Shoehorns

My Bert puts on his shoes using a shoehorn.  It has always been thus. 

The only time a shoehorn gets near my feet is when I am being fitted by a sales assistant.   My thumbs work for me. Always have.

My Bert is so dependent on a shoehorn that if there is none around he will fashion one from a magazine, folded paper, the handle of a spoon, a credit card, or my thumbs.  He is inventive and adept whether sitting or standing.

Shoehorns now for me have become analogous with my Bert’s aging and Alzheimer disease.  When his knee became arthritic he had to abandon the short stubby shoehorn and get one longer.  After his knee replacement the shoehorn became even longer so he could put on his shoes from a standing position. 

Among the travel essentials was the shoehorn.  We have forgotten them in places like the River Jordan and the Dead Sea and other places where we had to take off our shoes on our sightseeing explorations.     I still remember scouring a market in The Gambia looking for a shoehorn!

I have helped my Bert with his shoes and in disgust have discarded the shoehorn and resorted to my thumbs.  They work.

We are in the shoe store.  I have three pairs for my Bert to fit.  Every shoehorn is long.  My Bert is sitting on a padded bench and trying to get a shoe on.  The shoehorn only gets in the way.  An assistant comes by and suggests he stands up to use it.  I become the supporting post.  This is not working.  The assistant tries to help.  Bert hangs on to me and he thinks we are dancing.  He has completely forgotten the reason for us being upright.  He giggles and tells me there is a woman fiddling with his foot.

The bad shoulder begins to hurt.   My Bert wants to dance.  The assistant is sweating and I am sure the mumble I hear is not fit to print.   It is a Herculean task but finally one foot is in.  It is declared to be ‘good’.   I choose the opposite foot from another box and with equal effort gets it on.  My Bert walks around a few times and declares that they both fit and are ‘good’.

I buy both pairs.  I am never doing this again.  It is hazardous to my health!

“Paula, do you have a short shoehorn?  This one is too long to use to help Bert with his shoes.”  The question comes from our wonderful helper who was on her knees, valiantly struggling to use the shoehorn.  The shaft came up to my Bert’s knee and she was working awkwardly with the curved portion at his heel.

Laughter burst out of me as I thought my Bert is like the shoehorns.   I decide I better give an explanation for the mirth before she decides to call in to her office to say she has two clients on her hands and to please send in the emergency squad.

“Your question has reminded me of that old phrase ‘Once a man, twice a child.’   I am thinking how Bert is living his second childhood in conjunction with his shoehorns.   First it was the tiny shoehorn which with age gradually grew longer and longer.   Alzheimer disease has set him back to the tiny shoehorn which he can no longer use by himself.”

The laugh was bittersweet. 

Helping my Bert with his shoes is agonizingly slow.   He has to be in a standing position. I direct him on each step of the process while he holds on to the wall.  Sure, I could still use my thumbs.  It is the getting down to the floor which has become the problem.   Actually, I could get down but how would I get back up?  Calling 9-1-1 is not an option.   I smile to myself again.   I am thinking about having a crane on call.  Nah!

I can’t help but wonder how we will cope when he can no longer stand by himself.

The Meander:  My Bert and a shoehorn.   It is not such an odd juxtaposition.    He has been known to put on his slippers with a shoehorn. Then again, I am the one who sees the sublime in the ridiculous.  Only problem is that in this case what is sublime?  What is ridiculous?  I can only laugh.  Laugh with me so I do not cry.

A Darker Day

Alzheimer disease has been called The Long Goodbye.    It is also The Long Grieving.  Over the last few weeks I have watched my Bert lose some more brain cells.  Now I am more instantly aware that it is happening.  That was not always so.  Prior to this it would take some prolonged period of imperceptible change for the loss to be noticed.

One morning he had his yogurt after his sandwich as usual.  The next morning he does not eat it and I ask: “Don’t you want your yogurt today?”

My Bert looks at his plate, his cup, and his knife then picks up the banana peel and says:” Oh, yes, I do.  I want my yogurt.”   He begins to put the peel in his mouth.  I stop him and give him the yogurt.  I do not wait for this to recur.   I know yogurt is now another item that befuddles his mind.  His brain no longer recognizes that so familiar item which has been a part of his breakfast for as long as I can remember.

My Bert now tells me goodnight and says he is going upstairs to bed.  There is no upstairs in our home.  In fact we live in a condo and have always lived in bungalows.  He needs to be reassured that yes, this is our bedroom, yes, this is our bed, yes, I will be sleeping in that same bed, yes we will be sleeping together and yes, Jan, Gerard, Ossie, Wendy, Marg, Meintje and a few more people, all who are already dead will be sleeping with us too.    I offer no correction nor explanation.   If my Bert is less anxious having them with us, well, come on in.

Each day my Bert tells me repeatedly how much he loves me.  I wonder if he is saying it to reassure himself.  Maybe it is just that familiar phrase he has been saying for so long and so often.  Maybe he likes the smile it brings and the:”I love you too.” I know it has not lost its meaning for him nor for me.

I sometimes catch a vacant look, accompanied by an unintelligible mumble.  I wonder what is going on in his brain.  Do the amyloid plaques cause any sensation as they fill up and kill off another cell?   What about the tau tangles? Do they emit any sound as the deterioration accelerates?  There is no indication of pain but I wonder if there is anything, any sensation that tells my Bert something is amiss.  I will never know.

My Bert is entering the late stages of dementia.  I am in the beginning stages of grieving.   

To see the Light you must live in the now, yet I cannot forget what was.   I remember the good times, the fun we had, the amazing life we lived but I am remembering in the past tense as if my Bert is the past.  I censor myself.  My Bert is still here.  There are still moments of absolute clarity and I can see what used to be in the here and now. 

Now I understand the ambiguity of memory.  It can be soothing and at the same time cruel.  Memory is the handmaiden of grief.  The mind of its own volition brings up memories and by definition that means the past.   I am remembering the then, the before and it is making the now unbearable.  The mind and my memories are not static or finite.  Therefore, neither is the grief.  I am grieving the loss of yesterday, last year, our beginning and yesterday.   My memory meanders with the mind’s stream of consciousness, skittering hither, thither and yon and grief is its partner.

My Bert is slowly leaving me.

The Light dims as I contemplate the inevitable.

Imagining the after is unendurable.

There is still some light.  The loss is not complete.  I grieve but do not yet mourn.

Not yet.

The Meander:  My respect and admiration for caregivers is immeasurable.   No matter how special this particular challenge is, the journey is heart breaking.  It tests the will.   It is an obligation made bearable by love.   You have no choice.     I know.  I love.  I hurt.  I am a caregiver too. 

Progressing to Regression

The doorway going into the main bathroom was the measuring post.   Every now and then we would catch a child as he rushed hither and thither and announce cheerfully:

“Let’s see how much you have grown.”  Then out would come the measuring tape and a new pencil mark would be placed on the door jamb.

“Hey, you have grown another inch.”

As our boys grew there were other measuring tools.  Next grade in school, clothes and shoes that were outgrown far  too quickly.

There are no boys in the home any longer but I am still measuring.  It is a different kind.  Now I measure the regression.  I notice a similarity.  The boys had growth spurts; the regression also has spurts.   For a month or three I am relishing the pause of a good plateau and a manageable routine, and then:

“Paula, I got three.”   My Bert is lying in bed.  The sentence catches my attention as the tone has a certain timbre that tells me this is not a welcome ‘three’.

“Three what?” I ask.

“Three!!”  There is a note of impatience.

My Bert puts his thumb and first finger together to form a circle and says, even more impatiently:

“Three.  Three of these.”   I look at him and calmly say:

“Three round holes?  What do you want to do with them?”

