The Alzheimer’s Experience, Part I: ‘Which Island is This?’

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Henry Van Winkle came out of the men’s room and sat down in front of his-half empty glass of beer at the small table nearest the promenade. The distinguished look of his full head of gray hair and neatly trimmed gray beard was not diminished by his wildly-colored floral shirt.

“Boy, that was a big place,” he thought as he took another sip, “. . . but come to think of it, this is an airport . . . restrooms are usually big in airports. I wonder which one?” He noticed his loose flowered shirt and the floral lei and then recalled, “Oh yes, we’ve been planning this trip to Hawaii for a long time. Funny, I don’t remember getting started . . .but I’m sure having a good time.”

“Waiter,” he said to the chunky, Asian-looking bartender, “Which island is this?”

“Island?  What do you mean, sir? This is Phoenix, Arizona.”

“Oh,” he said, and thought to himself, “We must just be getting started.”

“Did you see which way my wife went?”

“No sir, you came in alone.”

“Oh,” he thought, “she must still be in the ladies’ room. Women take a long time.”

He sat back and relaxed, enjoying himself and the trip to the fullest. “I always like to get my money’s worth,” he thought.

He finished his beer—still no wife. “She must be out by now,” he thought.  “Maybe I was supposed to meet her out by the plane. I wonder which gate we leave from?” He checked his pockets for a ticket and found none. “She must have the tickets,” he reasoned. “She never trusts me with things like that anymore; I forget them.” He stood, picked up his carry-on bag and noticed he was a little unsteady on his feet. “I wonder how many of those I had. I only counted one glass. One beer shouldn’t do that to me,” he thought.

He headed toward the boarding area. The airport was crowded. Suddenly he found himself at the curb. A man opened the door of his taxi and said, “Where to, sir?”

“Hawaii,” he said. “No. That’s silly. Downtown of course, I’ve just been to Hawaii. My wife and I went. We had a great time.”

“Yes, sir,” said the cabby, and he started to drive. “Now I’ll have a few minutes to remember who I’m going to see,” he thought. “I’ll look in my briefcase. It’s probably written down in there. Let’s see, here’s my bathing suit, razor, tooth brush . . . this isn’t my briefcase. I must be going to the health club.”

“Downtown YMCA,” he said.

“Yes, sir.”

“Hey, wait a minute. That doesn’t seem right,” he thought. “It’s been years since I’ve belonged to the health club.” He lapsed into silent reminiscence.

“I haven’t really worked out since Pa’s mule pulled the hay wagon over my foot. Oh, those were the days, going back home to visit Pa on the farm. It was so relaxing to get away from the rat race for a few days. Boy, he knew how to live. He’d build houses and do construction work to support us kids, and put us through school and keep the farm going. No rat race for him. Finally, when everything was paid for, he sold the tractor and let the place go to pasture except for the garden he worked with the mule. He said you couldn’t talk to a tractor while you worked. There was always a place to go when he was alive. By the time Ma died he was getting pretty forgetful, but he always got up and fed the animals and weeded the garden and seemed real happy and healthy, till finally brother Dave got a court order, sold the farm, and put him in a nursing home. It was a nice place, but he just sat there. Then he died. But boy, those were the days down on the farm.”

“Here we are, sir. Where shall I let you off?” asked the driver.

“Over there by the park,” he answered.

He still didn’t remember where he was going, but the park was green and reminded him of the farm. He figured he could sit on a bench and collect his thoughts. No sooner was he seated than he needed the restroom again. None being available he found an inconspicuous tree. “I must have drunk more than I thought. That’s why I can’t remember so well. It affects me that way these days. I’ll have to remember to drink only at home after this—and keep it to just one. I’ll just sit here and enjoy the sun and let it wear off, then I’ll be on my way.”

The sun went down and he started to get cold. “In the winter it gets cold at night even in Sun City. That’s why we went to Hawaii in the winter, to get away from some of the cold. It bothers us more nowadays,” he mused. He opened his bag to look for a sweater but found none. Before he could get it closed, another cold, hungry-looking, young man came up and asked,

“Could you spare a buck for a sandwich?”

He noticed he was getting hungry too.

“Yes, I think I can.”

He looked in his wallet but it was empty. “My wife doesn’t trust me with much money anymore, I spend it foolishly. I must have given the last of it to the taxi driver. I wonder how much that was? But it must have been enough, he looked happy,” he mumbled as he looked.

