I met Elizabeth, my very first active PTSD resident, while working at a locked dementia facility.  Other than medication to minimize anxiety, there was nothing anyone could do for her.  “You simply cannot treat PTSD in a dementia patient,” I was told.   Yes, the meds would stop Elizabeth’s incessant questioning, “Where’s Marty?!”  They’d also stop the rest of her day as she sat in the nearest chair sleeping them off.  I just couldn’t accept that.

Her repeated anxious questioning needed to be addressed for Elizabeth’s own peace of mind.  Eight million (maybe a slight exaggeration there but not by too much really) times a day Elizabeth would ask anyone who made eye contact with her, “Where’s Marty?  Where’s Marty?  Where’s Marty?!”  

She was literally driving the staff crazy.  They began avoiding eye contact with her even when they were talking directly to her.  Talk about confusing a person with dementia … holding her hands, walking down a long hallway face-to-face, never making that “dreaded” eye contact while taking her to the dining room to eat a meal.  Elizabeth began feeling the isolation, but she couldn’t understand why it was happening.

So where was Marty?

Marty, Elizabeth’s husband, had passed away many years ago.  I first began “treatment” by giving her the excuse, “Marty is working overtime tonight,” and in the beginning that seemed to help, a little.  I felt this was a gentler way to deal with Marty’s absence.  

After about a week Marty’s overtime excuse had no effect on Elizabeth’s anxiety anymore – back to square one.  Her daughter’s told me she never really recovered from the shock of Marty’s death.  He got up one morning, went to work, had a heart attack and died before the ambulance could reach him.  The last thing in the world Elizabeth expected because Marty promised he would always take care of her.  

One morning Elizabeth saw me coming down the hall.  She ran to me asking, “Where’s Marty?!”  I had three other residents around me at the same time.  Elizabeth decided to “spank” them and send them on their way so it could be just her and I.  It worked.  Each resident got spanked and each resident turned and walked away.

Elizabeth knows the answer to Where’s Marty

Now face -to-face she anxiously asked, “Where’s Marty?  Where’s Marty?  Where’s Marty?!!”  Her inner being knew he wasn’t working, he wasn’t out of town, he wasn’t on his way to pick her up.  Clearly, her inner being knew there was something very wrong, something so vial and horrible she couldn’t bear facing the truth of it.

“Elizabeth, Marty died,” I gently said.  She stopped moving, breathing, everything.  She just stood there like a statue, looking at me.  Then she began to laugh while repeatedly asking, “Where’s Marty?!”  She couldn’t accept it.

A couple of days later Elizabeth found me in my office.  She “chatted” with me for a bit then started asking, “Where’s Marty? ”  I sat there quietly staring at her for a brief moment then just like the last time said, “Elizabeth, Marty died of a heart attack.”

This time Elizabeth didn’t laugh.  She sat there looking down at her lap.  “When did he die?” she solemnly asked.  “It’s been many years now.  Your daughters know he died too,” I continued.  “Oh,” she softly said.  A brief pause for maybe fifteen seconds before Elizabeth stood up, started laughing, and asked, “Where’s Marty?”

The change is coming

Other than the momentary pause, I saw no change, no relief for Elizabeth.  The next day however, she came rushing up to me as I was walking down the hall.  Grabbing my hand she began physically pulling me around the corner, down to a little alcove where few people ever went.  

Elizabeth sat in the chair on the right and motioned with her hand for me to sit in the chair to the left.  All this time I remained silent.  Our eyes met but this time Elizabeth quickly looked down at her clenched hands that were now resting on her lap.

“Where’s Marty?” she achingly said.  Just one time, not over and over.  In retrospect I briefly sat there quietly pondering this changed behavior – what was its significance if anything at all?  Breaking my silence Elizabeth whispered, “Marty died.  He died, didn’t he?”

“Yes.  Marty died and now he’s waiting for you to come be with him in heaven some day,” I solemnly said.  “He’s gonna have to be a very patient man then cause I ain’t going nowhere for a very long time!” Elizabeth laughingly said.  “Besides,” she chuckled, “He knows full well I’m always late.” she chuckled.

Where’s Marty finally faced

After that encounter Elizabeth still asked, “Where’s Marty,” but the anxiousness and driving force was gone.  I’d say maybe once a week or less she would ask where he was and to me it seemed to be asked in a moment of uncomfortable silence, using it more now as a conversation filler, without the drive to repeat it over and over and over again.

It took a number of tries to get Elizabeth to a place where she wouldn’t laugh when she heard her Marty was dead, showing her long-needed awareness of the truth had finally emerged.  Her brain’s chemical reaction to each intervention was invisibly redirecting Elizabeth’s erroneous thought pattern while gently allowing her to face the truth.  To be successful Elizabeth needed to face that truth with someone she loved and trusted; someone she considered to be “that one that will cause her to survive.”  It was in meeting her grieving psychosocial needs Elizabeth found peace.

Looking at and accepting her truth helped Elizabeth obtain high quality of life personally (by taking away the fear of facing Marty’s sudden death) while allowing the caregivers and staff to return to treating her as generously as they did any other resident.

Psychosocial Encouragement

• Validate their feelings by echoing their own words back to them.  “You ‘freaked out’ because you couldn’t find your car keys.'”
• Normalize their feelings.  “I freak out too when I can’t seem to find my car keys.  I think maybe everybody does.”
• Strengthen their sense of autonomy by providing options.  “Do you want to go to the beach or go shopping?”