This OSP Journal of Case Reports section is a vignette almanac whose purpose is to provide a record of the emotional climates of the general practitioner, expressed as metaphors of landscapes, geographical features, atmospheric data, lunar phases, sunrises and sunsets, beginning and end of the seasons of the year, winds, tides, etc., when dealing with different clinical cases, with the aim of achieving a greater understanding of what we are and what we do as doctors, and then achieving greater empathy. Here, a vignette of a case of “forgetfulness” in an elderly person is presented where the general practitioner asks himself how he can help fill in the gaps of forgetfulness and increase the patient's safety margins? This situation creates an emotional climate in the doctor that suggests the patient seems to be swimming, without realizing it, in a dangerous zone that drags him through narrow gaps between the nearshore bars by rip currents.
Emotions; Ageing, Alzheimer, Old people; Metaphor; General practitioner
[“Rip currents are strong offshore directed currents that occur when high waves break over nearshore sandbars”]
Vignette
Mr. Casimir was the next patient.
He was 75 years old. He had been a farm worker. He had high blood pressure.
The general practitioner (GP) reviews his medical history: On amlodipine… Last blood test 2 years ago… He has already finished the medication prescribed electronically at the pharmacy…
The doctor imagines that Mr. Casimir is coming to renew his antihypertensive medication.
Thirty minutes before the appointment time, Mr. Casimir is already sitting in the waiting room. He comes, as always, alone.
He enters smiling and shakes the doctor's hand. A big, fat, hard and rough hand. He sits down and continues smiling in silence…
To break the silence, which has already lasted a few seconds, the doctor tells him that he no longer has medication for his blood pressure in the pharmacy and that he has just renewed it for him.
But Mr. Casimir does not answer, and continues smiling, with a happy face. At last he says that “it is fine… I do a lot of exercise…, I walk in the countryside…, I like the countryside a lot, and I go fishing, and I ride a bike at home… For dinner I eat 2 oranges…”
-” And now what did you want to ask me?”, asks the doctor
-”……. Well now I don’t remember”, answers Mr. Casimiro smiling.
-” Would it be about blood pressure?”, asks the doctor, trying to smile as well [1].
Mr. Casimir does not answer, he gets up from the chair in front of the doctor's table, and still smiling and narrowing his eyes, he shakes the doctor's hand again, with his hand big, hard, fat, rough.
-” Well, goodbye doctor.”
- “Maybe Mr Casimir, when he half closes his eyelids, sees the countryside where he have worked all his life, the wheat fields and the olive trees, the trellis at the entrance to the house, and the poplars that bordered the river…; but he can't remember almost anything else,” thought the doctor.
The GP reflects on the patient's forgetfulness [2].
What attitude should he take? How can he help fill in the gaps of forgetfulness and increase the patient's safety margins? [3] -” At least he keeps his smile” [4], the doctor thinks.
The GP imagines Mr Casimir swimming dangerously in rip currents. When breaking, high incident waves raise the water level in the area between the beach and nearshore sandbars. This elevated water is discharged by rip currents that flow seaward through narrow gaps between the nearshore bars. A local setback in the shoreline is often seen opposite the rip opening. The rip opening travels slowly downstream [5].
-” Rip currents are dangerous for swimmers”, thinks the GP.
- Butler A (2024) Give Alzheimer's patients your empathy, smile. The Gadsden Times.
- National Institutes of Aging (2024) Memory Problems, Forgetfulness, and Aging. National Institutes of Health.
- Yoon PS., Ooi CH., How CH (2018) Approach to the forgetful patient. Singapore Med J 59: 121-125.
- Lizuka T., Kameyama YU., Fukasawa M., Akishita M., Kameyama M (2023) Impaired ability to smile in Alzheimer’s disease is associated with reduced brain volume of nucleus accumbens and pallidum, revealed by artificial intelligence. Alzheimer's Dement 19: e082571.
- The Coastal Wiki (2024) Definitions of coastal terms.
