In medical school, students learn to view the world through a biomedical lens. While necessary clinically, this lens can be impersonal. For example, the mental status examination (MSE) evaluates cognitive function through a brief assessment of alertness and orientation to person, place, time, and situation. While clinically useful, the MSE often neglects to capture a person’s individuality. Visiting my grandmother who has Alzheimer disease highlighted this tension. I juxtaposed the impersonality of our MSE orientation scale with my grandmother’s lived experiences. My grandmother is identified using a pseudonym. Informed consent was obtained from her health care power of attorney and family.
Birds twitter and chirp as they flit into the shade,
the covered patio a respite from the morning’s heat.
I sit with Joanna and show her a painting:
an apple, red peppers, a garlic clove, and a grapefruit
rest on a white napkin.
Produce so vibrant the napkin is stained
with their vivid reflections.
The wrinkles around her eyes deepen as she squints at the picture.
She always liked to see my artwork.
Bright colors illuminate the lines of confusion on her face.
Where did you get all this food?
We’re rationing for the war to stop Hitler.
I have evaluated dementia:
limited treatment options, behavioral interventions.
Cognitive changes alter
orientation to self,
place, time, situation.
Joanna and I sit on the memory care patio.
The birdfeeder dances in the humid summer air.
I’ve shared my artwork with Grandma Jo
from crayons’ waxy scrawl
to crisp acrylic colors.
Today a t-shirt replaces my white coat.
The war is over, grandma.
The produce is from a grocery store.
I redirect with another painting.
This is a bridge in a park—
She smiles: it’s New York City, I miss going there.
In the middle of Central Park,
a cement bridge in a grassy park
spans a wide, still pond.
Today, the colors of the bridge,
reflected on the water,
spark a glimmer of my grandmother.
This time she knows the memory is in the past,
as she tells me about New York in the Forties.
With the beating of sparrow wings,
the moment of clarity ends
as past and present are blended again.
When the sun sinks, my visit will fade.
I clutch what happened
outside, away from the clinical setting.
What we cannot quantify
with A&O x1: oriented to self.