For many years, my widowed mother lived alone. She was across the border in Malaysia, and just one hour’s drive away on a good day, or three or more on a bad day. Her closest family was here in Singapore. I knew one day she would move in with me, and I feared the day was drawing closer as she had started to show very early signs of dementia. But we had not seen any doctors about it, and she seemed able to take care of herself apart from a couple of strange incidences.
During her visit to me June 2011, I got up one Sunday to find she was already awake but still lying in bed. “You know,” she said, “I think I cannot walk”.
“Can you sit up?”, I asked. She could. “Are you giddy? Are you weak?”, the answers was negative. “What happens when you try to walk?” She answered tentatively, looking for the right words, “I… almost…… fell”.
The conversation sounds almost childish in its simplicity, but this was how she already was at the time.
So I got her to stand, and she looked steady enough. When she tried to take a few steps forward, she stumbled and quickly twisted her body so that she landed on the bed. She told me that was how she “almost fell” earlier. But she had been able to get to the toilet and back holding on to the furniture and the wall.
I got her to sit up straight on the sofa and brought her a cup of tea and bread. I took my breakfast too just in case. After half an hour, I made her stand and try to turn on the spot. She could not turn steadily. And so I drove her to the Emergency Department.
At the ED, when we said she cannot walk well and had a probable fall, the “fall” became the red herring and drew questions on whether she had hurt her head or any part of herself. It didn’t help that mom enjoyed the attention and said she was okay to all the questions. I often let mom do all the talking, just to hear what she would say. But finally I had to interject and say, “She cannot walk since getting up this morning.”
The MRI showed a small stroke, and she was admitted to the stroke ward.
I have many blessings to count and be grateful for:
a) my mother had the stroke while visiting me instead of when she was alone at home
b) it happened on a Sunday morning and the ED was not crowded; in fact it was uncharacteriscally empty
c) it was a small stroke and although it gave her temporary unsteadiness in the right arm and right leg, it did not affect her speech
d) after four days in the hospital, she was able to walk unsupported, albeit very slowly, and today she walks almost normally.
e) she did not fall and hurt her head or any other part of her body
f) she participated in the training of medical students, because she was cooperative and verbal and smiled a great deal, and she enjoyed their company
g) the occupational therapist discovered she could only remember two out of three objects and suggested a pillbox and to monitor her medication schedule more closely
h) as a result of the hospitalisation and recuperation, she made the transition from living alone to living with me quite naturally
g) she made contact with the medical team which subsequently led to her diagnosis of dementia.
One point to note is that her diagnosis of dementia was not made during this hospitalisation. Despite my highlighting to the staff that she cannot be relied upon, they reassured me she was fine because she scored 28/30 on the memory test. I guess whilst the changes by then were significant to me, they had not reached the point of clinical significance nor warranted treatment. As it turns out, my mother was diagnosed four months later, when her score on the same test was 26/30.