Category Archives: A Doctor’s Diary

The White Room (A Poem About Dementia)

The White Room

I lie on the bed

in the white room

They sit around me

These strangers with familiar voices

I think we are waiting for something

or someone.

These strangers, they look at me

They mutter words I don’t understand

A man in a white coat walks in

He stands next to my bed.

He speaks not to me,

but to these strangers

They are talking about me, I know.

About what, I don’t understand.

Irritated, I kick off the covers.

Mother! They chide me and pull them back.

About the poem: This is a poem about dementia, the hallmark of the disease being loss of memory. I write about a scene I came across during my rounds in the hospital—an elderly woman in the advanced stages of dementia is lying on the bed surrounded by her caring relatives. It’s difficult to know what’s going on in the poor woman’s mind because she has lost the ability to speak, even comprehend. Yet it’s apparent she’s unaware of her ailment. She doesn’t even know where she is or who she is with.

Dementia is a syndrome that results in gradual and progressive decline of previously acquired mental abilities that results in a loss of social and occupational functioning and ultimately to loss of independence. It is imperative to distinguish this from normal aging- normal aging never results in loss of independence. For the diagnosis of dementia there should be impairment in at least 2 of the following– memory/learning new information, executive function (ability to perform usual tasks such as handle finances that one was able to do before), perception (recognize people, hallucinations) and motor abilities (ability to write, draw, walk, coordination), language, social cognition. Alzheimer disease is the most common type (60-80%) followed by vascular dementia (in those who have suffered strokes). Other types such as Lewy body, Parkinson’s dementia, frontotemporal dementia are less common. Aging is the major risk factor. For vascular dementia risk factors are diabetes, HTN, heart disease, smoking and obesity (same as for heart disease). Other risk factors include history of head injury, APOE e4 allele, mid-late life depression, alcohol abuse, HIV infection. On the other hand, higher education and occupational advancement can lead to reduced risk or delayed onset of dementia. Dementia also results in reduced life expectancy–an average of 4 yrs for vascular and 8 yrs for Alzheimer’s and Lewy body dementia.

Therefore, if you are aware of someone who is missing appointments and arriving at the wrong time/date all the time, is not able to follow instructions, is losing weight, is failing to thrive, has new or worsening depression and or anxiety, is exhibiting changes in behavior, poor judgment, loss of initiative, he or she could have dementia and it is important get an evaluation. Though at present there is no specific pharmacologic treatment that can halt or reverse neurodegeneration there are a few drugs that have been shown to slow down the symptoms of dementia. What is most important is understanding what a loved one with dementia is going through and providing them support and a loving and safe environment.

Here is an excellent website that provides guidance for caregivers.

simi blog imageDr. Simi K. Rao, is a board certified internist and hospitalist currently practising in the Denver area. She has special interest in preventive medicine. She is also a published author of four novels. Her newest book of poems and short stories ‘Under the Shade of The Banyan Tree’ will be published in December ’18. You can learn more about her work at https://simikrao.com//