I found my new patient in bed with his eyes closed. Though in his late 70s, Dimitri had a full head of mostly dark hair and the sculpted cheeks and chin of a model.
A day earlier, he had arrived at our nursing home’s advanced dementia unit with little more than lists of diagnoses and medications. From those few pages, I learned that Dimitri had end-stage Parkinson’s, dementia and several other common chronic diseases. Like nearly half of Americans in his age group, he was taking more than five medications each day to treat his ailments — 10, to be exact. Marina, the unit’s head nurse, told me he’d been living with his wife and adult daughter, but they could no longer manage his care at home.
I said his name, but he didn’t respond. Then I touched his arm. Nothing. I shook him a bit, repeating his name in a louder voice, and finally his eyes opened. Marina, who spoke his native Russian language, explained who I was and why we were there. He stared back at us with blank, unblinking eyes.
With Marina translating, I asked Dimitri two questions: What is your name, and are you having any pain? Because Parkinson’s slows people down, we had to give him some time to respond; I sang the chorus of “Happy Birthday” in my head to make sure I waited long enough. In response to the first question, Dimitri’s lips moved, but no words emerged. He didn’t even try to answer the second one, so we skipped ahead to the physical exam.