“I don’t know.”  Now he sounds agitated.  I remain calm on the surface.   This is totally out of context and beyond the norm.  This is entering Alzheimer’s World. 

“They are just holes.  Don’t worry about them.  Just ignore them and go to sleep.”

“I can go to sleep?  Do you have them?”  He shows me the round holes and I make as if to take them away as I open his fingers.

“Yes.  I have them.” I say with a smile.

“OK, good.  Goodnight, Sweet Pea.  I love you!”

“’Night, ‘night.  I love you too.”

That is not all.  I now regularly sleep with a variety of people that only my Bert sees.  They are real to him.

“Paula.  They are there.”

“Who.”

“You know, them.  The ones, who um, but they go to sleep.  They sleep with us.”  He chuckles: “They are going with us.  They are…see… and we need cheese.”

I grasp onto that: “Tomorrow I am going to the Dutch shop and I will get cheese for your breakfast.”

“What cheese?  I want to sleep.  Take care of …mumble.”

“OK.  I will.”

We are preparing breakfast.  My Bert is painstakingly building his usual cheese sandwich.  He puts the cheese away and looks at the sandwich.  He is not satisfied and I notice a spot where the bread is not covered.   I know that will not do.

“I see an empty spot”, I say.

“Oh yes.  Give me the shoes.”

Without the least hesitation I pass him the cheese.  He takes it, covers the naked spot.  He looks at the sandwich and smile.   Should I have corrected him?  Why?  I am in Alzheimer’s world and I speak and understand Alzheimer.

In less than 12 hours I have witnessed a bit of anxiety, aphasia, confusion and hallucination.  I think we have just fallen off the plateau.  There will be another and I will have to adjust.  I know there will be more work, more care, patience and love needed. 

I have received notice of the new plateau.  Now after eating I surreptitiously stack the dishwasher.  Yes, my Bert wants to ‘help’ me by doing the few dishes but he has forgotten how to get hot water.  The kitchen tap is a single faucet.  You turn the lever to the left for cold and right for hot.  My Bert, until two weeks ago had no difficulty.  Now he calls to tell me there is no hot water.  I notice he is pulling the entire faucet forward and my Bert is strong.  I can imagine the plumbing bill should he wreck it.  So as soon as we eat I collect the dishes and put them directly into the dishwasher.  I tell my Bert we are letting the dishwasher do its job so we can have time to play,  listen to music or dance.   Usually he opts for music and promptly falls asleep in his chair.  Many times he will just decide to go to bed.  That works for me too.

The Meander:   “The time has come,” the Walrus said,
“To talk of many things:
Of shoes–and ships–and sealing-wax–
Of cabbages–and kings–
And why the sea is boiling hot–
And whether pigs have wings.”

Thank you, Lewis Carroll for nonsense verses like The Walrus and the Carpenter.  I smile and think Alzheimer’s World is in truth Through the Looking Glass.  Perhaps my Bert is the Walrus and I the Carpenter.  Maybe the next plateau will be pigs with wings.

Sweat and Small Stuff

Caregivers are the experts at not sweating the small stuff.  We have no choice.  Start sweating and you would morph into a walking swimming pool.  As we continue the journey I am often surprised at what gets thrown into the small stuff bin.  Most people would be sweating buckets at what we cavalierly designate as small stuff.

A diagnosis of dementia brings instant despair.   Thoughts are of death and the horrors of caring for a loved one you can only envision in the final throes of the terrible disease.    Contemplate possibly living for eight to twenty plus years with the spectre of death hanging over you and nothing, absolutely nothing is small stuff.

Having been handed life sentences for two, we gird our loins to tackle the issues as they come.

Among the first was the constant repetition of questions that drove me nuts.   Same question, over and over.   I would vary the answer just to keep my sanity.  Now: “What time is it?”  “It’s eight o’clock.”  One, two: “What time is it?” “It’s eight o’clock.”  If it continues long enough I may get to:”It’s nine o’clock.”   No problem: small stuff.

