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The Art of Medicine


Reed, Harrison MMS, PA-C

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Journal of the American Academy of Physician Assistants: September 2016 - Volume 29 - Issue 9 - p 58
doi: 10.1097/01.JAA.0000490954.56179.38
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“Last night I found him in the kitchen, urinating into the refrigerator.”

Peter threw his head back and let out a single, barking laugh before snapping back to attention as if he noticed others in the room for the first time.

“Does he do this often?” I tried to measure my tone.

“A few times before,” Peter's wife said. “But I can usually get him back into bed. And then I clean it up.”


“Sometimes I can't. Sometimes I can't convince him of anything.” Her voice was also tempered, as if we had rehearsed this before in some preappointment deposition. We hadn't. But she was accustomed to telling her story to young strangers with stethoscopes and good intentions.

“What do you do when that happens?”

Peter's face was flat again, the way he settled down between outbursts. He wore the same expression when he shuffled into the examination room moments earlier. He was agreeable and obedient; he shook my hand, said hello, and sat when I gestured to his chair.

“I don't know what to do,” his wife said. “People think dementia just takes away the memory. That's not true. It took away him, the entire person he was. It takes the soul.”

Peter giggled and studied some imaginary object between his fingers.

“I've been married to him for 45 years,” his wife said. “And I know this is no longer the same man. I can handle him acting like a child; it's awful, but I can handle it. It's the other things, I just can't bear it.”

“What other things?” I said.

“My Peter would never swear. He hated swearing. He used to say it perverted a beautiful language. And then...”

Her voice trailed off and her face, until now a stone facade, creased with pain as if some invisible hand had grabbed her chest and wrenched her insides.

“My Peter was affectionate, of course, but he was tender, gentle. Now, when he has an episode, he is like a teenager. He grabs me and he doesn't understand when I say no.”

Peter smiled and gazed through me.

“Do you need help?” I asked.

“I don't know,” her voice cracked for the first time, “I don't think I can give up on him yet.”

She stared at the floor. I stared at Peter and he stared at me.

Then Peter blinked once, twice, and a third time. His grin disappeared and the creases around his mouth and eyes softened. He turned to his wife, took her hand and laid it on his own palm. He pecked a kiss on her cheek and gazed at her features.

“I love you,” he said.

Then his eyes regained their former, lost glaze. The mask returned. The gentle man, an ephemeral guest in his own body, was gone.

His wife didn't look up from the floor but tears streamed down her face.

“I know,” she said.

Copyright © 2016 American Academy of Physician Assistants