The man with dementia was astonished to find himself in a world that made no sense

He had good long-term memory, telling me about his two grown-up sons and his wife, whom he thought was in poor health. “Mary passed away three months ago now,” the carer said gently.

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I’d not been to the home before. Through the Edwardian bay window I could see about 15 residents, some seated, others shuffling aimlessly around the large lounge. No sign of any staff. I rang the doorbell a third time. Once again, several inhabitants glanced out at me through the evening gloom. But still no carer materialised.

I retraced my steps to where John, the driver, was waiting in the out-of-hours car.

“Better give them a call,” I said, sliding back into the passenger seat. “I can’t get a reply.”

John tapped some digits into the car phone. I sat listening to it ring, staring across the pristine garden to the lights blazing in every window of the old house. I was beginning to entertain thoughts about a home full of dementia patients having been left to look after themselves when, finally, a woman’s voice came on the speaker. She was very apologetic, explaining they’d been busy with a resident upstairs and couldn’t hear the doorbell from there. She would come at once.

I took a briefing. The man I’d been asked to see, William, had been involved in an altercation with another resident. There’d been shoving, and a punch had been thrown. William had only been with them a couple of months, but he’d had urine infections in the past and the staff wondered if that was causing his aggressive behaviour now. They’d obtained a sample. I performed a dipstick test. There was no infection.

The carer led me to the lounge. As soon as I entered, an elderly man with a grey beard called out: “You! Where do you think you’re going?”

I assumed this would be William, but the carer walked straight past.

“Get out of here!” the man shouted at me. “Go on! Go home!”

William turned out to be a thin-framed man sitting quietly by the bay window. I introduced myself and he gave me a diffident smile, regarding me over the top of his glasses. Heading to his room, we passed the bearded man, who once again seemed offended by my presence: “Go on! Get out of here! Go home!”

I ignored him, but William stopped. “You,” he said, “are a very rude man.” His voice was tremulous with disapproval. “Rude, and very ignorant.”

Up in William’s room, I quickly ascertained that he was physically well. He had good long-term memory, telling me about his career as a soil scientist, which had taken him all over the world. His two sons were grown up now. But he was worried about his wife, whom he thought was in poor health.

In the corner of my eye, I saw the carer give a brief shake of her head.

“Is this her?” I asked him. There was a framed photo on his side table of a cheery, round-faced woman. He nodded.

“Mary passed away three months ago now,” the carer said gently.

We talked a little more. Yes, he realised there had been an “incident”. But he couldn’t say too much about it. As for today’s date? Well, he really couldn’t be sure. The more the gaps in his short-term memory were exposed, the more perplexed he became, as though astonished to find himself in a world that simply made no sense.

Talking to the carer downstairs, I learned that the grey-bearded man had been the other party to the altercation. Not his fault: his dementia had a paranoid flavour, rendering him hostile towards strangers. Not William’s fault, either, his failing memory making it impossible to understand the other’s behaviour as a symptom of disease rather than verbal abuse.

They both needed close supervision until William gradually became an accepted part of his fellow inhabitant’s world. The carer agreed, but I could see the gulf between the needful and the possible. The few night staff only had to be tied up with one resident and the rest would be left to their own devices. There are currently no legally prescribed safe minimum staffing levels in health or social care settings. That is something that has to be changed. 

Phil Whitaker is a GP and writes the New Statesman’s “Health Matters” column. His books include Chicken Unga Fever: Stories from the Medical Frontline (Salt)

This article appears in the 31 May 2019 issue of the New Statesman, Theresa May’s toxic legacy

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