Article

MEMORABLE PATIENT ENCOUNTER

The man in the mask

“Mr. J,” who was a friendly older patient of mine, presented some unique challenges. Namely, Mr. J suffered from dementia, specifically short-term memory loss.

I first met him as a patient about 10 years ago at the Jones Eye Institute, University of Arkansas for Medical Sciences, where I still practice; I didn’t normally see patients with Mr. J’s condition, so it took a little getting used to. He came to see us for an eyelid that had rotated inward and caused him redness and pain, and he always had a relative with him in the exam room who could comfort him and give him a frame of reference for where he was.

Even with having someone he knew nearby, Mr. J was still always a little scared and anxious, so my staff and I had to repeat ourselves often to both reassure him and to make sure he followed our instructions.

FIXING THE ENTROPION

At Mr. J’s fifth trip to the clinic, we were ready to perform the operation to fix his entropion on his right lower lid. We put him under local anesthesia and numbed his eyelid. We woke him up after a minute, and, as expected, he began asking questions and then forgetting he had asked them. “When will the surgery be over?” “Are we done yet?” “When will the surgery be over?”

I did my best to reassure him, telling him every time he asked that we were making progress in his operation. My staff and I knew how important this was to him by this point, especially while he was in the operating room. Thankfully, as we were used to patients talking to us during surgery, we didn’t find Mr. J’s repeated inquiries distracting.

BEST TO LET IT LIE

I next saw Mr. J in the recovery room, complaining about a pad taped over his right eye. I had gotten to know him fairly well and considered him a friend, so, with my surgical mask still on, I gently removed the pad and jokingly told him, “I know you complain a lot, Mr. J, so let me take this eye patch off.”

After I had peeled it off, Mr. J looked at my masked face and sternly said, “Now wait a second. I haven’t complained about anything all day, except for this eye pad.” I shrugged off his remarks, and went back to writing postop orders.

I returned to his bedside a few minutes later, mask now removed, to check on him again. Mr. J gave me a serious look and said, “Doc, there was a man here a few minutes ago, and he said I was a complainer. When I find him, I am going to give him a piece of my mind.”

I knew it was best to just let the matter lie.

Mr. J was a pleasure, and while he presented some challenges, the experience taught me to be extra patient, reassuring and sensitive to those with dementia. OM