My favourite patient

TAUREEF MOHAMMED

(Identifying details have been changed to protect confidentiality.)

MRS WALKER was admitted to the hospital for a problem that I cannot remember. When that acute issue had resolved, her care team recognised that she had difficulty with some day-to-day tasks like taking her medications on time, and felt she would not be able to manage at home on her own. So, they referred her to the geriatric medicine team for “Query dementia,” and to help with discharge planning.

At the time, I was doing a one-month stint in geriatrics. I had not yet made up my mind about a specialty.

I met her sitting up on a chair at her bedside; she was alone, doing nothing. The covid19 pandemic was in full swing – no visitors were allowed – and the sight of an elderly person sitting alone, doing nothing, was a familiar one.

She looked healthy. If she had dementia, at least it appeared she was still eating well. Her skin was white and wrinkled; she had a few purple blotches on her forearm. Her hair, thick and curly, was also white. Unlike her skin, her hair looked untouched.

The most distinctive feature about her, though, was her British accent. And it was her accent that got my attention. In Canada, I had learnt, there was usually an interesting story behind a distinctive accent; a white-haired Canadian with a European accent, for example, might tell a story about the Second World War.

We started to chat, an exchange of Trinidadian and British accents in a hospital in a city called London in Canada – I was in a fantasy! We must have started with the usual medicine talk: Do you know why you’re in hospital? How are you feeling? Eventually, with some additional information from the nurses, it became clear she had dementia.

Then, about 30 minutes later – I don’t know how the conversation reached here – Mrs Walker started to talk about Trinidad, about the Queen’s Park Savannah, the horse racing, the railway! Her description was similar to my grandparents’ description of colonial Trinidad. “My husband worked at the Canadian Imperial Bank in Trinidad and we lived there for some time before moving to Canada,” she explained.

That a white, British-Canadian woman was telling me about colonial Trinidad stirred my curiosity. How did our countries’ histories intersect? I could make sense of the British part. But the Canadian part was difficult for me; I was a newcomer here. Was Canada linked to the painful history – the sugarcane plantations, the slave trade, emancipation, indentureship, the white masters, their punishments – that I had learnt about in school in Trinidad?

Not too long after my encounter with Mrs Walker, I would hear on CBC Radio that on August 1, 2021, Canada – for the first time in its history – would be officially commemorating Emancipation Day. So there was a link! Canada was just lagging behind, far behind: Emancipation Day had been a national holiday in TT for as long as I could remember. But I digress.

As I said, the pandemic was in full swing; I had not visited home for some time; I was home sick. And here was a Canadian woman with dementia describing Trinidad – my home – so vividly. She sent me to the moon. The happy feeling that I felt when I left her room made the decision to do geriatrics an easy one.

A few weeks ago, in describing my job to a friend, I said most of our patients in geriatrics had dementia. “Your job sounds very depressing,” he said.

The response was not unexpected. Alas, dementia was no fantasy: it robbed people of their memories, their emotions, their independence, their humanity. “I could see the man I married is no longer there,” a caregiver once told me. A couple years ago, I would have shared the same view.

I have come to learn, though, the biggest mistake we can make is to think of people with dementia as being lost to an enigmatic disease – nothing is more damaging.

For example, if a person shouts out, our first reaction is to ask, “Why is he shouting out?” If a person with dementia shouts out, we are tempted to skip the "why," and say, “It’s the dementia.” After all, the person has been lost, so why bother asking, “Why?”

But the more time one spends with someone with dementia, the more one realises that the person is still there.

We need to seek the person, not the disease; what we find may surprise us.

Taureef Mohammed is a graduate of UWI and a geriatric medicine fellow at Western University, Canada