She “Booped” Me

It is a routine Thursday of clinic work. Cold and cough, follow up for diabetes and hypertension, shoulder pain, and general physicals. Phone calls, prescription refills, and records are coming in steady, but not overwhelming. My nurse let me know that my next patient is ready. I take a moment to smooth back my hair and straighten my lab coat.

My next patient is Mrs L who has been coming to see me since I opened my practice. She is an impressive 90+ year woman who has always kept me on my toes with her questions. She doesn’t complain so much as point out things she finds annoying about the aging process. Her back hurts even though she works out regularly. Her legs ache and get puffy when she stands too long even though she has reduced her salt. Her sleep is never as restful as it used to be even though she maintains her schedule. Her diet has not changed, but now she has to take something for constipation. Aging is not graceful and it disturbs her sense of order and manners. But she keeps meticulous notes and works hard to keep her body and mind active.

Her outfits are always coordinated and her nails and make-up are impeccable. She never seemed to use hair products and I think it is because she has trained her hair to be obedient. She never slouches or sinks into her chair to relax. I can easily picture her dressed up formally with lovely white gloves when traveling by airplane as a young woman. As my personal style leans heavily toward rumpled, she is intimidating. However, she is always gracious and never unkind and I am grateful for it. I know she likes me because she continues to come to see me. If she didn’t like me, she would have transferred her care as she does not suffer fools, particularly when it comes to her healthcare. I recognize it for the compliment it is.

She and her husband were partners for life and devout Alabama sports fans. He passed when she was 88. At every appointment, she makes a point to look me dead in the eye and remind me that he has died. I reply that he was a good man and that I missed talking to him. She nods and then we move on. Although I never quite figured it out, I always felt I was a safe place for her to talk about him or maybe it was her way of telling me that she missed him or making sure that I did not forget who he was. But she never cries to me in her grief. That public expression of emotion would never be proper.

We have our typical patient encounter where we run over her typical concerns – back stiffness, constipation, varicose veins and a new mole on her face that is not cancerous, but she finds its new arrival rude. I run over my list including vaccinations, lab review, medication refills, etc. Her hearing has decreased so I have to make sure I face her to speak. She takes a little longer to process things, but I attribute it to her hearing. We were winding up our conversation when she looked down at my hand and noticed an ugly scratch on my hand from working in the yard. Then the unthinkable happened. She poked it with her finger and murmured, “boop” then looked up at me and smiled like nothing happened.

Bam! Everything shifted. I have known this delightful, strong and intelligent woman for fifteen years and she has never crossed the touch barrier or teased me. I have a moment of hope where I want to believe that she has become so comfortable with me that she could tease me. But there is no sly twinkle in her eye. Or maybe she has a new medical problem that is changing her behavior. But we have just completed a full exam and reviewed extensive lab so I know that is not the case. I realize a truth I want to deny. Her memory is starting to slip. I had unconsciously attributed her slowed processing to her hearing. Asking me again about her chronic concerns was actually her seeking new information rather than reinforcement of our treatment plan. This is the beginning of the process that will rob her of her independence, her intelligence and her strength. I say nothing in that moment, but my heart feels the sadness. Telling her now will not change the outcome and frankly, I need the time too process this new information.

This encounter was three years ago. There has been a slow unrelenting progressive decline complicated by falls, confusion, hospitalizations, and best attempts a rehabilitation. With great sadness, I signed off on her hospice orders this week. Her understanding of complex information has been reduced to a child’s and her insight is gone. She struggles to understand the changes going on around her. She is restless as she knows something is wrong, but she cannot identify what it is. She remains comforted by her loving and attentive family and I am grateful for them. In our few recent interactions, I still see brief hints of the woman she used to be, but nothing more. I only hope that she can feel the respect and affection I continue to carry for her.

Unfortunately, it is another typical Thursday.