Rose is a 78 year-old woman living alone in her condominium. To family, friends, and neighbors, she seems to be doing well. She is in good health and remains physically and socially active. Her adult children call “bright” and note her steady interest in reading and current events. She views herself as competent and independent and is proud of her intellect.
Rose begins to notice that her keys aren’t where she recalls leaving them. She is uncertain if she paid her phone bill and can’t find her checkbook. She leaves a pan of soup on the stove until she is alerted by the smell of burnt food. She forgets a lunch date with a friend.
No big deal. She finds her keys. She finds her checkbook. She pays her phone bill. She throws out the burned pan. She apologizes to her friend] and schedules another lunch date.
Although these forgetful incidents continue, Rose doesn’t mention it — there’s nothing to discuss. She doesn’t want her children to think she needs help, and she’s not interested in making changes. Nevertheless, the burned pan gets her worried, so she stops preparing meals and turns to snacking. No big deal, she’s never had a big appetite and eating less is fine.
Rose is distressed, however, when she notices she can no longer follow a novel to the end. She forgets who the characters are and begins to mix up their motivations. Nothing like this has ever happened to her. And still, she tells no one. She is competent, independent, and intelligent.
Unfortunately, Rose’s poor nutrition makes her vulnerable to illness and she catches pneumonia. She is hospitalized and a dramatic change in her behavior is noted. She doesn’t want to take prescribed medications and tries to leave the hospital. She is transferred to a geropsychiatric unit and extensive evaluation determines that she has deterioration of the brain consistent with dementia. Once Rose is stabilized on medications to calm her, she’s transferred to a nursing home that has a secured dementia unit.
Rose had been experiencing gradual cognitive decline but did a good job of hiding it. However, eventually, she underwent rapid physical decline and accompanying change in behavior that required dramatic medical intervention.
To understand Rose, let’s step inside her head. You’re living on your own and have tricked yourself into believing that the changes you see in yourself do not require changes in your day-to-day life. You continue to be proud of your intellect and competence and want to be damn sure that others are proud you too, especially your children.
You get sick and delirious. Medical professionals you don’t know and have no reason to trust are giving you pills and preventing you from leaving. You want to go back to your condo and resume the life you enjoy. And you desperately want to get back to your old self, the self you are proud of. There is nothing familiar about this place, nothing that reminds you of who you are. But you’re surrounded by people — doctors, nurses, aides — who are in-your-face with their ignorance of who you are.
Take your medications. You have to stay here. No, you can’t leave. We’re just trying to help you.
They see you as sick and suffering, unappreciative and uncooperative. They have no idea who you are, who you have been. They do not know your story. They do not see you.
And then you are in a secured (locked) unit. You have never had to wonder what was beyond a door. You just walked to it, opened it, and walked to the other side. And your mind, your innate intelligence, has allowed you to open many figurative doors to other worlds. Now, an all-too-real door is closed to you.
Now I ask you, wouldn’t you want to go out that door?