Ukelele, as I am going to call her, was strumming along as well as could be expected for a 76 year old widow. Fairly healthy, except for Type II Diabetes, she first came to see me to establish care at our new clinic, which was closer to her home.
A month later, Ukelele thought she was getting Alzheimer's disease, complaining of short term memory loss manifested mostly with forgetting names and misplacing things. I named three objects and asked her to repeat them. Five minutes later, I asked her to repeat those three objects, which she did easily, grinning like a fourth-grade spelling bee winner when she got them right. (I, too, breathed a sigh of relief that I remembered them.)
She passed all of the other components, too, of the mini-mental state examination (MMSE), a screening test used to identify memory and thought impairment. Even more importantly, she drew a clock with clock-like precision, spacing the numbers evenly in circumference. Those with dementia, and forms of hemispatial neglect, typically draw the numbers of the clock bunched on one side. She denied any hint of urinary incontinence.
Whatever she had, it probably wasn't dementia.
Then Ukelele said something which caught my attention.
"When I come to your office or the grocery store, I can remember things perfectly."
Suddenly, I had a clearer understanding of where this conversation and probable diagnosis was heading.
"Tell me about life at home," I queried.
She began to tell her story while I listened, intently, a therapeutic measure in and of itself. She was struggling with financial pressures, missing her husband, and feeling overwhelmed with home repairs and upkeep.
Then, after scoring moderately high on the Geriatric Depression Scale, I presented the idea of depression as a possibility for her memory impairment. We both agreed to try a low dose anti-depressant medication to tackle this.
One month later, she presented for follow-up. Her eyes were wide and bright as she reported,
"I am slowly starting to remember where I put things.... I am sleeping better and not so sad."
Her serotonin-induced improvement incited a dopamine surge for me. I was genuinely happy she was feeling better.
"My knee hurts" she then abruptly changed subjects.
More questions, a knee exam, followed by an x-ray dappled with osteophytes gave me reassurance that she was suffering from the inevitable wear of aging on the joint cartilage: osteoarthritis. Though painful, it is usually not as destructive, nor require toxic medicines as does the pesky cousin: rheumatoid arthritis. This was good news. When I told Ukelele I thought she had arthritis, she clapped her hands in the air, raised her head to the ceiling and squealed,
"Thank you, Jesus!"
She continued, "I have been praying to Jesus that you would say that."
Then she grabbed my hands. "And I have been praying to Jesus, every day, for YOU."
Oh....I thought. What a sweet thing to say, Ukelele. Music to my ears, really.
Because, as God knows, I need it.
We all do.