And Then We Sang

Atkinson, Susan

She was nearing seventy when she became my patient. One of my colleagues was retiring from clinical practice, and he asked that I take on several of his patients, most of whom were older. Her husband, who was almost twenty years her senior, joined the practice at the same time. I started the process of getting to know them, and soon discovered that the routine appointment length was not going to work. Mrs. E. was a delightful woman who liked conversation. We talked at length about her worries. She struggled with anxiety, which was quite crippling for her during the first part of the day. She worried about her husband’s health and she worried about her own health. She worried about their large home, and how they would cope with its care as they aged. She worried about her two grown children who lived in Quebec and in Ontario. She missed them and was grieving the fact that she was unlikely to be a grandmother - her daughter had just turned forty, and she felt her son was unlikely to have children. Sometimes the conversation strayed away from her worries, and we talked about city politics, or whatever else might have made the news. Needless to say, after the first couple of visits, I asked our receptionist to book her for a longer time slot whenever she called to make an appointment. Mr. E’s visits also required more time. He was a very organized and detail-oriented man, who had worked for years as a general contractor, and who, even in his eighties, remained very involved as a volunteer on several boards and at his synogogue. He would come in for his appointments with typewritten lists of symptoms and concerns that were complete enough to glue directly into the chart, saving me the trouble of having to handwrite the details of his history into the progress notes. He, too, joined the list of those requiring half hour appointments.

As time went on, Mrs. E. began losing weight. She complained of a lack of appetite and no real interest in food. After exploring her symptoms further, and completing some initial investigations, it became clear that she was depressed. She was started on an antidepressant, and visits were booked a bit more frequently. There was some gradual improvement in her condition, but Mr. E.’s typewritten lists began to include worries about what he was observing at home. Mrs. E was becoming more forgetful. She was struggling to remember the recipes for things that she had cooked all of their married life, and she seemed to be having problems organizing meals. Mr. E. soon began losing weight also, because he was finding that some of her cooking was becoming quite unpalatable. Unfortunately, he was of an age and ilk that the kitchen and it’s workings were a mystery, and he had no skills to offer with which to make things better.

Mrs. E. was a bright, educated, and socially adept woman, and despite her failing memory, our conversations continued much as before, as we waited for her appointment with the Memory Clinic. She was overjoyed to report that her daughter, at the age of 42, was expecting, and a few months later brought in the first photos of her long awaited grandchild. Soon, our fears were confirmed, and a diagnosis of Alzheimer’s Disease was made. Over the next months, as her memory deteriorated, I saw those same photos many times.

Mr. E.’s lists continued to include concerns about his wife’s declining function. Home Care became involved, but meals continued to be a problem. The Jewish community in the city is small, and finding a source of pre-prepared Kosher meals was a challenge. Eventually contact was made with a woman who had had experience cooking at a summer camp that served Kosher food, and she was hired to prepare frozen meals. In addition to worries about his wife’s health, Mr. E’s lists still documented concerns about his own health, but with a new urgency that centred around the possibility of him predeceasing Mrs. E., and who would then manage her care. He very much wanted her to be able to stay in their home for as long as possible. To complicate matters, Mrs. E. was beginning to deny the home care workers entry into their home and was fearful of the fact that they seemed to be strangers. Eventually a private company was hired to provided more consistency in caregivers, and she became more accepting of care.

As Mrs. E.’s illness progressed, our conversations became more sparse and repetitive, but she continued to greet me with a smile of recognition and call me by name. One Monday morning I arrived at the office to find notice that she had been admitted to hospital over the weekend for a non-life-threatening issue. I went to visit her later that day. She greeted me with the same smile of familiarity, but it soon became clear, that without the context of being in the office, she had no idea what my name was or what role I played in her life. Her assumption was that I was a family member, so for fifteen minutes that day I was pleased and honored to become a member of her family. I sat on the edge of her bed and we talked about her children and her grandchild, and her husband, and I didn’t so much mind that she didn’t know who I really was.

Before long, Mr. E.’s worst fears came true, and he passed away, leaving Mrs. E. on her own. Mrs. E’s grieving was complicated. She felt the physical pain of her loss, but didn’t always remember that Mr. E. was gone. She would come to the office and begin to cry, but often wasn’t able to identify what she was sad about. My heart ached for her.

For awhile, Mrs. E. had been accompanied by one of her caregivers when she came to her appointments. As time went on, she was no longer able to speak coherently for herself. Her words would be a mixture of unfinished thoughts, and rambling, unconnected words. I began to grieve the loss of our conversations. I wondered how her daughter was, and what new thing her grandchild had accomplished. I missed hearing about her worries and concerns in her own words, rather than as a list of observations about her behaviour that had been noted by her caregivers. I missed the connection that we had established over the period of time we had known each other, and it seemed that that connection was likely forever lost.

One day, after addressing the concerns that Mrs. E.’s caregiver had about her health, I asked what Mrs. E. was doing to pass her time. I was told that she liked to watch “The Sound of Music” over and over again. I have always loved to sing and am rarely without a tune in my head. I was introduced to “The Sound of Music” as a young child, and have seen it many times over the years. I started to sing “Edelweiss”, and to my surprise, Mrs. E.’s face lit up, and she joined right in. Despite being unable to put a sentence together, she remembered the tune and all the lyrics, and sang along with gusto and obvious enjoyment. We moved on to “Do-Re-Mi” and “The Lonely Goatherd”.

Mrs. E. and I were no longer able to have our conversations, but as her condition changed, so did our relationship. Our visits took on a new pattern. We dealt with the health business at hand... 
                              ... and then we sang.

Theme: Death and Dying | Décès et le mourir
Theme: Relationships | Relations
Theme: Family | Famille

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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