Pearl

Pearl

Pearl was 81 years old when she was brought to see me by her husband and daughter–in- law.  They noted that she had been having problems with her memory over that past three years. Her husband of almost 60 years had been her caretaker and up until recently had felt comfortable in this role.  Recently she had been getting up during the night and at these times would become agitated. On a couple of occasions she had wandered outside the house.  

Pearl was a pleasant and engaging lady.  She had moderately severe deficits in her orientation and memory.  Considering the degree of her dementia, however, she had an amazing ability to carry on a conversation in a goal directed and sometimes appropriately humorous fashion.  She could still talk meaningfully about her childhood days spent on the farm.  It soon became evident, however, that she did not know that the man and woman who had accompanied her to the office were her husband and her daughter-in law.

After discussing possible risks and benefits I prescribed a very low dose of a major tranquilizer to take at bedtime and requested that they return for a brief follow up a week later.

Upon their return her husband and daughter-in-law indicated that Pearl was now sleeping through the night and was again quite manageable at home.  I next turned to Pearl and asked her if she remembered having seen me before.  She said, “Sure.”  Her husband and daughter-in-law, not surprisingly, looked shocked, knowing that she had continued to be unable to recognize either of them.  I then asked her where it was that she had last seen me.  She said, “We were out dancing last night.”  I apologized for asking such a silly question and asked her, “How did I do?’  She replied, “Nothing above average.”

Pearl continued to decline and several months later required around the clock care in a nursing home.  She no longer needed medication for episodes of agitation but developed an intractable stiffness of her neck that was probably caused by the tranquilizer I had prescribed for her.  Fortunately, it did not appear to cause her physical discomfort in her remaining days.  This did make me more cognizant of how thin the line can sometimes be between risks and benefits in our attempts to be helpful.

2006