Decline

Traci Drennan
Jul 29
6 min read

The first time my mother saw the neurologist was after my father had died.

At that appointment, he gave her a cognitive test and used the words mild cognitive decline.

At the time, there had been no MRI. No one yet knew exactly what was causing the changes we were seeing.

Two years later, after my mother’s double mastectomy, she seemed noticeably worse.

She was also having trouble swallowing. She choked often while eating and drinking, so I took her for further testing. A swallow study and an MRI revealed a Thornwaldt cyst, which doctors believed was causing the choking. It was not something they recommended operating on unless it became a serious problem.

The MRI revealed something else too.

The neurologist showed me four obvious spots where my mother had experienced strokes. He explained that she had small vessel disease and that it was likely the cause of her cognitive decline.

He wanted to evaluate her again. This time, he would have more than the results of a cognitive test. He could see physical evidence of what had been happening inside her brain.

At the beginning of the test, he gave her three things to remember. They included the words red and car. He also gave her an address.

I remember thinking that I might not be able to remember the address myself.

I connected red and car with a fire engine in my mind, certain that would help me hold onto those words. I listened carefully to the address too, even though the test was not meant for me.

When it was time for the evaluation, the neurologist asked me to leave the room.

My mother looked at me.

“Don’t leave me.”

There was something childlike in the way she said it. She did not seem embarrassed. She seemed confused and afraid, as though she did not understand why I would leave her alone with someone she did not know.

I stayed.

The neurologist agreed that I could remain as long as I did not answer any of the questions for her.

He began with things she should have known.

Her birthday.

The day of the week.

The year.

Who I was.

This question carried more weight for me than he could have known. Not long before, my mother had looked at me and failed to recognize that I was her daughter. But this day, when he asked who I was, she answered matter-of-factly, “My daughter.”

She did not do terribly at first. She was able to answer most of these, but before she did, she looked toward me.

She searched my face as though the answer might be written there.

Watching her do that made me realize how many things she had begun relying on me to remember for her lately. It was happening so gradually in our everyday life that I had not fully recognized it until that moment.

At first, I reminded her that she had to answer for herself.

As the test continued, I began avoiding eye contact. I hoped that if she could not look to me, she might search for the answer on her own.

Then she began repeating the questions instead of answering them.

He would ask her something, and she would repeat it back.

Then she would ask him to say it again.

He would repeat the question, and she would repeat it once more.

I could see his frustration building.

I understood it more than I wanted to.

My mother’s repetition sometimes frustrated me too. I knew how exhausting it could be to answer the same question again and again, only to have it return moments later as though it had never been asked.

Then he raised his voice and slammed his fist against the desk.

The sound startled all of us.

My mother sank farther into her chair, reached for my hand, and lowered her head.

I remember sitting there thinking, How is she supposed to answer anything now that you have frightened her?

I did not say it aloud.

I was too stunned and confused by what had just happened.

He did not apologize. He seemed to compose himself and then tried to continue, but my mother participated differently after that.

She had already been uncertain.

Now she was afraid.

At the end of the test, he asked her to repeat the words and the address he had given her at the beginning.

She could not remember them.

I could.

After the appointment, I wrote the address down.

I wanted to know where it was.

It had seemed unusually demanding to ask someone to remember an entire address. A street name, perhaps. A city. But a full address?

When I looked it up later, I discovered that it belonged to a memory care facility in Florida.

I found that strange.

I wondered whether he might be leaving the practice to work there.

At the end of the visit, he told me my mother was getting worse. He believed the changes were related to the small vessel disease causing the four strokes shown on her MRI. He wanted us to return in a few months to reassess her and discuss whether medication might help.

I scheduled the follow-up appointment before we left.

But I scheduled it with the other neurologist in the practice.

I never said anything to him about what had happened.

I did not say anything to the staff either.

I did talk to my husband about it when I got home.

Three months later, we returned.

While we were there, I mentioned the neurologist to a nurse I knew. She had worked in more than one department involved in my mother’s care, so I had spoken with her before.

I told her I had looked up the address from the memory test. I said I had wondered whether the doctor had moved to Florida to work at the facility.

Her response stopped me.

He had retired early.

He had moved to that facility, but not as a doctor.

He was living there as a patient.

She confirmed that he had developed dementia himself.

Suddenly, the moment at his desk looked different to me.

I was still angry that he had frightened my mother. I was also troubled that someone experiencing cognitive changes had been evaluating her cognitive decline.

But somehow, I was less angry at him.

I began to wonder whether his family knew what was happening at the time.

Perhaps they had noticed small changes but had not yet understood them.

Maybe the people at work were still trying to make sense of behavior that seemed unlike him.

We are quick to explain people’s behavior using only what we can see.

Impatience.

Anger.

Rudeness.

A lack of compassion.

Sometimes those explanations are accurate.

Sometimes they are only part of the truth.

I could not excuse what happened to my mother that day. She was vulnerable, and she deserved to feel safe.

But learning what had been happening to him gave me a different perspective.

It reminded me that we rarely know the whole story behind another person’s behavior.

I think that's why compassion matters so much.

It's why we need to give one another a little more grace.

Because we honestly never know what someone else is carrying or struggling with.

Dementia had not only been sitting on one side of the desk that day.

It had quietly been sitting on both.

Reflection

How often do we believe we understand someone based only on a single moment?

Sometimes we do.

And sometimes we discover there was a story unfolding that we could not see.

Have you ever learned something about a person that changed the way you understood their behavior?

Did it erase the hurt they caused?

Or did it simply allow compassion to exist alongside it?

Perhaps one of the hardest truths in life is that we can hold people accountable for their actions while still recognizing that they, too, may be carrying burdens we cannot see.