A 90-year-old gentleman has been admitted to our ward under the care of a neurologist. He was diagnosed with an ischemic stroke after experiencing weakness in his left upper limb and slurred speech. His mental status is fluctuating, and the stroke has impacted his memory. However, it has not affected his ability to walk and move around.
He and his wife had been living independently for the past 20 years. They have three children, all of whom live abroad. When the children learned that their father had fallen ill, they all returned home to be by his side. He was very irritable and refused to stay in the hospital. He was unwilling to admit that anything was wrong with him. Before the stroke, he had been active and managed all his tasks on his own.
Some days, he struggles to remember details about his family, and on other days, his slurred speech makes it difficult to understand what he is trying to say. However, there is one constant: his desire to go home. Each day, at least two to three times, he gets out of bed, puts on his cap and waistcoat, finds his cane, and walks into the corridor, exclaiming, “Acha jee feir salam-alikum, main chaleya hun,” which means, “OK, I am leaving now/going home.”
One day, I noticed he was dressed as if he were ready to leave the hospital and was heading towards the ward gate. A staff nurse quickly ran to stop him, and we brought him back to his room. According to him, he simply wanted to be discharged; otherwise, he said, “Nai tey puttar main fer nass jana,” meaning he would leave without informing anyone (his tone implying a threat).
The situation clearly illustrated his desperation to return home. Because of his deviated uvula and weak positive gag reflex, he needed to be fed through a nasogastric tube. However, he did not consent to having the tube placed. Each day, the consultant and medical staff counseled him extensively, but he remained adamant and refused to change his mind.
One evening, during his rounds, the neurologist was performing a neurological exam. After the examination, when the neurologist said goodbye and tried to shake hands, the patient wouldn’t let go of his hand. The patient again requested his consultant to allow him to go home.
The consultant tried to explain that he could not be discharged immediately since he had suffered a stroke. “Baba jee, aapko kaise jaanay dein? Dekhein na, abhi toh aapko faalij hua hai.” (We cannot let you leave immediately; you just had a stroke.)
The patient replied, “Daactar saab, menu nai, meri buddhi nu faalij hoya aaye.” (Doctor, you are mistaken. It is my wife who had a stroke.)
Everyone knew that, due to his condition, he was not speaking rationally. The neurologist tried to pacify him and attempted to take his hand out of the patient’s grip, but he wouldn’t let go. “Daactar saab, main jhoot nahi aakh reya, meri buddhi nu falij hoya hai. Tussi ennu check karo.” (Doc, I am not lying. My wife had a stroke; you should examine her.)
To comfort him, the neurologist agreed to see his wife. All three of the patient’s children were gathered around the bed, and they were feeling helpless. They knew that their father was not in his right mind.
His wife was an elderly woman, likely in her late 80s, sitting beside his bed. She had a smile on her wrinkled face, and not a single tooth in her mouth, revealing her gums when she smiled. She appeared to be a very simple lady.
The neurologist signaled to her, asking to shake her hand. When she attempted to return the gesture, we noticed that she had a high amplitude intention tremor in her hand, which piqued our interest.
Later, the neurologist conducted a thorough examination, assessing the lady’s powers, reflexes, and cranial nerves. He also asked the lady to walk in order to evaluate her gait. It was clear that she had significant balance issues, along with a slight cognitive impairment that might be attributed to aging.
The patient felt reassured knowing that his doctor had taken his concerns seriously and performed a comprehensive evaluation of his wife. The neurophysician discussed plans with me, stating that he would schedule her for an outpatient appointment to conduct imaging studies and further investigations. This was to determine if there were any underlying neurological issues related to an old stroke, multiple sclerosis, or hyperthyroidism.
I was reflecting on how sweet our patient was. Despite his altered mental status and memory issues due to his illness, he remained more concerned about his wife than his treatment. Even while being admitted to the hospital and cared for by numerous people, he hadn’t forgotten that his wife was also suffering from something. He saw this as a wonderful opportunity for her to get examined as well. It’s truly heartwarming that our elderly patient was so caring towards his wife. His thoughtfulness and love made my day sweeter.
I pray that God blesses him with a fast and complete recovery, and may they always support each other in sickness and health.
Damane Zehra is a radiation oncology resident in Pakistan.
