Ten Cents Down, Five Cents A Quarter Mile

In the future I have a goal. I wish to one day be able to study the pathogenesis of Alzheimer’s Disease, and at one point develop some form of treatment. As such, I think it is important that one studies not only the molecular aspects of disease, but also puts into perspective those that are directly affected. One can read all there is about the symptoms of a disease but to experience it firsthand is an entirely separate matter.

Working within hospice I was gifted the company of a patient with progressive dementia and ALS. In sitting with him every week or so, certain things became apparent about him and his behavior. While always kind and engaging, my patient relied heavily on certain conversational pieces no matter how hard I attempted to stray. Originally, this was discouraging towards my hopes to have extended conversations with the man and hopefully instill some kind of memory of my person into him so that I would not have to reintroduce myself to him at every visit. This was not to be. However one may interpret that outcome, I found the conversations always interesting because of what my patient spoke about. With each repetition, I was the more intrigued. He spoke about his family, and his children, his time at college, his time serving in the war as a doctor, his upbringing and his view on life. Certain phrases became mainstays in my mind from his continual reiteration; “What’s the difference between you and I? What’s with all the fighting?” A quote he had said to “enemies” in post-war Japan and Germany. “Ten cents down, five cents a quarter-mile,” a statistic countlessly posed to me regarding how much his father made as a New York City taxi cab driver, an amount he made sure to note was not an exorbitant salary but a hard earned wage to be proud of. These tenets were what made him who he was, and they stuck with him as everything else faded and the new abandoned his mind. As his mind disintegrated with the disease, why were these temporally dissonant thoughts, so spread out over the course of his life, the things that stuck with him? How does the disease work if not by degrading sequentially one thought all the way back to the first? In my mind, by the example of my patient, the degradation is based not temporally, but in strength, how often a thought or a memory had been replayed by the individual throughout their life. Thus, whatever is left after the onset of the disease is what most makes up who that person was in life and what they held the most dearly.

Volunteering in hospice over the past couple months, I believe, was supposed to instill in me a recognition that death is not always stranglingly depressive; that all life is miraculous, even the end of it. In the same vein, I believe it has done just that with my perception of Alzheimer’s Disease. While devastating and debilitative, there is beauty in the condition, in what it reduces the individual to. It reveals their true character and that can often reveal the qualities that make us the most human. What I saw most vibrantly in my patient was compassion, contentment and perseverance, and if that’s what made the basis of this man, then I am glad to have been given the opportunity to have met him.