodbye.