Old and dangerous: Senior violence is getting worse

Last year, five elderly Canadians were allegedly killed by other seniors with dementia

Jim Goldberg/Magnum Photos

What do you do with a man like Jack Furman? A volunteer selected some 70 years ago to join an elite commando squad: the First Special Service Force. A lad from tiny Fort Macleod, Alta., trained to leap from planes, climb mountains, detonate explosives, launch amphibious assaults and survive behind enemy lines in wartime Europe—a man trained to kill for king and country, with grenades, with guns, with stiletto, with garotte, with bare hands. Furman did these things, and came back alive and was called a hero, though he rarely spoke of it.

What do you do with such a man, who now languishes in a fog of dementia; a man locked in a Kamloops, B.C., psychiatric centre, because this past August—at age 95—he is alleged to have killed again? This time Furman’s victim was not an enemy combatant, it was 85-year-old Bill May, a father of three, a retired executive at a glass company near Vernon, B.C. He was Furman’s roommate in Vernon’s Paulson Residential Care dementia unit—a facility that was supposed to honour, respect and protect both men in the last act of their lives.

Tragically, murder in a dementia ward isn’t an anomaly. Two elderly Toronto men—Peter Ray Brooks, 72, and Francesco Greco, 81—were, like Furman, charged with second-degree murder in 2013 for allegedly killing fellow residents in their respective care homes. And a 71-year-old brain-injured man in the Overlander Extended-Care Hospital in Kamloops, and a 74-year-old woman in Halifax’s Evan Hall dementia ward were also accused last year of killing fellow residents in care. The latter two weren’t publicly identified. The Kamloops man died before it could be determined if he was mentally fit to be charged and tried. As for the 74-year-old Halifax woman, an investigation determined charges weren’t in the public interest, presumably because of her mental state. She was neither arrested nor removed from the facility where the assault took place. “Evan Hall is already a secure facility,” says Halifax Regional Police spokesman Const. Pierre Bourdages. “She is being well taken care of there.”

The Halifax case speaks to the challenges and risks for care-home staff in balancing the safety of residents and the rights of perpetrators unable to remember, or comprehend the impact of their aggression. Those who aren’t charged usually remain anonymous. But those killed, they have names: Bill May of Vernon; Jack Shippobotham, 79, of Kamloops; Joycelyn Dickson, 72, and Francisco DaSilva, 87, both of Toronto; Joyce Renouf, 91, of Halifax. The five known care-home homicides in 2013 are a sadly typical statistic and the mere tip of the thousands of incidents annually of resident-to-resident aggression and violence in care homes and dementia wards across the country.

“The grey tsunami presents unique challenges to our communities, our health care system and our justice system,” Suzanne Anton, B.C.’s attorney general and a former Crown prosecutor, told a symposium on elder abuse in November. In B.C., Crown attorneys have the latitude not to charge if prosecution isn’t in the public interest. “Cases such as these difficult ones involving people with dementia, you can be sure the Crowns gathered the evidence and then they applied their experience and a real sense of compassion and restraint in deciding whether or not to proceed with the charge.” Even if charges proceed, the accused must have the mental capacity to appreciate they have committed an offence, Anton said. “Canadian criminal law recognizes that the morally innocent should not be convicted.”

They are the old and dangerous, and society is ill equipped to deal with what gerontologists warn is a widespread, under-reported and growing problem of patient-to-patient violence in residential care. It’s an issue burdened with more questions than answers. Every assault has a tragic impact on both victim and aggressor. For the families of the dead there is little hope of justice, for few if any of these cases will ever go to trial. And what exactly would an appropriate sentence be for a guilty verdict? How do you punish those who are no more responsible for their actions than a two-year-old child? They are too frail for prison; too dangerous for release into the general care-home population; asylums for the criminally insane conjure disturbing images of a brutal past; and the prospect of trussing up potentially violent dementia patients with physical or antipsychotic chemical restraints raises human rights issues.

“The criminal justice system is not designed to meet the needs of dementia,” Vancouver defence lawyer Patti Stark told the November symposium, “Senior on Senior Abuse: What do you do when your loved one is the aggressor?” Too often a psychiatric review leaves the accused in legal limbo, rarely in a facility that meets their needs, said Stark. “If the review board says they’re unfit, they just sit and wait until they become fit. And with someone with dementia, they’re not going to become fit.” The majority of dementia patients aren’t a significant threat of violence, studies show. But a third of people living with dementia are aggressive at times, notes the Alzheimer’s Society of the U.K. Agitation, paranoia, wandering and sexual disinhibition are other challenging behaviours that contribute to confrontations. As such conditions worsen, and home care becomes impossible, the problem inevitably concentrates in care homes, which are rarely prepared to deal with the most violent.

In Furman’s case, the second-degree murder charge was stayed on Nov. 27, three months after it was laid, and after an extensive review of the medical and psychiatric records. “The evidence indicated Mr. Furman caused the death of Mr. May,” however, his mental state would “be a significant issue at any trial,” said a statement from Crown counsel Neil Mac­Kenzie. “He remains confused and disoriented as to both his current circumstances and the circumstances of the incident in question. According to the evidence, his condition is unlikely to improve.” He’ll remain at the 47-bed Hillside Psychiatric Centre, a secure, acute-care mental health facility in Kamloops, “with measures available to address any risk that he might present to other patients, to staff or to himself,” the Crown statement said. What those measures are remain unstated. Hillside is a secure facility for those of all ages in severe psychiatric distress. It has common areas, an outdoor patio, ready medical and psychiatric care, and individual rooms more intimate and comfortable than any jail cell. Some patients may be locked in their rooms at times if they are deemed a risk. Staff work in pairs and are well drilled in security measures. Although Hillside’s mandate is temporary care to rehabilitate patients and reintegrate them into the community, the Crown statement suggests Furman will remain there, at least until he is no longer a physical threat, an expensive solution to a complex problem.

Gloria Gutman, a professor at Simon Fraser University’s gerontology research centre, and president of the International Network for Prevention of Elder Abuse, told the Vancouver symposium that people are entering care homes at older ages and with increasing levels of dementia. While victims of violence in care homes are a minority, “We can’t sweep this under the rug anymore,” she said, “because we’re going to see more of it.”

About 750,000 Canadians are living with dementia—15 per cent of Canadians 65 and older—a number expected to rise to 1.4 million by 2031, according to the Alzheimer Society of Canada. The estimated annual cost of dementia in direct and indirect health care, and lost family income of caregivers, is $33 billion. It’s expected to reach $293 billion by 2040. “Meanwhile, our acute-care hospitals are overflowing with patients awaiting long-term care placement and our long-term care facilities are understaffed, under-spaced and under-equipped to care for our most vulnerable seniors,” said Chris Simpson, president-elect of the Canadian Medical Association in a recent call for a dementia strategy.

Among the least-studied impacts of the epidemic is the scope and impact of resident-on-resident abuse in care homes. It’s rarely broken out as a separate statistic, if it’s even reported at all. A May 2012 report of Ontario’s long-term-care task force on resident care and safety found that in 2011, 57 per cent of the abuse and neglect incidents (1,568 of 2,273) studied in long-term care were resident-to-resident encounters. The rest were staff-to-resident or resident-to-staff encounters. CTV’s investigative show W5 found 60 nursing home homicides over a 12-year period, after combing coroners’ reports, news stories and care-home statistics—an average of five murders a year. But the level of attacks and abuse is much higher. Using incomplete data from seven provinces, W5 found almost 6,500 resident-on-resident incidents. Extrapolating that nationally, it put the annual number of such confrontations at more than 10,000.

“Long-term-care homes are increasingly being pressured to accept residents who are inappropriate for congregate living, and who overwhelm the services and the number of staff and skills that are currently available,” says the Ontario task force report. “Homes are caring for more elderly demented residents with behaviours that need to be diffused, more residents with physically aggressive behaviours, and more younger persons with mental health, developmental and behavioural problems.” The families of victimized relatives face a conundrum: What alternative do they have in the event of an assault? With few safe facilities for dangerously demented residents, care homes are often the last resort for both victim and perpetrator.

A U.S. study, “Resident-to-resident aggression in long-term-care facilities: An understudied problem,” found the problem grossly under-reported. Some nursing home administrators fear adverse publicity or liability. Nursing home employees fear losing their jobs if they report mistreatment. “Residents and their relatives are often reluctant to report abuse because the residents fear retribution and the relatives fear that residents may be asked to leave,” the report said.

Professor Lynn McDonald, director of the Institute for Life Course and Aging at the University of Toronto, says the crisis of resident violence needs further attention and study. “Overall in Canada, we are estimating that a third of the cases of abuse in institutions are resident-to-resident,” she told a conference in Vancouver in May, appropriately titled, “Taboo topics in residential care.” “This form of abuse is highly, highly prevalent in nursing homes,” she said. “It causes a considerable amount of harm and it costs a lot of money because most people end up in hospital.” And some die.

