"This isn't The Notebook"

I've been spending some time in the neuropsychiatric ward, the saddest place I've ever been, taking care of some patients. I guess the neuropsychiatric ward is what people thing of when they think "psychiatric hospital." Patients are either so medically sedated that they are just passed out in their wheelchairs, heads on the table, or they are aimlessly wondering around, going into other patient's rooms, and following you wherever you go.

My first time in the ward, a patient came up to me, crying, asking "can you take me home?" It turned out that she was one of our patients. Talking to her was difficult through her broken sentences, confusion, and word finding difficulties, yet I felt I could follow some train of thought she was trying to convey. She pointed to the attending rounding, and said "I know him." I was excited by this -- she recognized her doctor, but when I tried telling the attending that, he dismissed me saying, "She just recognized a white male figure -- she doesn't know who I am."

Am I too idealistic? Am I biased in working with my patients with dementia to hope for the best, to only see the good? I have another patient with progressive Alzheimer's dementia with receptive and expressive aphasia, meaning she has trouble understanding and using language. Yet, I try and talk to her and understand as much as I can. I ask her name, and she tells me, "Penny*." I ask her where she is, and she tells me, "hospital." Every time I talk to her, I feel that I can see the person behind the confusion -- if I'm patient enough, I can understand what she's trying to tell me. When discussing her with my resident, I reported that she knew who she was and where she was, and that I thought she might know more than we give her credit for. My resident responded, "This isn't The Notebook. She is confused and doesn't understand us and doesn't know where she is."

It might not be The Notebook, and I understand Alzheimer's is a progressive disease that doesn't have periods of improvement/return to normal function, but that doesn't mean we shouldn't try and find the remainder of the person left inside.



*name changed for patient privacy