Thursday, October 6, 2011

Dementia, when ignored, may have deadly consequences.

Mental illness and mental health are part of our overall health concerns throughout our lives.  As our society becomes more fragmented, we must remain aware of those who have few relatives or friends. It is estimated that in the United States there are over five million people with Alzheimer’s and many more who have other forms of dementia. How we help them says a lot about our society.

The Story
                Muriel Davis was 78 years old when her husband Ray died. They had been married 60 years. Ray had spent his entire work life at a company that made timing chains for car engines. His cancer had been a long drawn out affair that caused heartache and cost a good deal of their savings. Muriel acknowledged the pain of her husband’s death by being constantly reminded of their only son’s death in an automobile accident many years earlier. 
                Muriel didn’t experience loneliness in any specific way. She and Ray had lived a fairly quiet life.  She’d spent nearly twenty years serving food at the hospital cafeteria. Her work friends had never been to her home and when they gave her a retirement party at a local restaurant, it had been Ray’s first time meeting them. When Muriel and Ray were in their forties, after Ray Jr.’s death, they’d attended church and joined a bowling league. The demands of both proved too much. One winter they “forgot” to join the league and also avoided the phone calls of a pushy pastor. When retirement came at age 65 they focused on their home. Ray built a garage and made small repairs. Muriel worked in her garden and made preserves. Winter months were spent in front of the TV.
                The house was a small white farm house a few miles outside of the city of Ithaca. When it was built in the 1850’s, it sat in a grove of trees 100 feet from a dirt track where people walked, rode horses  or drove wagons, beginning their decent into the valley where Ithaca and Cayuga lake lay. When I first visited, it was seven years after Ray’s death. The house was thirty feet from a busy highway where cars and trucks roared by at sixty miles an hour. Sumac and other scrub trees hid most of the front of the house, while a partially dead maple tree threatened the detached garage. I climbed the uneven front steps to a six by eight foot enclosed porch. Battleship grey paint chipped and peeled under my feet. Ripped plastic, an earlier attempt at winterization, snapped in the fall breeze all around me.
                I rapped with my knuckles on the door. “Mrs. Davis, Mrs. Davis? It’s Terry Garahan. I’m from the county and I need to talk to you.”  My voice was raised to overcome the sound of traffic and what I assumed was a TV blaring in the living room. No response. “Mrs. Davis, Mrs. Davis. Can you come to the door please; I need to talk to you.” My voice was just short of a yell.  I could hear movement in the room behind the door. “I’m sleeping. What do you want?”  A scratchy older woman’s voice said.  “Mam, I need to speak to you, can you come to the door please?”  “Hold on, hold on, I’m going to be a minute. “ Moments later the door opened to reveal a short broad woman with thinning white hair. She had on a faded, flowered housedress, orthopedic stockings and bedroom slippers. I tried to peer around her, but her body blocked most of my view.
                “What do you want?” she said cautiously. “I’m from the county and I need to talk to you, do you mind if I come in, it’s awfully noisy out here,” I said referring to the trucks passing by. “I don’t know. This isn’t really a good time,” she replied. “It’s really important that I talk to you today,” I continued. “Oh all right,” she said, pulling the door open. “Come on in, but be careful, I haven’t had time to clean.” I held the door and watched her wade through knee-high trash to a fake leather recliner.  She turned and sat, pushing back hard to elevate her swollen legs. Oprah spoke loudly from the television three feet in front of her. The door slammed behind me and I found myself in a swamp of Styrofoam containers, paper cups, plastic lids, brown paper bags and bits of food.  I took a step and noticed movement along the floor under the mess. Things scurried for a moment and then stopped. I took another step and it happened again. “I suspect you’re here about the plumbing. I knew somebody would finally show up. The bathroom is there,” she said, pointing to a partially opened door where the tide of trash seemed to dissipate.  I steeled myself for my brief passage across the room. Ripples of movement preceded me as I carefully raised my feet above the rubbish seeking a safe place to step. As I got to the bathroom door I turned and took in the scene.