Jack Furman was typical of the surviving members of the 1,800-member First Special Service Force. What they did in wartime Italy and France was rarely discussed beyond their band of brothers. “A lot of these guys went to their graves without even telling their wives,” says John Hart, whose father, Geoffrey, a special force member, died in 1966 without sharing his experiences with his family. A hunger to learn more led his son John to join the special force’s association. It was at a force reunion in 2002 that he first met Furman. “He made us feel like family,” says Hart in an interview from his home in Medicine Hat, Alta. “He always had that knack of finding humour in just about everything.” Even in war, Furman, a platoon sergeant, was a ready source of humour in bad times, his compatriots have said. “I do know, when he had to do his business, he was pretty lethal,” says Hart. “They all were.”

The two men spent many days together, in B.C., Alberta, and on an association tour of the Italian battle sites that Hart arranged in 2010. In the early stages of their friendship Hart pressed for wartime details only to be told, “It’s none of your business.” But during the 2010 Italian tour, with his friend’s dementia becoming apparent, Hart recalls sitting at a separate restaurant table in a hotel near Cassino, Italy, as Furman reminisced over coffee with a fellow soldier. He talked of the weeks that Allied soldiers were caught on the beach at Anzio, Italy. It was the special force’s task to break the stalemate. Faces blackened with boot polish, they’d stage night patrols, taking out sentries or machine gun emplacements. In their kit was the V-42 combat knife, designed specifically for the special force: a pointed hilt capable of crushing a skull, and a double-edged stiletto blade for silent kills. “You’d take that damn knife and you’d exterminate a German sentry,” Furman recalled. “I wanted to fill my pants, but I couldn’t—I had to do it again.” On each body, the soldiers left their calling card: a sticker printed with the special force’s red, arrow-shaped insignia, and the German words: “Das dicke ende kommt noch!” (“The worst is yet to come!”) German solders spoke of the “black devils,” a term the soldiers made their own as the Devil’s Brigade.

Furman shared some thoughts on war during a recorded interview with Historica Canada’s Memory Project. “When I look back on it now, and see what we’ve done, and how we did it, it’s a miracle. And bloody crazy,” he said. As a young man he said he couldn’t stand the sight of animals being killed for food. “And then you get over there and you see guys that are seriously wounded, and you wonder how in the hell we could do this to each other. It’s just beyond imagination.”

What triggered Bill May’s murder may never be known, nor have details of the assault been released. Furman was involuntarily removed from his home and placed in a strange environment, sharing close quarters with May, a stranger also living with dementia. Frustration, loss of privacy, fear of change, late-onset post-traumatic stress and even wartime flashbacks are all known triggers.

“We recognize that people such as combat veterans may have a traumatic reoccurrence under an emergency situation,” says Gutman. But at times the root cause of violence is inexplicable. “Aggression may be linked to the person’s personality and behaviour before they developed dementia,” says a fact sheet from the U.K.’s Alzheimer’s society. “However, people who have never been aggressive before may also develop this type of behaviour.”

It took a week after his murder for the May family to gather their thoughts. They then assembled the local media to discuss the circumstances of his death. For days after the murder, he’d been known only as “the victim,” but their father was so much more than that. William “Bill” May was quick with a joke—a sense of humour he passed on to his three sons, Phil, Paul and Scott May. He married Bonnie, “the love of his life,” and they were together 57 years until her death in 2007.

“I hope there is something that can be done to prevent this from happening again,” said Scott. “It’s a tough population to deal with because of the dementia and potential for aggression.” With incredible grace, the Mays said they hold Furman blameless, but they wanted it known there were two victims in this tragedy. “Much has been said about Mr. Furman being a war hero, a hero to many, and for that we honour him,” said Paul May. “However, you need to know that Dad was also a hero, a hero to many: to his staff, to his wife and his children.” There are steps that can and must be taken to better house vulnerable seniors, said Scott May. “I just don’t want anybody else to go through this, because this is really lousy.”

Furman, too, had a long, happy marriage, returning from the war to take Meryl, his childhood sweetheart, down the aisle. They moved to Hope, B.C., and built a motel from the ground up. They operated it until they retired to Vernon in 1971, where they built a home with a view of the local lake.

