Pink Elephants on the Wall

I was reminiscing this morning about medical school and some of my psychiatric training.

I clearly remember the first day of my psychiatric rotation in medical school. It was my last rotation in my final 4th year. and knew by that time that psychiatry was the field for me. I felt anxious and excited when I walked into the hospital that morning. I met the attending psychiatrist who was assigned to me. Without further ado, we immediately went onto the locked ward to make morning rounds. He said, “Don’t worry. You’ll be fine. You’re training starts now. You’ve learned a lot of theory in the books, but this is where it’ll start for you.” I never had been on a locked psychiatric unit before. I felt apprehensive but not totally frightened. Short of 5 minutes on the unit, we discovered one of his patients sitting in a wheelchair in the middle of the hall. She looked to be in her 70s. Well made up. Hair curled. And pretty. She was energetic and animated given my internal concept of what “old” people were supposed to be like.

The Dr. began to speak with her. She smiled warmly and it appeared that she totally understood him. Then she spontaneously looked over at the right side of her to the wall and stated, “Oh, yes. I totally understand what you mean. Aren’t those pink elephants up there on the wall pretty? I think they are playing. Let’s go over and look at them.”

I began to feel up with tears not knowing exactly what I was feeling. Being an astute man, the Dr. took me into a side staff room and sat down with me. He said, “I can already tell that you are going to be an excellent psychiatrist just by your reaction. But, I need to remind you of something. You’re going to see, hear, feel and experience more things in this field than you ever imagined—more than most people could ever dream or think of during their entire life. So, you can either laugh or cry. One of the two. For your own insanity during your career, you must learn to laugh. Otherwise, you’ll burnout and never last. It’ll take some time to learn to laugh but it will protect you in the long run. (And, yes. Humor is the 2nd best defense mechanisms out of over 30 of them. I don’t think we use it enough with patients with dementia and their caregivers.)

As I ponder this now, I would be highly convinced that she suffered from Lewy Body Dementia (LBD) since seeing non-existing animals and people can be a pleasant experience. This is one of the features that is different than Alzheimer’s disease.

Just think. Few people know about Lewy Body disease now in 2009. Imagine the little information that even neurologists knew back in 1977!

As I type this, I am reminded of how I saw pleasant flying peace doves, my dog, and other playing animals at the bottom of my bed last at the end of 2007 while in the hospital being evaluated for LBD.

So let’s use some humor. I laughed a lot when I tried to answer these questions…………I hope you do too!

Take the test presented here to determine if you’re losing it or not. The spaces below are so you don’t see the answers until you’ve made your answer. OK, relax, clear your mind and begin.

1. What do you put in a toaster?
Answer: “bread.” If you said “toast,” give up now and do something else. Try not to hurt yourself.. If you said, bread, go to Question 2.

2. Say “silk ” five times. Now spell “silk.” What do cows drink?

Answer: Cows drink water. If you said “milk,” don’t attempt the next question. Your brain is over-stressed and may even overheat. Content yourself with reading a more appropriate literature such as Auto World. However, if you said “water”, proceed to question 3.

3. If a red house is made from red bricks and a blue house is made from blue bricks and a pink house is made from pink bricks and a black house is made from black bricks, what is a green house made from?

Answer: Greenhouses are made from glass. If you said “green bricks,” why are you still reading these??? If you said “glass,” go on to Question 4.

4. It’s twenty years ago, and a plane is flying at 20,000 feet over Germany (If you will recall, Germany at the time was politically divided into West Germany and East Germany). Anyway, during the flight, two engines fail. The pilot, realizing that the last remaining engine is also failing, decides on a crash landing procedure. Unfortunately the engine fails before he can do so and the plane fatally crashes smack in the middle of “no man’s land” between East Germany and West Germany . Where would you bury the survivors? East Germany, West Germany, or no man’s land”?

