Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler






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    Sunday, August 17, 2003
     
    Psalm 39, Verse 12

    Early this morning I received a call from the daughter of one of my patients. He's an elderly man with dementia, and has been my patient for about eighteen months. In the last two weeks or so he has been declining very rapidly, has become paranoid and insists that his family is trying to poison him, and is refusing to take his meds. The daughter has called me several times and I have tried to intervene and reason with the patient, to no avail. (I could have told you that would happen, but if the family asks me to talk to him, what am I to do?)

    This morning the daughter called me, clearly at her wits' end. Because my patient's wife (who had been taking care of him) had to stay in the hospital overnight after a minor surgical procedure, my patient stayed with his son last night. This minor change in his surroundings completely threw him off; he walked out of the house, refusing to return. They had to coax him back inside. He became even more paranoid, refusing to eat. We are making arrangements to get him into the geropsych unit at the hospital. ("Geropsych" is the shorthand for geriatric psychiatry, or psychiatric problems of the elderly.)

    I found myself in church later in the morning, reflecting on this family drama. After hearing all this, you may understand why the reading from the Psalms for today affected me:

    With rebukes for sin you punish us;
    like a moth you eat away all that is dear to us;
    truly, everyone is but a puff of wind.


    If that isn't a first-class description of Alzheimer's, I've never heard one.

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