On being old, lonely, demented, and hospitalized

Last Tuesday I had my hip replaced. The procedure went amazingly well and the care was superb. But I had the opportunity to witness one of the challenges of geriatric care.*

After the procedure and some time in a post-operative unit, I was taken to a room on an orthopedic ward. I shared the room with an elderly woman who had broken her femur in a fall. She woke up shortly after I arrived, looked at me and said:

Günter?!? Wo bist du gewesen?? (Günter, where have you been?)

She was frightened and unaware that she was hospitalized. She had some English, which was fortunate because I was the only one around with a touch of German. The nurse and I were able to persuade her that I was not her husband, but this led to agitated demands that we find her husband. He was in fact at the nursing home where they both lived. We convinced her of this and she fell back to sleep.

This scene repeated many times over the next 24 hours, until I was discharged. Sometimes she would wake up and demand to be released so that she could find Günter and care for him. She retained nothing from our prior encounters. Each time she woke, I had to explain to her that I was not her husband and that this was not her home. The staff was wonderfully patient with her, repeatedly spending the time required to soothe and reorient her. The alternative was restraining her, physically or chemically.

There is an important health policy choice here (read Atul Gawande’s Being Mortal). Adequately staffing hospitals to deal with demented patients is expensive. There is no medical cure for dementia. What good care does, for these patients, is that it respects their dignity. There will be nothing tangible to show for this, nothing will restore this woman to a productive or even coherent life. We just have to decide what the dignity of others is worth to us.

*The details of what follows have been changed to protect privacy.


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