He answers the door wearing only a button-down shirt and incontinence briefs, no pants, paper towels in one hand, his walker out of reach on the other side of his assisted-living apartment.
“Who are you?” His brow crinkles as his dark eyes bore into me, vacant yet suspicious.
“We met here last month,” I say. I reintroduce myself as his new primary care provider and remind him that he was referred to me by his longtime, beloved clinic-based doctor for home-based primary care.
During our intake visit a few weeks ago, he was pleasant but asked the same questions repeatedly—his lack of short term memory betraying him. Now he moves as if he has something to hide. He looks at me a second, considering. Slowly, with a sheepish, downcast gaze, he turns around and walks with a limp into the apartment, still without his walker.
I see a mug on its side on the floor, with milky coffee sprayed across the hardwood like a huge Rorschach test. He moves toward the puddle, wielding the paper towels as if he’s about to swat a fly. I recognize his mix of despair and confusion, the look of someone losing their independence.
“You need to tell me when you’re coming!” he barks. I know that our office called his son yesterday to confirm the visit. But the son isn’t here, so I choose not to reply. I call housekeeping to clean up the spill.
“You talk too loud!” he says. I turn down the volume on the blaring television, then asked him softly how he’s feeling. “I can’t hear you,” he says.
I convince him to let me take his vitals. His hand is shaking with a tremor that threatens to loosen the oximeter, so I rest the weight of my hand on his. When I ask if the shaking bothers him, he pulls away.
“How dare you come in here and ask me such private questions?” he says. I apologize and leave with a heavy sigh.
As I’m on my way out, the med tech tells me they need my signature on their annual Residential Care for the Elderly form, adding, “We don’t accept residents with dementia. If he has dementia, he can’t stay here.”
I will check that box on the form, as it’s legally required. His former primary care physician probably left that duty to me, probably didn’t want to force this man out of his longtime home. So now I am forced to be the instigator of kindness leading to devastation, of rage leading to safety.
Sara Lynne Wright
Mountain View, California
1 thought on “The Instigator”
The system is so cruel. And so many people who operate within its confines are cowards, leaving the rest of us to stand alone in the aftermath. It so hard to always be the one in that position. I wish you much peace.