The return of the infant

One of the things I have noticed about about life on all of my rotations is that we come into this world as infants and ultimately we leave as infants. The only difference is that our second time as an infant we smell worse and we are not all that cute or adorable. It can be very frightening examining these patients with serious neurological illnesses. You realize that they are not who they once were. Life has been sucked out of them and they remain like a shell that no one recognizes. I think that it is more painful for their loved ones to watch than it is for the actual patient. 

As the brain breaks down in diseases like Alzheimer's, severe strokes, and other forms of dementia loved ones watch as a little more of the patients personality is lost. This continues until the patient is no longer themselves. It is sad to watch and to see. It has to be frustrating to see a person who has been a very loving and gentle individual slowly become the exact opposite and even violent. The family members can't understand why this is happening and it changes the way they feel about the person. It is difficult for people to separate the man from the disease. Imagine if your best friend hit you. You would not stand for it, but imagine if your best friend had a debilitating illness that stripped him of his personality and then in the throes of the illness strikes out at you. These are the lasting memories that the loved ones are stuck with after the patient dies. This can be a long process taking many years to play out. Often the family needs more attention than the patient. It is called caregiver stress.

I have had several patients with these debilitating diseases and it is frightening. You can have a life time of experiences and knowledge sucked away from you in a few short months to years and then be forced to carry on as a shadow of who you used to be.