The envelope contained a lovely letter. In this new world of electronic communication, it’s uncommon to receive a hand-written card, and even more unlikely that you will get a fully formed letter. So this was a welcome surprise.
It was a very heartfelt letter written by a daughter who visited me with her father over a number of years along with her mother, as her father gradually declined into a greater degree of dementia.
At the beginning, the reason they sought assessment was to try to define what was going on and try to give his condition a “working label” they could deal with. At that time, as is often the case, he denied any problem. He was still very active in the Jehovah’s Witnesses church and was still actively proselytizing door to door – which according to what I gathered from his family, he did with enormous respect and grace.
As his cognition declined despite symptomatic treatments and he faced the usual traumas such as reporting his condition to the Ministry of Transport, which removed his driving licence, the focus of discussions with the family, with him in attendance, was always on future plans and preparation for the further decline that ultimately would lead to the end stages of dementia. He would often participate at some level, but the family carried the conversation.
Then he was accepted, after a long process, at a suitable long-term care facility and it became clear that the whole trajectory of their life together would be changing. That event prompted the letter I received. At my final visit with the man and his family, he clearly was not involved in what was going on, but I did get a chance to thank him for teaching me about his religious movement and tell him how much I learned from him. That was something he clearly was able to understand, and with a smile, he thanked me again for seeing him. And that was our final goodbye, although I asked the family to let me how he acclimatized to his new milieu.
Even though his belief system was alien from mine and those of most of the people I care for, the important thing for me was how much emotional, intellectual and spiritual support it provided for him. Without getting into the complexities of the implications of belief systems and religion, I want to emphasize that for many of the older people I see clinically, having a belief-system – usually with one of the recognized religions – seems to matter a great deal in how they deal with the challenges of what are often daunting illnesses.
Much of my practice is with ambulatory geriatrics, where the majority of patients come to me with multiple medical problems in which cognitive impairment plays a major role. The other part of my clinical activity is on the palliative care unit at Baycrest, where patients are at various stages of the end of life process with, for example, malignancy, late end-stage heart failure and dementia.
For many, it becomes clear after admission how much they seek some religious or spiritual support to help them through this very difficult part of life. We have the assistance of religious leaders, consultants from virtually all the religions in the city including, as expected, rabbinical support with which we are fortunately well-endowed. A good part of our support comes through the work of chaplains who, whatever their own belief associations, are able to minister in a general spiritual way to anyone who wishes to participate.
The important principle is that for many, and for seniors in particular, belief in a deity matters – especially during the crises of life and at the end – and it may provide a meaning and important succour that nothing else can match. We must understand this in order to provide the best of care in all domains.