Disclaimer: This story is about a fictional event. The characters are not real.
PART 1
“Soon-yi! Soon-yi! Daddy’s home, my little lotus! Soon-yi! Hey! Soon-yi! Get over here! Daddy needs a taste of your sweet nectar! Give it to me, Baby! Come on now, Soon-yi, Daddy knows you’re not shy! Come on and smoke Daddy’s pipe!”
The nursing home staff looked at me, giggled then the ones tending to this little man attempted to redirect him. I could tell they all loved this dirty old geezer.
“I used to joke my nurses that when we get tired of the medical profession we were all going to go blonde and become professional pole dancers. I already have the clear heels that light up and have my professional pole dancer name all picked out. Mei-lei Mi” I jokingly told the nurse at the desk.
Then someone smacked my butt. I spun around “I got your pole right here, Baby, now dance for me”
If it were a 20 something year old Bipolar patient, we would have to consider the possibility of “medicating” him for acute agitation. Impulsivity that knows no boundaries is be a dangerous thing.
After my heels that did not light up made a 180, I saw this crusty old man in a wheelchair right behind me. He had his arms open in a welcoming gesture and he was wiggling his hips and shoulders. He had a huge smile on his face and was kissing the air. The staff just burst out laughing. I did too. I have to admit, the old man was cute as a button.
“Dr. L, that’s Mr. Herecome. He’s on your list for today. He has a history of Fronto-Temporal lobe dementia. He not really a problem right now but he’s been getting a little bit more inappropriate over the past week and we wanted to see if you could adjust his meds, you know, kinda like nipping things at the bud?”
“You mean like, castration? Oh, that’s not within the scope of my practice. You might want to consult surgery on that one. Just kidding. Let me take a look at his chart”
“I like your style, Dr. L! Do you think you could see the other people on your list first? His wife requested she be present when you speak to him. She should be here in about 15-30 min. She comes every day. She’s a sweetheart herself”
"Sure"
"Sure"
PART 2
She was impeccably dressed with cute shoes and a purse to die for. She was in her 70’s and she was adorable. She was like a well preserved antique doll. Her hair was dyed to perfection. Her hands were delicately manicured. On her left hand she wore a beautiful diamond.
Along with aging comes the normal degenerative process. When this affects the central nervous system, our brain functions are not as precise as they were back in the day.
I don’t know if Mrs. Herecome was a dancer back then but she still moved with the grace and poise of a prima ballerina. In spite of her grace and poise, she looked noticeably tired. She a few times I’d catch her slouch only to watch her rise like a ballerina returning to first position.
“Soon-yi! My little Asian slice of heaven. Gimmie a taste of your lovin’!”
“Daddy! Where are your manners! That’s no way to talk to a lady! That is your doctor” She was firm but loving. She must have been a feisty firecracker back in her day. After several more sexually inappropriate statements, Mrs. Herecome eventually got her husband to settle down.
“You’ll have to excuse my husband. He is a Korean war veteran”
“You’re fine, Mrs. Herecome. The staff tells me you come every day. Where are you guys from?”
“We live in Abingdon. It’s just about 20-30 minute drive from here”
“You drive 20-30 minutes back and forth every day? Do you not have any other family members who can help you with your husband? I mean, you do look tired if you don’t mind me saying; and it seems like he might be a handful for you. I wouldn’t want you to stress yourself out”
“Oh, I’m fine. Brandon and I have two children, five grand children and a great grand baby on the way. They all have their obligations. Brandon is mine. He wasn’t always like this, you know. He was diagnosed with Fronto-Temporal lobe dementia way back in…I can’t remember. He might be like this but he is still the best man”
“The best man for the best woman in the world” Mr. Herecome lovingly said to his wife.
“Tell me about your husband, Mrs. Herecome”
PART 3
“…and there I was, standing at the altar in my wedding dress with a church full of my family and friends but no groom. Brandon knew my fiancée wasn’t coming. Brandon got down on one knee and proposed to me on the spot. He had a marriage certificate ready for me to sign and everything. He was a very meticulous man back in his day”
“I was shocked! I told him that I couldn’t marry him. He was the best man! And you know what he said? ‘You are the best woman in the world. The best man for the best woman in the world’. We have been married for over 50 years.” She smiled and kissed his temple.
“Brandon and my fiancée were best friends. My fiancée was a little bit on the wild side. I had a “thing” for the bad boys” she blushed. “He and I ‘fornicated’ until I got him to make an honest woman out of me. Later on in our marriage, I learned that Brandon paid my fiancée to not show up”
I looked at her startled as she went on. “My fiancée was a drunkard and had a bit of a temper. Maybe he had a few girls on the side but I was his one true love. He eventually went to jail for brutally beating his wife. Brandon saved me from that”.
