Dressed like a Mexican

E. was my first patient today. She handed me a piece of paper: "Fax this letter to my child's school for me".

E had enrolled the child in school A, went the first day, didn't like it, pulled the child out, enrolled the child back in the school she had attended the year before, or school B. However, she didn't notify school A of the change. Her rationale was that since school A administrators did not pay my patient enough attention when she showed up with her child on the first day, she would exact her revenge by not notifying them of the withdrawal. Naturally, school A had been calling her every day to find out where this child was, and finally threatened to call the authorities if she did not provide proof of enrollment somewhere else.

So here she was today in my office, offended and annoyed by school A's unreasonable request, but willing to give in and send the letter. She had obtained the letter of attendance from school B where the child currently is, and that's how she came to hand it to me this morning, a gesture accompanied by a 'fax this to School A for me'. No question mark, no please, no thank you.

I wondered why she didn't ask the person who wrote her the letter to also fax it to school A and she answered 'I didn't want to bother them'.

Next!

S. was patient #2. S. came with her home attendant, as she does every week. S. is demented and the home attendant helps me understand what is or is not going on in S.'s life, since S. herself is often confused. Besides the fact that it is not possible to do any kind of psychotherapy with someone this impaired, sitting with her for a session is a sad, disheartening experience. She has no memory and no short-term memory in particular, so we'll talk about something and shortly after she'll want to talk about it all over again, having forgotten all about the first talk. For example, she'll say 'My daughter hasn't visited me in years'. She'll look really distraught and I'll help her remember that yes, her daughter does visit her twice a week, and S. will smile, reassured. Then five minutes later she'll say 'My daughter hasn't visited me in years' and so on.

It's like watching Memento, which gave me panic attacks even as a movie.

And every week is a bit different, since dementia apparently has its ups and downs, good days and bad. Today S. complained that she was tired and could not remember my name, which was frightening to her. "What's happening to me?" she wanted to know.
Before I could intervene in any way, the home attendant decided to cut the tension by telling me that there was another lady in the waiting room that also couldn't remember my name! How funny! The other lady was apparently mumbling to herself 'what's her name? miguelina? magdalena? mariaclara?...' The home attendant thought it was a hoot that nobody seemed to remember who I am today, and S said: "I remember your name now! You're Ribaldina!". Which I'm not sure it's even a name, let alone mine. But S. felt better.

My third patient's first words to me were: you are dressed like a Mexican. I happened to be wearing a long summer skirt from India, with pieces of mirror and lots of colorful embroidery. Third Patient stared at it with a look of disapproval.

Oh, but the lady with dementia? She said one wise thing. We were discussing how she has been forgetting to eat, and she giggled -inappropriately- and said "I may forget to eat but I'm hungry when I'm angry!"

To which I absolutely, most definitely can relate.