A 78 year old woman, living alone in her condominium, begins to notice that her keys sometimes aren’t where she recalls she left them. She is uncertain if she paid her phone bill and can’t find her checkbook. She puts a pan of soup on the stove to heat, remembers that she was cooking only when she smells burnt food. She forgets a lunch date with a friend. Although these incidents of forgetting are occurring more and more, she doesn’t mention them to anyone. She certainly wouldn’t want her children to think she needs help managing the details of her life. And she is not interested in making any changes. No big deal, she thinks. She finds her keys. She finds her checkbook and pays her phone bill. She throws out the burnt pan. She apologizes to her friend and schedules another date to meet for lunch.

Still, the mishap with the pan makes her anxious about using her stove; she stops preparing meals and turns to snacking. She has never had a large appetite anyway. No problem, she rationalizes.

To family, friends and neighbors, she seems to be doing well. She is in good health and remains physically and socially active. She continues to read regularly and discuss current events. She is proud that she has always been regarded by friends and family as competent, independent, and above all, smart. It is distressing to her, however, when she realizes that she can no longer follow the plot of a novel from the beginning to end. She forgets who the characters are and gets their motivations confused. Nothing like this has ever happened to her. And still she tells no one.

Eventually, her poor nutrition lowers her resistance; she catches pneumonia. She is hospitalized and a dramatic change in her behavior is noted. She doesn’t want to take medications and attempts to leave the hospital. They transfer her to a geropsychiatric unit where she undergoes an extensive evaluation. The verdict: she suffers from dementia. She continues to try to escape the confines of the hospital; they put her on medications to calm her. Once stable, she is transferred to a nursing home — a nursing home with a secured dementia unit.

Rose, from the inside

Rose had been undergoing a gradual cognitive decline. She did such a good job hiding it, from herself and from those who love her, she accelerated her decline by not taking adequate care of her health. What followed was a rapid physical decline and a dramatic change in behavior leading to equally dramatic medical intervention.

Now I want you to step inside Rose’s head with me:

You’re living on your own and have tricked yourself into believing that the changes you see in yourself do not require any changes in your daily habits. You continue to be proud of your intellect and competence and want to make damn sure that others continue to be proud as well, especially your children.

Then, suddenly, you’re sick, delirious. Complete strangers force you to take pills, force you to stay in the hospital. You want very much to go back to your condo and resume your life. The life you enjoy. And you desperately want to get back to your old self, the self you are proud of. There is nothing familiar about this place, nothing that reminds you of who you are. But you’re surrounded by people — doctors, nurses, aides — who are in your face with their ignorance of who you are. “Take your medications. You have to stay here. No, you can’t leave. We’re just trying to help you.” They see you as sick and suffering, unappreciative and uncooperative. They have no idea who you are, who you have been. They do not know your story. They do not see your self.

Now you are in a locked unit. You have never had to wonder what was on the other side of a door. You just went over, opened it, and walked to the other side. And your mind, your innate intelligence, has always allowed you to open many figurative doors to other worlds. Now, an all too real door is closed.

Now I ask you: Wouldn’t you want to go out that door?