"I know we've met before but I actually don't remember you," she says.
"That's OK. I remember you, and that's what matters. Nice to see you." I sit down at the table after she shakes my hand.
"I'm sorry I don't remember you, but you are very tall and handsome. Are you married?" She gives her ubiquitously flirtatious octogenarian smile.
"Yes, I've been married for 21 years." I take out my notebook and her client folder.
"Oh, too bad. I was hoping you'd stay with me." She sips some tea and folds her hands neatly in her lap again.
"Well, I don't think my wife or my boss would approve," I say, winking at her and getting out my blood pressure cuff and stethoscope.
"Did you have a nice Christmas?" I ask as I wrap the cuff around her arm.
"Oh, was it just Christmas? Oh, yes! I did," she says tentatively. "Thank you for asking." She looks confused.
As I inflate the blood pressure cuff, I watch her closely. Her respirations are normal---about 16 breaths per minute---and she seems at peace, but her mouth is quivering a little at the corner.
"Are you upset about something?" I ask, putting my supplies back in my bag.
"No, I feel fine," she says.
"Are you sure?" I ask again.
"Yes, I think so. I was upset about something this morning, but you know what?" She looks at me sharply.
"I forgot what it was!" She laughs and drinks another sip of tea.
"Well," I say, "if you're ever upset about something, you can always talk to me."
"And what would I talk to you about?"
"Anything you like, my dear."
"Well, that's nice." She hesitates. "Are you going to stay with me?"
"No, I can't. But I'll be back next month, OK?"
"OK. Do you know what I forgot?"
"No, tell me."
"I forgot that Christmas is coming, and I didn't get my daughter anything." She begins to cry.
I hold her hand, and contemplate what to say. At this moment, the home health aide comes in, and intercedes on my behalf.
"You didn't forget your daughter, Mrs. ______. Don't you remember that we went shopping last week and bought her the red scarf? You told me she loved it."
My patient lets go of my hand, wipes her eyes, and looks up at the home health aide.
"A red scarf? You're sure?" She attempts a smile.
"Oh yes, I'm sure," the home health aide says. "You can ask your daughter about it later when she comes home. I think she's wearing it today."
"Oh, good. I thought I had completely forgotten. When is Christmas again?"
"It was last week, dear," I say, and the home health aide nods.
"Oh yes. That's right. Thank you." She sips her tea, wipes her eyes one more time, and it seems we've averted a crisis and an unnecessary dementia-related upset.
"Well, have a happy New Year, and I'll see you at the end of January." I take her hand and squeeze it gently.
"Thank you. I'm sorry you won't be staying with me. Are you sure you can't?"
I stand up and take my coat of off the chair. "No, I really can't. I have to get home to my wife. It's a holiday week and we have a lot to do. I'll be back to see you, though. I promise." I bend down to give her a hug, and she grabs the lapels of my coat.
"You're so handsome. Will you come back and see me on Christmas?"
"No dear, not on Christmas, but I'll be back soon. Happy New Year."
She smiles again, sips her tea, and picks up the paper. It's as if I've already left and she's forgotten that I was ever there.
I give the home health aide a hug and slip quietly out the door. Snow is falling again, and I look back at the house. My patient is sitting in the window, the picture of winter tranquility and coziness.
A red scarf, falling snow, a cup of tea, and the promise of a new year.