Five Minutes With Dementia

Paul Rousseau, MD

Fam Med. 2022;54(6):480-480.

DOI: 10.22454/FamMed.2022.725317

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I ring the doorbell.

“Please, hurry.” Barbara’s voice is distraught and frightened. “I need help, now,” she shrieks.

I pitch the door open and scramble to the kitchen. She is on the floor, a large, purpling bruise rising beneath newly-bent eyeglasses. He is standing over her, glaring, like the victor in a boxing match daring the rival to stand. I scan his figure. He has lost 20 pounds the past year, but he is still burly—and intimidating.

“Tom, it’s your doctor.” He pivots toward me, eyes feral, face flushed.

My body stiffens. “Sit down in your wheelchair.” My words are calm yet assertive. He gnashes his teeth and pounds the kitchen table. I widen my stance; I am frightened but persist. “Sit down Tom, please.” My tone is more forceful. He pauses, glances around the room, and plops into the wheelchair. I approach cautiously, but am unable to slip a restraint vest over his head. Instead, I reach for the wheelchair seatbelt and click it securely. He glowers and flails his arms. Barbara wrestles to her feet and scurries to my side. I notice fingered welts on her arms.

Before we can settle, Tom grabs a breakfast plate and tosses it across the room. It shatters against the wall. Then, he pincers a butter knife and slices the air, his face furrowed in anger. Barbara screams. I quickly move behind him, catch his wrist, and seize the knife. He clenches his hands and pummels my arm. I jump aside and glimpse the clock on the stove—I have been here 5 minutes. Five brief minutes. I cannot imagine enduring this 7 days a week.

Barbara collapses into a chair and rests her head between her hands. She informs me she was on the floor, cowering, for 10 minutes before I arrived. I tell her Tom must be institutionalized, despite her past refusals. There is no other option. She is alone, and her finances depleted. She is also 80 and exhausted, her days bell-jarred into unending caregiving. Moreover, his outbursts of anger and physical violence are increasing; she could have died today. She gazes out the kitchen window, pensive. “He had such a maddened look; I didn’t recognize him. If you hadn’t arrived when you did, I really think he would have killed me.” There is a glint of tears in her eyes; I cradle her shoulders. They have had 59 years of marriage. However, there is no reciprocity in their relationship now; she has become another nameless person in his chaotic and tangled mind. “I’ve tried,” she whispers, “I’ve really tried.”

I assure her no one has tried more. She exhales a deep breath, looks at Tom, and reluctantly agrees to nursing home placement.

Lead Author

Paul Rousseau, MD

Affiliations: Palliative Care, Mount Pleasant, SC

Corresponding Author

Paul Rousseau, MD

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