Intangibles

Intangibles

Years ago I was seeing a frail demented lady with terrible venous stasis. In her
confusion she sat most days 12 hrs or more in a wheelchair as her granddaughter
doted on her. Her husband a cowboy with worn boots would come in too quiet but
worried. The three would sit in a small room and we would try to “do no harm”.

I recall the pendulum talk. This is the talk that I select out of the library of
experience to explain why a person can’t stabilize. Here she sat dazed but calm with
weeping legs and a medication list that seem to crawl and change and creep and morph
each week. Here we sat trying to carve out a plan for a moving target. She would
swing from too wet to too dry to too weak to too short of breath.

I recall she didn’t eat or did eat or ate salty things or drank too much water. I
don’t recall what was happening overall because each day she elected a new
governance and left me scurrying to make amends for variable or insufficient intakes
and outputs. Her legs weeped then withered and I just kept stabbing and push open a
tiny passage for success.

Then one day we made her hospice. The labs stopped. The medication list got thrown
away. She unknowingly crawled into comfort care and we stepped aside to let her. She
didn’t have a clue.

A year later her husband showed up again. I saw him and thought for a second he
might have left a personal item and had come to retrieve it.

“Hi. Are you… Did you…” I stammered trying to quickly piece together why he was
in my office greeting me in the waiting room.

“I just checked in,” he said.

“Oh! He’s a patient now,” I thought. I wasn’t used to yet families coming in
connected to prior patients.

He said little. We did talk about his loss. He shared he was sad and lonely that
even though she was confused often with little memory she was at least still around
then.

Then. The idea of time dropped an anvil on my mind. When was then?

Now.

I bid him good bye with some reassurance he was not so bad off and kidneys seem good
for another “20,000 miles” and then the cowboy tipped his head and left.

We carried on for two years with a curtsy and a head tip.

Then she came. I didn’t recognize her at first. I greeted my new patient and
immediately considered her very young to be in my practice. She said strangely dry,
“We have met before.”

I feared I rear ended her one day and let nameless insurance people handle it. I
feared I didn’t say hello in the elevator to her. I feared I had hurt her.

She said the unusual last name and I recognized the relationship. She had gained
40lbs. She was the demented weeping leg lady’s granddaughter.

“Ah yes,” I thought.

Then. Now.

I hope she didn’t hold me in ill light because I offered so little fix those years
to her dear grandmother.

We began.

Her story was very different. Her questions very different. Her needs very different
and not the story today but when she was leaving we came around to her grandfather.

“How is he really,” I asked.

“You see him next week,” she said. “He is sick but he won’t tell his doctors
anything.”

“I see,” I replied logging the detail so I didn’t gloss over his silence and simply
replies next we meet. “I’m sure your grandmother’s loss was very hard on you both,”
I offered a life line.

Her eyes welled up.

I knew those eyes.

“Dementia just took her,” she said. “It was strange it…. Just took her.”

I exhaled. “I know. It’s hard to describe because you don’t have an enemy. It’s
insidious because a person doesn’t die of dementia. They die of not eating or falls
or infection. They die because dementia erodes capability and capacity. And you want
to hate dementia but the death certificate says malnutrition and dehydration and
renal failure and cardiac arrest and pneumonia.”

She nods and her eyes well up.

I knew those eyes.

“Long ago I lost my grandmother. She meant something to me I couldn’t understand
then. She was something deep. Something grounding. She spoke to me without speaking.
We were connected and she was affirming life as I understood it. Her death left
me…” I stopped and stood and acted light and floating away.

She opened her eyes wide and nodded rapidly.

“I felt detached,” I confessed. “Years later I realized there are some deaths that
cut us because they were losses to our very identity. I know your eyes. But it can
be a good thing to realize this different connection. They are rare but they are
real and now you can recall how they feel and go find them. Put your time and energy
in those. Go. Go find them. You are young.”

Her shoulders straighter she stood and she contemplated this goal and followed me
out the small private confessional.

Go find them.

The advice echoes in my mind and I think of my grandmother and her soft hands. We
all thought we were her favorite. We all thought she only had eyes for one of us.

Intangibles kill us. Intangibles can save us.

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