Tales from the Couch

Seeing the patient from psychiatry’s perspective

"I Thought We Had A Good Marriage"

When Medication Isn't What The Doctor Orders

I was making psychiatric rounds at a nursing home where I visited weekly. Occasionally, elderly residents became agitated, as much a result of confinement and lack of stimulation, as from dementia.

 One morning, while I was reading charts, an aide approached me saying, “Mrs. Barnes hasn’t come out of her room in three days. I looked in on her and she was crying. I think you ought to check her out.”

 Helen Barnes was a 91 year old woman who was admitted to the facility two years earlier. She had two sons who rarely visited. She was living an isolated life of emotional deprivation. Over the time I had seen Mrs. Barnes, her memory had worsened. As often happens with dementia, her recent recall was poor, while distant events remained retrievable. She could relate incidents of 30 or 40 years ago, but couldn’t recall eating breakfast that morning. She was genial, outgoing, and had never presented with problems before now.

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 I knocked on the door and entered her room. Sitting in a chair, Mrs. Barnes was a portrait of emotional desolation. Her hair was disheveled; her face was drawn; her eyes were bloodshot and the lids were swollen. Her face and body sagged with despair. It was obvious she was depressed and had been crying.

 “Mrs. Barnes. How are you feeling?”

She shook her head and cast her eyes downward. Her hands were shaking.

 “Can you tell me what’s got you so down in the dumps?”

 She raised her head slowly, looked into my eyes and said, “I thought we had a good marriage…”

 She burst into tears and placed her hands over her eyes.

 Mrs. Barnes was a widow. Her husband had died at age 90, three years earlier. They had been married for more than 60 years. Yet she was now lamenting the state of her marriage.

 “I don’t understand, Mrs. Barnes. What do you think was wrong with your marriage?”

 “I’m here all alone. My husband just picked up and ran off without me…” she sobbed.

 It dawned on me suddenly: her memory had deteriorated to the point where she no longer recalled her husband was dead. She now thought he’d abandoned her.

 “Mrs. Barnes, your husband didn’t desert you…”

 “No…?”

 “No. He passed away three years ago.”

 Her eyes widened. “You’re sure…?” she whispered. “He died?”

 Yes, I’m sure. He died peacefully in his sleep.”

 Her face seemed to light up. Her eyes danced with life. Something ignited in her brain—the memory of her husband, or perhaps his funeral. “That’s right,” she said, suddenly smiling. “I remember…yes, I remember…”

 I spent the next ten minutes asking about her life with her husband. She talked volubly; and by the time I left, she was a different person. It was amazing: paradoxically, being reminded of her husband’s death cheered her up.

 At the nursing station, I said to the head nurse, “Please tell the staff to remind Mrs. Barnes her husband died three years ago.”

 “Why…?” she asked. Her brow furrowed and her tone registered confusion. Reminding a patient of a significant loss was a most unusual “doctor‘s order.”

 “She’s forgotten he died. She thought he’d abandoned her. Just mention it to her every day… even a few times a day. It’s better she knows he died than if she thinks he left her.”

 On my way to the parking lot, I couldn’t shake the feeling there are many people like Mrs. Barnes in nursing homes, everywhere. People, who because of failing memories coupled with isolation from family and close friends, suffer terrible emotional sorrow. Often, they do so needlessly, because no one takes the time to talk with them and listen to what they say, or inquire about their thoughts.

 Instead of pumping nursing home patients with anti-anxiety and anti-psychotic medication, maybe the best first-line drug should be simple conversation.

 Mark Rubinstein

Author of Mad Dog House, Love Gone Mad and The Foot Soldier

 

 

 

Mark Rubinstein, M.D., is a former professor of psychiatry at Cornell. His most recent book is the novel Mad Dog House.

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