I didn’t think it was possible for routine outpatients in the Wound Clinic to get sicker, but apparently it is. At the end of a long and defeating day of unsolvable problems, my last patient was a retired physician in his 90’s with a cardiac ejection fraction of 15%. Every organ in his body is failing except his brain. Even though his guitar playing days are over, he recited for me the song lyrics he had written the night before. He’s driving his family and the Home Health nurses crazy. He’s difficult and angry and there is no fix for what ails him. He’s lost control of his life and he’s dying slowly with his mind intact. All I could do was put my arms around him.
I haven’t talked much about the 12-year battle I had with my husband’s dementia. It’s been 8 months since he died, and I am starting to process things. Only a few weeks before the end, as his brilliant mind completely came apart, he started hallucinating. Normally a sweet man, he became volatile. I thought I could handle him – but I couldn’t. I got him admitted to a locked psych facility under the care of geriatric psychiatrists. I knew they couldn’t help his dementia, but I hoped they could help his mood. I was afraid he’d go berserk at this final loss of autonomy, and I was nervous when I arrived for my first visit. The staff and the doctors were wonderful, but the 1970’s era decor was dreadful. The “accent wall” of his spartan room was painted a hideous olive green – Army green. But he was sitting in his room waiting for me, beaming happiness. He was really enjoying this summer training back on active duty, and Ft. Hood had not changed a bit. He wasn’t sure when the base commander would let him come home, but I wasn’t to worry about him. He was meeting such nice people and making friends. In fact, He had decided to go on one more tour of duty before he retired. He was, however, worried that the Army seemed to be taking absolutely ANYONE these days…
It’s OK to laugh just a little. For a decade I lived inside the movies “Finding Dory” and “Fifty First Dates.” It’s not as funny in real life, but you have laugh when you can. My husband never got over having to give up medical practice. If losing his reason for living wasn’t bad enough, the relentless, incremental loss of all autonomy drove him literally insane. Then suddenly he was his old happy self – because he thought he was back at work. Not in his nice private practice, but in the Army no less! He wanted so much to be useful, you see.
Our lives are dominated by the unceasing demands of work, school and family. We are physically exhausted from lack of sleep and mentally exhausted from stress. But one day we may look back on this difficult time and wish we could have it back again. So, I am resolved to appreciate these challenging days. Today I will savor the companionship of the dedicated people I work with, the blessing of meaningful work, the privilege of easing human suffering and the satisfaction of healing horrible wounds. And I’m also contemplating the value of the occasional delusion.
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
I can’t imagine anything harder than the loss of a spouse (except possibly the loss of a child) whether it be gradually or in an instant. Both circumstances offering their own relative agonies or blessings.
Thank you for sharing your story showing a glimpse of both ends of that spectrum. A true reminder that whether you be the patient or the clinician we are all merely human and not impervious to life’s challenges. I’m sorry for your still recent loss and I am hopeful that we all can endure such hardships with the grace and fortitude that you are striving for.
Thank you for taking time to send such an encouraging message.
You have such a gift of putting thought to words. Words that make perfect sense and how I would think them. I empathize with you as I watched many of my aunts, uncles, and one grandmother slip away with Alzheimer’s, not to mention the many patients. My last uncle and my friend and family patriarch, Harold. A veteran of both WWII, as was my dad and two of my other uncles and one aunt and Korea. Watching him, and helping when I could, the decline in his once brilliant mind, was upsetting. He would recite to me countless times special moments in his life, many from his days in the military as a Naval Communications officer, like he was telling them to me for the first time. He recently passed away after a fall that resulted in a femur fracture through his prosthetic hip. He made it through the repair, but died shortly after as he went into heart failure and would have required reintubation, and his heart (EF
It is hard to lose the last of the Greatest Generation! But I realized that the patient dying with his mind still sharp suffers more than those with dementia- they are sparred none of the pain. With dementia, WE are the ones who suffer the most- we lose them before we lose them. But the dementia is a sort of protective shield for them -they are protected from at least some of the reality- and that’s a kind of mercy. A lot of the grief is our own – And that’s our problem to deal with.
Bless you, tbis took courage