Alive and happy or long-lived and sedated?

My mother, now 85, has practically no short-term memory and has been diagnosed over the past few years as suffering from dementia, Alzheimers, silent strokes, or various combinations of these. There seems to be a great need to give her condition a name. Depending on the favoured label, different doctors predict her further deterioration in different ways. Neurologists, who are of course the experts in this field, often prescribe strong medicines to manage her moods and modify her behaviour.

It seems to me that much of this attempt to modify her moods and behaviour is geared to keeping us, her family, happy. Most of the talk is about managing her symptoms, real and predicted, so that we have an easier life. What about a happier life for her?

So far, the only discernible mental deterioration is the loss of her short-term memory. Her deductive powers and her ability to resolve practical problems remain sharp. Her hearing is better than mine, her sense of smell is still sharp, her eyesight is reasonably good since she had her cataract operation. She can still add, subtract, multiply and divide in her head without any problem.

And her ability to feel is very strong. Small expressions of love and cherishing make her immensely happy. Conversely, lack of attention or respect make her unhappy. Pity or disrespectful behaviour and words make her angry. Her own inability to remember things frustrates her.

I see all this and try to find ways of keeping her happy - make her feel special in some way, let her know she's important to me and I love her, support her in something she says, praise her when she comes up with a good idea. I try also to play games that engage her mind and encourage her to walk and do simple yoga and meditation.

Some of her doctors, on the other hand, prescribe medicines that slow her down mentally, or leave her living in a mental fog. I can't imagine how this helps someone with a failing memory or a mental degenerative disease. If I oppose this strong medication, I'm told her condition will get worse and told of all kinds of dreadful future scenarios, especially by those who believe she has Alzheimers. Granted this is a degenerative disease, but who among us knows (i) if she really has this disease; (ii) if she does have it, exactly what course it will take in her case, and over how much time; and (iii) how much longer she has to live. In any case, I really can't see how a state of sedation and mental fog helps her hold on to her faculties, thus delaying the onset of that feared later stage.

Keeping her sedated does, of course, make it easier for the rest of us to "manage" her. Is that the goal then? What is a doctor's primary responsibillity - to enhance the wellbeing of their patient or ease the burden of her caregivers? To help the patient live as happy and fulfilling a life as possible or to keep her alive as long as possible albeit in a state of heavy sedation?

No comments:

Post a Comment