Shay Jacobson, RN, MA, NMG, LNCC, CNLCP
Martha Kern

helping_a_friend_800_clr_11915

Esther was of the opinion that “you get what you expect”, from a medical perspective, and she did not expect to get sick.

The day we initially met her, she explained that she could “self-heal” and only occasionally took an herbal supplement to make her body stronger.

A few minutes later, she explained that she had a ruptured cyst on her chest.  She said it bled on her sheets at night.  She showed it to us, and it looked far more ominous than a cyst.

Esther eventually agreed that day to have a doctor look at it and we took her to the emergency department.  There, we learned that it was far more ominous, indeed.

The Road to Here
Esther had been a real estate broker for many years and, together with her husband, had raised four children.  The story of her life pointed to a pattern of hard work, stability, tradition and good health.  Later in life, she divorced her husband.  Each of her children, all adult and pursuing their own life stories, moved out of state.

So often, we find ourselves alone, quite by accident.

And so it was that Esther’s gradual loss of insight, judgment and decisional capacity went largely unnoticed.  She was friendly with the door staff in her high rise apartment building, but had few other relationships of any consequence.  She talked to her children periodically on the telephone, and one or two of them noticed that she seemed more distant.

It wasn’t until her children visited and found her to be in a trance-like state that the first ripples of concern took hold.  Shortly thereafter, Esther was found wandering outside with the nagging sense that she had an appointment.  It just so happened that she asked for help from a group of Appellate judges, who were enjoying a meal in a restaurant.  One of these judges took it upon herself to investigate Esther’s situation further, and to seek resources to help her.

Finally, Esther’s decline was gaining notice. Lifecare Guardianship was contacted to act as temporary guardian, at least until such time as Esther’s legal documents could be sorted out (she had re-executed Power of Attorney documents more than once) and a decision-maker identified.

Diagnosis: Dementia….and More
Although Esther is alert and oriented to place, person and situation, she mentions needing help with “processing”.  Her medical records indicate that she has seen doctors over the years with various complaints, and that she sought treatment for the chest “cyst” at an urgent care center over a year ago.  They referred her to a surgeon….but she did not pursue it.

When Esther complains of trouble “processing”, it seems that she means to say she cannot formulate and follow the necessary steps to solve problems.  She recognized that she might have a medical problem, knew how to find urgent care, but could not piece together the process of contacting the surgeon, making an appointment, remembering the appointment and getting there.

Her inability to take these steps led, ultimately, to the emergency department that day where we learned that Esther had a rather advanced cancer.

Shortly thereafter, we would learn that there was cancerous fluid on her lung, as well, indicating metastasis.

Dementia’s Long Shadow
When we hear of dementia, particularly when it is combined with social isolation, a number of fears spring to mind.  We worry about falls and wandering, leaving the gas on, getting lost in the car.  We fret about exploitation and the terrible likelihood that someone will recognize an opportunity and abuse or steal from a defenseless person, desperate for social connection.

The possibility that a cognitively impaired person will develop a serious medical problem and ignore it, deny it and/or allow it to worsen well beyond the scope of simple treatment, is less commonly contemplated, but this is exactly what happened to Esther.

To this day, Esther says she never expected to have cancer and alleges that she does not have it.  It seems safe to say that had that Appellate judge not encountered a very confused Esther in a restaurant one night, Esther’s cancer would have continued its march through her body and killed her.

Esther is receiving treatment and is safely placed in a skilled environment where her wandering tendencies can be managed and her medications steadily administered.  More important to Esther, perhaps, is the fact that she has other people around to help her “process” and that the day-to-day struggle to get her basic needs met is no longer hers alone to carry.

© Lifecare Innovations