“I don’t know what happened.” Head bowed, my partner’s clenched fists move to cover his eyes, his shoulders slump.
From where I sit, relegated to the sidelines in the examination room, the doctor standing between us, I am unable to reach my partner, to distract with touch. “Honey,” I whisper hoping the endearment will pull his attention to me. His hands drop to his lap, our eyes meet. “Dr. R. told us we can’t get back what’s lost, but you’re doing everything possible to slow the loss and stay healthy and strong.”
He nods and his posture changes, shoulders back a little, chin lifted. “I am.”
“You are, and I am proud of how hard you work. You should be too.”
From the corner of my eye I notice the doctor slide the offending clock picture into the back of the paper file along with the results of the three word test, sit down on his rolling stool, and pick-up a small light. “Let me take a look at your ear,” he comments as he slides the stool to my partner’s left side. The discussion takes a meandering path to the appointment’s conclusion and ends on a positive note.
The clock and three word test is usually given in a primary care setting to determine if a patient is showing early signs of dementia. Three random words are spoken to the patient at the beginning. Then a paper with a circle in the middle is provided with instructions to complete the clock and place the hands at a particular time. When the patient completes the clock, he/she is asked to recall the three words. A result of 1 to 2 word recall with a complete clock including the time means no sign of dementia. Regardless of the number of words recalled, if the clock is incorrect or incomplete, the diagnosis is dementia.
My partner settles into the passenger seat for the ride home. As we pull onto the street he comments, “I don’t know what I was thinking with the clock. I had the twelve and six right and then wrote fifteen for the other numbers. What’s our schedule today?”
“Latte next, power exercise class with your favorite drill instructor, lunch, then your eye appointment.” A silent debate rages inside, do I respond to the clock comment or hope he’s lost interest in the idea and will let it go? As a family we’ve just survived two weeks of unremitting gloom and agonizing over past decisions. Finally, with the help of both his therapist and our daughter he’s walked out of the cloud. Looking for direction, when I stop at the light I glance at his hands where they rest in his lap. His fingers are fidgeting, small random movements. I reach across the seat and take his hand. “You probably just lost focus for a moment when drawing the clock.”
“Yes, you’re probably right.” His hands still. “Sometimes my thoughts wander.” He settles into the seat, shoulders back and hands quiet. “Overall it was good doctor report. I’m stronger. Other than drinking more water and eating less dessert my diet’s good.”
“And you’re working hard to maintain your balance and build muscle tone.” I change the subject, reminding him of his recent visit to the studio where our daughter is the executive producer of a digital show focusing on mental health. Accompanying his daughter to work played a large part in chasing away the cloud. Everyone was kind to him, no raised voices or angry words. These are people working together to create a project they believe in. They were both welcoming and kind.
Eventually I pull into the senior center for his class. Today I choose to wait inside in the library. While he works hard for the “drill instructor” I make a note to call the doctor before the next evaluation appointment. I plan to politely ask that the clock test be removed from his evaluation. I can see no point in a diagnostic tool for something we already know. One thing about conditions involving cognitive decline, while each is different they do not improve. Isn’t the first rule of medicine, do no harm?
From where I sit, relegated to the sidelines in the examination room, the doctor standing between us, I am unable to reach my partner, to distract with touch. “Honey,” I whisper hoping the endearment will pull his attention to me. His hands drop to his lap, our eyes meet. “Dr. R. told us we can’t get back what’s lost, but you’re doing everything possible to slow the loss and stay healthy and strong.”
He nods and his posture changes, shoulders back a little, chin lifted. “I am.”
“You are, and I am proud of how hard you work. You should be too.”
From the corner of my eye I notice the doctor slide the offending clock picture into the back of the paper file along with the results of the three word test, sit down on his rolling stool, and pick-up a small light. “Let me take a look at your ear,” he comments as he slides the stool to my partner’s left side. The discussion takes a meandering path to the appointment’s conclusion and ends on a positive note.
The clock and three word test is usually given in a primary care setting to determine if a patient is showing early signs of dementia. Three random words are spoken to the patient at the beginning. Then a paper with a circle in the middle is provided with instructions to complete the clock and place the hands at a particular time. When the patient completes the clock, he/she is asked to recall the three words. A result of 1 to 2 word recall with a complete clock including the time means no sign of dementia. Regardless of the number of words recalled, if the clock is incorrect or incomplete, the diagnosis is dementia.
My partner settles into the passenger seat for the ride home. As we pull onto the street he comments, “I don’t know what I was thinking with the clock. I had the twelve and six right and then wrote fifteen for the other numbers. What’s our schedule today?”
“Latte next, power exercise class with your favorite drill instructor, lunch, then your eye appointment.” A silent debate rages inside, do I respond to the clock comment or hope he’s lost interest in the idea and will let it go? As a family we’ve just survived two weeks of unremitting gloom and agonizing over past decisions. Finally, with the help of both his therapist and our daughter he’s walked out of the cloud. Looking for direction, when I stop at the light I glance at his hands where they rest in his lap. His fingers are fidgeting, small random movements. I reach across the seat and take his hand. “You probably just lost focus for a moment when drawing the clock.”
“Yes, you’re probably right.” His hands still. “Sometimes my thoughts wander.” He settles into the seat, shoulders back and hands quiet. “Overall it was good doctor report. I’m stronger. Other than drinking more water and eating less dessert my diet’s good.”
“And you’re working hard to maintain your balance and build muscle tone.” I change the subject, reminding him of his recent visit to the studio where our daughter is the executive producer of a digital show focusing on mental health. Accompanying his daughter to work played a large part in chasing away the cloud. Everyone was kind to him, no raised voices or angry words. These are people working together to create a project they believe in. They were both welcoming and kind.
Eventually I pull into the senior center for his class. Today I choose to wait inside in the library. While he works hard for the “drill instructor” I make a note to call the doctor before the next evaluation appointment. I plan to politely ask that the clock test be removed from his evaluation. I can see no point in a diagnostic tool for something we already know. One thing about conditions involving cognitive decline, while each is different they do not improve. Isn’t the first rule of medicine, do no harm?