Dementia, In Retrospect
by Kwame' J. LeBlanc, MSIII
These last two years of medical school have been a roller-coaster ride of experiences: triumphs, failures, friends gained and lost. But the harshest lessons I've learned have usually been off-campus. Recently my grandmother was diagnosed with dementia. I was fortunate to have spent some time with her and help my aunt take care of her before heading off to clinicals. This is my take on the whole experience.
I would be remiss in not admitting that when you have a loved one who suffers from such a condition, it tends to cloud your judgment, even if you have medical training. At first, I did not want to admit to myself how poorly she was doing. I kept coming up with differentials in my head like: "Maybe she has a vitamin deficiency, or a thyroid problem, or hydrocephalus." That's right, I thought. I, a medical student, could pick up something that the more experienced physicians could have missed. So, I waited and watched. I not only asked questions about her regular medical checkups from my aunt, but also asked Grandma questions to test her memory.
The thing is, it was an emotionally exhausting experiment of highs and lows. The highs were when she had her moments of lucidity and could tell me how she got from her quaint home in Antigua all the way to Dallas to live with my aunt. The lows were when she could not even remember what decade we're in, let alone what country. Needless to say, I soon abandoned my exercise in hubris. It was ironic that the very person who had helped nudge me toward pursuing a career in medicine was the one I was now using those career skills to try to help.
Those few weeks were a peculiar mixture of the most heartfelt and heartbreaking moments of my life. Having conversations with her in our dialect about all of our family and friends, watching her light up when we visited long-lost relatives here in Texas brought us closer than ever before.
Though I'm a grown man, Grandma still always checks to make sure that I've eaten, then asks what I've eaten and if I've eaten enough. Even in her state, a grandmother's love never quite goes away.
Currently, she has trouble with what we call in the medical field ‘orientation to time and place.' Something as simple as taking a nap could lead to a whole barrage of questions: "Where am I? How did I get here? Who brought me here?"
At this point, we have the response down to a stump speech, a refrain, ready for any of these questions. Sometimes, she accepts the answers and the explanation that she has memory problems. Other times there have been arguments; not over the usual, mundane things such as how to rinse rice properly or make up a bed – after all, she was a homemaker for 40 years. The arguments are about sending her back to Antigua, the only home she has ever known. If someone had overheard such arguments, they would have sworn we had kidnapped her and were keeping her locked in the house. Admittedly, I have been known to suppress a chuckle when my 77 year old Gran threatens us by saying: "One o' dem days y'all nah go find me here. I go left and find ma way back home."
Unfortunately, what always stabs at my heart is the fact that when I try to explain to her that she can't function on her own, that she will forget her medication and that the worst possible outcome will occur, her response is usually, "Well if God come for me, so be it." or some other, even more fatalistic acceptance of the results of following through on her desire to be repatriated. It seems more and more, she reminds us that she has had a good, long life and that she has lived to see her "kids and grankids." Sometimes, she says it with such calm and grace that it borders on mysticism.
She was always a resilient woman, even through all the hardships she has suffered. Barely literate to the age of 19, when she had her first child, she was already taking care of her two siblings. She eventually ended up a single mother after her third child and only daughter, always working long hours as a waitress at the military base in Antigua to put both her children and her siblings through school and college. She would always tell me, "I may not be educated, but I always make sure I look about myself and my kids."
And she did; they became the first people in our family to get college degrees.
Supplemental Note from the author: "My reason for writing this is not only to tell of my experience with watching someone I love slip away to dementia but to remind me of the lessons I've learned from my grandmother, my second mother, about resilience and caring for others. My greatest wish is to become at least half the man, let alone doctor, she believed I was."