Opening the doors to lost worlds: me and my dementia patients
A familiar lone figure waits directly behind the security doors of the geriatric ward.
There in his mint green pyjamas and long plaid overcoat he stands, overnight bags packed — always on the hour.
His hunched frame twitches nervously as he awaits his train, destined never to arrive.
“Good morning, Mr Bradley!” I say.
His spectacles slip down the bridge of his nose as he lowers his chin and squints over the rims suspiciously.
“What time is it?”
“It’s 9am.”
“Oh!” He squeezes his eyes shut and grimaces. “I’m so late — can you help me find my train?”
“Certainly. Here, let me help you with your bags…”
“No!” he cries, “get away from me!”
The weight of his luggage drags him backwards as he pulls away from my helping hand, slamming his back on the wall behind him.
Mr Bradley’s fits quiver as he grips the handles tighter, cheeks and nose flushed with vexation. Without uttering a word, he straightens his peaky cap and brushes past my shoulder.
In my months caring for Mr Bradley, I have watched with amazement as he weaved his way through the maze of the geriatric ward, dodging the numerous obstacles with utmost precision. As if experiencing a resurgence of the strength and vitality of his youth, Mr Bradley is made anew for his great venture.
A petite elderly woman, sitting cross-legged on her perfectly tucked bed, flips the pages of her bedside chart with amusement.
Her hospital gown accentuates her cachectic frame and almost conceals the small, brown dog toy tucked under her right arm.
Though mute since her most recent stroke, her blue eyes light up on my arrival. Ms Price’s endearing toothless greeting makes you feel in that moment that you are her favourite person.
“Morning, Ms Price!”
She nods excitedly while placing her folder down — open on her bowel chart — still clutching her inanimate companion. She then lies back, feet dancing playfully in the air, ready for her wound check.
As I begin, a new addition to her room catches my attention: a faded black and white portrait taped crookedly to the wall.
The image is of a young girl on the cusp of womanhood; her eyes beam with delight as she kneels on the ground, arms wrapped around a charming kelpie.
I take a moment to superimpose the two faces before me.
In my mind’s eye, I see the wrinkles on Ms Price’s face smoothing out one by one; her pale, gaunt cheeks returning to a healthy plumpness bestowed by youth, her skin sun-kissed with a radiant, rosy hue.
I see her wispy, snow-white hair become a vibrant shade of honey-gold, tousled delicately over her shoulders.
I am snapped out of my reverie by her incomprehensible whispers into the ears of her toy. She embraces it and looks up at me encouragingly, gesturing for me to pat its head.
She squeals with delight as I give the dog an affectionate scratch behind the ear.
On my way back to the office, I spot a troubled-looking Mr Bradley en route to his train.
“Excuse me, Miss, have you seen this woman?” He shuffles towards me and produces a small monochrome photo from his wallet, the edges fraying and torn.
“I’m afraid I haven’t.”
He looks up at the ceiling and sighs with exasperation.
“Is everything okay?” I ask as his hands fidget with his coat button.
“No. I have to get home! My wife annulled our marriage last night and married another man! The kids are home alone!”
“Oh, I’m so sorry. Is there anything I can do?”
“Yes – get me home!” Mr Bradley shouts as he bolts for the doors, arms flailing in the air.
I feel helpless as I watch him approach the medical student with those despairing eyes — “Excuse me, Miss, have you seen this woman?”
My next patient is Mr James. He greets me with a slow nod of his head.
My longest residing patient, now tearful, explains he is growing more despondent with each passing day he is separated from his beloved wife.
“Sixty-four years … we haven’t been apart for 64 years.”
His voice cracks and tears run down his cheeks.
“I need to…” he sniffs, “get home to her. I … need her.”
Though I know very well that Mrs James is not at home waiting for the return of her husband, I do not have the heart or courage to watch him drop to his knees when I break the news to him once again.
