It’s a Wednesday afternoon and a group of patients, medical representatives and a journalist wait outside Dr Meena Gupta’s chamber at Paras Hospital, Gurgaon. Sitting amid them is an elderly woman, looking around vacantly as her daughter-in-law asks the nurse, “When can the doctor see her? She is getting impatient.” They are called in minutes later by the neurologist. “Why didn’t you walk inside? I thought you would,” the doctor asks emphatically. It is loud enough for the rest to hear. It is also clear enough for them to know that they will have to wait a little longer. This will take time. The woman leaves the chamber after 40 minutes.
“She has been suffering from advanced dementia,” she informs later. “Most times they feel they are not wanted. If they have more than one offspring, then they keep on oscillating. She has come to her son for a month. Poor thing, she was so confused after coming to a new place,” the doctor carries on, adding, “Aren’t we are all confused when we go to a new place? In advanced stage of dementia, it becomes all the more difficult as the confusion can multiply.” One understands, Gupta’s greeting was not just emphatic but also empathetic.
Forgetfulness, a manifestation of increasing age, is not entirely abnormal. “Saathiya jaana, sattar battar ho jana is a normal ageing process,” the 70-year-old doctor says, carefully choosing seemingly inoffensive but unsympathetic phrases one tends to use to refer to it. “We all tend to forget but when the forgetfulness starts interfering with the quality of our life, with our daily activity, with our socialising then it becomes a disease.” This cluster of symptoms, consisting of progressive loss of memory, impairing the functioning of day to day activities, affecting our cognitive skills, are indicative of dementia. An umbrella term in itself, it can be caused by various factors. Alzheimer’s, characterised by memory loss, is one of its symptoms. “It causes and leads to dementia,” says Dr Rajnish Kumar, a neurologist.
The cruelty of Alzheimer’s as a disease cannot be undermined for its ability to fundamentally change someone from who they once were. “Patients develop psychological symptoms. Sometimes, they have hallucinations, or turn suspicious,” the doctor points out. “Often, patients enter the operation theatre and feel there is a snake inside,” Dr Kadam Nagpal echoes his colleague.
Such a condition not only affects the patient but their immediate family members and caregivers as well. “There are patients who do not let the caregiver leave their sight even for a moment. It can be exhausting. There is a woman who brings her husband to me. She has not slept for years. Their son gave up his job at the US and is now working from home. They ask me what they can do and I tell them to treat him with empathy, to give him a hug. He is a child now. He needs empathy,” Gupta comments.
The doctor, who is also a paediatrician, tries to practice what she preaches as well. On the day we met, she saw three patients in the span of four hours. “They require a lot of time and patience.” Besides carrying out various tests, she engages with them, talks to them. “They crave for attention”, she says, and then — as if assuming they would be judged — adds, “Who doesn’t? Don’t you? I do.” She treats them like children, because, she says, they are. “They are like children. These doctor visits are like outings for them where they are taken out just for themselves, where someone talks to them.” She often spends more than an hour with each patient, making them perform, asking them to draw for her. “Some even get their colouring books with them. I am a hard taskmaster,” she says with smile.
“People suffering from Alzheimer’s do not need your sympathy, but empathy,” Nagpal remarks, and admits that this profession has taught him to be more patient and empathetic. “They want that kind of time, and often, this is more important than medicinal treatment. All they want is someone to give them an ear. They might have insignificant complaints but they want somebody to hear them and we need to do that,” he adds.
However, treating a condition that entails forgetfulness also involves the risk of being forgotten. The doctor-patient relationship needs to be re-forged with each visit. “There are instances when the patient has no memory of the interaction they had with the doctor. They might not even recognise us,” Nagpal concedes. Kumar has found a way to deal with this. “I ask my patients to make small postcards and note down the date they visited, the doctor’s name. I ask the attendants to jog their memory about their visit to the hospital. For those in the early stages, this helps.” For doctors, treating a condition that has no certain cure, these small steps go a long way. “You cannot afford to be negative. I always say, sab theek ho jaayega (everything will be fine). You may call it an art of deception but it is necessary. And sometimes when they look at me and recognise me, I feel like I have succeeded.”
Gupta agrees and, recollecting her meeting that afternoon, confesses, “When I told her I liked her sari, she smiled at me. I still have goosebumps.”