Class of 2016, Icahn School of Medicine at Mt. Sinai, New York, United States (Fall 2014)
I am sitting in a class on dementia. The doctor is lecturing about the condition’s prevalence, prognosis, neuropathology, diagnostic criteria, risk factors, deterministic genes, and pharmacologic treatment. On a slide entitled Non-pharmacologic Management, the doctor tells us that dementia often leads to wandering. Half of those who wander and are not found within 24 hours are found dead. To try to prevent patients from wandering far, some assisted living centers have installed fake bus stops. When their patients’ urge to roam strikes, they will end up on a fake bus bench, next to a fake bus sign on the retirement home lawn—a twisted Waiting for Godot. We in the audience let out a collective slough of whats? and reallies? We cannot believe such a peculiar solution has been tried and proven.
After class, I look up the history of these phantom bus stops. The first was installed on the front courtyard of The Benrath Senior Center in Dusseldorf, Germany. The mean age of their patients is eighty four, and many have dementia. The house staff catches most of the patients en route to their wandering locales, but before the bus stop the center’s only options were to lock them in their rooms or sedate them. Both of these options were deemed unacceptable. A few seniors had made it onto city buses. In a fervent search for her long-dead mother, one patient had made it back to her childhood home, only to find other people living in it.
When escapees could not be found on the grounds, the center had to call the police. Phone calls with panicked family and manhunts ensued. Looking for a solution, the center began brainstorming, and consulted a local care association, which suggested the fake bus stop. In a leap of faith in the unusual, the center persuaded the local transit authority to install an exact copy of a Dusseldorf city bus stop outside the center’s front door, complete with the city’s green and yellow bus stop sign, posted times, and a bench matching all the others in town. So convincing was the imitation that neighbors of the center started waiting at it for buses to arrive, until knowing nurses explained the get-up and shooed them away. They waited to see if a patient would be so convinced.
A few days went by until a woman from the center insisted on seeing her young children. She was frantic and agitated and could not be convinced that her children were grown. A nurse led her to the bus stop, and they sat down. They listened to the birds, and felt the afternoon sun. They watched cars go by. Soon the resident’s panic receded. She forgot why she was there in the first place. The nurse invited her inside for coffee and the two walked back to the center.
Is it unkind to offer a partial omission of the truth—that no bus stops picks up at this stop? Do we owe them a dose of the hard facts? Or it crueler to inflict a reality onto a patient that has a limited to no capacity to understand it? The director of the center says you can’t argue with these patients because they cannot rationally be convinced. “You have to deal with them in the reality in which they live” he says. He commented that the bus stop has changed how the staff approaches all residents—the staff has become more amenable to their patients’ insistences, and more readily make allowances for a patient’s perceived reality. The bus stop was so successful that soon other senior centers in the city installed their own faux stops, and the idea spread across Germany, and soon Europe.
Working with a disease of unknown etiology and medications that are generally ineffective, this thinking-out-of-the-box senior center designed a treatment that allowed their patients to explore their panic and pain, and let go of false realities. In all of its unlikeliness, their solution is stunning in its tragi-comedy, simplicity, and genius. It does not fight the aging brain, but allows for it to be. It is non-invasive. There are no side effects, it is cost-effective, and kind.
Before moving on to the next slide, the lecturer mentions that wandering could also be a search for meaning. That not only are patients with dementia searching for their past, but they are trying to find a purpose they know has been lost along with the health of their hippocampi and medial temporal lobes. I would like to believe that their hypothesis is true. What a testament to the aging human brain, that despite atrophy and invading debris, there perhaps remains a deep, underlying resolve to search for a meaning, for something more.
KATIE TAYLOR, MFA, received a double major in creative writing and fine arts at Stanford. She received a masters in fine art in oil painting before entering medical school at Mt. Sinai. She is currently a third year medical student living in New York City.