Before Henry could say anything else, the young man grabbed his wallet and bag and started to run, Henry’s favorite pair of longjohns trailed out behind. He wondered if his sweater was in the big suitcase, but grabbed the longjohns, in an effort to retrieve his property. The force of their acceleration threw him to the ground.

“I don’t remember how I got here to the police station,” he said to his wife as she stood frowning over his chair.

“I just remember getting fingerprinted and trying to wash the blood and ink off of my hands and forehead, and shirt, but they’ll blend in well with the floral pattern. I did have to wait an awfully long time for you to get here. . . . Oh, and by the way, I’m still real hungry.”

“You say I shouldn’t be because I ate like a pig in Hawaii? And did I do the Hula? Did I have a good time? Did I get my money’s worth? Oh, that’s good. Thank you, dear.”

Mrs Van Winkle brought her husband to Dr Miller’s office. Henry couldn’t remember, but his wife related that they had retired in Sun City and that Henry had always wanted to go to Hawaii. Sun City is an upper-middle-class retirement community, but like many of its residents, the Van Winkles spent almost all of their fixed income on fixed expenses and had little left for recreation or emergencies. They had no savings because their children had just finished school and left home. Since retirement, they’d lived inexpensively and saved. She clipped grocery coupons and he collected aluminum cans. Finally, they realized their dream before it was too late.

Henry retired early because he was having trouble keeping track of things at work, but after they moved to Sun City he was fine. They both fit right in. There were lots of scheduled activities, and everyone was expected to be a little forgetful. Henry got used to the new house quickly and established a routine he maintained to this day. She did all the shopping, cooking, and reminded him to take his blood pressure medicine.

As Henry gradually did less, she took over without realizing it until, “When Henry got lost at the airport, I was really worried,” she said. “Now that we’re home, taking care of him is a much bigger job than I realized. What’s wrong with him, Doctor?”

Dr Miller explained. “I believe Henry has Alzheimer’s disease. At Henry’s stage we should see considerable brain shrinkage on a head x-ray or brain scan. We’ll do medical tests to be sure there’s no treatable disease, but if they’re negative, we must make a presumptive diagnosis of Alzheimer’s.”

Dr Miller ordered a CT scan and blood tests. He advised Mrs Van Winkle to arrange the house to make things as easy as possible for herself. He suggested door locks that operate with a key on the inside so Henry couldn’t go out and get lost, and to remove the knobs from the stove so he couldn’t leave it on and burn the house down. He, also suggested she call the local Alzheimer’s support group.             He went on to explain that about half of nursing home patients have dementia similar to Henry’s and a little more than half of those are Alzheimer’s. The others are due to arteriosclerosis, multiple small strokes, diffuse alcoholic brain damage, and other diseases. Up to seven percent of people over sixty-five, and twenty percent of people over eighty, suffer from Alzheimer’s, and it may begin in middle age.

Dr Miller concluded, “No treatment modifies the disease process, but don’t assume that nothing can be done. Some medicines slow it and others may modify some symptoms. We should focus on maintaining Henry’s quality of life, and yours. As with many other disabilities, people often continue a productive and satisfying life in spite of them. You’re lucky to be in a community with many services, and people who understand and will help.”

 

 

Charles Patterson

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I was born in Santa Monica, California, earned a BS degree in biochemistry at California State Polytechnic University in San Luis Obispo in 1962, and an MD at the University of Louisville School of Medicine in 1966. I completed a psychiatry residency at Rollman Psychiatric Institute in Cincinnati in 1970. My working career consisted of private practice in five locations, six fulltime employed positions, and included eighteen hospital staff memberships, sixteen professional titles, and membership in twelve professional organizations; and unintentionally grew into a nomadic life style. My career goal was to learn as much as possible about normal human nature, in addition to make a living. Now my goal has extended to understanding as much as possible, especially life and death. I wrote a newsletter about psychiatry for the general reader to support my practice in Arizona, and consolidated it into my first book in 1984. From that my interest in writing grew along with interest in horse care that was stimulated by my wife’s interest in endurance riding. We enjoyed the sport together during our thirty years of marriage, until we retired in 2008 to an equestrian community near Tehachapi, California, with three horses, two dogs and four cats, and a plan to rejoin the sport, but without realizing they all had become too old. The subsequent loss of my wife to ovarian cancer in 2010, and much of the animal herd, reawakened my interest in the process of death and the potential for “life after death,” that continues to motivate my writing and study.

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