No such thing as Difficult
When Milly sees things differently, I’ve learned to stop arguing and to adjust my approach . . . most of the time!
Theme: The Beauty
Quick Take:
Milly’s not difficult. Dementia is.
Normal? We let that go.
Routines, predictability, peace.
Learning in A&E
“There’s no such thing as a difficult patient.” Many people, including nurses, laugh when I say this, but it’s a philosophy I was taught back in the 1980’s during my nurse training.
In A&E, when a drunk or frustrated patient arrived shouting, angry, and demanding attention, we didn’t have security guards to call. The nearest nurse or doctor dealt with it alone, because everyone else was busy.
Had we shouted back and insisted on quiet or respect, things would almost certainly have escalated. Instead, we were encouraged to pause and consider what might be driving their behaviour - fear, pain, confusion, illness - and build some trust.
Quiet respect, calmness, and gentleness de-escalated the situation surprisingly quickly.
I’m told that times have changed - that healthcare is more pressured and staff no longer receive the professional regard they once did. I no longer work as a nurse, and I can see how frenetic the world has become. When I trained, I felt hugely respected - receiving a free newspaper as I passed a news vendor, free taxi or bus fares, and even free theatre tickets if a couple of us waited at the box office. Things have certainly changed.
Meanwhile, specialists in dementia, and charities that offer guidance and help, also support the view it is the carer’s approach that, more often than not, needs to adapt.
Most of Us Aren’t Professional Carers
In everyday relationships, we’re constantly adjusting - compromising, communicating, caring - while coping with our own stresses and family dynamics. Even at the best of times, relationships are hard work, requiring commitment and compromise.
And our loved ones aren’t patients - they’re family, with all the complexity that brings. So when dementia enters the picture, behaviours that might once have been minor irritations can feel utterly overwhelming.
Changing My Approach
However, understanding the professional approach eventually helped me - though it didn’t feel relevant or even possible at first.
In the early days, when things became challenging for Milly and me, I corrected her. I argued. I tried to explain. It took time for me to recognise what was happening.
It wouldn’t be natural to instantly think, ‘this isn’t her fault,’ because some of her behaviour was typical of her!
But I could also see that my approach was making things worse. Rather than feeling supported, Milly became more anxious around me and increasingly resistant to my suggestions and solutions.
I realised I was getting nowhere. This wasn’t stubbornness. It wasn’t refusal. Milly had lost abilities she once relied on - and no amount of reasoning could bring them back. I had to adapt. She could not.
Adapting with Patience
That’s when I returned to what I’d learned as a nurse. As a professional, I didn’t argue my way forward. I had to slow down, adjust, build trust, and create safety step by step - knowing that progress may be tiny, but still meaningful.
Seeing Milly through this lens, rather than through frustration or blame made kindness important and I was able to see Milly behind the dementia - not just my mother, who has always had her quirks, but a human being navigating a confusing and frightening world.
When I think as a nurse, I look for meaning in Milly’s words, not accuracy.
The more I notice her vulnerability, the more patience I can offer. The annoying moments don’t disappear - but they certainly feel less overwhelming.
A Daily Example
Every morning, I put Milly’s pills in an egg cup and told her to take them with or after breakfast. Every day - literally every day - the tablets remained in the cup. I used to ask why she hadn’t taken them, and she would always question if she should.
“Well who else are they for, for goodness sake?” I’d say, exasperated and I’d feel like throwing them at her. She’d just stare at me, looking either disinterested or bewildered, depending on her mood.
I had to step back and stop rushing to work out what was actually going. One day I asked patiently and gently why she hadn’t taken them and she explained quite clearly that she wasn’t sure if she should be taking them at a specific time.
I felt so mean; I remembered her taking, for many years, one tablet that had to be taken about half an hour after food.
Practical Ways I Create Safety
There are lots of things I now do to create a safe place for Milly, but three simple daily acts that help me care for her with more kindness.
Firstly, I don’t tell Milly about visits or appointments in advance.
They make her fret, and memory fragments get caught in a loop:
Where am I going?
When am I going?
Why am I going?
Who’s coming?
What do I need?
Where do we have to be?
What time are we going?
Even when she already knows the answers, the idea creates anxiety. Repeating explanations only frustrates us both, so I tell her as close to the time as possible, calmly and simply - never rushing, never alarming. I don’t mention anything unusual or remotely threatening, like a dementia review. I stick to things she finds stress free and understandable. If a friend is visiting it’s because they were passing by not because the meeting had been booked.
Wellbeing Over Expectations
Secondly, I no longer prioritise the needs or expectations of others over Milly’s comfort and wellbeing.
She has always been a thoughtful, caring friend - sending cards, making calls, and checking in on others - and I know she’d worry about disappointing people. In fact, she regularly masks her feelings, telling people she’d love to see them or that she’ll definitely talk to them on a particular day, even when she really doesn’t want to.
My approach has evolved as her dementia has progressed and my understanding of her needs has deepened. This allows me to decline visits or celebrations, even birthdays or Christmas gatherings with more confidence, and in a way that I hope feels more respectful to everyone.
Meanwhile, if Milly chooses to stay in her nightdress and dressing gown most of the day, I regularly encourage because it’s something she’d never have done in the past - far too decadent!
If she puts a piece of clothing back on that needs washing, I gently point it out, but it rarely matters to her. She still cares a little about looking respectable and I support her dignity, but not to meet others’ expectations.
The Comfort of Predictability
Thirdly, I stick to a routine - written clearly on a whiteboard Milly can look at for reassurance.
The daily routine suits us all: I try to get her up at the same time each day, take her for two-hourly walks around the kitchen and trips to the toilet and I keep other regular patterns in place. Sticking to this helps her ask less about what is happening next. If she has any queries it’s generally about the next day which is where the whiteboard comes in.
Milly didn’t like the whiteboard at first, thinking it unnecessary but over time, after a year or so, it became an anchor for her and brought some calm. I also used to write little uplifting messages that I knew meant something to her and might make her smile, like “We love you!”.
Now, Milly lives with us, so the whiteboard is less important because we’re always around to confirm what’s happening. But I still update it every week as it helps me if I’m feeling impatient - I point to the board while I take a deep breath!
None of this makes dementia easier. But it makes caring kinder. And in that kindness, I’ve found something that lasts - a beauty that helps both of us keep going.
What I learned as a nurse still holds true. Milly, with dementia, isn’t being difficult - there are just situations I need to think more carefully about.