He arrived alone, a thin man in a white shirt with light blue checks, the top buttons undone. He matched the shirt with shorts and slippers and his hair was uncombed.
Had he fasted? the radiation therapist asked. Yes, since 6 am. That’s more than 3 hours, she said, so we can see you next.
When he finished, he told the therapist he had a fever every afternoon. He declined her suggestion to see the doctor on duty.
You can call for an appointment with your doctor anytime, she said. You don’t have an appointment now but you can call and make one if you need. The number is on your card, let me show you.
I have so many questions. The shirt was too loose, was it someone’s discard or was it his own shirt and he’d lost weight? Does he have family? Does he know how ill he is? How does he cope? Who made the appointment for radiation therapy? Why doesn’t he have another appointment?
On another day at the clinic, there was another old chap. I slowly realised he was actually chaperoned by two nursing home staff who sat far apart from him.
He looked like any other patient waiting his turn except he echoed what he heard in a soft, high-pitched voice. When the nurse called a patient’s name, he would repeat the name in his falsetto. When the appointment board chimed, he would echo that too, “Bing Bong!”
I know dementia is more than a mental deterioration as it is also accompanied by physical losses. Gradually and inexorably, abilities are lost. The ability to walk, talk, toilet, swallow…
I’ve often been told how lucky I am that Mom has a healthy appetite. She would eat her meals and snacks in between mealtimes. Though before she came to live with me she was actually losing weight. I suspect this was because she forgot her meal times rather than due to any loss of appetite.
With readily available hot meals she gradually regained the weight. I remember the surprise I felt when the geriatrician asked, “Does she chew her food and spit it out after extracting all the juice?” I said, Not yet. Apparently letting dementia patients spit out the hardest bits is okay.
Anyway we’re not there yet. However, over time, she has lost the ability to use her utensils well. She spills food, she slows down. Sometimes she is unable to swallow her food, and keeps it wadded in her cheeks. When she stops chewing or swallowing, we check if she’s still hungry, because we are not sure if she stopped swallowing because she can’t or because she is already full. Very often she nods and indicates she is still hungry.
We’ve taken to feeding her and reminding her to swallow, encouraging her with mouthfuls of water. We cut all her food up to small pieces. She can still finger feed when we offer a sandwich or fruit such as grapes.