In 2010, I walked back into the Department of Behavioural Medicine at Sultan Qaboos University Hospital, where I had first started as a junior doctor after graduating from the College of Medicine in 1994.
I was returning from the UK, having completed my training in old age psychiatry, with a clear mission: to establish a memory clinic where people with memory problems and their families would be treated with dignity. I wanted a clinic where care would not stop at a diagnosis and a prescription, but would also give caregivers a safe space to express their feelings without being judged or labelled.
Since then, I have learned how much of dementia happens outside the clinic, in the long years at home that doctors rarely see. That is why I was drawn to 'Faithful As She Fades', a memoir by Robert Fischbach, who describes his wife's journey following her diagnosis with frontotemporal dementia at the age of sixty. Over almost nine years, Robert cared for his wife as the illness took her speech, her personality and, gradually, the woman he had married.
Frontotemporal dementia is less familiar to the public than Alzheimer's disease. It often begins in middle age, and the person shows changes in behaviour, judgement, empathy or language, while forgetfulness may not be present.
A kind person may become blunt or careless, making reckless decisions. Families sometimes attribute the symptoms to stress, depression or marital trouble, so the formal diagnosis arrives late.
As with other forms of dementia, caregivers experience what psychologists call 'ambiguous loss': mourning someone who is still physically present. As the disease progresses, the patient loses the ability to speak or fails to recognise close family members, and may even mistake them for intruders and try to force them out of the house.
The book's title raises a hard question. What does faithfulness mean when the person you promised it to no longer knows you? The author cared for his wife until the end, and later found love again and remarried.
Some readers have judged him for this. I have sat with many husbands and wives who felt ashamed of their loneliness, or of the relief they felt when a long illness finally ended. With dementia, faithfulness means protecting a person's dignity, keeping them safe and comfortable, and staying present.
The author had resources, such as paid caregivers and the ability to take breaks. These are not available to every family.
This matters especially here in Oman and across the Gulf. Our strong family bonds are a true blessing, and people with dementia are cared for at home. But the burden often falls on one person, usually a wife or daughter, who is unpaid, exhausted and rarely asked about her own health.
Many families are still reluctant to accept outside help, as if it were a failure of duty. It is not. Seeking respite, joining a support group or arranging professional care is part of caring well, not a betrayal.
'Faithful As She Fades' is a husband's account of watching the woman he loved slowly disappear, and of finding the strength to go on. Behind every patient I see is a story like this one: a marriage, a family, and years of quiet devotion.
This is why we need to support families caring for a person with dementia as they navigate their emotions through the long journey.
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