Sometimes a patient or caregiver decides that letting an illness take its course is preferable to seeking a cure. As someone who’s used to fighting battles, this approach often leaves me surprised and disappointed.
Some years ago, a woman came to me for help implementing the Bredesen Protocol for preventing and reversing cognitive decline. For a few months, she and her husband attempted to follow the multi-faceted regimen but ultimately decided it was too overwhelming. She felt relief upon dropping out, and though displeased, I could understand their decision.
My cousin’s husband made the same choice for his wife, who has late stage dementia. Because the Bredesen program is intended for patients in the very earliest stages of dementia, he reasoned the chances of success were slim. I understood his decision as well.
And yet, there is an intermediate ground between following a protocol in its entirety and letting the disease run its course. I can’t help but wonder, If my cousin-in-law had managed to get his wife to follow even part of the program, such as the diet, would she have fared better than she has? On the other hand, I also know that getting a dementia patient to follow a diet is challenging.
I have another dementia patient, Sarah, who has neither spouse nor child to care for her. Recently, her assistant scheduled a Zoom meeting so I could meet Sarah's health proxy and the friend who has assumed power of attorney. Mark, the health proxy, asked if it was worthwhile continuing the Bredesen protocol, given Sarah's progression over the last few years. Whereas she once understood her condition, she now no longer realizes she has dementia. She has developed episodes of paranoia and requires a night aide.
Mark's question was entirely reasonable. After all, it is difficult for Sarah to take so many nutritional supplements and hormones and to follow a complicated exercise and diet regimen. Nevertheless, I felt confident in assuring him that the effort is worthwhile. I believe that following the program has enabled Sarah to remain in her own comfortable home rather than having to move to a residence (although I wouldn’t rule that out in the future). Even though we haven’t reversed her cognitive decline, we have certainly slowed it down.
Another example of someone who is still fighting the battle is my patient with advanced Parkinson’s disease. Although he is bedridden and requires assistance for every activity of daily living, he still texts me with various protocols he has researched online and wants to implement. He and I are of the same mindset. Why give up when options are available?
Another patient, diagnosed with prostate cancer, traveled across the country to visit a residential treatment spa and recently decided to retire from his demanding job to take control of his diabetes. I’m all in with him as well.
While my first instinct is a full-on battle to beat any illness, in many cases, that is simply not feasible. I remember years ago, a potential new patient described herself as a minimalist. That is, she wanted the least number of health interventions possible. For a young, healthy person, this is a reasonable request. For someone with multiple medical conditions, however, it’s another story entirely.
What makes some patients go all in, while others drop out? Is it an innate optimism, a natural tenacity of spirit, or a fear of disability and death? Or perhaps they fight on for others — to be with a beloved child, grandchild, spouse, or friend. For me, sheer love of life would be incentive enough to carry on. I think some deeply religious patients would do it to serve God. In any case, it’s something to ponder.
In most cases, it’s possible to chart a course between the two extremes, picking and choosing your treatments. Doing everything may be optimal but not always realistic. Sometimes you simply need to adjust your sights.
Have you ever encountered a patient who made you adjust your sights? Share your experience in the comments.
Marjorie Ordene, MD is an integrative physician practicing in Brooklyn, NY. Her essays, short stories, and poetry have been published in various magazines and anthologies including The Sun, Tablet, Lilith, and Michigan Avenue Review.
Names have been changed to protect patient privacy.
Illustration by Diana Connelly
