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games - Setting Sun Retirement Home*
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By Lara Hazelton, MD

“We’re going to play a tapping game now,” I say, but it’s not true, not exactly.

We are sitting in her kitchen, even though she says it is not her kitchen, but a room in a different house that has replaced her own. It looks like her house, but it is not the same. Even the ocean outside the window, rolling restlessly under the grey sky, is a different ocean. She doesn’t know its name.

We are at the table, seated opposite each other the way chess players would sit across a chess board, or arm wrestlers would face off in the moment before they lock hands. My patient is seventy-four years old, but she looks much older, with a white mop of hair and deep-set grey-green eyes, which right now are glaring at me with a mixture of fury and bewilderment. She is thin and frail, and if we really were going to arm wrestle across the table, I’m sure I’d break her arm. It would snap like a twig in winter. Any of her bones might, at any minute. She has a bruise on her forehead, and she can’t remember when she fell. Home Care is scared she’s going to break a hip one day.

I smile encouragingly.

“The rules of the game are as follows: when I tap once, you tap twice.” I demonstrate by tapping the table. She taps her twisted finger twice. We do this three times.

I know Mrs. MacDonald likes games, puzzles. Lying on the coffee table in the living room is a newspaper from last week, open to the comic page. She told me quite proudly, when I inquired, that she did the crossword puzzle every day. The squares of the crossword grid are filled out in ink. Under the newspaper, I found her pills, neatly blister-packaged by her pharmacy. The foil cells are punched out randomly, and brightly coloured pills lie scattered on the table and the floor.

By all accounts, she was a very bright woman. She worked in the city, never married, and then came home to this village twenty years ago. Her nieces and nephews are intimidated by her, which is why the situation has been allowed to deteriorate this far.

“Now,” I say, “When I tap twice, you tap once.”

She tries, but even this simple instruction confuses her, and she taps twice. I try again, but she slams her hand down on the table. “This is damned foolish!” she says, “I’m not doing any more.”

“Mrs. MacDonald…”

“No!” She points her finger at me her hand shaking. There is a strange flatness to her affect, but you can still tell she’s very, very angry. We are twenty five minutes into the assessment, and a couple of times before this I thought she was going to cut me off: fortunately, I have developed a few tricks for coaxing reluctant elderly patients to complete cognitive testing. But I have a feeling that we’re through now. I look down at the partially completed Frontal Assessment Battery. She did poorly on abstractions and verbal fluency, not the mention the fact that she only scored 18/30 on the Mini Mental Status Examination. There is rotting food in the refrigerator, and she doesn’t know how to operate the telephone. I don’t really need to hear any more.

She stands up. “Go. Go now.”

I stay sitting. “Mrs. MacDonald, you know people are concerned about you living here alone.”

“Out!” She points at the door.

She’s probably going to hit me if I don’t leave. But I hate to go without at least trying to explain to her what will happen next. “I am concerned about your memory. I was asked to come here by Adult Protection…”

“No, no…”

“…And I’m going to have to tell them that I don’t think you should be making decisions without assistance…”

She tells me to go to Hell. For a moment we just look at each other. She’s so scared, and I’m so sorry. I stand up and gather my things. As I pass through the living room, I look at the crossword puzzle. If she weren’t so angry with me, I would ask if I could take it. It would be a useful teaching aid. All of the squares of the grid are filled, but the words themselves don’t make any sense. They aren’t the right answers: they aren’t even real words. Her brain has conveniently filled in the empty spaces, yet there is nothing there.

As I get back in the car, I look back and see her standing on the front step, wearing an expression of grim satisfaction. I’m almost glad that, for the moment, she’s had a last opportunity to think she has won.

Photograph taken at Setting Sun Retirement Home (a pseudonym) by Matthew Christopher of Abandoned America.

Also in: Setting Sun Retirement Home*

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