Sandra W. Reed on Life Care Planning: Fictional account of Alzheimer’s sufferer mirrors real life

By Sandra W. Reed

The novel Turn of Mind by Alice LaPlante is an excellent example of how fiction can often teach us as much about life as non-fiction. LaPlante takes us on a journey through the mental wanderings of a renowned hand surgeon who, though only in her 60s, floats in and out of reality due to the progression of Alzheimer’s.

Attorney Sandra W. Reed answers your life planning questions.

Attorney Sandra W. Reed addresses your life planning questions in her weekly column.

The fictional account demonstrates vividly the mood swings — from petulance to aggression to downright meanness - the sufferer often exhibits to caregivers and loved ones. The protagonist, Dr. Jennifer White (no relation to Walter but at times as cruel) lashes out at daughter, Fiona, son, Mark and primary caregiver, Magdalena, on a regular basis. Those living in proximity to individuals afflicted with dementia may find this behavior disturbingly familiar.

And LaPlante nails the commonly exhibited conflict between siblings over who will control the money. Neither child is an ideal candidate to manage Dr. White’s affairs, another occurrence all too often present in real life. As frequently is the case, Fiona, as the less impaired offspring, is given a power of attorney and takes over. At least she, unlike her brother, doesn’t have substance abuse problems. If Mark had taken hold of the financial reins, he would likely have depleted the substantial estate Dr. White had accumulated.

Mark would have slapped his mother into a “memory care” facility under lock and key at the drop of a hat. Fiona, on the other hand, struggles to balance her mother’s needs for autonomy against her need for safety. Thus, Fiona spearheads the hiring of Magdalena to care for Dr. White in her home for as long as possible. Following a series of misadventures in which she wanders from home, has near misses at being killed in traffic and takes off her clothes in public, Dr. White is ultimately judged by her daughter to be a danger to herself.

Fiona sees that her mother is surrounded in the nursing home by beloved objects – her Calder, her Renoir and her treasured icon of a special saint.   Each time Dr. White demands to be taken home, Fiona reminds her mother that this is home now and that her most precious possessions are here. And, though most Alzheimer’ patients won’t own such expensive art objects, Fiona’s actions project the importance of recreating a familiar environment to the extent possible.

The novel deftly demonstrates the unevenness with which dementia can attack the mind and memory. Dr. White recalls in amazing detail the anatomy, diagnosis and treatment associated not only with her own field of orthopedics, but also with areas of medicine she was exposed to only in medical school. Through Dr. White we are reminded how the Alzheimer’s patient can seem so capable in one arena and at the same time not recognize the function of a toothbrush.

Dr. White displays the clear cognition and recognition Alzheimer’s sufferers experience on good days and the misery of confusion and inability to relate on bad ones. She identifies her best friend Amanda’s husband, whom she hasn’t seen for years, when he visits her on one occasion. But, when her son visits, she repeatedly mistakes Mark for her deceased husband, James .

In Turn of Mind Dr. White’s mental capacity is assessed regularly. In real life, periodic assessment is vital to determining the amount of control over decision-making one with dementia should be given. We also see how physical safety issues must be addressed. From exposure to her interior mental world, the reader learns that Dr. White is “addicted” to her scalpel and the love of cutting. The nursing home staff, aware of this, doesn’t allow her to be near knives even at the dining table.

Dr. White’s caregivers keep a journal of her daily activities and she is encouraged to add her own observations when possible. Dr. White reads the journal to recapture thoughts and events from her previous days when her memory has failed. This is another feature of the story that mimics good practice in real life.

Through the vehicle of fiction, LaPlante lets us observe the travails of dementia through the smitten one’s point of view. The reader is taken inside Dr. White’s head, sees with her eyes and feels the anger, frustration and confusion she manifests as she disintegrates. Dr. White gives a first-hand account of her struggle to maintain dignity and fight the disease’s destruction of self.

The genius of the book is that all is revealed through an Alzheimer’s patient’s muddled mind. Even though Dr. White’s is the experience of only one person saddled with dementia, nurses, caregivers and family members who have reviewed the book indicate that LaPlante’s is a spot-on depiction of the nature of the disease, the challenges and heartaches it imposes.

The greatest lesson from Turn of Mind is that dementia is not all horror. The novel contains moments of triumph, humor, compassion and forgiveness. I highly recommend reading it for the understanding and insight the book provides. Life care planning includes garnering knowledge of this prevalent disease. Those seeking valuable information need not be limited to non-fictional resources when a novelist like LaPlante has meticulously researched the topic and has gotten it right.

Sandra W. Reed is an attorney practicing in Glen Rose, of counsel with the Fort Worth elder law firm of Katten & Benson. Phone: 254-797-0211; email: swreed2@yahoo.com.

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