This weekend was to be my weekend to visit my son, Takoda, in Burlington, Vermont, where he has been attending college. Instead, he finished classes sooner than I had anticipated and used some of my United Airlines miles to fly to Hawaii to visit his girlfriend. Suddenly I had a completely free weekend, so I decided to visit Toronto where a friend was helping his mother put his father into long-term care. My friend's father had progressively deteriorating vascular dementia, meaning that his dementia had been caused by multiple strokes, each one leading to a stepwise deterioration in brain function. He had the usual risk factors hypertension, overweight, high fat diet, excess hard liquor consumption, history of long-term cigarette smoking, family history, but, of course, that doesn't make it any easier on the family when the inevitable stroke occurs. This was the long awaited weekend in which my friend's mother had finally had enough she couldn't care for her husband at home any longer. No one could blame her. He couldn't control his bowels or his bladder. He talked incessantly and understood little. He required half an hour of coaxing just to take his morning medication. The only way he could read the newspaper was to sing it, since that recruited a part of his brain that could still read. He couldn't recognize words unless he sang them. Even then, it wasn't clear whether he comprehended the words he was singing.
I was recruited to take Ian for a walk while my friend took his mother shopping. I was a bit apprehensive because I had heard stories about his aggressively accosting people and wandering into strange houses. I wasn't sure what I would do if he pooped his pants in the middle of the walk. What would people think if we were walking with poop dripping out of his shorts. Nevertheless, I kept my worries to myself like a good guest. After all, I am a geriatrician and a psychiatrist. I should be able to take one octagenarian with dementia for a walk. My friend's mother laid out the route on a map of their neighborhood one large square designed to take him past several parks and on roads that were not too busy.
My first challenge was to get Ian to the washroom before his walk. I had been strongly advised to do so to avoid mishaps on the walk. However, regardless of how hard I tried, Ian wouldn't go into the washroom and was suspicious of why I wanted him to do so. He kept suggested I go to the washroom or that I come inside and see what he could do. That sounded like more than I could handle on a Saturday morning, so I declined, abandoned the pre-walk washroom idea, and steadfastly resolved that I would muddle through whatever came. I told him in no uncertain terms that we were going for a walk. At first, he heard talk. I spoke louder and repeatedly, and he finally heard walk. I handed him his hat and his walking stick, and then he clearly understood. We stepped out of the house and preceded North along his street, walking a slight incline. His wife had warned me that he walked with the speed of a turtle, and she was not entirely wrong, though I have seen wombats in Australia move this slowly, as well as koalas who've eaten too many intoxicating gummy leaves.
Nevertheless, we had a marvelous walk and I learned much about the workings of his brain. In a fascinating way, his brain matched the patchwork that one would expect with a vascular dementia in which there were intact islands of function surrounded by much more immature brain processes. His patterings on the walk gave me some insight into how the brain of an infant or a young child might work. First, he was fascinated with trees. He kept saying, "they put them here." "They put them here." Sometimes they fall down or they take them down." He had the concept of trees being placed instead of growing on their own, and I learned later that he had been instrumental in arranging for trees to be planted along many of the streets in his neightborhood during the earlier years of his retirement. Trees, in his world, had literally been placed instead of springing naturally up from the sides of busy Toronto streets.