The hearing aids somehow get stored in the freezer.  Hah!  The bread knife is in the washing machine:   small stuff.  If my Bert ‘helps’ by washing the dishes and I have to go on a treasure hunt to find where he has put them away?  So what?   I give him a big smile and loud thank you.  He is happy, while I hope I am able  to find everything before bedtime.

A ray of sunshine comes through the window and I see a film of dust on the coffee table.  I choose to see the sunshine.  I will get to the dust later.   I have to cancel my hairdresser’s appointment because my Bert’s appointment is taking longer than anticipated, no problem, I will wear a hat.   My Bert exhibits an inappropriate sense of humour or lack of rectitude in announcing loudly in church or a restaurant: “I have to go pee.”  I used to be embarrassed.  No longer: small stuff.

The little irritants that used to be stressful are just that, little.  So he puts on his t-shirt backwards, shaves off his eyebrows, wears two different coloured shoes (I did not catch it in time) to his ‘club’:  Small stuff.

In great anxiety I consult our counsellor.  I am distressed as my Bert now has Obsessive Compulsive Disorder (OCD)!  Want to be bored out of your gourd?  Watch my Bert make his breakfast open-faced Gouda cheese sandwich.   For the rest of the world, and formerly for my Bert, bread, cheese, put one on top the other and voila – open faced cheese sandwich.  Now my Bert has to cover the entire surface of the bread, just so.  I have watched as he carefully rearranges the cheese pieces until the bread is completely invisible.  The cheese must not be too uneven which will result in complete dismantling  and new reconfiguration of the same piece of bread and  cheese pieces.  I have seen him look at the composition and not being satisfied take another slice of cheese to even out the masterpiece.  The construction must then be divided into four equal parts.  The precision with which that is done is awe inspiring.  The greatest architect would be tested to get it any more precise.   The yogurt, juice, banana, tea, are another post!  I reported all this and tearfully asked:

“What can I do about this OCD?” 

“Nothing.  This may be just his way to have some control in his ever increasingly uncontrollable world”  was the answer.   So, I did nothing.  Now I will even point out a small space without cheese which my Bert will immediately fix.  Hah!  Small stuff.

I asked one of my Lifeliners what constituted small stuff to her and she answered: “Everything.”   We all laughed but related well.  We wished everything was small stuff.  Of course, it is not.  We have learnt to de-clutter our caregiver lives by paying attention only to the essentials.   I determine the very important issues by asking:  Is this a case of emergency?  If the answer is no then it is just small stuff.   It’s self care or rather, self-preservation.  

The Meander:  As the journey continues you do recognize what is important and gain confidence in identifying those issues, new behaviours and changes that need immediate attention, help and/or professional intervention.   My greatest accomplishment each day is to see my Bert happy, teasing, being himself, inadvertently cracking a joke and ‘helping’ me.  All the rest is just small stuff.

Something New or There’s a Name for That!

Something new or There’s a Name for That

“Hey, why are you crying?”

“I love you so much.  You do not know how much I love you.”

“That’s no reason to cry.  I love you too.  I am happy because I know you love me, and I love you.”   My Bert is still crying, so I give him a hug and say: “I love you more than you love me.” Then the game begins.

The game is a couple tradition begun when we met and fell in love.  We would try to outdo each other in professing our love.  It was my Bert who first started to use distance measurements in the game.  It was: “I love you to the moon and back.”  Then I would top that.  We would signal the end of the game when my Bert said: “I love you to eternity” and I would counter with: “I love you to infinity”.  We would then segue into a debate as to which was the greater, eternity or infinity. That is yet to be decided.

Lately, both ‘eternity’ and ‘infinity’ have lost their meaning to my Bert but he still hangs on to distances.  It is not unusual to hear in the middle of having breakfast: “I love you fifteen million times around the world.”  Since mornings are busy and I have no desire to go around the mulberry bush a few hundred times I do not respond with distance but with a smile and say: “I love you too, double that.”    That is enough to elicit a laugh and immediate satisfaction.  This crying was an addition I did not like.

