Dignifying Dementia by Elizabeth Tierney

some online editing and had become friends with the operations manager who lived near Boston. I told Belinda about Jim’s cancer diagnosis. She immediately contacted an oncologist in Kentucky, who invited us to call him at his home. He also recommended radioactive seed implants and added that the procedure was not ‘rocket science.’ He said, “There’s no need to go to Duke or Sloan-Kettering or to Kentucky to see me; Jim can undergo the treatment just as well in Savannah.” We thanked him, and I researched other websites. Jim looked at the printouts, reflected on the phone calls and decided on the method of treatment. His mind was working.
    After consultations with the radiation oncologist, the urologist, and the internist, Jim decided to be treated with radioactive seed implants.
    The morning of the procedure, I remembered to ask the anesthesiologist to avoid Versed because of Jim’s previous paradoxical reaction. He said, “I have never heard of such a thing in adults.” I pleaded with him. When Jim came out of the anesthesia, the recovery room nurse asked, “Where are you?” Jim answered, “Paris.” She looked at me and asked, “Does he mean it, or is he joking?” I had no idea.
    The radioactive seed implants were followed by a short course of external beam radiation. Despite his occasional tears, he was ‘of good cheer,’ to use his phrase. We walked hand in hand to his appointments. Did he understand the external beam radiation treatments? After each treatment, he said, “They were taking pictures.” But afterwards, he cried and said, “My life is useless.”

    Jim became sufficiently depressed during the prostate cancer treatment that our internist referred him to a psychiatrist. With Jim’s language skills deteriorating, he had difficulty talking with her. She prescribed different antidepressants – none of which worked and most of which resulted in more paradoxical reactions – agitation or greater confusion. The psychiatrist was excited about one particular drug, Remeron, which she thought might alleviate his depression and reduce his tremors – now in his whole hand rather than only in the tip of a finger.
    Within half an hour of taking the prescribed dose of Remeron, his lower lip drooped, he began to slur his words, and he was slumped over. He looked ‘stoned.’ I called the doctor. She said, “Put him to bed and let him sleep it off.”
    The next morning we had an appointment at a lawyer’s office to sign some papers. I spent the evening looking for our durable power of attorney, a document I soon would have to use more than I care to say, including once on a trip to a Social Security Administration Office for me to become Jim’s ‘representative payee.’ By then he had ‘sobered up’ and was able to sign his name many times – another drug, another reaction.
    The psychiatrist also arranged for Jim to have an EEG, an electroencephalogram, which measures brain wave activity. The test required Jim to be sleep-deprived. Because he had to stay up all night, we were both sleep-deprived. The results revealed that Jim’s brainwaves were slower than normal. But what did that mean? What were the implications?

    Eventually the radiation treatments exhausted him, and he developed an ‘urgency,’ which embarrassed him; he didn’t want to walk on the beach anymore. He preferred to stay close to the house for fear of wetting himself; he let me help him with some of the nuisances of his treatment. He believed he was dying. He became more withdrawn, and if I asked, “Do you want to go anywhere or do anything today?” his reply was, “What’s the point?”
    His new blood tests indicated that his PSA was lower, but I told the radiation oncologist that Jim didn’t believe that he had been treated successfully. Amazingly, the doctor braved a litigious