A Psychiatrist Calls

A Psychiatrist Calls

Six months after Mum came home, one of the local hospitals contacted us, to arrange a home visit by a psychiatrist, to check Mum's mental health, and level of dementia.

We all wanted to know how Mum was, so an appointment was made, and a few days later the doctor arrived to examine her.

He was very pleasant, and Mum was all smiles, and chatting away, about her life abroad - the doctor was also from overseas, so Mum felt they had something in common.

As their conversation progressed, Mum came out with a few outlandish remarks - she was going to marry a Frenchman, and was really looking forward to the wedding, which still had to be arranged; she was also working for Treasury. It was true that she had worked for Treasury, albeit a very long time ago, when she lived in Africa; she had been retired for years! When it was pointed out to her that she was nearly 93, and so probably wouldn't still be employed, she was quite insistent:

"Oh, yes! They have phoned me up, and they want me to carry on, because I make them so much money!"

Then came the clincher: "And I'm going to be working in Australia for Treasury, too!"

All these comments were noted down.  Then the doctor asked Mum, if she would mind answering a short questionnaire?

"Yes, I can do that!" Mum was confident.

"Please count back from 100 - in sevens."

Now, the doctor clearly didn't realise that all her working life, Mum's career had involved figures; without any hesitation, Mum started off: 100; 93; 86; 79; 72; 65........ when she got half way, he twigged it was absolutely no problem for Mum to reel off numbers all day long.

He progressed to other questions - the day of the week - she got that right; the date..... Mum was a number or two out. She also got confused drawing hands on a clock to show the time, but for me, the piece de resistance came when the doctor posed a question about the Royal Family.

He asked, "Who is the head of the Monarchy?"

The problem was, English was not the doctor's first language. Until then, Mum had coped pretty well understanding his earlier questions, but with this one, he placed the emphasis very firmly on the second syllable of the word "Monarchy," and pronounced it to rhyme with Malarkey.

We all wanted an accurate assessment about the state of Mum's mental health, but I could see she was never going to work her way back from what sounded like Malarkey, to the word Monarchy.  I said to the Doctor, "Excuse me, but I think you probably meant to say....Monarchy?"

On hearing the correct pronunciation, Mum came straight back: "It's the Queen!" So that was one more question she got right.

Finally, the test was complete, the scores added up, and the doctor gave us his opinion.  Mum certainly had dementia, and he would recommend she start on Memantine, as it could help her, perhaps by slowing the progression of the disease.

The next hurdle was to persuade Mum that taking another pill was a good idea. She has never been one for taking medicine, but I said I would put it to her, and see what she felt about it.

I knew it was no good telling Mum she had dementia.  As far as she was concerned, her mental acuity was perfect, and her memory equally strong, so I told the doctor I would suggest she take it more as a preventative measure, to stop anything happening in the future.

I did really well with this approach, and Mum agreed to try it; the doctor listened what I told her, and began writing out the prescription. He explained the dosage had to be built up slowly, over four weeks, with a gradual increase until the full 20mg dose was reached. If she had any worries about side effects, she could call him.

Mum was nodding her head and said she would try it, but suddenly, as if the previous conversation hadn't occurred, Mum asked:  "What are these pills for?"

The doctor then began to tell her, in great detail, that Memantine was for her dementia. I understood he wanted to be completely frank with her, but he nearly talked her out of taking it at all.

"I do not have dementia!" Mum was insistent.

The doctor looked at me, and I looked at him. I decided to have one last try to see if Mum would still agree to try it.

"You don't have to carry on with it, if you don't want to," I said. "It's up to you, Ma. But if I knew I could take a pill that would help me in the future, in case something went wrong, I would definitely take it."

"Oh," she said. "So, it's not for now?"

"I think you should try it. If you don't like it, you aren't forced to take it, Ma......"

"Alright then, I'll try it. But only for a month, mind."

I looked at the doctor, and he looked at me.

"That's fine," he said.

Before he left, he said there would be a follow-up appointment, to see how Mum was getting on.  It meant she would be taking a total of three pills a day: Amlodipine (a low dose) to keep her blood pressure at a good level; Anastrozole for the breast cancer she had been diagnosed with, 18 months previously; and Memantine.  I hoped that, if Mum didn't experience any side effects, after one month she would be accustomed to taking it, and simply carry on.

With hindsight, and six years on, we can't be sure if the drug has helped Mum or not.  Maybe if she had started taking it earlier, a more noticeable benefit would have been achieved; but at 98, we don't really know if it has made a positive difference.  I guess it's a case of the road not travelled.