Thursday, December 31, 2015

The Heart Remembers

One New Year’s Eve many years ago, EMS brought in an elderly man with dementia to the emergency department. The patient had become increasingly agitated due to the loud fireworks outside the nursing home. I have assigned a nurses’ aide to stay with the patient as we tried to sort out the bolus of patients who came in to the ED.

At the same time, a “happy drunk” staggered into the ED. Thankfully, the patient, who was a regular in the ED, just wanted an audience for his singing. The “happy drunk” entertained the triage area with opera songs like a Pavarotti. His impassioned O Sole Mio was surprisingly well-modulated and brought a smile to everyone, even to the ED staff who worked on the holiday, away from their family.

The elderly man stopped squirming in his stretcher. Somehow, the familiar melody broke through the cobwebs of his mind and he joined our happy drunk in total harmony. We later learned that he was an accomplished tenor in his prime. He remembered what he loved most.

I remembered the elderly man a few days ago when I accompanied my friend Anita when she visited her mother in the nursing home. Mrs. D. sat by the window, her stares focused at the gardens outside. Was she enjoying the beautiful flowers or was she lost in her own memories? Her gnarled fingers were gently caressing the lace shawl on her lap.

My friend Anita approached her mother. “Mom, I brought my friend today.”

Mrs. D. looked at us. I didn’t expect her to recognize her daughter’s friend from our apple-picking outings when we were still new in the United States. After all, she didn’t even recognize her own daughter.

Alzheimer’s disease had robbed Mrs. D. of her memories. She looked at her daughter like a stranger. She didn’t even respond to her daughter’s embrace. Her lined face was raised in fear at the sudden intrusion to her physical space.

Mrs. D. used to be a human dynamo. After she was widowed, Mrs. D. ran her daughter’s home with such efficiency as her daughter and son-in-law worked hard at their careers as nurses. She was a loving but firm grandma to both of her grandkids. I remembered her humming her favorite songs whatever she was doing at that time.

Anita’s family had no choice but to transfer her to a nursing home when she started wandering away from home. Mrs. D. had been missing for two days until an alert hospital worker notified the police of an unknown woman who was dropped off at the emergency department. She was lost in her own world. Mrs. D. was now a shell of her former self.

The deterioration was slow, but equally painful. What was once a vibrant woman was now profoundly changed. During the early stage of the disease, she expressed frustration for not remembering, for being a victim of her forgetfulness. Now, she looked calm, probably because she did not even realize what she was powerless to do.

Anita was sobbing in frustration. Mrs. D. was not responsive to any of her daughter’s attempt at conversation. I remembered my old patient from several years ago and suggested to Anita to sing some of her mother’s favorite songs.

Saan Ka Man Naroroon” (Wherever You Are) is a Filipino love song about a woman’s promise of loyalty to her loved one. This was the theme song of Anita’s parents. As soon as Anita sang the song, her mother’s face relaxed and her eyes focused on Anita. Mrs. D. smiled and caressed her daughter’s hair.

At that moment, with the sweet melody of a beloved song, there was a respite from the darkness in her mind. Her heart remembered, even for just a few minutes.