dementia and senility are pretty scary things. i can't say what it's like to experience them myself, but i do know that it can be disturbing to watch someone slowly lose their mind. and i think it's even harder to watch someone be confronted with what they've lost, because while the mental decline is a slow, insidious process, the moments of realization are usually very sudden, jarring episodes of realizing that while the patient wasn't looking, things have been slowly disappearing.
yesterday, my team of doctors interviewed a lady in her 70's who came into the hospital when she told her daughter that there were "little people" surrounding her in her kitchen. "i know it's silly," she said as we talked, trying to hide her embarrassment with a self-conscious chuckle, "but i believe they were there to punish me. i really do believe that." as her mom complained that the hospital stole her trash can and her cell phone, her daughter told us she'd been forgetting things more and more over the past year, but this recent decline was sudden and unprecedented.
doctors use something called a mini mental status exam to assess basic mental function in this kind of setting, both at a given moment, and its change from day to day. it consists of a series of simple questions, the answers to which are recorded. so we began:
"do you know where you are right now?"
"why do people keep asking me that?!? of course i know where i am! it's a..." and here she paused, realizing she didn't have the word she wanted, and apparently looking on the floor around her for where she'd misplaced it.
"it's a place where people go when they're sick. does that help?"
"don't rush me!", she snapped.
after a few minutes, we told her she was in the hospital, and asked the next question:
"what year is it?"
"1999", she answered confidently.
"who is the president?"
she paused, and then unmistakably, a light came on--she knew this one.
"obama," she scoffed in disgust, rolling her eyes and glancing at us with a look on her face that said "and you people think I'M crazy?!?"