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The Globe and Mail

A mind’s shifting landscapes of loss and light

Neal Cresswell/The Globe and Mail

I'm no expert on dementia, but I've learned a lot in the two years I've volunteered in a hospital transitional care unit – a way-station for people who can't live at home any more and are waiting for a bed in the community.

Jacques, an elderly patient, allowed me into his world, and I was grateful for his trust. We enjoyed a playful, but always respectful, kinship.

A true gentleman, Jacques had spent most of his life as an engineer, and a brilliant one, I'm sure. Even as dementia clouded his thoughts, garbled his speech and prevented him remembering what he ate for breakfast, the depth of his sharp mind was evident.

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"I'm talking about the fact that we must make things better," he said one day, raising a bony hand for emphasis. "We have a responsibility."

We were at Tim Hortons, and the recreational therapist was doling out Timbits to a small circle of patients who had made it down from the fourth floor to the wide world of the hospital lobby.

Jacques became agitated by the noise and activity around us, the Timbit forgotten half-way to his mouth.

"There's so much we should be doing, and I'm concerned the others don't realize the responsibility the committee has given us," he worried.

"Hmm, that must be difficult," I ventured in what I hoped was a soothing voice. "I know your work is important to you."

"Yes, it is! And I feel guilty just sitting around when I should be working. I'm just being lazy," he said with a scowl. There was no point reminding him he retired from his profession years ago, and was in hospital for a reason.

I tried to change the subject by commenting on the sun streaming in, but he wouldn't be sidetracked. He needed to make sure I understood the seriousness of the project. But as he searched for first one word, then another, the idea itself became derailed and speechless panic silenced him.

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His feet pushed and dragged his wheelchair in jagged motions. I had to twist my legs to the side so my shins wouldn't get bruised. His body and mind were constantly shifting, and he was keenly aware of this, which added a further layer of dismay and frustration to his daily existence.

The coffee and Timbits consumed, the therapist announced it was time to return. The 45-minute excursion had been tiring for everyone, and we straggled upstairs. Jacques shuffle-wheeled himself into his room and I said goodbye.

The next week, the therapist led the group in music and movement in the activity room. Jacques was eager to join in, and made light-hearted jokes in his hoarse voice. The rhythmic activity seemed to focus the restlessness of his body.

I went around the circle of seated patients, taking their hands to "dance" with them. Jacques swayed and smiled, enjoying the moment. There was no talk this time of work projects and responsibilities.

Winter turned to spring and Jacques became a long-timer in the unit. Some patients stay a few days, others a year, depending on how long it takes for them to stabilize and for a bed to become available elsewhere.

One week, I found Jacques lying in bed, as he often was, but he seemed different. His eyes were closed and he was free of agitated movement. He was dressed elegantly in black pants and a black sweater. It was a warm April day outside, but the seasons don't change inside the hospital. His profile caught me off-guard.

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As the sun streamed in the window, I suddenly remembered the bright September day six years earlier when my father passed away. As he'd lain sleeping that morning, the sharp line of his nose and the boniness of his skull made me wish for his peaceful passing. (I had my wish a few hours later. His 72-year-old body had been invaded by leukemia, but he was still himself, his brilliant mind evident to his last breath.)

I knocked gently on the bedside table.

"Good morning, Monsieur Jacques," I said gently, using my nickname for him. He opened his eyes quickly.

"I have to talk to the bank manager," he said. "The account was overdrawn by only $50, but the teller … she didn't understand my instructions."

I stood for a minute, wondering if I should let him sleep in peace.

Then I said: "Hmm, that's tough. Especially because you're so good with money."

"Exactly!" Jacques responded. "That's just it. I'm very good with money."

Then his eyes focused on my face, and his eyebrows lifted into delighted triangles. He was awake.

"I'm Jane," I said, as I do every week no matter how long I've known a patient.

"Yes, yes, Jane," he said in his debonair way. "I'm feeling much better today. I was just taking a little nap here in the sunshine."

"Would you like to join us for an activity this morning? We're going to play cards."

"Yes, yes, cards. That would be very nice." A mischievous smile played at the corners of his mouth, and his eyebrows pointed up again.

"Perhaps you'll have to watch that I don't cheat."

It was a good day for Jacques.

I helped him into his wheelchair and he was off, shuffle-wheeling down the hall ahead of me.

Jane Wood lives in Ottawa.

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