The patient was a man in his sixties, sitting in the armchair. His wife was next to him. He was there for his routine appointment with a psychiatrist about his depression, stress and anxiety. A year ago, he had a stroke, followed by a motor vehicle accident. His wife is now his caretaker.
“It’s hard to take care of him at home, when I’m at work all day, too,” she said. “And he hasn’t been sleeping well. He gets up in the middle of the night and then wanders through the house because he’s anxious about where he is and he thinks he’s trapped in the house. I try to follow him so that he doesn’t fall down the stairs or get into the kitchen knife drawer. He doesn’t come back to bed. He tries to fight me off.”
She looked worn down, like she was under a lot of stress.
Her husband now has mild cognitive impairment and he is frequently unaware of where he is. He doesn’t remember much about his past; half of the time, he also doesn’t understand much about his current circumstances, except that something is wrong with him and that his body doesn’t work the way it used to. His speech is slurred. That combined with his impaired memory and awareness means that most of what he says is either inaccurate or confused.
In spite of seeing many patients like him (or ones that are even worse off) on my psychiatric rotation so far, situations like this are still uncomfortable. I try to remain entirely emotionally detached from patients when I hear their unfortunate stories. Certain things always stand out, though. It is easy to see that he is frustrated that his life is like this now. And when we hear these stories, we sympathize and want to help. It’s even easier to see that it hurts his wife more than it affects him.
Sometimes when I’m sitting there listening to patients like this, I have a sudden eerie realization that they were young and happy and in love once. They have an entire life that they have lived, before the accident or stroke or whatever it is that makes them come to your office today. I felt sorry for him, especially because there isn’t much we could do to significantly help him cope with his stressors. We can’t change his situation.
And I felt so sorry for his wife. It was very obvious that she loves her husband, and to her, taking care of him was a part of her commitment to the marriage. I don’t personally know what that kind of commitment is like, but it seemed difficult to take that on and continue shouldering the responsibilities when her husband is not be contributing to the relationship in the same way anymore, and when it might not feel like an equal partnership to her anymore. They probably did not anticipate this turn in their lives on the day they got married.
Then he started to speak in mumbling sentences about his years spent working and with his family.
“I … was a … engineer. I loved it… And…” he trailed off. But he patted his wife on the arm once, and I’d like to think that he was showing his appreciation for his wife, even if he couldn’t express it in any other way.
The patient could not answer any of the doctor’s questions. He couldn’t understand the question, couldn’t verbalize the answer, or just didn’t remember things anymore. His wife answered on his behalf. Towards the end of the visit, the doctor tested the patient’s memory, cognition, language skills and awareness. He asked him to spell “w-o-r-l-d” backwards, count from one to 10, and then he asked him to write a sentence on a piece of paper. Any sentence that the patient could form and that he wanted to write. He shakily scribbled something down. Before he handed it to the doctor, I saw what it said.
“I love my wife.”
The wife didn’t see what he had written down before he handed it over to his doctor. But I hope she figured it out anyways.