Karl

Dementia is an amazing and horrendous disease in what it takes and what it leaves behind. We saw my patient, Karl, today. He has what some would term "moderate" dementia. He remembers who I am, though not my name, and does not recall the last time I visited. He cannot manage his medications, and despite having been a realtor and insurance salesman, can no longer do simple arithmetic. However, he holds onto languages, and being an immigrant from Lithuania, speaks six of them (English, German, Polish, Lithuanian, along with some French and Italian). He lives upstairs from his brother and his brother's wife. His apartment is dim, colored in shades of brown, is like something out of film noir, where the private detective lives in the back room of his offices. The air feels about a hundred years old. He sits behind a large desk and I sit on the other side like a client asking advice. Behind him are piled books that he can no longer understand. Among them is a binder labeled "medical," into which he has meticulously placed pages from his clinical history. He remembers none of the them. Not his high blood pressure, nor the stent placed in one of the arteries of his heart. None of it ever happened. He has the worried expression of a child who neglected to study for a final exam. But Karl has studied. He is constantly taking notes. When I excused myself to go the bathroom, I found the mirror over the sink covered in reminders, little rectangles scribbled in a trembling hand: therapist comes Fridays 1pm; meals delivered Monday, Thursday 11am; don't forget the mail. There are notes on that mirror dating back to 2008, testifying to a desperate attempt to maintain order in his life, leaving no room to view his reflection. Karl never married. There was no one to outlive. If his apartment is any indication, he made a life in business, filled with clients and files, and a brother downstairs. He is kind, and gentle, and shyly affectionate, and frightened. On my second visit he gave me the note below:

It makes me wonder. Emotions are so highly reactionary, if my own are any indication. When I things are going well and I am confident, my needs are few, and I am in search of adventure. But when times are uncertain, when I feel small, then I reach out for those around me. I look for solace and crave validation and love. This side of Karl. This affection and neediness: was it always there? Or now that parts of him are disappearing and life grows ever more daunting, has this loving, necessitous person emerged, surprising to those who knew him before? I guess this sounds mean. It is a little mean. I like Karl. He is a sweet man. I enjoy him and wish I had more time to spend before his desk. Each time I come he asks me for a business card and before today, I always forgot to carry one. But today I dig one out of my pocket and hand it over. He is pleased. He takes a pen and writes on it the day and date: Thursday, 3/24/2011.