Cognitive Disorders

Story of a Math’s Teacher

Mr Ram was born in 1941 in a town near Trichy; his father was a farmer, so his mother had three younger brothers and 2 younger sisters. He was the first child who had studied in Tamil medium school up to 5^th grade and was sent to study in Trichy in English medium, and he was above average in studies, secured 79% in X and 82% in XII standard. He was interested in math’s and joined BSc mathematics in Trichy, secured first class in this and continued to study MSc maths and B’ed. He soon got a job and started his carrier as a math’s teacher; his passion for mathematics continued, he was a strict teacher, and he used to solve any sum from 1^st grade to 12^th-grade syllabus, and students would keen on learning from him, even after the school timings.

His goal was to make every student pass in his subjects and take special classes and free tuitions for students who needed it. But was short-tempered and would trash naughty students. He had a good reputation from his fellow teachers; some were even envious of his school popularity. He started smoking cigarettes at the age of 22 and now would smoke up to 10 per day, though he wouldn’t smoke in students’ presence. After he settled his brothers and sisters in the right place, he got married at 35. One of his brothers was a BE graduate and got a job in an MNC company in Chennai and within a year flew to the US, and the other two ended up doing father work.

He had two daughters, and his wife felt he loses temper soon and consulted a physician, who found his blood pressure persistently high, and advised medications, exercise and quitting smoking. Due to his hectic work- school, evening tuitions, he did not find time to go for a morning walk and unable to quit smoking. He continued taking the prescribed medications. His parents passed away; consequently, he distributed his father’s land to his younger brothers and sisters, who were not educated and dependent on agriculture within a couple of years. Following his parent’s death, all his younger siblings moved to a nuclear family.

He moved to Trichy, rented a house, his daughters were studying in private schools, continued to work in the same school, took tuitions for the needed and thus his day starts with teaching maths from 9 AM to 8 PM. Even during Sundays, he would take special tuitions for students from other schools as well. He continued to smoke now up to 15 per day. Though he maintained weight, his blood pressure remained high. Towards his retirement, he got both of his daughters married, one in Chennai and another in Pudukottai.

He lived with this wife, continued to take tuitions. He continued to smoke, and at 62 years of age, he developed chest pain, and his physician diagnosed him with angina, prescribed medications and advised him to stop smoking. Mr Ram, though he took medications, but couldn’t stop smoking, yet reduced by half. Due to his health conditions, his wife and daughters did not allow him to take tuitions, took him to Chennai, found an apartment for the couple.

Mr Ram felt lonely in the new city, with heavy traffic and no other work, he spent time watching TV and reading newspapers. No friends here and felt depressed. Gradually he was found dull, less interactive, irritable, eating less and sleepless nights. A year passed by he was taken to a psychiatrist in Chennai, who diagnosed him with clinical depression prescribed antidepressants and sedatives. His sleep improved, irritability reduced, and he was interactive, yet he was not fully recovered. He longed for his passion for teaching maths to students. Years passed by, at 69 years of age, his wife found him dull more, lazy, retarded and irritable and assisted him, did not allow him to go out.

She found him misplacing his personal belongings like a watch, spectacles and searching, even getting suspicions that someone is stealing these belongings. Scolded his wife for misplacing his things. He was moody would play well with his grandchildren or often locks himself in the bedroom. He had a memory disturbance that would misidentify his grandchildren of both of his daughters.

Once they had been to “Tirupathi”, and in the crowd, he was lost, after nearly five hours of announcement and search he was found in anther end, he could not tell his address or phone number. Upon returning, his wife took him to their psychiatrist, who suspected early Dementia and sought a neurologist opinion. His scan report showed diffuse cerebral atrophy; he was prescribed medications. Days passed by, he was found deteriorating in his memory and could not tell names of his daughters, sons-in-law, his address, and unable to tell what he needed.

His wife has to feed him, bathe him by force. Physicians psycho educated it was Alzheimer’s Dementia, and it has a deteriorating course, yet the medications would only reduce the progress a bit. Within  3 years of diagnosis of Dementia, he was so impaired needed assistance in daily activities like bathing, dressing, feeding.

He has lost all his mathematical abilities, unable to do simple calculations, even addition or subtraction. His wife was depressed, and the psychiatrist has to prescribe antidepressants for her. At 72 yrs, they shifted back to his hometown, where his father lived. He couldn’t identify his brothers or sisters, and none helped, took a rented house, and his wife alone cared. Many of his old students and colleagues came to visit him, none he could recognize; once he was invited to the school function where he worked, he just sat on the stage ideally couldn’t deliver a speech.

Once, he tripped while getting down from his house and sustained a fracture of the hip. Orthopaedic suggested hip replacement due to severe osteoporosis, which costs 2 lakhs. He was surviving with a pension of Rs 6000 a month, which she couldn’t afford. None of his brothers helped. He was confiding to bed, and his wife would nurse him, often irritable, spit food on her, cursing her as a devil. He would soil his clothes often, soon developed bedsores, lung infections and diarrhoea.

At his 73 rd year, he once aspirated in his sleep and had his last breath.

Moral from the story- What went wrong? How could this have prevented?

Diagnosis: Dementia

Continued smoking, poor control of hypertension. He was forced to quit his passion, left alone in a crowded city