His wedding ring catches the afternoon sun through the window as he buries his face in his palms.
I take a seat on his bed and offer my hand. While I lack the words to ease his pain, I embrace the healing power of Mr James’ storytelling. I know it is now time to hear my favourite love story, the one that began for him in the fateful summer of 1951…
Later, just as I take a seat and begin to welcome the rather eerie peace and quiet, a loud shriek echoes through the corridors.
A crowd is gathering around a patient lying face down on the floor, pants to the ankles.
Three security guards hold the man down as a team of nurses administer intramuscular antipsychotics into his thigh.
The scene stirs the residents, who start emerging from their rooms.
Some look on cautiously from afar, others begin lowering their pants in a show of solidarity, hollering in support of their freedom fighter.
Weaving through the crowd, I discover that the man at the heart of this spectacle is none other than Mr James.
Against the advice of security, I inch closer, confident I can placate him. I know the real Mr James better than anyone in this place. I know he is in there, somewhere.
“Mr James, it’s me, Dr Belle, we were just chatting together…”
Without a moment’s hesitation he swings at me, landing a frantic punch on my ankle. My leg gives way as I skid backwards, landing on the floor, finding myself back-to-back with Mr James.
As he rolls over, I curse my attempted heroism and shield my face in anticipation.
Nothing.
I slowly uncover my face and lock eyes with Mr James. I see the remorse pour from his sad green eyes as his demeanour shifts.
“I’m … I’m so sorry…”
“It’s okay, really, I’m fine,” I say.
I slide myself up to lean against the wall, catching my breath. Mr James reaches for my hand and gently places it to his chest — I feel his heart pounding.
“I’m so sorry,” he sobs. “What have I done?”
We sit together in silence as the crowd begins to dissipate, side by side, hand in hand.
“Please promise me something,” he whispers.
“What is it?”
“Please promise me that those men will never, ever come back.”
I peer around the corner to my left. Security are still there as expected, ready to take charge at any sign of aggression.
“Well…”
“Please,” his voice quivers, “you have to promise.” His sweaty hand clutches mine tighter.
“I…”
“Please,” he mouths.
I feel the terror in his eyes as he looks at me.
“I promise.”
Another lie I justify telling this poor man. The repetition never dulls my sense of guilt.
I guide Mr James back to his room and help him into bed.
As he bundles himself under the covers, the pen clipped to my scrub top catches his attention.
“That’s a nice pen you have there!”
He eyes it intently.
I let out a smile as I reach for my pocket. “Here, you can keep it.”
“Is bed 22 back in bed now?” the nurse in charge asks curtly.
“Twenty-two? Who’s that?” I watch her fumble for the ward list in her scrub pockets before retrieving a crumpled, coffee-stained page.
“You mean Mr James?”
She runs her finger down the page and smacks her lips together, “Yeah, that’s the one.”
“Yes, Mr James,” I say, “is in his bed now.”
I let out an exhausted sigh as I limp past the two security guards who have planted themselves around the corner at my request, out of sight of the patient.
Behind each bed number exists a vibrant individual with a name and a life story worthy of sharing.
My time on these wards has proven that with an open heart and mind, there are no bounds to what you can discover in these moments of great cognitive vulnerability.
Each room contains a moment from times past — painful or joyful, but a moment that marked a failing mind.
The memories of my patients run like a reel, with an opening and finale. Though each time I try my best to fulfil my role, I never quite know if the story will run to completion.
For them, at any given moment, I can revert from friend to foe. But I also know that tomorrow this familiar little world will be behind that door, reset and waiting.
Later that evening I decide to check in on Mr James.
“Good evening, Sir.”
“Yes?”
The word hangs in the air with a coldness as he glances over the top of his newspaper.
I see in his eyes that the events of the morning are long forgotten — the impossible promises, the regretted blow, the tears.
As Mr James lowers his paper, I see my pen clipped to his left shirt pocket. The token of friendship still sits close to his heart. I quietly slip out of his room, comforted.