A few days later I go to get my Bert from his ‘club’.  I am met by staff who report that he has been crying for maybe an hour or more.  It seemed they were having a music programme and somehow a song reminded my Bert of World War II.  He became very emotional and started talking about his experiences as a child during the war.  He had spoken quite eloquently and very often about this but it was not accompanied by this type of crying.

I was asked to wait a few minutes while they continued to calm him as he had told them: “I do not want my Paula to see me like this.”  I waited.  The door opened.  I smiled at my Bert and he burst into tears.

I was flummoxed.  Not only was he getting emotional frequently, he was expressing an emotion that was beyond the dictates of the situation.  A happy baby on television could start a crying episode.

Then came enlightenment.  It was a scheduled home visit from our Geriatric Mental Health Counsellor.  She is wonderful, warm, caring and most of all very knowledgeable.  When she asked me if there were any new behaviours to report, I told her about the crying.  She immediately said: “Oh that is called emotional lability and is a condition that people with dementia experience.

“Emotional liability?” I exclaimed.   You may recall that I am that individual with a syndrome not yet named as evidenced when my doctor first diagnosed a Baker’s cyst and I in confusion asked: “Baker’s Yeast?”  Obviously my syndrome is intact as she smiled and said: “Not liability, lability.  Let me write it down for you.”  Smart woman, I thought.

As soon as the visit was concluded and advice given as to how to deal with the condition I went to the internet and found this:

“Emotional lability refers to rapid, often exaggerated changes in mood, where strong emotions or feelings (uncontrollable laughing or crying, or heightened irritability or temper) occur. These very strong emotions are sometimes expressed in a way that is greater .than the person’s emotions”

“Labile Affect, also known as Pseudobulbar affect (PBA) or Emotional Incontinence, is a disorder where the patient has excessive displays of emotion, or expresses emotions that are not congruent with the situation.”

It is exactly as my Bert demonstrates.

The Meander:  Daily, it seems I am made more aware of the incredible organ called the brain.  It is simply amazing.  Will we be able ever to unravel its intricacies?   I wonder if Artificial Intelligence, or those fantastic robots that can do anything and everything and which will replace or conquer us in the end, can experience emotional lability?  I dare to think that the operative word is ‘artificial’ and it will ever be thus.

Resolutions

No doubt resolutions are being made left right and centre.  Resolutions are being broken even as I write.  Resolutions made at the stroke of midnight as 2019 dawned are already in the trashcan of what might have been.  I rarely make resolutions even though I see the New Year as an opportunity to begin anew, to look forward, even to dream and to plan.  However, to continue my ruminations on 2018 I have decided to take a leaf from Melinda Gates’ book and choose one word to guide me throughout this year.  It has been reported she does that and since I am not that enamoured by resolutions this seems a good alternative.  I have chosen ‘Light’ to be the word that will guide me throughout 2019. I have decided to walk in the light to see the light and whenever possible to be the light.  It sounds laudable but  I have to acknowledge that this may be the hardest objective I have ever set.  Yet at the same time I have some confidence that it is the one I may be able to attain.

So far keeping resolutions has not been my forte.  I am going to lose weight is a recurring theme which starts with gusto and swiftly ends with gusto – usually with the Valentine chocolates.  I am going to start and stick to an exercise regimen.  Yes!  Except that I have not decided which year this is to begin.  Since I make the resolution at midnight I should begin on New Year’s Day.  If I have stayed up until midnight I am too tired to start that day, and by January 2nd the enthusiasm has curbed to the point of lethargy and there is a book somewhere that is calling me.  How much more civilized to exercise in such a peaceful, restful, and for me the necessary occupation of reading a good book while swaddled in a soft throw and curled in my favourite chair.  The mind needs exercise too!

