DEMENTIA: What Dickens Knew

The situation is as old as a Charles Dickens’ novel, as recent as the Glenn Campbell movie, I’ll Be Me, which was broadcast on TV this past month: How best to help our relatives and friends who are beginning to show signs of memory loss. Thinking back, I was fortunate to be raised by parents who both treated their own parents with respect and assistance in their old age, as did many of their siblings and their spouses, my aunts and uncles. But as La Rouchefoucauld  once said, “Each age of life is new to us: no matter how old we are, we are troubled by inexperience,” and by the time my time rolled around to assist, fifty years had passed and the world had changed for the elderly, for all of us. For one thing, there are many more of us living longer, acquiring this debilitating disorder.

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Charles Dickens has over 200 elderly characters among the 3500 or so which people his novels, among which is  Little Dorrit’s Mr. Nandy, my favorite for showing how very wrong-headedly some people respond to the elderly.

Mr. Nandy is an old man who has had to commit himself to the poor house, where he is both pitied and patronized by Mr. Dorrit, who is also old and in the poor house, but who somehow considers himself better than Nandy because he is not so old. In one scene, over tea with Nandy and other people, Mr. Dorrit keeps up a running commentary about the old man’s failings, right in his hearing, as though the older man were deaf, which he clearly is not. Mr. Dorrit asks if he walks much. No, says Nandy, he’s never liked walking. (“Legs going,” Dorrit whispers to the other people present.) Mr. Dorrit offers him something to eat and on Nandy’s “not instantly replying,” Dorrit whispers, “His hearing is becoming very defective. He’ll be deaf directly.”

But the most telling exchange is this one when Dorrit asks Nandy how old his younger grandchild is:

“John Edward,” said the pensioner, slowly laying down his knife and fork to consider. “How old sir? Let me think now.”

“[Dorrit]…tapped his forehead (‘Memory weak.’)”

“John Edward, sir? Well, I really forget. I couldn’t say at this minute, sir whether it’s two and two months, or whether it’s two and five months. It’s one or the other.”

“Don’t distress yourself by worrying your mind about it,” he returned, with infinite forbearance. (“Faculties evidently decaying—old man rusts in the life he leads.”)

Whew, if a grandparent’s inability to recall immediately the exact age to the month of each grandchild is the test of mental decay, most of us are in deep trouble.  

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Mr. Dorrit reminded me of the nursing home doctor I encountered when I first flew in to find my father, who had been unceremoniously dumped there the week before by a relative. Just two weeks before that, my 84-year old father had visited me in Boston, walked all of Plimoth Plantation with me, and spoken kindly to the Harvard administrators and Michigan tourists at our Thanksgiving table. Now, he was sitting in a dark nursing home at 1:00 p.m., bleary and trying to stay awake through what seemed like a drug-induced state.

“Your father is so far gone with Alzheimer’s that I don’t even know if Aricept will help, but I got him on it right away,” the doctor glared at me.

“Alzheimer’s?” I asked. “Are you sure? My grandfather had this type of dementia and it doesn’t seem like Alzheimer’s to me.”

Dad had fallen asleep, so the doctor shouted, “Russ, what did you have for lunch?” He shook Dad and repeated the question. Dad, roused himself and looked up, ginning through his memory as though through cotton bolls and replied, “I…I can’t quite recall.”

The doctor turned to me, triumphant, “You see right there: if he can’t remember what he had for lunch, that shows that he has Alzheimer’s.”

Oh honey, if not remembering what you had for lunch immediately upon waking up is the diagnosis for Alzheimer’s, then most six to sixty year olds have it. I thought there might be a more scientific way to a diagnosis. And yet, I can’t tell you how many of my friends self-diagnose their parents’ and others’ dementia as Alzheimer’s, even though they wouldn’t diagnose skin cancer without a medical opinion. There are many kinds of dementia, many stages and ways to approach it. Many doctors are as untrained and insensitive as the public on the issues.

Then the doctor said, “And if you even try to remove your father from this place, I will lock him up so tight, you will never see him.”

As the adult child who had taken the primary care for my parents for the previous 15 years, the only adult child to show up for every out-patient operation and hospitalization, whether I lived two hours away or thirteen, his words absolutely stunned me. However, my parents had never signed medically proxy papers, so my fifteen years didn’t count for anything. I was terrified.

At the urging of my great high school friend Linda Ecksmith, I made an appointment with the Cleveland Clinic Geriatric Medicine Department for an evaluation and management plan. Linda had done a lot of research and made an appointment there with Dr. F for her mother, whose condition was not related to memory loss. I mention this to show that the department is not only about issues of memory loss but the full range of health and disease for the elderly. 

If you aren’t close to the Cleveland Clinic, you can find referrals for good geriatrics referrals at Health in Aging

My father was thrilled: the Cleveland Clinic had saved his eyesight 60 years earlier when, as a welder, he had gotten a piece of steel in his eye. He revered the place. And, my Cleveland nurse friend poet Mary Chadborne told me, the Geriatric Department would medically access the situation, speak to the whole family, and help us through now and whatever stage came next.

In my next blog ("Dementia: The Cleveland Clinic and Beyond") I will briefly outline what went on in our three monthly appointments at the Geriatric Medicine Clinic, update my Dad's situation today, five years later. After that,  I will post a list of some good books (Dementia: 12 Books ) I've read over the past ten years on the subject of aging in America. I include Little Dorrit where Mr. Nandy, while a minor character, is such a character. So is my dad.