He was grateful to have survived the war after taking machine-gun fire to his neck and chest; grateful enough for the good life back in Canada that Hart says he has made the Canadian government the sole beneficiary of his will. He and Meryl never had children. Among their best friends were their neighbours, the Riedlers, who emigrated from postwar Austria. Physically, he was still robust and able to walk without a cane in his 90s. His mind was failing, but he refused to leave the home he shared with Meryl. He’d sit there sometimes in his later years waiting for her return—not remembering, or accepting, that she died nine years ago.

His friend Susan Riedler visited several times a day to ensure he ate his meals and took his medicine. At times war memories surfaced, she says. “Those goddamned Germans,” he’d say, “they shot me.” Some days he didn’t want to get out of bed. He once chased Riedler from the house, but when she returned, he’d forgotten the incident.

He was assessed by health authorities and it was clear he would need to move to a care home. A spot opened at Polson Special Care in August, just days after Hart paid his last visit to Vernon. Furman was assessed and exhibited no signs of aggression, a spokesperson for the Interior Health authority has said. But days later May was killed. The Riedlers were in Europe, returning to the devastating news that their friend was charged with murder. “You walk around in circles because you can’t believe that’s Jack,” Riedler says. “He’s a kind man, a good man. A sickness can do so much to you.”

The Riedlers have visited Furman several times at Hillside. Although Susan says she once found him wrapped in something akin to a “wetsuit” after he repeatedly ripped out a catheter, she says he is well looked after. “That’s the only place they can put him,” she says of Hillside. He’s stopped talking about returning to his home. Susan says he has no recollection of the attack. “He doesn’t even know he did it. If he would know that, it would kill him.” She mourns, too, for May’s family. “They think their father is in a safe place, and then that happens,” she says, fighting tears.

last summer, weeks before Bill May was killed in Vernon, a quiet, reserved one-time accountant named Jack Shippobotham met an eerily similar fate in the Overlander care home in the nearby interior city of Kamloops. An industrious man, he’d kept a paper route well into his 70s. It gradually became clear he was having trouble making his deliveries. He became increasingly confused. “He was doing odd things like putting his shoes in the sock drawer” or dressing in two layers of clothes, says his daughter, Moneca Jantzen. His personality changed and he began to wander at night. His exhausted wife, Vera, couldn’t manage. Reluctantly, the family moved him in February to Overlander when a space opened. He was put in a four-person room with three other dementia residents who were non-verbal and non-mobile. “Within a week or two he was paranoid, quite terrified,” says Jantzen. “He kept looking for my mom, he wouldn’t settle down.”

He was moved to a single room in a different ward. His wandering continued. “He’d get right in people’s space,” says his daughter. “For some of the people, I think they found him a little bit irritating.” She visited once and found he had black eyes. The staff speculated he bumped into a shelf or window sill, but her father would only say: “ ‘The door went wham, wham, wham,’ ” says Jantzen. “We believed at that point that somebody had hit him with a door.” On June 12, Vera took a call from the home: “Jack’s OK, but he’s been assaulted.” He had a broken nose and a broken pelvis. He was treated, given painkillers and returned to the home, bedridden and in declining health. The 71-year-old brain-injured man who assaulted him was briefly assessed at the city’s Hillside Psychiatric Centre then returned to his room near Shippobotham’s, with an alarm installed on his door, says Jantzen. A nurse, concerned about the risk the man presented, quietly urged Vera to press charges, her daughter says. Her father died three weeks after the assault. Police were now dealing with a murder investigation. The suspect was moved back to Hillside for further evaluation, the only real option for a man in his mental condition. For a time he was a neighbour with Furman—both men at Hillside under psychiatric evaluation for separate homicides. Shippobotham’s assailant died at Hillside on Sept. 19. The death was not deemed suspicious and the police investigation ended. A coroner’s investigation continues into both care-home homicides.

Jantzen had never expected a legal resolution; the assailant was not mentally responsible for his actions, she says. Those she wants to hold accountable are senior administrators at the home and the Interior Health authority. They failed both men by not housing them appropriately, she says.

While the health authority is reviewing the death, it has so far refused to share its findings with the family, or what protocols, if any, have been instituted to prevent further tragedies. A frustrated Jantzen continues to push for answers and has created a Facebook page, “Stop POP (patient-on-patient) Violence,” that has become a clearing house for nursing home incidents. “I realize it’s a difficult disease to care for,” she says in an interview. “We’ve got to find ways that work better.”

