Read Making Rounds and Oscar (2010) for Free Online Page A

the 4 and 5, rather than at the 9.
    Convinced that she had once again aced her exam, Ruth looked up at me with a sense of extreme satisfaction. As I looked over at her husband, it was apparent that he didn't share her enthusiasm. A tear had come to his eyes, which he quickly wiped away before it could find its way down his check.
    I then launched immediately into another battery of memory tests without saying a word about her performance. She seemed momentarily disappointed by the lack of feedback, but there is nothing much that I can say in that situation--nothing that the patient wants to hear, anyway.
    "All right, Mrs. Rubenstein, I'm going to say three words and ask you to commit them to memory."
    I recited three words-- apple , book , and coat --and asked her to repeat them back to me. She remembered two out of three. Five minutes later, she would almost certainly remember none.
    I asked her to spell a five-letter word, world, forward. She did so, quickly and precisely. A smile that said "I told you there is nothing wrong with me" appeared on her face.
    "Now can you spell it backward?" I asked.
    She looked at me with the sort of lethal stare she gave her husband earlier.
    "Doctor, I don't understand why any of this is necessary. I'm totally fine."
    I repeated my request and she continued to struggle; she was finally able to get only two of the five letters in place.
    Switching gears to another memory test, I asked her to write down the names of as many four-legged animals as she could in a minute. Normally, patients can name over ten in this test of executive function. Today, my five-year-old son could probably name twice that, but Ruth named only six that day and wrote cat down twice.
    We finished a few additional tests and I asked Frank to escort me to the waiting area so I could conduct a more thorough physical examination. He seemed reluctant to leave, but did so grudgingly after his wife gave him a reassuring smile.
    "It's okay, dear. It's just part of the exam," she said.
    In the hallway, I used the opportunity to openly ask Frank some harder questions about his wife. I have learned over the years that there are many things family members do not want to disclose in front of the person suspected of having dementia.
    "Has she done anything dangerous?" I asked.
    "What do you mean, Doctor?"
    "Has she left the bathtub running or has she left the stove on?"
    "I suppose she's burned the meatloaf a couple of times but she was never much of a cook."
    He attempted a meek smile.
    "Has she crashed the car or been in any fender benders?"
    Patients with dementia have an extremely high rate of car accidents although few are ever reported. Frank shook his head.
    "Has she acted strangely or have you noticed her behavior changing?"
    "She's a little more suspicious than she used to be. The other day, I went out to a restaurant with a few friends. When I got home, I caught her going through my wallet. When I asked her what she was doing, she accused me of being with another woman. Doctor, you have to understand that I would never ever do something like that!"
    I nodded again and told Frank to sit in the waiting room. I returned to the examination room to complete Mrs. Rubenstein's physical. She had changed into the paper gown and was sitting on the examination table waiting for me.
    "Doctor, I really think I am okay."
    She looked at me for any evidence of an opinion to the contrary. I have learned not to give anything away: if I played poker I could probably make a killing.
    "What did my husband say to you out there?" she asked me. "I don't know why he's so concerned about me."
    I smiled.
    "He loves you, Mrs. Rubenstein, and he is concerned about your health. By the way, how long have you been married?"
    She looked at me and then beamed.
    "Too long, Doctor. We met in Europe during the war."
    "Oh, yeah? What was that thirty, forty, or fifty years ago?" I was pushing her for an exact number.
    She shrugged her shoulders. "Too long,