Wednesday, July 19, 2006

The Forgetting

As I was totally feeling sorry for myself (oh, poor Dr. A), I was asked to see Isabel at the nursing home at the end of my morning. She has Alzheimer's which I would say is in the intermediate stages. She was having some arm pain and had a question about a cortisone shot for her shoulder.

I'm thinking to myself, "Oh great, just another thing that I have to fit in. How am I going to do that? I have to drive back and forth from there and make sure I'm not late for my afternoon office hours."

Following her exam, I thought she had a pulled muscle and prescribed some physical therapy and analgesics. She then asked me, "How long am I going to be here?" As I was frantically writing in the chart, "Well, we talked about this the last time I saw you. It is unsafe for you to go home because your husband has a lot of medical problems as well, and he cannot take care of the both of you."

"No, doctor," she looked right at me, "How long am I going to be here?" "Oh," I paused a long time before speaking again. "I don't have any idea on that. The Alzheimer's may slowly or rapidly progress. You're on the best medicines we have right now."

"What would happen if I wanted to stop all my medicines?" she asked. "Likely," I said, "this would probably progress rapidly for you." "I certainly don't want to live like this in a nursing home when I used to be independent, and yet I want to be around for as long as I can -- especially for my grandkids."

This is one of the tragedies of Alzheimer's -- when people are not mild, and yet not severe. They feel themselves slipping away as they forget more and more and, in addition, they start to lose their bodily functions.

If you know little about Alzheimer's, here is a link I want you to check out. It has a video clip that's about 3 minutes of a PBS program called, "The Forgetting." It really personifies what this tragic disease is all about.

Isabelle and I and a nice discussion and ultimately she made a decision that I went along with. Needless to say, after this humbling experience, I was brought back to reality and then went back to the office to continue my day....


Anonymous said...

Alzheimer's is a terrible thief. It steals everything a person is and leaves behind an empty husk.

My Mom had it for 10 long agonizing years until we lost her 9 years ago.

Isabel has got to be going through a terrible time. I think that those who have no idea what's happening to them are actually much better off. Those who see themselves disintegrating ... have it pretty rough.

Hang in there, Dr. A! Take some extra special time for yourself every chance you get ... you're in a particularly rough place right now.

{{{ blog hugs }}}

Lea said...

Isabell does put things in perspective, but remember we all have things to deal with that are valid. Take care of yourself too, not just your patients.

Anonymous said...

What they said....

HP said...

And ditto from me!

Dreaming again said...

I wish people would stop posting about alzheimer's ... at least till we find out if that's my mom's problem or not. Sigh.

I should probably go to that link, but I'm afraid it will just confirm that what I've been seeing is what I'm seeing.

Thanks for this post though ... it really is insightful, even if I don't like it.

The Domesticator said...

This is something I unfortunately know a litle about.My Dad was diagnosed with Alzheimer's several years ago...early onset. It is hard to watch because he has plenty of his faculties, but he KNOWS he is declining.

Oh yeah, and ditto what Moof and Lea said! :)

NeoNurseChic said...

Add my ditto to what moof and lea said, too - couldn't have said it better.

PK - I hear ya. My grandma was diagnosed with early Alzheimers a couple of weeks ago, but get aunt took her off the medication that was prescribed to treat it (either aricept or namenda) because she is in such bad denial. She claims that she doesn't want my grandma to take that medication because she doesn't believe she has alzheimers. That darn near sent me over the edge while I was on vacation and my dad found that little tidbit out. My grandma wasn't experiencing any side effects to the med, and they even use those meds for headache prevention now, so it's not like taking it means she definitely has alzheimers... And what's even more important is that my aunt is willing to let my grandma's condition get worse simply because she doesn't want to believe that it is what it is...which only ultimately hurts my grandma and the rest of us in my family that much more. It's a sore subject right now....

I just emailed my boss tonight to ask if I could change weekend rotations so that I'm more available to go help take care of my grandma now. My aunt works in the clinical laboratory for a hospital in New York, so she has weekend rotations as well, and I figured that if I could switch weekends (besides the other reasons I've mentioned that have made me want to switch), then maybe I can be there a little more often to help. My grandma already threw out the home health nurse that came to help take care of her. *sigh*

It's a tough road... Kudos to you, Dr. A, for being so compassionate and caring so much about your patients. Ultimately it makes a tougher road for yourself because when you care that much, it's hard not to become attached and very hard to "leave work at work" as we are so often expected to do by family and friends around us. However, in the long run, I feel it is better to care. It helps you help your patients more in the long run and on some level, your caring helps yourself cope with all of it, too. Hang in there and know we are all here for you!

Carrie :)

Dreaming again said...

Carrie, I'm sorry about your grandmother.

My sister and I are on the same page this point anyway. She's letting me handle it all. Period. While she's in agreement mom isn't normal.

Mom has the neuropsychiatric exam a week from tomorrow.

It's frustrating because 3 years ago, mom was desperate to find out what was wrong with her, something was going wrong inside her head. Now, she just thinks she's always been this way and everyything is honkey dorey.
She always has an excuse for what has happened.

I just want my mom back. Yet, I know, if it's alz ... I'm not getting her back.

Dr. A ... I do hope you are enjoying your time to yourself today!