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By Kerry Maxwell
As part of my job, I give people dementia. Two or three people, on average, each week. Before they come to see me they have a concern, a suspicion, a worried relative perhaps, or a memory that 'just isn't as good as it used to be'; when I'm done they have an incurable disease that will change their lives irrevocably.
So, as I call another new patient in to my room at the memory clinic, I am aware of a certain responsibility. I'm well supported by my consultant, but for all doctors, along with the privilege of treating diseases comes the burden of giving them.
A little slow on his feet, the patient picks his way gingerly along the corridor behind a walking stick, but otherwise looks well. He is dressed smartly for the occasion. He gives me a nervous smile and a firm handshake.
I watch him struggle with the memory tests. You get a sense of how each patient is doing even before you add up their score. Then I bring in his wife. Reluctantly, she testifies to his increasing forgetfulness, and the other little things too, tell-tale signs adding up to an increasingly clear picture.
I have the notes from the screening clinic too. It all tallies. I give them the diagnosis.
People react differently at this point, and it’s hard to know how much to say. I brace myself, waiting for the questions – what does it mean, what will happen, how long? Worried, expectant, trusting faces. There are no clear answers.
It can be daunting, but I’m getting used to playing the role – calm, empathetic, reassuringly authoritative, packaging up the uncertainty as a positive as best I can. Yes, things will get worse, but everyone’s disease progresses differently…
In fact, initially, it’s their holiday to Spain, booked for next week, that he and his wife are most concerned about. Will this affect the insurance? Can he start on the drugs when he’s away? I’m not sure whether this is a coping mechanism, or just evidence of a pragmatic mindset, but I feel a little relieved. Discussions of more difficult issues can be saved for future appointments.
Then I remember to ask about driving. He looks puzzled – yes, of course he still drives. I explain that he won’t necessarily have to stop, but he must tell the driving agency and his insurers and he might have to take a test. His face falls.
Usually, putting a name to something helps the patient feel in control, but a diagnosis of dementia raises the spectre of a gradual, devastating loss of autonomy.
What else will it mean for him? It’s what he’ll tell his friends and family (or not). It will make him reconsider his future. It has changed how he thinks about himself already. When they know, other people will make assumptions, or make allowances. It will go on his medical record, his insurance forms, and possibly his death certificate.
It will open up access to help as well. Drugs that might hold things in check for a year or two. For after that, a safety net of nurses, carers, social workers, physios and occupational therapists – an invaluable resource, but it seems scant recompense.
There’s a form to be filled out for the dementia register. I tick the box for Alzheimer’s. Sign the bottom. I watch as the patient makes his way slowly back out through the waiting area and into the thin spring sunshine.
Kerry Maxwell is a foundation doctor 2 in psychiatry in Northern Ireland
Thank you for a very insightful post. Just one thing, I don't think you are playing a role - you are doing your job, and doing it very well. Thank you.
I love the topic of Zoe life. We should all become syncsettingswindows10.com masters at it so that we can live the life He intends for us to live.
I read some articles on this site and I think your blog is really interesting and has great information. Thanks for sharing.
Dementia affects thinking, behaviour and the ability to perform every day tasks. Brain function is affected enough to interfere with the person's normal social or working life. The hallmark of dementia is the inability to carry out everyday activities as a consequence of diminished cognitive (thinking) ability.
Although the early signs vary, common early symptoms of dementia include: memory problems, particularly remembering recent events. increasing confusion. reduced concentration.