Lavender Nails
By Austin Stelmach
Third Year Medical Student at University of Colorado Anschutz
While rotating in outpatient medicine, I met a woman with dementia who was brought in by her adult children to discuss hospice care. Their mother, once a radiant figure in their lives, appeared profoundly confused, quiet, and disconnected from the world. As she stared blankly at the ceiling, seeming to track invisible butterflies, her children described the toll her cognitive decline had taken on their family and their growing concern that they could no longer provide the care she needed.
Austin Stelmach
My preceptor gently attempted to communicate with her, but she hardly responded, her affect flat. As I listened to her heart, I noticed her fingernails. They were a soft lavender purple. I paused and told her how pretty they looked. Her eyes lit up, and she smiled like something had suddenly clicked. With surprising clarity, she told me that her daughter had painted them. Her daughter, now in tears, nodded, and I felt a sudden rush of emotion that brought me back to my own grandmother, who is 90 years old and also grappling with dementia. She still smiles with the same warmth I grew up loving, yet with each visit back home I feel pieces of her slipping away, our conversations becoming increasingly one-sided as though I am speaking to her rather than with her.
In studying for the MCAT, I had learned of the word countertransference. It sounds very academic, right? I’ll be honest - it didn’t feel very academic when it hit me. In that moment, I wasn’t just seeing a patient, I was seeing someone I cared deeply about - my grandma. I thought about the times we used to bake cookies together and our trips to the dinosaur museum where we would tease her about having a crush on the paleontologist. I could feel my face turning red as I choked up, thankful that my preceptor kept the conversation going while I tried to hold it together. This encounter stayed with me, not because of any diagnostic complexity, but because it was both emotionally painful and deeply meaningful, reminding me of why I chose medicine in the first place – for the human connection. Dementia is particularly difficult because it can feel as though that connection is slowly being stripped away. In fact, so much so that we often forget to celebrate and appreciate what remains. Commenting on her nails evoked something in both of us: for her, perhaps a memory of being cared for and loved by her daughter; for me, a myriad of meaningful moments with my own grandmother. In that instant, I knew her family’s pain because I had felt it too. At the same time, I also saw a family actively celebrating the joyful life their mother had lived through the warmth of shared memories.
When I look back on this moment, I sometimes wish I had paused longer - given her daughter more time to speak, to grieve, and to be seen. I wish I had asked more about who their mother was before this visit or perhaps even shared stories about my own grandmother because I think they probably would have been friends. But, I also know that this small moment of connection mattered.
In Crow and Weasel, Barry Lopez wrote: “The stories people tell have a way of taking care of them. If stories come to you, care for them. And learn to give them away where they are needed. Sometimes a person needs a story more than food to stay alive. That is why we put these stories in each other's memories. This is how people care for themselves.”
These words felt more relevant than ever that day, as our memories seemed to speak louder than words. Though memories may not always swell with the same intensity as they did at their inception, fleeting reminders - such as lavender nails - can spark light, even when the memory itself feels lost.