The surprising thing this patient was missing

By | November 27, 2018

She had everything she needed.  Her husband had died long ago.  But the fortune he left her would suffice.  She had given up on mansions long ago.  There were no children, so who needed the space?  She was happy as can be in her little condo in the city.  The building had the most lavish pool, exercise room, and views.  She absolutely adored the doormen.  They would let her various people in when she was out shopping.  The housekeeper, the errand boy, the handyman.  Eventually, as her health started to deteriorate they also would direct home health and her caregivers up to the apartment and let them in.

Memories lost

She had everything she needed except her health.  Her muscles grew weak, and her mind began to wander.  Sometimes in the lucid moments, she reminded herself of her mother.  Her mother who died years ago of what now would be recognized as Alzheimer’s.  They called it senility then.

It started as basic forgetfulness, but over the years her needs grew.  Her best friend, and power of attorney, used her funds to hire a bevy of helpers.  They attended her day and night.

As her memory got worse, the agitation began.  Only at night in the beginning, but eventually throughout the day.  The caregivers learned that they could calm her down by surrounding her with things.  Her elegant collection of knick-knacks collected from her various travels throughout the world.

Crisis

She had everything she needed until the sore formed on her foot.   The nurse from the home health agency tried various salves and dressings to no avail.  The infection was stubborn, and one day the ambulance came to take her away.

The doctors shook their heads.  The surgeons twirled their scalpels, and ten days later they spit her out of the hospital and into the very best nursing home in the area.

Surrounded by her caregivers, her knick-knacks, and the elegance of a five star hotel, she was agitated and confused.  The staff said that her behavior would calm over time, and yet it didn’t.

Three months later her foot was healed, but she was far to agitated to return home.  A permanent room was arranged in the nursing home for her to live out the rest of her days.  Confused.  Agitated.  But well cared for.

An uncharacteristic calm

I came to see her one early morning in the nursing home for her monthly check.  The staff reported that she had become uncharacteristically calm and well-behaved as of late.  I entered her room wanting to see the change with my own eyes.

She was lying quietly in bed.  A baby doll was swaddled and rested gently in her arms.  On the chair beside the bed was a fluffy stuffed animal dog sitting in a pretend dog bed.

When I came close, she hugged the baby close to her bosom and radiated a warm smile.

She had everything she needed.

Diagnosis?

I later found that the disappearance of the agitation coincided perfectly with the introduction of the doll and the stuffed animal.  And it is well documented that Alzheimer’s patients often improve with such measures.

I couldn’t help but wonder if surrounded by her knick-knacks and the best accommodations money could buy, that she didn’t truly have everything she needed all those years living life alone in that condo.

Maybe what she was missing was something deeper.

Something more profound.

“DocG” is a physician who blogs at DiverseFI.

Image credit: Shutterstock.com


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