I am 23 years old. I am working for a neuropsychologist who generously decides he believes in me and wants to support me in my own quest to become a neuropsychologist. He teaches me how to administer several types of assessments to screen for dementia and depression. So off I go to the nursing home, in my thrift store blazer so I at least appear to be a professional.
I am meeting with Mrs. Sabotino. She is of Italian descent, even having a trace of an Italian accent. She is barely five feet tall. She just moved into the nursing home. I am a little nervous, as I always am when I ask these questions. She is warm and seems happy to have a visitor. This makes me more nervous because I know I am going to disappoint her, as I am not here to socialize with her. I start with the Geriatric Depression Rating Scale.
I clear my voice.
“Mrs. Sabotino, are you basically satisfied with your life?”
Mrs. Sabotino shrugs. Looks out the window.
I wonder how long I am supposed to wait. Can she hear me?
She interrupts my thoughts.
“When I can make the sauce…..”, she says evenly.
I make a mental note. Clearly dementia.
I confirm, “When you make the sauce?’
“Yes.“ Mrs. Sabotino nods at me like she is bored.
“Have you dropped many of your activities and interests?”
She shakes her head. “Yes, because I cannot make the sauce.”
I write down “Yes?”
I start to panic. Maybe Mrs. Sabotino is not going to answer my questions! What do I do? I don’t think I am supposed to be chatty with her. I decide to stick with the plan.
Okay, next question.
“Do you feel that your life is empty?”
She nods more vigorously. “When I cannot make the sauce!!”
“Do you often feel helpless?”
“Yes, that is when I cannot make the sauce.”
“Do you often feel downhearted and blue?”
“Yes.” Mrs. Sabotino nods sagely. “Because I cannot make the sauce!” Her voice raises slightly.
Oh, boy. I was definitely not trained for this. I am in full blown panic mode. Do I write notes about the sauce? I carry on.
“Do you feel pretty worthless the way you are now?”
Mrs. Sabotino takes my hand, and looks right at me. “You see….I cannot make the sauce.”
We go through the rest of the questions, and each answer is sauce-related.
Although I am a bit confused myself, I decide to administer the mental status exam to her. She gets a low score, one that would indicate, according to neuropsychological interpretation, that a person has limited awareness and high levels of confusion.
Yet, Mrs. Sabotino knew how much she wanted to make the sauce. She was very aware of that. She was not confused about that. She was very certain about that. She knew there was something missing in her world. She could see it. Maybe even taste it. Maybe she could not say where she was. Maybe we would say she was not oriented. But she could tell me WHO she was. She could tell me what was important to her.
I wish I would have asked Mrs. Sabotino more questions. Not questions about counting backwards from 100, or if she would draw a clock for me. But things like, “Who do you make the sauce for?” “How do you make the sauce?” Or even, “Yum, how good does that sauce taste?” I wish I could have listened more.
I wish I would have made sauce with her.
After some time, I decided that neuropsychology was not a great fit for me. And I am eternally grateful for the many people who tolerated my questions, especially Mrs. Sabotino. Something started unraveling in me that day, and made me start questioning how we see people living with dementia. Or, maybe, more accurately, how we do not see them. That sometimes we are looking to see something about them, usually something that is wrong with them, and miss all the other things that are right with them.
4 thoughts on “When We Don’t Make the Sauce: An Assessment”
What a beautiful look for lesson for you! ❤️❤️
What a beautiful look for lesson for you, Sonya!
Sonya, You don’t need me to tell you that we’ve all made similar “mistakes” in our journey to be with folks with dementia in ways that are helpful to them. As you show, the important thing is to learn from them.
I want to comment on your last sentence. To me, this represents one of the most important ways that we can change our thinking about olders, aged living (and care), and dementia. Instead of asking “why doesn’t she?”, we need to ask “why does she?”. Instead of fearing all the bad things that might happen if we “let them” walk about, go outside, or eat what they want, we need to celebrate the good things that happen when they are “allowed” to live freely (because we know the person and have a plan that includes guard rails). Instead of fretting over health behaviors that we think produce bad outcomes, we need to ask ourselves: How did he get to 95 (or 85 or 105) years-old? He’s really done okay, hasn’t he? Maybe we should let him be and celebrate his ability to navigate all those years successfully.
Thanks for sharing your story, and your wisdom.
I love all those things you said, especially the real examples of how we might focus on what people CAN do and DO do. Maybe elders would be less fearful of changes as they age if they know that they would not be 100% assessed for everything that is “wrong” with them and had some assurance that they would be seen for everything they are, especially the “right” things. Thank you for joining the conversation!