This year I am transitioning from the ridiculous to the sublime of resolution making.  No resolutions, just   a word and determination.  Walking in light, seeing the light, being the light is incredible conceit, a pipe dream, or maybe setting me up for failure.  Yet I think, even though it is only day five, that I will succeed better than I have ever done before. 

Living with a loved one with Alzheimer disease is living in darkness.  Caregivers know that because until this we have lived in light.  This is my first purposeful plan that is not me focused.  This is for my Bert.  My Bert needs light.  He needs to see the light outside, inside and see me as light.  His happiness is my light, my happiness is his light.  Caregivers live for two.  I want to shine a light for my Bert, for other caregivers and everyone I meet.  Still I am being selfish as I believe I will benefit the most if I succeed.

This is also the first plan that will perforce depend on outside help.  It is family, Lifeliners, friends, counsellors, my support system who will walk in the light with me, seek to see the light with me and encourage me in my efforts to be the light.  They know and they care.

The Meander:   “Your success and happiness lies in you. Resolve to keep happy, and your joy and you shall form an invincible host against difficulties.” — Helen Keller

This is from someone who knew the dark intimately.  I wonder how invincible I can be against Alzheimer disease.   Then again it is not a ‘difficulty’ it’s a disease. I do not have to be invincible.   Come walk in the light with me. 

Ruminations on a Year-2018

We look at the world; the world looks back at us.   Some call me brave.  Brave?  Far from it but I do accept responsibility.  They call us a loving couple and that we are.

“Oh, Bert looks so well, you would hardly know he has Alzheimer disease”.  If only they knew.  I choose to accept the compliment on behalf of both of us, after all carers get so little thanks, if any.

“How can you write so positively about your situation?”  I choose to do so.  No, I do not have a Pollyanna complex.  Rose coloured glasses obscure too much.   I have to see clearly not just for me but also for my Bert.  I hurt.    Of course I do.  However, I am grateful that I do see the glass half full and have been blessed by an offbeat sense of humour and with a partner who makes me laugh.

“You are a Saint.”  Hah!  Leave that sobriquet to Mother Teresa.  There are times when I must be more akin to the devil incarnate.  Have I experienced bitterness?  Yes, but as Norman Vincent Peale said: ”Change your thoughts and you change your world.”   Sure I will have negative thoughts; they come with the territory, but I hope they are not bitter.

In 2018, the learning curve reached a peak.  We sit on a plateau not knowing when the change will come.  Will it be again upward or will it be a downward helter-skelter tumbling into the abyss?   More than likely it will be a combination of upward learning as we tumble ever downward.  I choose to let the future be, holding on to the present and refusing to be weighed down by the past.  2018 taught us we can live, differently yes, but live nonetheless.  This is neither bravery nor sainthood, just accepting the things we cannot change.

In 2018 I learnt banging my head against the wall only results in a headache. Therefore I count to ten or maybe twenty or maybe…  I must be long past a million by now.

In 2018 I learnt that I am actually quite pragmatic as I know I have to acknowledge the darkness.  I have to grant how awful, how evil, how depressing this disease is.  Yet I must also look for the infinitesimal spark of light within that darkness.

2018 taught us to live by smalls, like small mercies, small moments, small comforts, and small miracles.  We learnt to wonder at the beauty of one song within the symphony, one iridescent droplet after the rain, one star within the constellation.  In a shrinking world our universe expanded.

In 2018 I would sometimes awaken with tears streaming and fall into a chicken and egg reverie.  Are these tears of joy for a rare good night’s sleep or is the sadness deep in my soul finding release?  I try to unravel the conundrum while in my suspended animation shifting between waking and sleeping I endeavour to decipher the meaning of the tears.

The yin and yang are played out in every way thinkable every day.  It seems that happiness and sadness are always holding hands, walking in tandem and interlaced with uncertainty.  What’s next is an ever present question and the answer is always we do not know.