Mr. Herecome tried to expose himself. “Daddy, not in front of the lady… No, Daddy, no…”
“In our first year of marriage, Brandon did not touch me. He courted me. He brought me flowers every day and we went to the movies every Friday night. We had our ‘honeymoon’ on our first year wedding anniversary. Then he got sent out to war”
“When Brandon got back from the war, went to law school and put up a practice. Our son has now taken over. He was so full of life before he got diagnosed. It seemed like the older he got the more active he became.”
“He put up several successful businesses but then he also started running around with other women; he would even flaunt them in front of the children. His behavior became more and more erratic then he started gambling. Fortunately, he got diagnosed around that time and we took charge of his finances.”
“So how old was your husband when you noticed these changes?”
“Late 40’s, early 50’s maybe?”
That would be about right. The personality changes associated with Fronto-Temporal lobe dementia can be very subtle and start relatively early on in life. The decline in other cognitive functions come later.
PART 4
“Dr. L, I have one and a half consults here for you. Dr. Bleedingheart wanted me to tell you Brandon Herecome got admitted today. You had seen him in the nursing home the other day, right? Well, he spiked a fever last night and is kinda sorta not himself. He’s not quite ready to be seen” the voice at the end of the line spoke in a cheerful sing-song like voice.
“Dr. Bleedingheart wanted you to see Mr. Herecome’s wife, Florence today. She may have had an MI and he wanted to see if you could do something for her anxiety. She is in room 26 hall B while Mr. Herecome is in the ICU bed 223A”
Mrs. Herecome was asleep when I arrived. She rested peacefully. Watching her, I felt like I put my favorite doll to bed.
“Please don’t wake my mother. I’m sorry for being so abrupt. I’m her daughter, Carolyn. I am power of attorney over health making decisions for both my parents. Dr. Bleedingheart told me you were going to see them” she smiled in an attempt to regain her composure. She had inherited her mother’s poise and beauty. They had the same graceful moves.
Carolyn went on to tell me about her father’s deterioration over the years and how her mother struggled to keep him in line.
“She does everything for that man. He wore her out. He did this to her…” Bitter tears dripped down her face. Her sobs were filled with hurt and anger.
I received the consult late in the day. My daughter was texting me to hurry up and come home. It was a Friday and I wasn’t on call that weekend. In my profession, I have found that silence is the best way to ask a question. She regained her composure and sprang back to first position, just like her mother did when I first met her. I sat back and prepared to listen.
“I know about the dementia and how he is no longer himself. Mother did everything, she loved that man. He put her through hell even before he became like this”.
PART 5
“Mother and Daddy were all about each other in the early years. There was no happier couple. They were so devoted” Carolyn started to shudder. Her words were chopping up. Her poise was lost and she made no attempt to regain it.
“…and Daddy was the best father anyone could ever have. He was busy but he always made time. Then he changed. He started cheating on Mother. He would spend hundreds and thousands of dollars on his women. There was a time when he tried to buy 3 Cadillacs for 3 different women all at the same time. The dealer was a close family friend. He told us before the sales finalized. Evidently, Daddy made a very violent scene when the dealer tried to refuse the sale.”
“Daddy would make Mother cook huge meals for his business associates; she would slave in the kitchen for hours only for him to tell her to get ‘all prettied up’ and meet him at the restaurant. Mother would do everything to please him and it was damn if she did, damn if she didn’t. A man like that didn’t deserve my mother”
“I was told your father has Fronto-Temporal lobe dementia. Back in the day, your father was the best man in the world. Those changes you described are consistent with the beginning of his illness. He was most likely not the man he truly was by then. All those changes you described were most likely his illness. Not him”
As I continued to explain how her father's illness affected him, Carolyn looked away. She cried. She hid her face. She shuddered and sobbed. Her tears were filled with sorrow and guilt.
She called me directly the next day to tell me both her parents died and wanted to thank me for telling her about her father’s illness. “I didn’t know”. Those words echoed in my mind.
Every physician is trained to deal with death. For me, the death of a patient doesn’t really bother me unless litigation is involved. Honestly, I wasn’t too affected by the death of Mr. and Mrs. Herecome. For all I knew, they were in Heaven.
All these years, Carolyn resented her father because she didn’t understand her father’s illness. “I didn’t know, Dr. L. I didn’t know. Thank you for helping me understand”. Those words echoed in my mind.
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