Gerontologists say there are many ways to lower the risks of assaults in dementia wards, not the least of which is respecting a resident’s right to privacy. Eliminating four-person and even double rooms should be a top priority. “Roommates have a dreadful record,” McDonald told the Taboo topics conference in Vancouver. “One woman couldn’t stand the sound of the other person’s oxygen tank so she just disconnected it.” Even single rooms in most dementia wards are little guarantee of privacy. The Blueberry ward, where Jack Shippobotham lived, was typical of most homes in that the rooms have no locks, in part to give staff easy access and to allow quick evacuation in a fire. As anyone who visits a dementia ward knows, residents wander into other rooms, taking clothes or other possessions, even crawling into bed with other patients, sometimes with sexual intent, other times merely seeking company. Shippobotham was assaulted when he entered the room of a man who was highly territorial and prone to violent outbursts, concerned staff later told his family in private phone calls.

Tragically, Jantzen said her father was in line to move to the Brocklehurst Gemstone Care Centre in Kamloops, which officially opened in September. Rooms there are equipped with locks that allow residents to leave but prevent unwanted people from entering. Locks would have prevented her father entering his assailant’s room, and allowed him security and privacy in his own space, she says. B.C. Health Minister Terry Lake said the health authority will install similar locks in other facilities but it takes time and money. “We’re making great strides and there will be a time when all facilities are like this,” he said.

So-called Dutch doors, where the bottom half stays shut, are another way to secure a person in their room while allowing staff to monitor the resident. Rooms of violent patients, or even patients themselves are sometimes equipped with an alarm to alert staff if they wander. Sometimes a table placed in front of a wheelchair is enough to limit mobility. Actual physical restraints are a last resort, but the use of sedation or antipsychotic drugs is far more frequent and difficult to quantify. “As much as we all hate restraints?.?.?.?perhaps under some circumstances maybe chemical restraints may be the appropriate thing,” Gutman, the gerontologist, told the symposium on aggression. “We have to think about the aggressor—and the victim.”

The use of restraints, physical or chemical, is a legal grey area, notes a September 2013 assisted-living project report prepared for the B.C. Law Institute and the Canadian Centre for Elder Law. “The safe use of restraints in a clear emergency to prevent bodily harm may be fairly non-controversial,” it says. “Experience in other care settings and other jurisdictions shows, however, that there is room for legitimate concern that a practice may develop of using restraints more routinely for reasons of institutional convenience.” An outright ban on restraint was deemed unworkable by the project authors. The compromise is a statement that care providers have a duty in extreme circumstances to “restrain a person under care to prevent harm to that person or a third party.”

More palatable, though hardly foolproof, are preventive measures: better assessment of incoming patients and their history, and strategies to defuse aggression. The Canadian Alzheimer Society’s advice for dealing with aggression includes: “Look for an immediate cause. Give her space to cool down. Distract her. If your safety is threatened, leave.” For some incorrigible patients, though, such measures seem like wishful thinking.

One promising strategy being implemented by health authorities in several provinces is a program called PIECES, which stands for “physical, intellectual, emotional, capabilities, environment and social.” The program fosters a more patient-centred focus. It aims to engage dementia patients’ capabilities, and attempts to limit anti-social behaviour, preferably without medication, by identifying the root causes of their actions. The usual triggers are a menu of the challenges of age: physical pain, boredom, frustration over lost capabilities, memory or loss of privacy, loneliness, anxiety over noisy environments or unresolved emotional trauma.

Baycrest Health Services, a 472-bed long-term care facility in north Toronto, has been designated by the local health authority as a leader in implementing support strategies to limit dementia-fuelled aggression. Under an outreach program, teams go to private homes, care facilities or hospitals to help those dealing with aggressive or challenging patients. Andrea Moser, an associate medical director at Baycrest, calls the outreach teams a way to stretch limited resources, support care-home staff and build their capacity to read the causes of a resident’s distress and find strategies to reduce their aggression. “It’s not only the issue of the number of staff, but it’s the right staff, the staff who have the right training, the right attitude and the right approach,” says Moser. Consultations can involve diagnosing medical causes of distress, adjusting medications or simply trying a different approach. She cites an example early in her career of a male dementia resident so troubled it took four attendants to administer his care—until one day he was curiously co-operative. It turns out it was his birthday and staff had sung Happy Birthday to him. “You know what that means,” she and the staff agreed. “It’s now his birthday every day.”

