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.