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I had a fascinating visit with Mr. & Mrs. Jones a few days ago. They’re a pleasant couple from Connecticut in their mid-80s and have been married for over 60 years. Mr. Jones did extremely well in finance and retired to Hilton Head 30 years ago. Mrs. Jones has had four major cancers in her life. The most recent cancer was rapidly aggressive and has metastasized to her lungs. She can hardly breathe now. She gets out of breath just saying hello and talking about the weather. Her life expectancy is probably around 3-6 months. Mr. Jones has no major health issues, except he’s developing Alzheimer's, and is starting to slip beyond the point that Mrs. Jones can care for him, in her weakened state.
I found Mrs. Jones's cancer in time to delay its progression via radiation and chemo – right now she feels pretty well. She just gets out of breath easily. But she understands that this is a short-term reprieve. Her only goal at this point is to hang on long enough to care for her husband until he doesn’t know where he is or who she is, when going into a home will be less traumatic for him. A worthy goal, under the circumstances, I suppose.
They’re a wealthy New England couple who have been married for 60 years, so they bicker about things. His dementia has removed the filter between what he thinks and what he says, so they bicker more. She understands that he says things that can be hurtful sometimes, but they’re due to his disease, so she tries not to take them to heart. It’s often better not to know what someone is actually thinking, especially if you love that person. Which brings me to our visit last week:
Me: So look, Mr. Jones, I think you might have pneumonia. But if I put you in a hospital, in your current condition you’re likely to experience “sun-downing,” and your dementia will go from problematic to catastrophic. It may be difficult to recover from that. So it might make sense to try to treat this at home. On the other hand, your wife’s cancer makes it difficult for her to care for you. So you may have to go into the hospital whether I want you to or not. This is a difficult situation. I’m really sorry.
Mr. Jones: Why should I listen to you?
Mrs. Jones: He’s our doctor. He takes care of us, remember?
Mr. Jones: Yeah, well if he’s so smart, he would’ve found my wife’s cancer earlier, and maybe she’d still be alive today!
Mrs. Jones: Well, he did find it fairly early, so I’m on treatment now, and I am here today. Remember? I’m your wife! And I’m sitting right here!
Me: You have a lot of doctors. Hard to keep track of us all.
Mr. Jones: Which one are you? Are you the racist one?
Me: Racist?
Mr. Jones: Aren’t you from some small town up in the mountains of Tennessee?
Me: Yes, that’s me.
Mr. Jones: All you people are racist, right?
Mrs. Jones: I’m so sorry…
Me: No problem, Mrs. Jones. Yes, Mr. Jones, I’m the racist one. That’s me.
Mr. Jones: OK. You always seemed really smart. I never understood how someone like that could be racist.
Me: Yeah, it’s a mystery.
Mrs. Jones: Please understand that…
Me: Oh, I understand. No offense taken. It’s OK, really. It’s more important that he remember me, somehow. Whatever works.
Mr. Jones: So you think I should go in the hospital?
Me: Yeah, that’s a tough call…
Again, sometimes it’s better to not know what someone is thinking.
What’s interesting is that I’m sure Mrs. Jones thinks the same things. I’m from a poverty-stricken small town in the Appalachians, so I must be a racist. She’s a wealthy socialite from New England. What else is she to think?
But she would never say that. Unless she develops Alzheimer’s disease. Or unless she knows that she is among friends. Well, friends other than me.
Most people will never admit what they really think. Unless they’re compromised (children and drunks), or unless they’re hopeless and desperate. Only if they no longer fear the consequences of their honesty will they admit what they really believe.
Many Democrats have reached that point recently.
Our politics have become more coarse and polarized. But you ain’t seen nothin’ yet.
You just wait until it’s not just the Mr. Jones out there – wait until the Mrs. Jones start speaking their minds.
Oh my goodness.
Discussion (27)
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How very, very sad. And how very kind and patient you are, Dr. B. A difficult time for all of you.
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My experience with family with dementia is that they lose their memory, but their personality traits are enhanced. My mother, for example, was a very ornery woman (it's how she lived longer than anyone in her first family despite being a sickly child), but also emphasized hospitality and keeping a gracious home. On our once a year visits she would clasp her hands excitedly and say, "Oh, look who's here!" even though she had no idea who we were.
As she was nearing the end, she was living in a senior facility and became unresponsive at one point. I wasn't there (the family lives in Ohio and I'm living in Colorado and was dealing with health crises with my kids and myself), but my large extended family gathered at her bedside to see her through to the other side. As the story goes, they were singing to her and holding her hands and she (miraculously?) awakened. The first words out of her mouth when she saw everyone gathered were, "Is this what I have to do to get you to come visit me???" So very Mom. It was that personality that got her to age 93.
So maybe people with dementia who are inclined to call you racist based on where you're from always had such a sanctimonious, judgmental personality, which I guess is your point. I prefer ornery.
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I have no experience with Alzheimer's so will refrain from commenting on that. Regarding the things people say when drunk, I disagree with your assessment. I used to assume that a drunk person who says something outrageous or offensive is letting slip what he really thinks. But then I remember being at a party where a teenager was drunk, probably for the first time. He was telling everyone at the party that he loved them, even though most of those people he had never met before. He wasn't revealing his true feelings, that was just the booze talking.
I once was in a restaurant at a salad bar and a drunk man next to me was making a salad with his bare hands. He told me I should be burned up in an oven. We had never laid eyes on each other before. I doubt that deep down, he really always thought I deserved execution or that deep down, he thought the best way to make a salad was by grabbing everything with his bare hands. People do dumb things when they are drunk that they would never do while sober, and it's not because social convention says that it's improper to stick your hands in the lion cage at the zoo, and the booze has removed that social inhibition.
I'm not trying to be hard on you, my friend, but which is it? Is it right or wrong to presume someone is prejudiced based simply on their economic status and geography? Saying that white Southerners are mostly X, or Black people are mostly Y, or wealthy New Englanders are mostly Z is all the same problem.
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The same thing happened with my dad a few minutes before he died. He had been "out" for a while, when suddenly his eyes popped open and he was "there" for about 3 or 4 minutes, carrying on a conversation and calling us by name (His first words when his eyes opened were "I'm still alive?"), before he kind of drifted off again and died about 20 minutes later.
The medical types on the thread can correct me if I'm wrong about this, I'm told it's actually somewhat common as the body approaches death that organs shut down and release a shot of blood to the brain that kind of kick starts things for a few minutes.
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