Answer: You don’t bury survivors. If you said ANYTHING else, you’re a dunce and you must stop. If you said, “You don’t bury survivors”, proceed to the next question

5. Without using a calculator – You are driving a bus from London to Milford Haven in Wales . In London, 17 people get on the bus. In Reading, six people get off the bus and nine people get on. In Swindon, two people get off and four get on. In Cardiff, 11 people get off and 16 people get on. In Swansea, three people get off and five people get on. In Carmathen, six people get off and three get on. You then arrive at Milford Haven.What was the name of the bus driver?

Answer: Oh, for crying out loud! Don ‘t you remember your own name? It was YOU driving the bus.

If you’d like to receive an email whenever I publish a post on the blog click here: Get an email to “A Diary of a Psychiatrist with Lewy Body Dementia (LBD)”

Warmly…..David

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17 Responses

  1. I love the questions. That last one made me laugh out loud. Thanks for the chuckles.

  2. Thank you for the article about humor. Without it I would have caved a long time ago. I beam with pride when my primary care physician and my dear psychiastrist tell me that I am doing a great job. That is good for me to hear. When others try to pity me I tell them to stop. This is my pleasure and I know the fine line I cannot cross allowing empathy to over come my thinking. I could not do my job if I tried to be “the patient” as well as the caregiver. With humor, we still have a certain degree of our togetherness and much love is recognized between the two of us, much like the foolishness we experienced as teenages… he thrives on it and, as I said, I beam with pride. I know I am contributing something that no one else in the world can give to my love. So I laugh and sing and we are both calm for the effort. You are so special, Dr. David!

    Dorthea

  3. “I don’t think we use it enough with patients with dementia and their caregivers.”

    ~~~~~~~~~~~~~~~~~~~~~~

    You are so right, laughter is a palliative. When I am visiting my husband, laughter resounds.

    Last week Dave and I were sitting on one of the couches looking at the paper and chatting. As frequently happens three or four other residents came over to socialize.

    Jerry, only with us for a month, had been walking around the room telling whoever would listen his plan for something or other. There was not a doubt in my mind that he knew exactly what he was saying.

    When he joined our group, he began explaining to one of the men. He moved on to me next. After a few minutes I looked at Alice who sometimes cues from me–I asked her, “Do you understand this, do you know what he is talking about.”

    (No way that was an insult because his subject seemed very arcane. I am very careful.)

    Alice shook her head and started chuckling, setting me off, and soon the whole group including Jerry were practically rolling on the floor.

    including Jerry.

  4. David, I totally agree–laughter can get you through anything. You know that saying “If I didn’t laugh, I’d cry”? I live by that in my life and on the job. My main goal, when I walk through those doors to work, is to make sure every resident there has at least one good laugh while I’m there. Usually, they end up having several because I’m so goofy with them!
    Great post!

  5. Good for you Barbara.

    Our caregivers tend to give more hugs than laughs, but I am there every other day to help supply those.

    another thing I have noticed is that a lot of activity energizes the room. Not planned activity, people coming and going, socializing.

    Usually I help my husband settle down for a nap before I leave so that the parting is easier for both of us, but often he prefers to stay up in the big common area where life is happening.

    • Michelle………I think it is super that you’ve started a dialogue here.

      David

  6. I am eager to learn and share as much as I can.

    This is a world few people know exist. (Sorry, I have no stats on that, just guessing.)

    David, of course I am new here so don’t know much background, but have you though of doing some volunteer socializing ?

    I am thinking to give a gift, and receive one.

    Today i told our med-aid about this blog. He may drop in. Wants more info on Lewy body, had only heard the name, no specifics.

    Guessing my dear marge has it, hears voices in her ears (seems the right one). Pretty well under control which is good because they disturb her.

    • Michelle……………I’m not sure what the term means “volunteer socializing.” Could you explain more? Thanks…….David

  7. I mean regularly visit a place like ours where their are a good sized group of residents (ours has sixteen) and get to know some of the people.

