I believe that in many cases, the early stages of dementia do not necessarily make it impossible for continued life to be worthwhile. However, there is a point of mental decline beyond which I have trouble recommending aggressive treatment of certain medical ailments intended to prolong life...to prolong life that is no longer the type of life that the patient himself would necessarily wish to prolong. Q: Do you share those sentiments with patients?

A: No; and that is precisely the dilemma I'm thinking about. I realize that it is natural for patients' families to hold out hope of recovery regardless of negative medical prognoses. Likewise, I understand that it is difficult to acknowledge...acknowledge on a psychological level...that their loved ones are, essentially, already gone once they no longer recognize their own family members and cannot perform the simplest tasks for themselves. Not so much that they are physically unable to clean themselves for example, but that they are beyond the point of even caring whether or not they are clean or soiled.

Alzheimer's, is called the "long goodbye" for that reason, because in many ways, losing a loved only very gradually after their minds are gone is much more difficult than even a sudden tragic loss of life.

Q: Do you or your staff ever make medical decisions based on your feelings about that?

A: No, never. I dispense medically accurate information to my patients and their families and I present the clearest clinical picture possible about medical choices, decisions, and the likelihood of positive outcomes and negative consequences. My staff are never in position to make such decisions either. We treat patients as they and their representatives...

Q: Is it safe to say that that is the worst part of your job?
A: Yes. On a professional level, every procedure I perform is beneficial to me, but I have mixed feelings operating on patients in circumstances where I wouldn't have made that choice for myself or a loved one of mine.

Q: I'm not so sure I agree with that point-of-view. Don't you think all life still has some value?

A: Many people share your view, which is one reason I keep my sentiments to myself in the professional arena. But if you had as much first-hand familiarity as I do with the effects of late-stage dementia and if you could see the physical destruction and deterioration of the brain the way I do, you might come to a different perspective of what constitutes living and where "treatment" might amount more to prolonging suffering than to helping patients.

Q: Do you share your personal feelings with your staff?

A: No. I would not want any of their decisions or practices affected by that point-of-view and I don't necessarily trust other to separate their personal feelings from their professional obligations the way I strive to.

A: I understand. Thank you for being so candid.

Q: You're welcome.