As a senior clinician, I have been spending more time reflecting on my life and medical career.  As clinicians, we are privileged to become an important part of the lives of our patients, families, and staff.  Part of this work is making future memories, but also part of it is facilitating the recall of past events and how that relates to the present and future.  We all bring our background to this process.

I grew up in a singing family where Christmas caroling was an integral part of the “Joy” of the season.  My love and respect for seniors in part reflects this background, since my maternal grandparents raised my siblings and I in a small town in Missouri for parts of the early 50’s as my father and mother recovered from TB and post strep glomerulonephritis.  I remember walking with my grandparents and other relatives to various homes of neighbors and frail seniors bringing familiar Christmas carols of “Good Tidings & Joy”. 

This tradition continued after we moved to California in the late 50’s to live with my Aunt’s family during a time when my father was in between jobs.  I remember piling into their large Dodge Station Wagon (7 kids and 4 adults – prior to seat belts) to Christmas carol at the homes of the frail seniors they knew.  This tradition was actually extended to also Christmas Carol just before Easter.

As a young physician with 3 children, I carried on this tradition by working with facility activity directors, to schedule caroling as a part of the holiday schedule for youth in our church.  This was the first time many of them had ever been in nursing homes or seen seniors with significant functional impairments.  Their initial fear were overcome as they saw the happy faces of seniors brightened by their presence and as they began to see our patients as knowable people.

Life races on.  I have continued scheduling opportunities for Christmas caroling in homes through my church and now my grandkids may occasionally come.   

About 4 years ago, something happened with one of my patients that shocked me.  Ruth at the time was in her 80’s and in the last chapters of a life well lived.  She was a pastor’s wife, but he had died of a heart attack many years prior.  Her son was a local pastor and her daughter was a missionary in South America.  Unfortunately, she developed a progressive Alzheimer dementia necessitating nursing home custodial care.  By this Christmas, her cognition had declined to the point where she had lost language and seldom recognized her son or daughter-in-law during their frequent visits.

As we began to carol in the activities room of that facility, I noticed Ruth in the second row sitting slumped in her wheelchair.  The vacant eyes and slumped posture changed as we began to sing. Surprisingly, she joined our singing with perfect and energetic recall of every carol.  Even more amazing, she could sing from memory all 3-5 verses of each carol.  Her son and daughter-in-law had tears in their eyes as they saw the Ruth of the past for a brief moment.

Prior to this occasion, I had known that the music domain was usually functional even in advanced dementia, but I had never seen it so well preserved and such a source of joy.  I’m not alone in this observation.  Some of my facilities have partnered with local rotary clubs to develop an individualized music program using iPods modeled after the Alive Inside work of Dan Cohan (he’s a keynote speaker at next year’s annual AMDA meeting in Orlando, FL.)

While making rounds recently on one of my patients in her 90’s with severe hearing loss and advanced dementia, I noticed the headsets connected to an iPod and doubted they would be of any value.  However, to my surprise, she replied she was enjoying the music.  We subsequently were able to have a simple meaningful conversation which hadn’t seemed possible in the last several years.

This is a great time to be involved in the practice of long term care medicine.  Stories like mine are occurring every day.

I look forward to hearing your stories of how you are facilitating meaningful memories in the lives of your patients, families and staff.

Merry Christmas and a Happy New Year!