Several hours go by before I find Ms Price by the ward doors. A rage washes over her tiny frame as she opens her mouth to scream, tugging her hair as no sound follows.
She elbows me in the abdomen with an impressive force as I attempt to redirect her back to safety.
She absconds the ward but she is soon down on the floor, biting, fighting and kicking with every morsel of strength she possesses. Nothing can calm her.
Amid the mayhem, an idea comes to mind — the dog. Tracing back her route, I find the toy lying in the corridor.
I race back, crouch down slowly and lock eyes with the woman. I see the nurse coming up behind me with a needle, ready to administer sedation.
“Doctor, stand back!”
“No, wait!” I shout. “Stop!”
“What do you think you’re doing?” The nurse looks up at me, furious.
Ms Price breaks free of the nurse’s hold, her fist inching its way towards my face.
“I have something for you … look.”
I try to maintain a calm front — all eyes are on me as I outstretch my arm.
Ms Price looks at me wide-eyed. As if under a spell, her face softens and jaw unclenches as she parts her lips and slows her breathing to a steady rhythm.
Burying her face lovingly in the dog’s neck, she strokes its head tenderly, all the rage evaporating out of her frail and bruised body. I take a few moments on the floor outside the ward while Ms Price is escorted to her room.
Time slows for me. In my time as a resident, I have never experienced the ward from the outside looking in.
Doctors move rapidly in all directions, always in a constant hurry. I watch as one exhausted resident lags behind her team balancing piles of worn-out folders, scribbling her notes frantically as the consultant powers down the hallway.
In the scramble to keep pace she drops everything — the papers shoot up into the air dramatically before drifting down to the floor, as if in slow motion.
I see the boss look over her shoulder angrily and point to the documents littering the floor. Nobody stops to help as the team moves on without her.
She looks spent as she hurriedly squats down to collect everything, struggling to hold back her tears. Her glasses begin to fog.
It is a look I recognise well. There is only so much you can hide behind a mask.
Amid all this I observe my patients meandering the halls, drifting in their own worlds.
Mr Bradley is walking to the doors again. I give him a comforting wave and smile. Though he looks directly at me through the glass, it appears he cannot see me.
I wave again — no response. Mr Bradley is so close that his breath fogs the glass, but he is a universe away.
In that moment up against those mysterious doors, I realise they are not as they seem. They are the portal to one’s most treasured memories; for others, the gateway to the darkest corridors of their past.
When Mr Bradley looks out through the glass, he sees a busy station where he will relive the journey that changed his life forever.
His first stop will be home, where he will find his wife packing her bags to leave for another man.
I see his anguish as he looks at his bare wrist and slams his forehead firmly against the glass.
The impact catches me off guard and I stumble back. Mr Bradley knows the time has come — he has lost her forever.
My mind skips to dear Ms Price and I imagine where her doors lead. I picture them opening to a glorious garden on a perfect autumn day, where she and her canine friend roam free among the glowing oak trees, the ground aflame with leaves all gradients of crimson and gold.
For Mr James, I like to think the doors lead him to simpler, more peaceful times.
They open directly to his porch, where he and his wife sit on their wooden swing, arms interlaced, her head resting on his shoulder.
Perfectly at peace, they admire the pristine landscape of their alpine farmstead as they bask in their love.
All the emotion of the day comes crashing down on me as I am overcome with tremendous weariness.
I close my eyes, take a deep, slow breath and allow myself to step through those doors. Soon I’m feeling the gentle warmth of the sun on my face, the grainy sand beneath my toes.
I breathe in the crisp ocean air as I listen to the sound of the waves crashing and … and … and beeping?
Beep beep beep. “Room 14C agitated, please review.”
*All names have been altered to respect patient confidentiality.
Dr Isabelle Schupak is an unaccredited radiation oncology registrar with Genesis Care in Melbourne.