    As I say, I am new here so don’t know much about your situation, but I would imagine fear of what the future holds is part of your ruminations.

    You may see that the reality is very different.

    • OK………gotcha. Thanks. I’ve thought about it but never went any further with it in my head. I’ll need to look around the our area to see what’s available. I like your idea.

      David

  8. Oh good. I can’t say enough about our Memory Care Unit at Skylark Assisted Living in Ashland, OR.

    I hope there are thousands more like it.

    If you decide to visit, I would be glad to give suggestions on how to approach people, or rather, make yourself approachable.

    For example, I have never had a hug turned down. Might be different for a visiting man, best saved until you are familiar,

    Michelle

    • Michelle………you said, “If you decide to visit, I would be glad to give suggestions on how to approach people, or rather, make yourself approachable.”

      Would you be willing to share with us some of these approaches and how to be approachable?

      Thanks…..David

  9. Sure, be happy to.

    I’ll give it some thought and send it by e-mail so you can decide what to do with it.

    Michelle

  10. People with dementia living in care facilities benefit from the stimulation of visitors. Even one visitor can energize the group. This is particularly true when the visitor interacts with other residents.

    Often people avoid this interaction because they are not sure what to do, say. I faced this initially when I admitted my husband into the Memory Care Unit of an assisted living facility a year ago.

    My determination to visit him every day for a few hours proved to have benefits that went beyond keeping our relationship intact. I became part of a population few have the privilege of knowing: people living in an essence of themselves.

    Realizing this banished my attention to our differences. I began by greeting each with a handshake and introducing myself, then asking her name. One person one day, another or two the next. Always re-greeting ones previously met. No different than any gathering you have been to.

    Some of the residents are in wheelchairs, so I kneel down to talk with them face to face. No different than you would in consideration for anyone else.

    What to talk about? It matters little, she will talk to you. All that is required of you is to care. Laugh any chance you get. Make the joke, laugh yourself, her laugh will follow.

    Touching. Very important. I have never seen anyone turn down a hug or hand holding. I spend time talking and walking, arm around her shoulder; or just including her closely within whatever group I find myself. It is comforting for both of us.

    A man who visits might want to take a while longer to initiate physical contact. However, we have several male caretakers (two very large) who are equally embraced.

    The men residents like hugs of course. And flirting. And dancing if the music is just right.

    I take my cues from expressions and body language. Sometimes a resident is in a mood not conducive to interaction. If you know them well, you might ask if you can help.

    ~~~~~~~~

    Sometimes the room is quiet. A nice time to lay your head on your hubby’s lap and read aloud from today’s paper. Soon others will open an eye, move toward the action.

    Sometimes tossing balloons. Sometimes starting a jigsaw puzzle or a structure with building blocks.

    Being open to responses is important, not ever pinning anyone down with “Do you remember?” If there is hesitation to a question, I back off immediately. I have found filling in words in when someone cannot finish a thought does not work and is only frustrating for both of us.

    For any who already visit a loved one and would like to bring comfort to fellow residents, I hope these clues allow you to begin.

    For those contemplating the move, or afraid of the invisible future, becoming acquainted with care facilities especially tailored to the needs of dementia patients, visiting, or even volunteering to come regularly has benefits you may not now appreciate.

  11. […] want to thank Michelle for her nicely worded comment which she posted today under the Pink Elephant blog. It is also listed on the right side of this page under ‘recent comments’. It is […]

  12. Dr. Thomas,

    Thank you for being so open and brave about your struggle. Its a tough thing that few people can really understand. Chronic Illness, robs us in so many ways. Ways most people can’t even begin to fathom.

    I stumbled here because I noticed someone from your blog was visiting mine. Lucky me.

    I hope you find peace… and maybe an answer or two along the way…..

  13. Those comments are wonderful and very wise. Thanks, Michelle. Maybe some of us will find something positive and helpful to do whith our free time.
    You are doing a great job!

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