Tuesday, April 1, 2014

Understanding the disease

How many times have you been at church or social functions and witnessed that “little old lady” that is running the show? From party planning to organizing the Christmas plays to cooking dinners for 30+ people, my grandmother has always been that person.  I often compared her to geriatric patients in my medicine clinic and thought, “how does she do it?”  No one in my very large family was prepared for the day when she suddenly was no longer able to juggle it all.

My grandmother had a very difficult 2013 that all started with her having back surgery.  She had undergone multiple back and other joint surgeries in the past and always seemed to be back on her feet within days (so everyone thought this time would be no different).  Unfortunately, following a very lengthy procedure, my grandmother woke up and really didn’t know anyone.  Her husband of 50 years, her 4 children, the multiple grandchildren, and even great grandchildren that she often babysat, were only intermittently recognized.  At first, I assumed (from 100s of miles away) that she just had hospital delirium.  I received calls almost daily from my very distraught mother asking “what is wrong with her?” and “is she going to get better?”  The longer my grandmother was hospitalized and as the confusion persisted, the less clear those answers became.  The decision was made to take her home after about 2 weeks as we all hoped that she would improve after being back home in her normal environment.  This unfortunately was not the case, she actually declined – screaming all night in pain, became incontinent of stool and urine, and completely exhausted my poor grandfather that was trying to take care of her.  There was no medical background in the family and this situation with my grandmother was not being handled well.  Some blamed my grandmother – they felt that she was “faking”.  Others blamed her pain medications (to the point that they essentially took all of them from her).  Everyone started to fight, cry, and many stopped visiting or communicating.  My grandfather on multiple nights took my grandmother to our local hospital because he did not know what to do with her.  The last night that he took her she was septic and transferred back to the original surgeon who did her surgery.  She was found to an abscess at the level of her new spinal hardware so AGAIN had to go back to surgery.  On one hand, everyone was relieved that maybe the infection was the problem all along and she would now to cured!! On the other hand, here she was going through ANOTHER surgery.  Following the surgery my grandmother’s memory did improve some, but she is certainly nowhere close to the person she was before this all started.  The more I talked with my mother about this case; there were subtle things that had been missed – like the fact that my grandmother had been forgetting places and names long before her initial surgery.  She likely did have some mild cognitive impairment that certainly did not help her in the recovery phase – especially with delirium (and superimposed infection).  My grandmother knows our family members now and is functioning quite well at home, but constantly has to be monitored and requires quite a bit of assistance. 

This story is just one example of the impact that cognitive impairment can have on someone and their family.  It is important to accept the process of aging and understand cognitive decline.  My family has learned a lot this year thanks to my grandmother, and finally has taken the initiative to start learning about cognitive impairment and dementia and how to prepare as things continue to change throughout both of my grandparent’s lives.  Educating family members and patients about what to expect is clearly important in the case above, and something that I have noticed to be emphasized often during my month on geriatrics.  

 -- Lindsey Prochaska

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