Hello, Mr. Carlin . . .

By Steve Paulus, DO

Mr. Carlin and I played this game, or perhaps it was a test; but who was testing whom? Anthony J. Carlin was a small, wiry, energetic 80-year-old man who was “placed” in an extended care facility by his family for a worsening Alzheimer’s dementia. His faulty short-term memory was exceeded only by his temporal confusion. His mind resided in the 1950’s, where images, emotions, and recall were sharp and clear. I always assumed that this must have been a satisfying time in his life, because he found comfort in the memories of this time period.

I no longer have a nursing home practice, but when I completed my Family Practice residency, I moved to a small farming community in California and performed the full spectrum of Family Medicine. I had a unique philosophic approach to the care of elderly nursing home patients. I would ask the family to bring old photos and tell me stories of this person, before the aphasic stroke or the development of dementia. This gave me a foundation of humanity allowing me to see this patient, who could no longer tell his or her story, as a human being with a family, friends, and a career.

Mr. Carlin had been a mechanical engineer with a major aerospace firm in San Jose. He had fought in W.W.II and following the war had gone to college. Mr. Carlin had an intense work ethic that resulted in rapid advancement to a senior design engineer. He was married, had three children and four grandchildren. His wife revealed that her husband had a hard edge. He was controlling, combative, and aggressive before he developed Alzheimer’s Dementia. Interestingly, within the cloud of Alzheimer’s, I found him to be quiet and peaceful, demonstrating the antithesis of aggressive behavior. To me, he still carried an air of formality and respect; therefore I never called him Tony or even Anthony–he was always Mr. Carlin.

The game we played was simple. I would walk into his room greeting him with, “Hello, Mr. Carlin.” Because I always had a stethoscope around my neck he would astutely reply, “Hi Doc.” I would then ask, “Do you remember who I am?” He would often reply, “Of course you’re Dr. Anderson,” who, according to his wife was his internist during the 1950’s. During my allopathic exam I would remind him that my name was Dr. Paulus. He would respond, “Of course Dr. Paulus.” After finishing rounds I would always stop by one more time to ask if he remembered my name, and again I would be transformed into Dr. Anderson, or any number of former doctors he recalled from some other time.

Because he had severe emphysema, he would intermittently develop some form of a pulmonary infection. During his first episode of pneumonia in the nursing home, I was able to keep him out of the hospital by treating him with Osteopathic Manipulation as well as with oral antibiotics. It was during this acute illness that Mr. Carlin gave me a tremendous gift.

While caring for his pneumonia, instead of exclusively performing an allopathic exam and simply adjusting his medications, I also gave him an Osteopathic Treatment. While I was treating him at the bedside, I asked, “Do you remember my name?” He responded, “No, but you’re my doctor.” I told him my name was Dr. Paulus, he smiled, and fell asleep.

Because of the pneumonia, I visited him every other day for a week. Each visit included allopathic exam and an Osteopathic Treatment. On the second follow up, I walked into his room offering the usual greeting of “Hello, Mr. Carlin,” and he gave his regular recognition of Dr. Anderson. But, this time, instead of first performing the allopathic exam, I began with the Osteopathic Treatment by placing my hands on his chest. Surprisingly he said, “Ahhh . . . Dr. Paulus.” This form of recognition struck deep within the core of my understanding of the potential of Osteopathy.

I was impressed with his keen kinesthetic memory but had real doubts whether this recognition could be reproduced. So, out of curiosity, I set up a series of tests over the next week. The next day I left my stethoscope at the nurses' station, came into his room while he was apparently sleeping, and without a greeting, placed my hand on his chest to treat him. He opened his eyes, look at me and said “Ahhh . . . Dr. Paulus.”

Two days later I came to see him in casual clothes (meaning, a T-shirt and blue jeans) with no stethoscope, and walked into his room greeting him only by saying “Hello.” I asked if he knew who I was, he answered “No.” I then placed one hand on his chest, the other under his back and again treated him with Osteopathic Manipulation. Moments into the treatment he responded with, “Ahhh . . . Dr. Paulus.” I now knew that we were communicating on a non-cognitive level and the sensory experience for Mr. Carlin was not being filtered through his dysfunctioning, dementia clouded central nervous system.

Over the next ten months, this same pattern of recognition–or knowing–was communicated over and over again at my regular follow-up visits. Finally one night, Mr. Carlin died quietly in his sleep of a heart attack.

Years later, he continues to remind me of how Osteopathy works beyond the “known,” to levels outside our conscious awareness.

Thank you, Mr. Carlin . . .