Upsetting the ladies (edit)

There was one more fellow to see. Ralph. I thought it might be good for my student to see a patient with a combination of dementia and delirium. The latter is medically-caused (like having a uninary tract infection) and can be reversed. The former is a one-way road to retrogenesis. (Retrogenesis describes how people with a dementing disease like Alzheimer's gradually lose skills in the reverse order the gained them as a child. It's like aging backwards except the body stays old.)

I'd been trying to check his swallowing, but he'd been too sick to do much of anything for the last month or so. The door was closed to his room. I knocked. Maybe there was some bathing going on. The physio answered and called me in. She was working with a fellow in bed one. Ralph was sitting in a geri-chair by the window. A rare glimpse of winter sunlight was shining on him like a far-away spotlight. The light was still anemic but it was warm enough for some nude sun-bathing. His hairy white body, still fairly strong, was sprawled out on the chair with nothing to hide.

My stout-hearted student didn't flinch. She followed me in like an seasoned colleague and introduced herself to Ralph. She shook his hand. Awesome.

I crouched down beside nekkid Ralph as my student moved back to watch.

"Ralph," I said, "why are you all nekkid?" (My young boys have given me a new appreciation of the pronunciation: nekkid.)

"I was rolling hose," he said. I looked over at my student and cocked an eyebrow. She allowed a half-smile.

"Rolling hose?" I looked back at him. He wasn't looking at me.

"Yeah. Rolling hose. Hot work that is. There was a fire at the mountain and Sally wanted to go for a picnic so I had to go find ..."

Ralph stopped and stared into space as if he was waiting for the rest of his story to appear. He looked over at me. "Who are you now?"

"Ralph, I'm the speech therapist. Are you getting enough to drink?"

"I'm a little dry," he replied, "can you get me my cup?"

I did and he swallowed it down with a gurgle and a cough. So it goes for Ralph. Aspiration pneumonia is almost expected with dementia. Patients forget how to swallow and accidentally inhale their food and drink into their lungs.

Just then, a nurse came in and my student and I watched while she gently wrestled and tricked Ralph into putting on his hospital gown. I chatted with my student about Ralph's history of small strokes (the likely cause of his dementia) and how he used to be a firefighter.

"We can't have you going around with your clothes off Ralph," she said, "You'll upset the ladies."

Ralph was still staring in the empty space that used to hold his memory, his connection to now. When we all left, he was already trying to wriggle an arm out of his gown.

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