It was the first warm day of spring as I walked into the assisted-living facility for what would be the last time. I was on my way to Larry’s room, the resident of the facility that I had been paired with, when I was stopped by my group leader. “I have some terrible news,” he said. “Larry’s wife was moved to another facility — her dementia has worsened since our last visit.”
For the first time in my short medical career, I felt numb. Today was supposed to be a day for my classmates and me to celebrate the final visit with our residents. We had a slideshow prepared of interesting places we had been, which specialties we were interested in and pictures of our families and friends. “Delete my slides,” I told Andrew — the first-year medical student who organized the slideshow — as I sped towards Larry’s room.
I finally reached his door and paused. I was frozen. I realized I had no idea what I was going to say to him. For the duration of the time I spent with Larry, from practicing physical exams to obtaining his medical history, he would always find a way to talk about his wife. “A romance of 70 years — 70 years! How many other people do you know who have had a romance of 70 years?” he would often ask, to which I always replied, “You are the only one!”
We spent a majority of our time talking about his relationship with his wife that kindled when they were both in their late teens and progressed into a lifelong partnership. He had a picture on his mantle of her and him lying on the beach together when they were both twenty-years-old that he always pointed out. My resident often dreaded the idea of death and often voiced his sadness knowing that one day this beautiful partnership would end. He feared, like many of us, the unknown, but mostly because he was in disbelief that a relationship like his — that has been through so much — could just come to an end. It seemed unfair.
I was still outside the door, still not knowing what to say, but I knocked and entered anyways. I sat down next to him and just let him talk, knowing there was no way I could understand the pain he was going through. As soon as he mentioned his wife, he broke down in tears — as expected — and he was under the impression that she was already gone. “I wish she would have just passed away,” he said to me, believing that it would have been easier to grieve her death than to continually be saddened each day seeing her in such a debilitating state. Even under such emotional distress, he grabbed a tissue and asked which exams I’d be performing today — technically the musculoskeletal and neurologic exam before joining my classmates for the slideshow — but there was no chance. Seven months of medical school certainly didn’t prepare me for this.
We skipped the slideshow, went outside and found a pair of rocking chairs to enjoy the warm spring day with each staff member attempting to console a tearful Larry as we passed with no avail. We sat in silence. Complete silence. The only occasional disturbance came from the creak of Larry’s rocker until Larry remembered something crucial. “She always smiles when I come in,” he said, “she can’t even get dressed in the morning, but she always smiles when she sees me.” I saw this as my opportunity for consolation. Coming from a neuroscience background and just having a refresher on dementia in my brain sciences block, I felt confident in my ability to explain the early predilection dementia has on short-term memory, language, and cognition, while preying on older memories later during advanced stages of the disease. This long-term memory sparing combined with recognition of her husband undoubtedly brought a smile to Larry’s wife each time she saw him, even if she didn’t know his name. I could’ve explained this to Larry but was it wasn’t what he needed.
“You know, Larry, my grandmother also had dementia, and I was very close to her,” I said, “I used to visit her every day after school and even though she would forget my name, she used to always smile when she saw me too.” I could tell this brought comfort to him. He wanted to know more about her, and I was honest and open with him. I used to visit her with my mom every night at her nursing facility not too far from our home to sit with her, make sure she was comfortable and eventually goodnight before heading back home. I told him it was difficult seeing her in such a debilitating state. Growing up with two parents working full-time, I spent the majority of my afternoons and evenings at her house, where she would take care of me. Now the roles were reversed, and it was difficult to witness, but it always brought me comfort seeing her smile, even though she often got me confused for one of my brothers.
I saw Larry smile. “It’s damn frustrating seeing someone you love forget who you are, isn’t it?” he said. I spoke to him further about dementia as a disease and what he should expect moving forward both from experience and as a soon-to-be medical professional with the hope that I could help — even in the slightest bit — assuage some of the angst that he had of what was to come. Before I brought him back to his room, I asked him if he had any other questions. “What happens if I visit her and she stops smiling?” he asked. I told him as difficult as it may be to keep visiting her even if her smile fades, she will always love him and always appreciate their 70-year romance.
We made our way back to his room, passing by the other first-years still in the midst of their presentation with each staff member approaching and attempting to console Larry along the way. Larry’s parting words were, “I hope that I was able to give you whatever you were supposed to get out of this experience, kid.” He embraced me briefly and turned towards his window. I closed the door behind me, catching one last glimpse of Larry and his wife sitting on the beach smiling nearly 70 years ago, giving me only an ounce of comfort after such an unsettling day.
Larry’s final words resonated with me. He was my first longitudinal patient that I came to admire and respect over the last five months filled with endless stories, life experiences and tales about young love blossoming into an eternal partnership. Above all else, each visit to Larry brought perspective. I often entered visits with Larry with my mind racing with all of the readings I needed to get through, the planning that needed to get done for extracurricular events I helped organize, the thoughts of when the next time I would see my girlfriend or my family again and the list went on — but ceased for days after a visit with Larry. Since our final visit, a little over a month ago, these thoughts have all but vanished. Perspective is one of the many beautiful and humbling aspects of medicine, and I’m sure it’s not the last time that we’ll meet.
Nicholas Koen is a medical student.
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