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I understand. The only reason I don't fear dementia more is because of a genuine confidence that it will be a solved problem by the time I'm old enough to be at risk. This almost certainly holds true for you too, modulo all the assumptions that lead me to have that belief in the first place. A mere example would be the recent discovery that semaglutide reduces the relative risk of developing Alzheimer's by 50%.
I have seen so many people utterly hollowed out by the illness. It is an unavoidable perk of the psychiatry of old age. The lucky are those who are far gone, they are past all but the most primal of pain or pleasure. The prick of a needle, as I pull blood like an anorexic vampire, the recognition that a smile means friendliness. Their inner world seems to have shrunk to a point. It is often better for them, and certainly for everyone else, when they are physically frail. A robust body attached to a shattered mind is a uniquely challenging combination.
We had a gentleman who was 95, and as strong as an ox. He broke two noses on the ward before nearly dying of a stroke. I went on vacation and had every confidence he wouldn't be around when I came back. Nope, he shrugged it off, and everyone was happy to have him back even if it came at the cost of their facial features. It takes a certain kind to work in that field in the long-term, I'm not cut out for it.
My own grandpa, who I love dearly, is at the same age. Covid killed him, if not physically, then the enforced idleness killed the man he was. More man than me, mostly gone now. It was the clinic and regular interaction with his patients that kept him truly alive, and the decline was obvious when it stopped. It's enough to make me cry, and I try not to think about it if I can help it. When he sees me, all he remembers is that I'm back from the UK, and his only concern is when I'll visit again. This loops every five minutes. It is enough that he can do this, and I get to hold his hands one more time. They're very similar, those hands. His and mine. He had a good run, almost 92 years of putting others to shame. 3 where the survivors finally lapped him. Outlived his enemies (the very few he had), most of his very many friends, but not his family. He has the comfort of his two daughters these days, if not the grandson he loves the most. He was the kindest man I know, he used to feed honey to the bees by the window sill, and the angriest I've ever seen him was when he tried to do the same to a wasp and it stung him for his kindness. God, I wish things were different. The universe is cruel, and physician heal thyself? Fucking hell, I can't heal the people I actually love. What good are these hands after all?
I digress. It is easier to talk about the problems of others. It helps me pretend to have a degree of clinical detachment, and gives time for the tears to dry.
The worst-off are those who know, or even suspect. The disappointment on their faces when the diagnosis is disclosed, the scans finally in. The furtive glances at their loved ones, the attempts to put on a brave front. Some sob. Some smile and talk about the weather. None really withstand the blow, but most come to terms with it. Then the dread sets in.
Putting myself in their shoes, it is the present, horrifying knowledge of what they are and what they are becoming, a slow-motion unraveling they are forced to witness from the inside. They are passengers in a vehicle that is slowly, but unstoppably, falling apart around them. Is it any surprise that many come to terms with the inevitable, and seek to go out on their own by wresting the wheel into the nearest tree? Can't blame them, poor bastards, even if it's my job to stop them. I wish it wasn't my job, and I wish my job allowed me to let them exercise the last bit of agency they have left.
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