Days at work

On the geriatric psychiatry service, I spend a lot of time talking to families and friends. After spending years dispensing hope (and pills), I now dispense realism (and pills).

I tell them that dementia is a terminal illness with a downward course, that every little infection/broken bone/stroke is a step-down, that we don’t really have any medicines that can make it better. That its not physically painful, but it does sometimes run in families.

I tell them their loved one is going to die on someone’s watch.

When my patients tell me they plan to die in their own beds, in their own house, I support them. I tell them they can make bad decisions, as long as they know what they’re doing.

When they start seeing things that aren’t there (and that don’t bother anybody), I hold the medicines. I hold their hands. When they yell at me for reporting them to the DMV, I apologize. When they start telling me stories, I sit down and listen. They have the best stories, stories they’ve perfected over the years, stories that they imagine will amaze and impress this woman who’s too young to be a doctor. And they’re right.

At the end of the day, I come back home tired and happy.


About purplesque

Psychiatrist, cook, bookworm, photographer. Not necessarily in that order.
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24 Responses to Days at work

  1. zottavox says:

    Wow! I guess we could do worse than perfect our best stories, ay? Thanks for sharing. Glad things seem to be good. Sound like a great way to handle DMV issues. Brava!

  2. I’ve heard this prognosis in many forms—some candy-coated (if another medical professional tells me what “a great time” this is to get to know my parents, I will scream), some very bitter, others a balance of both. I prefer the realistic and truthful to the “never give up hope” message, because I know too well what to expect: but I admit it’s also a shock when the changes really start to happen. My mother still knows who I am, but recently I laid out freshly-laundered clothing for her to wear, and she said they weren’t hers and refused to wear them. Later she began crying because she said “someone has changed the house around” and she couldn’t find a place to sit. A day later, she had no problems getting dressed and finding her usual chair: but I know I just had a preview of the days to come.

    Doctors like you are rare and much appreciated. You haven’t forgotten that your patients are adults, and yet they still need to be comforted and treated with kindness. Thank you for that.

  3. Boston Margy says:

    And your charges are better off for it, too. Thank you for taking care of them with such devotion.

    • purplesque says:

      Its not really devotion, is it, Margy, when the ACGME (rightly) requires that you work 8 to 5 and then go home, passing over the care of your sickest patients to another person.

      I do try to not get carried naive optimism (aka the GOD complex), by science, by resources, and to stick to what is best for the patient from the patient’s perspective.

  4. bookmole says:

    Respect, Purplesque. Too many doctors feel they have to make us happy, when what we really need is the truth. Thanks for being honest with your patients and their families.

    • purplesque says:

      A lot of my training has simply been about how not to dispense fake hope, how to tell people the truth and be there with them in that moment. I have a lot to be grateful to my teachers for.

      (My English teacher would be appalled at the way I murdered that last sentence, but whatever.)

  5. Jabulani says:

    Thank you purplesque. My grandmother died with dementia. For the last 5 years of her life she had not a single clue who I was. I was there the day she didn’t recognise my father, and witnessed how it slew him. I ached for him, but for me, it wasn’t a big deal. Her GP had been honest with me every time I spoke to him – said she would only ever get worse, there was no magic ladder out of this hole. I still bump into him at gymnastics functions, and I’m still immensely fond of him. His honesty may offend some, but honesty – whatever form it takes – often does! It’s a sad fact and a hard-learned lesson to be learned. Onwards, my dear, to the “Back in my day” time of your life. May you carry this wisdom with you. πŸ™‚

    • purplesque says:

      One of my favorite teachers had made this into an art form- he offended people with his honesty and relentless curiosity, got a LOT of helpful information out of them after making them cry, and then helped them back- usually in that order. That was also usually the point where his patients started stalking him. πŸ™‚

  6. robpixaday says:

    You’re such a treasure!

    The value of honesty, compassion, and patience is often underestimated by the medical/care community. And families, too, sometimes. What you’re doing is wonderful.

    And I’m so glad you’ve found a good solution to the decision you needed to make!!!

    • purplesque says:

      Hey, you. Welcome back! ((hugs))

      Thank you. I’m still learning..taking different approaches from different people, trying them on, keeping some and discarding others. Also struggling with my own personality that keeps getting in the way. πŸ™‚

  7. phantomxii says:

    Your last sentence is crucial. You’re doing right by yourself and others. People get by without doing that, but it isn’t pretty.

  8. jaklumen says:

    I’m living round #2 right now.

    My paternal grandmother died with Alzheimer’s/dementia, and now it’s taking my maternal grandmother. That’s all I wish to say at the moment, besides adding that knowing the real truth IS important. The grief process has to begin sometime.

    I’ll say again if you were ever to decide to come out to the Columbia Basin in southeastern Washington someday, that I still think there’s a place for you here. There’s a strong Indian community in the West Richland/Richland area (Sikh/Muslim/Hindu if I remember right) and people overall here are laid back and congenial. I still worry about the heavy California/Seattle invasions (because it’s so cheap to live, especially retire, here) but things are good. Of course, like most anywhere around the nation, community mental health here still needs a lot of work, and a lot of help. We could use more people like you.

  9. Aussie Emjay says:

    In the event that I find myself needing to be advised of a loved one’s dementia/Alzheimer’s I hope the medical professional infront of me is as honest, open and compassionate as you are.

  10. Zottavox says:

    At the risk of promoting something, the New York Academy of Sciences,where I have a friend who’s Chair of lectures for seniors, Do you feel like going to this?

    I’m very likely attending and thought you might like this. It’s probably more like something where you yourself would be speaking. I could give you a ride to NY, too.

    • purplesque says:

      Ooh, Z, it sounds wonderful. Thank you so much for the offer!

      Unfortunately I’m all caught up in finding places to live, studying for exams and Oodles of paperwork. Maybe next year..

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