Blissfully Unaware

How is it possible that the best part of my workday yesterday was with the patient whom, in many ways, is in the most unfortunate circumstances? But, I guess it’s all about perspective, and maybe her situation is not so unfortunate. After all, she is safe, cared for and seems to be happy.

See, I spent quite a bit of time with one of my patients in the memory care unit of a facility. She has Alzheimer’s Disease, and while otherwise healthy, cannot remember much of anything outside of a few things about her husband and son. She is relatively pleasant, generally has a smile for me, and is willing to engage in conversation…most of the time.

Yesterday was a wonderful adventure outside onto the patio, where the sun was shining and there was an abnormal spike in the temperature, causing it to be a lovely 78 degrees. There was a refreshing breeze as well, which made the totality of the opportunity too good to pass up. My patient no longer walks on her own, but she easily maneuvers in her wheelchair by “walking with her feet.” Sometimes, it was hard to keep up with her!

As I walked beside her, we talked about the sunshine, the breeze and the newly growing plants and flowers. All of these topics did not require any specific memories from her, so it was easy for her to respond to questions and to formulate opinions. Yes, that plant is beautiful. I love the fresh air. It is really bright out here. It is when I ventured into deeper topics that her conversational abilities shifted. She would begin sentences, but then not be able to finish. She would “cover” her lack of cognitive functioning with comments like, Oh, you know what that is.  Or, I never liked that because, you know… I didn’t press her to continue, but let the conversation flow where it did. She could not remember details of her life, such as if she ever rode a horse, or flown in a plane, or been on a boat. She could tell me the basic information required about how she was feeling, if she had to use the bathroom, or if her stomach hurt, but she could not offer anything deeper than the present here and now. More than that, she still did not recognize the pathway we were walking on, even though it was basically a circular one and we had made the trip around it no less than a half dozen times. When she asked, “Where does this path go?” I was struck that for the rest of us who have not lost any memory or cognitive functioning, we take so much for granted.

As I think about this visit, I am affected by all that it implies. There is so much we can lose in life, and so much we can also gain. What we each lose is different. For some, the loss is a limb, a breast, or the ability to walk. For others, the loss is a job, a home or even a child. Sadly, for many, loss is a combination of many things, including a limb, a job or a child. Which loss is the worst though? Obviously, any loss each of us suffers is the worst, because we are going through it. No one could possibly understand our personal loss, because that loss is not personal to them. One would think our empathy would increase for our fellow man in light of this knowledge, but somehow, our society has seen our empathy decrease, because we become selfish in the light of that loss. We refuse to see others and their understanding of what it is like to suffer a loss, and instead assume we ourselves need to be coddled and babied. No one could possibly understand, right?

Some say the loss happening with Alzheimer’s Disease is not the worst because, At least they are unaware of what is going on. On some level, that might be true.  But what happens when all cognitive abilities have ceased, and what is left is fear and uncertainty? Your limbs may be working, you can feed yourself, and you can still manage to go to the bathroom on your own, but you don’t recognize anyone, nothing is familiar and nothing makes sense? Would any of us want to be in that situation? Sometimes this notion of blissful unawareness is anything but blissful. And realistically, it is not a state of unawareness because we would be aware of one thing: fear. That’s not a state I want to be in for an extended period time.

Thankfully, my patient is not yet at that point. She still smiles, talks and can, for the most part, carry on a conversation. But I’m sure there are others in her residence who are not as lucky, and who are moving swiftly to the state of fear, losing all other abilities. My patient is my reminder that each of us lives in our own little bubble of the world, interacting with others minute by minute. I don’t want to continue to live in this bubble. I want to live in the larger world, seeing as much as I can and feeling as much as I can. And I want to recognize the differences between us as opportunities to come together and to get to know how we can be supportive of each other in our losses, whatever they may be. I don’t want to live my life blissfully unaware of those around me and their struggles. More often than not, seeing the struggles of another person brings perspective on how to get through the struggles in my own life. The bonus is, now I can be a comfort to someone who is coping with a loss of their own. So the best part of my day yesterday was realizing there is still hope for things to be better, one realization at a time.