Wednesday, February 28, 2007

Dementia

We're sent for hallucinations -- a third party caller -- a man's daughter says her father is hallucinating and needs to go to the hospital. She says her mother is concerned.

**

“We’ve been married 70 years,” the wife says in a deep cigarette voice. “Last night he says there’s a man in the shower. There’s no man in the shower. He ain’t right in the head. I can’t take care of him. I ain’t well myself. I only got one valve."

The two of them, husband and wife, ninety years old each, are sitting there in matching arm chairs in the living room that needs to be vacuumed.

“Now, honey, you don’t understand, what you’re going and doing now. You don’t understand the trouble you’re causing.” He raises his voice and looks at the police officer who is the first responder. “Seventy years, seventy years, I never raised a hand to this woman. 65 years in this house, I never once said God dam under this roof. And now look at what she’s gone and done.”

His wife shakes her head. “He said there was a man in the shower. There was no man. Never anything like this happen before. He needs to get his head checked out.”

“I never laid a hand on her,” he says again to the officer.

“You’re not in trouble,” I say. “The officer is only here as a health responder. You’d have fallen and cut your head, he’d be here. You are in no trouble.”

“Never so much as said goddamed under this roof."

“Tell me about the man in the shower," I say.

“Left the bathroom a mess,” he says. “Water everywhere. She wouldn’t let me get out of bed to chase him out.”

“One valve I have,” the woman says, shaking her head sadly.

“What you’ve gone and done,” the man says.

He agrees to go to the hospital to get checked out. He is very lucid on the ride in. He knows his phone number, but not his social security number. “I only remember the important stuff,” he says. “The hell with the rest of it.”

He tells me his son died two weeks ago. “67 years old. Sugar problems. Ate too much. Couldn't breath when he tried to walk. Water in his lungs, they said. Drowned in his own fluids. February 12. Died on his birthday. I’ll remember that day thirty years from now, you ask me.”

I offer my condolences, and then try to steer the subject to something happier. I ask how many grandchildren he has.

“We don’t count,” he says. “You ask my wife, she’ll say the same, 'We don’t count.' There’s just grandchildren and great children. Can’t count them. They just are. Quite a many." He smiles, but it fades as he focuses back on what is happening.

"What's my wife going to do now? I do all the cooking and cleaning. I do the laundry. She just sits and watches TV.

“You want to know what kind of a man I am?” he says suddenly. “I bought 57 new cars. One every year. I was a salesman. I could deduct it. Put 40,000 miles on the car each year, then traded it in. You keep it two years, that’s 80,000; no dealer would want that car. Trade them in before they get run down.”

He tells me the Oldsmobile was his favorite car, but he stopped buying them when he heard they might stop making them. "People wouldn’t want to buy a car you couldn’t get parts for. It'd have no trade-in value.”

Later when we are back at the hospital after bringing another patient in, I see him in his room, and he beckons to me. He is in a hospital gown with an ID tag on his wrist. His clothes are in a plastic bag. They are getting ready to admit him for the night. “You know I was thinking," he says. “I made a tactical error back at the house. I should have sent you upstairs to check out the bathroom for yourselves. The floor is wet, the boards are soaked. Water seeps out of the ground when you step on it. You would have had your proof, if only I'd had you go up there, I wouldn't be in this predicament.”

***

I read a book recently called Jimi Hendrix Turns Eighty. It takes place in the year 2022 when the baby boomers are in the nursing homes. One of the main characters, Guy Fontaine, (who has recently moved to California to live with his daughter after the death of his wife in Oklahoma) is playing golf, and then the next thing he knows he is riding his golf cart down the freeway thinking he is cruising in his old Bell Air. When the cop pulls him over he realizes what he has done. He is back to reality. The episode leads to his getting placed in the nursing home. On his first day there on his way back from the dining room, he can’t find his room. It’s not that he is lost; it’s that no one had told him his room number. The nursing administrator accuses him of being disoriented. She asks him where he is.

Guy said, “the third ring of hell.”

“Sarcasm is a defense mechanism we do not appreciate, Mr. Fontaine. Tell us where you are and what month it is, or I shall be forced to call Dr. Beaver."


He answers specifically and exactly, and then recites the names of the books of the Bible and more. “If I recite the Gettysburg address, will you tell me my goddam room number?"

She then accuses him of being aggressive and disoriented.

“I am not aggressive, Miss Truman. I just want to go to my room and lie down.”

“Then you are dizzy.”


They argue back and forth.

“And what would your daughter think if I let you wander the grounds alone and disoriented?"

“I wandered for seventy two years without my daughter’s permission. I can wander now.”


**

As a result he is forced to visit with the nursing home doctor, who tells him his new adventure – wandering the halls disoriented – just confirms he has multi-infarct dementia. Guy argues against that, telling the doctor he’s been researching on the internet. “Absent mindedness to the point of hallucination is completely normal after a major trauma, such as losing your wife. It’s a natural defense against grief and almost always temporary.”

The doctor then says, “Let’s pretend I’m not a highly trained physician and twenty minutes on the internet has made you a medical expert. What is it you want, Mr. Fontaine?”

Guy says he just wants to go back to Oklahoma where he can take care of himself and not be an embarrassment to his daughter. The doctor says fat chance – he’s been declared legally incompetent, his daughter controls his money now and he is just in denial. “Here is the hard truth. You are in deep, deep denial if you think there’s a chance in hell of you ever going back to Oklahoma. You are in continuing care now. My care. Adjust your attitude, Mr. Fontaine. You aren’t going anywhere.”

It was a funny novel (the old hippies revolt and take over the home) but it is also very sad. I had hoped it would help me see people in nursing homes in a different light, but I admit it is hard to see them as unique people. I try, but its hard to see through the skin. I think the fact of being institutionalized strips people's uniqueness and personality away after awhile. I guess I need to try harder.

I wonder if maybe the 90 year old man’s hallucination of a man in the shower wasn’t just his body dealing with his grief over the loss of his son.