John is 83 years of age, round faced, tanned, cheerful, smiling a shock of white hair and a slight roll as he walks. A picture of health, strong legs and a good gait, he always comes into the clinic room first followed his wife. She is 77 years, slim, even underweight, walking more slowly than John and the waddle in her gait is due to pain and stiffness in her right hip. John, my patient, always greets me with a cheery “Hello, Doctor”. I’m not sure if this is rehearsed in the waiting room or whether he is reminded on his way down the corridor by his wife, Maureen. The expected question from me is always followed by “very well, thank you Doctor”. The next question from me is hardly considered before he looks at his wife to respond. No recollection of their recent holiday. No idea of where we are today or, needless to say, time or date. Quickly, Maureen takes over, anxiety shown in the deep lines on her forehead. Her smile is there but weak and uncertain.
John is no worse. He is affable, easy in company but a constant drain on Maureen who looks thinner and thinner, less able to walk at their 6 month appointments. I have been seeing them for nearly 7 years, still encouraging and complimenting Maureen on her 7 years of “24/7” since they have no children and no immediate family. Friends dwindle away or suddenly die as they both face mental and physical deterioration in the years to come. John is of course the more cheerful one. Today, Maureen is even more worried. She has put off hip surgery for 3 years because of her anxieties over John – who would look after him, what if something happened to her during or after the operation – what would happen to John?
Insurance companies soon stop paying for consultations when illnesses such as Alzheimer’s Disease are first diagnosed. “You have a chronic disease, for which there is no known cure and as such your condition is not covered by your policy”.
Maureen had decided to continue to bring John to see me, paying herself, believing that I could best help them both in the long term. Maureen was still covered by insurance. We were at the Nuffield Health Brentwood Hospital, Essex. I talked to Maureen’s surgeon and then to Matron. We arranged for an extra bed in Maureen’s room so that John could stay with Maureen throughout her inpatient stay and rehabilitation on the ward which included a longer period of inpatient stay to allow for Maureen to be stronger when she returned home.
The operation was a great success. John was very happy in Maureen’s room. There were no problems.
John still has his cheery face when he comes to see me. He does not remember his stay in hospital. Maureen is much happier. She has put weight on. She is no longer in pain. She is walking well. She still looks after John “24/7”. If I can keep Maureen well, then they will manage at home for a while yet.
Dr Rudy Capildeo, FRCP