For extreme or dangerous cases, Baycrest has a 23-bed transitional behavioural support unit where aggressive or unmanageable residents may stay four months or more until they’re stabilized. It’s a secure unit, with individual single rooms, a much higher level of staff support, as well as a dedicated social worker, geriatric psychiatric residents and a clinical psychologist on call. “The purpose of this unit is to implement behavioural strategies and pharmacological strategies if needed to allow the individual to move off the unit,” says Moser. There are three such secure behavioural units in Ontario, with two more under development. The high cost of such units means they are a last resort only, she says. The answer rests with improving the facilities and staff skills at all care homes to ensure a safe and humane environment.

Baycrest CEO William Reichman, a geriatric psychiatrist, estimates 60 per cent of those in care have various forms of dementia, and up to 80 per cent of those will at some point exhibit anxiety, depression, paranoia or aggression. While strategies can limit such outbursts, not all confrontations can be anticipated or prevented even if staffing levels were increased to financially untenable levels, he said in a recent blog post on violence in long-term care. “Short of incarcerating patients with dementia to prevent these challenging behaviours, we must try to rely on other approaches,” he said. “What risks for potentially assaultive behaviour are we willing to accept,” he asks, “as a trade-off to protect an individual’s right to autonomy and freedom of movement?”

Shortly before Jack Furman was moved to the care facility, John Hart received a chilling email from another elderly member of the First Special Service Force. The man wanted to circulate a warning in the event he is stricken with dementia. It reads as follows, exactly as Hart received it:

“I HAVE LIVED IN FEAR?.?.?.?SINCE wwii?.?.?.?THAT I WOULD KILL SOMEONE. WE MEMBERS OF?.?.?.?The first Special Service Force were trained to kill, went on to kill?.?.?.?TO MURDER?.?.?.?WITH OUR BARE HANDS. NOT THE LEAST BIT DIFFICULT?.?.?.?I WAS DELEGATED TO CONTINUE TEACHING HOW TO KILL with my bare hands.

“I PUT IN PRINT?.?.?.?should I show signs of Alzheimer’s?.?.?.?IMMEDIATELY INFORM ALL WHO KNOW AND ASSOCIATE WITH ME?.?.?.?IMMEDIATELY INSTALL DOUBLE LOCKS ON OUTSIDE OF ACCOMMADATION [sic]?.?.?.?WHEN I NEED ASSISTANCE?.?.?.?two trained attendants respond. everyone?.?.?.?HELP?.?.?.?God?.?.?.?please help.”

The plea for help will resonate with everyone who has taken a loved one through the doors of a care home; for anyone who has seen a fine mind laid waste and a personality distorted in cruel and unpredictable ways by this pernicious disease. The time is past due for a “healthy debate” on how society treats those living with dementia, on finding an acceptable trade-off between safety and an individual’s right to autonomy, says Baycrest’s Reichman. “We must not treat our long-term-care residents as prisoners. Their rooms should not be prison cells and our devoted staff cannot be expected to serve as prison guards,” he writes. “What resources are we as a society willing to allocate to the care of older adults with dementia? These long-term-care residents are our parents, they were our teachers, and they will someday comprise a sizable number of us.”

When John Hart visited Furman at his home in August, days before he was moved to the Polson care home, he brought a plaque that he and others in the force association then installed in December on an Italian mountainside. It commemorates a brutal mountain battle, Monte la Defensa, in which members of the First Special Service Force scaled a 300-m cliff face to surprise and overpower a heavily fortified German artillery position commanding a vital transportation corridor in the valley below. The battle inspired the 1968 movie The Devil’s Brigade, but for surviving members of the special force, it was a painful memory of a victory achieved at enormous cost.

Furman sat on the couch in his wood-panelled living room and read the plaque’s engraved message: “December 3, 1943 Ridge 368 Monte la Defensa. First Special Service Force suffered a 40 per cent casualty rate. NEVER FORGET.” He was silent for a time. “I knew the wheels were turning. I could tell he was in real deep thought,” says Hart. “He looked and said, ‘That’s darn nice.’ ”

But remembrance is a capricious thing for those with dementia. There’s no picking and choosing the memories that are lost, or those that refuse to be forgotten—or the consequences that may follow in either case. Bill May and Jack Shippobotham, good men, are dead. And many more. And Jack Furman sits in a locked psychiatric ward, oblivious to his fate, like legions of others­—a prisoner in the present; a prisoner of the past.

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