What's left inside.

“Careful,” the nurse warns as she wheels her computer out of the patient room and into the hallway, where I stand waiting my turn. “This one’s a doozy.” Nudging her head towards the doorway, she rolls her eyes for a split second, and leaves me to fend for myself. “Oh! Doctor! Please, come in! Have a seat!” A tall brunette woman leaps off the bed. She had been seated snugly against the patient, her hand in his. She’s beautiful; tastefully fashionable for a woman in her fifties; her make-up, subtle. Diamonds weight her earlobes, almost precisely matching the sizable ring on her left hand. Such a stark difference from the drooling, unshaven patient staring blankly from the bed. “My name is Valerie—John’s wife.” My eyes shift back to John, disheveled and scruffy, eyes dull, gown stained with Jello, then back to Valerie. Slender and pretty. If I look a little harder, I can see it; I can convince myself that his unshaven face is purely a result of this hospital admission, and his grey hair is not old age, but distinguished—premature. Certainly he is among the youngest patients on the floor, but in a terrible, heart-wrenching way. Valerie paces, not furiously, but with intention, in front of the windowsill. As she talks, I try to recall the sign-out I received just hours earlier: 56-year-old white male with past medical history of frontotemporal dementia admitted for first seizure. Loading with Keppra and Dilantin. Should be discharged home on these new meds shortly. But the story Valerie tells is different: 56-year-old white male with history of a completely normal life. Handsome, well-educated. Business executive with money to spare. He married a beautiful woman, they had a son. I never ask to hear Valerie tell me their story, but then again, I don’t ask her to stop. “Do you know how most patients with frontotemporal dementia are diagnosed?” Valerie asks. She stops pacing, and perches stiffly on the windowsill. I wrack my brain nervously. Frontotemporal dementia, synonym: Pick’s disease, frontal lobe destruction, humiliating lack of inhibition, no known cause or treatment. But I cannot remember how most are diagnosed. “No,” I admit. “I can’t remember.” “Fifty percent are diagnosed upon being fired from their jobs,” she recites. “And fifty percent are diagnosed upon divorce.” I’m sure I could run a quick search, tweak her statistics a bit, but I don’t. All I care about is that John is among the latter. Valerie came home from work everyday, like most of us, wanting to talk—about her job, the neighbors, their son. But she started getting nothing in return. John would sit at their kitchen table, and stare. Sometimes he’d laugh. Sometimes he’d just get up and leave. Valerie was hurt, then infuriated, and then at wit’s end. She tells me about the day she left him. She spares nothing: the expletives, the tears, the gut-wrenching words she never thought she’d say. Weeks later, a physician friend picked up on John’s diagnosis, pivoting Valerie back to her husband, unsure and afraid, but determined to navigate her family through this newly diagnosed nightmare. She tells me about a day not too long ago, when she was helping John in the shower. She washed him in a way that irked him. But with his pickled frontal lobe, he couldn’t express this, and instead, he dropped the soap, grabbed her by the shoulders and slammed her against the shower glass, roaring some incomprehensible syllables. Valerie was shocked—scared at first, then perplexed by a strange relief. Months had passed with John becoming flatter, blanker, more glazed over, and now there was this volcanic declaration of something left inside. It was the first sign of life she’d seen in him in months. “He could’ve killed me, you know. He could’ve shattered the glass as he pushed me. I could’ve bled to death on my bathroom floor. But it didn’t matter, you know why? Because this meant there was something left of my husband.” Her voice cracks. “It gave me something to cling to.” Then the seizure. The Keppra. The Dilantin. To Valerie, it seemed John had retreated into the inaccessible world of his disease, the medications dead-bolting the door behind him. She pauses. I try to catch up with my thoughts and my heart, racing, pounding. “I’m telling you this,” Valerie continues, “ because I need you to realize my husband’s potential. Not his potential to harm. His potential to be human. Look at him!” John sits staring, drooling. “Before the meds, he still had his disease. But I still had what little of my husband was left.” Valerie looks at me, with such pleading eyes, that I feel it scorching my face, seeping into my bloodstream. She asks me to stop John’s medications. Not so that he might seize, or die. So that he might live. I sit frozen in my chair. She slinks off the windowsill. I stand without knowing it, and we hug. Her tears are out now. They are on my coat, and in my hair. Outside, I stop briefly at a computer. Click. Click. Right-click. Scroll. Pause. Keppra-click—discontinued. Dilantin- click—discontinued. It feels odd. In this place. I almost never undo, or revoke—especially without adding, or adjusting. I’m a doctor, I tell myself—I do, I tweak, I intervene. I certainly don’t stop life-altering medications in times like these. And I don’t stand by and watch. But I can, and tonight, I do.