The Meander:  As a new year dawns I promise myself that when I see myself sliding into the slough of despair I will ponder the imponderables:  How can there be darkness if we do not know light; how can we know good if there is no evil.  I can be joyful because I am intimate with sadness.

Honest Mistakes

Oh, the stigma of having a mental illness!  Once we got the diagnosis of dementia – Alzheimer Disease my heart sank and I thought: “How do I cope with a mental illness?”  It was an honest mistake.  Dementia of which Alzheimer Disease is the most prevalent form is NOT a mental illness. Yet, I too immediately classified this brain disease as  mental illness.  It was easy for me to grasp the outcome of a stroke, or brain aneurysm, but deterioration of the brain without such a direct cause was suspect and to be shunned.  Yes, we have come a long way in recognizing what mental illness is but there is still a stigma about it and since dementia concerns the workings of the brain it all gets lumped into that basket of things not understood.   It comes down to being ignorant, not knowing, a state we dislike, so we stigmatize.

Persons with a mental illness are no longer shut away in an asylum, or ‘madhouse’.  Both understanding and treatment have advanced where we now recognize mental illness as just that, a mental illness.   On the other hand dementia is a physical illness.   Although this disease is being studied and research abounds there is still not a definitive cause for the more than 120 types of dementia that have been identified so far.  Technical and medical terms like beta-amyloid protein fragments usually referred to as plaques and tau or tangles are batted around.   I now can bat around such terms with understanding but they are the mechanics of a disease that attacks the brain and leads to death.  You can begin to understand the complexity of the disease when examples include Lewy Body, vascular, frontotemporal, Parkinson’s disease and even Cruzeveldt-Jacobs Disease which is the human form of what is commonly called Mad Cow disease.  Naturally the latter is an example not trotted out too often as the word ‘mad’ is a red flag to any raging bull or misunderstood brain disease which can lead to even more stigmatization.

Another honest mistake is to think that all these numerous forms are just a different kind of Alzheimer Disease.  Like Alzheimer Disease these are types of dementia.  In fact Lewy Body has its own abnormal protein called alpha-synuclein buggering up the works in the brain.  Each one identified has its own pathology and just to make life more difficult there is also mixed dementia which is now recognized as being more prevalent than previously thought.  That is usually a diagnosis which is a combination of vascular dementia and Alzheimer Disease.   It signifies too that the two main engines of our body, the heart and the brain are both compromised.   I think since research is ongoing we could wake up one day and hear that ‘mixed’ is not only two, but three or four or more ganging up on one brain.

My Bert is a classic case of Alzheimer Disease.  The last doctor told him his blood pressure was better than many younger people, to which Bert replied:  “I am only 19.”  I was not going to correct him to say he was a toddler in the brain department!   Yet, it is true that my Bert is healthy.   He eats well, has not put on or lost weight.  Whatever negative symptoms he exhibits, and there are many, all stem from those darn plaques and tangles that are filling up his brain, interfering with the memory and communication processes.  Messages are confused, delayed, misunderstood or not understood at all.  We are both frustrated.

It is uncharitable to stigmatize anyone for any reason.   We have had the honour to meet and become friends with a most accomplished, outstanding citizen, and the epitome of a gentleman who had actually been institutionalized in a mental health facility twice.  He was completely cured and felt enormous gratitude for the professional help he received.  He acknowledged the fact of having a mental illness.  He knows the difference between that and dementia.  Many of us do not.  However we can learn.

The Meander:  A doctor making rounds in a Mental Health facility sees a patient writing furiously.   “What are you writing?”  He asks.

“A letter.”

“Oh, who are you writing to?”

“Myself.”

“What does it say?”

“How the heck would I Know?  The postman hasn’t come as yet!”

A doctor making the rounds in a Memory Care facility sees a patient painstakingly forming letters on paper.

“You seem to be writing a letter.” He says.

“Yes.”

“Are you writing to a friend?”

“Yes.”

“What does the letter say?”

“What letter?”

Short Shorts

My Bert calls me Mama.