Standing on the edge of this sea of trash I was able to confirm the call I’d gotten earlier in the week. A young Hispanic man had called to tell me about an older woman he was worried about.  He was the delivery man for a pizza and sub shop downtown. He’d worked there for about a year and delivered to Mrs. Davis four or five times a week. She’d also made a separate arrangement for him to pick up wine for her at the liquor store once or twice a week. “I’m worried about her. She seems to be really losing it and her house looks like a horror movie.  I tried talking to social services and they told me to call you. They think she might be crazy.”
The assault on my senses reached a peak with the smell of the bathroom. Feces and urine filled the toilet to the brim. The seat was smudged and cracked. The sink was a brown stain of iron from the well water. The bathtub was filled with dirt and dust. I tried the sink faucet. Nothing came out. “Mrs. Davis, there’s no water in here.  Do you know why?” “The well pump broke a while ago. Aren’t you here to fix it?” she responded. “Do you mind if I look in the kitchen. I want to check the sink in there.  Is that all right,” I asked. “Sure, help yourself,” she replied.
The counters and sink in the kitchen were filled with dirty dishes, pots and pans.  Empty wine bottles littered the floor and pantry. Near the back door was a five gallon paint bucket with a toilet seat on top.  It was nearly full. I peeked out the back door and determined that Mrs. Davis had dumped many other bucketsful onto the back steps. 
I went back to the living room to see what else I could learn. I waded through the mess trying to ignore the critters under foot. “Could you turn off the TV for a minute? There seems to be a real problem with the plumbing,” I said.  “Ray’s going to fix it when he gets home.” Mrs. Davis answered, clicking off the TV with a remote. Up close, I noticed the sores on her legs and the immense swelling around the ankles.  There was also a rash on her arms and what looked like blisters on her chin that appeared to be filled with pus. “Mam, you have some sores there”, I said pointing at her arm.  “Do you have a doctor? Has anybody taken a look at those?” “I see Dr. Spanger. She’s always treated me real good.” She replied.  “Mrs. Davis, I know you live alone here, but does anyone come in to help?”  “Her watery blue eyes stared at me. “Why in god’s good name would I need help?  I’ve lived in this house almost seventy years and I think I’ve done all right by myself. I forget, why are you here?  The cable’s fixed, see?”  She clicked on the TV just in time to see Oprah giving things away. “Mrs. Davis, I’m going to leave now.  I’ll be back in a little while. Are you going to be OK?” “Could you get me some of that Lambrusco wine when you come back?” she asked.
I went back to my office and called Dr. Spanger.  She said her office had been trying to get Mrs. Davis in for at least six months. She’d even arranged transportation.  When the appointment time came Mrs. Davis hadn’t answered the door. When I explained things, the doctor let out a sigh. “I knew she was demented, but I hadn’t thought it was that bad.” I signed the paperwork and arranged for the Deputy Sheriff and ambulance to meet me at a gas station nearby and informed them of our goal.  “She’s a nice old lady, but spirited. The best thing we could do is walk her out. Believe me; you don’t want to drag your gurney through that mess.”
The EMT’s and the deputy waited on the lawn.  I went up on the porch by myself and banged on the door a couple of times. The TV was still blasting. “Mrs. Davis, it’s me, Terry Garahan. I was here a few hours ago.” I pushed open the door and started to enter.  Mrs. Davis was leaning back in her recliner. In her right hand was a pistol. “What do you want? Get the hell out of my house.  I don’t want to have to shoot you!”
I pulled my head back behind the door. “Mrs. Davis. I’m from the county. I was looking at the plumbing. Remember? Could you put the gun down please?"  Behind me, the Deputy unholstered his weapon. Mrs. Davis waved the gun around for a minute and then set it on a table next to her. “Judge Judy’s on.  I like her!” she said to the TV. Moments later the small room was filled with the Deputy and two Emergency Medical Technicians.
When I visited her at the nursing home the next week she sat on a soft sofa next to another old woman watching an episode of Judge Judy.
The Stories
The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health. I have changed the names and identifying information of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time.   I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given.  Please enjoy them in the spirit with which they were written; to educate and inform.

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