“I am not your mother. I am your wife”

“I know.” he says.

“So, why do you call me Mama?”

“You are my Mama because you take care of me.”   This is no longer a momentary lapse; it is a delusion.   My name alternates between ‘my Paula, my wife and Mama.’   I presume that since I go from Alzheimer’s world to the real world perhaps my Bert goes from reality to delusion and back again in much the same way.  I do not know.  I doubt the transition from Mama to wife means anything to my Bert.  I do know that to him I am Mama in that juncture of time.  When he calls me my wife or my Paula it is the truth, the reality of that moment.

The only significance in those moments is that whatever he calls me he knows who I am.  He has not forgotten me and in fact has more cognition, where our relationship is concerned, in his world in that I am not one or the other but a composite of the roles I fulfill.  He does recognize that I am wife and mother and also just Paula.   What do I do?    Nothing.

***

We are on our way home.   My Bert has spent the day at his ‘club’.  He was happy, telling me that ‘They all like me and they tease me’.  Teasing will always get a positive response from Bert as he has a PhD in teasing.   A soft white splatter, then some more hit the windshield.  Omigosh.  I am not ready for winter.

“Look, it is snowing.  It is too early for snow.”  I sigh.

My Bert leans forward and says: “Don’t worry, it’s only hard water.”   His perspicacity generates a chuckle.   I wonder if I should pass on this definition to a meteorological agency as another descriptive word for snow.   It does sound logical doesn’t it?   Think of ice.  That is definitely hard water.

* * *

My Bert lost his hearing aids.  If I have told him once I have told him a hundred times to leave his hearing aids in until I remove them.  Well, that goes in one ear and out the other, hearing aids in place or not.  I look in all the locations that would seem logical for him to put them.  Then I look in some unusual places.  I enter Alzheimer’s World and begin to look in the most implausible places imaginable.  No hearing aid.  I remember the bread knife in the washing machine and begin the search again.

Although I know the hearing aids had to be somewhere in the home I cannot find them.  I give up, realizing Alzheimer’s world has defeated me.  I call, order a new set and make the appointment to have them fitted in three weeks.

The loss of the hearing aids becomes a subject of conversation.  This happens more frequently than you may think.  I heard of them being in shoes, in a flower pot and other such interesting but bizarre places.   It makes for a good laugh but I am thinking of the replacement cost and wondering how to ensure I do not have to do a repeat.  Three days before the appointment I open the freezer, root around to find what I need and right in the corner there is a pair of twisted together, flesh-coloured objects  winking at me.  You guessed it.  The hearing aids.   Of course they are no good anymore.  My Bert has frozen his ears off…well the hearing aids.

* * *

A new Personal Support Worker (PSW) is coming to get my Bert ready for the day.  It is not the usual male aide but a woman.  I am unsure how my Bert will respond to this.  She arrives.  We all go to the bathroom.  I will hang around just in case.  I call out cheerfully:

“OK, Love, time for your bath.”  My Bert looks at me balefully and I am mentally preparing what to say if he balks.  He harrumphs as only he can, begins to undress and says: ” Why do I need two people to give me a bath?”  The PSW is marvellous she laughs and says:

“You are so lucky; you have two beautiful women to help you.”   Without batting an eye and with a devilish grin my Bert turns around and says: “Want to change places?”

We all burst into laughter.  I leave them to it.

The Meander:  As long as I can laugh with my Bert at the vagaries of this dreadful disease, we remain its masters.  I had no idea that Alzheimer disease could provide so many instances of comic relief.   I hope we have many more moments of merriment at its expense.

Employment Opportunity

The Company:  Dementia and Partners

Job Title:             Caregiver to a loved one with dementia

Duties:                 Advocacy or dealing with agencies, organizations and bureaucracy

Nurse and Social worker

Mother, Father, teacher, daughter, son, husband, wife, friend, protector, security blanket, lover, dance partner, punching bag (literally and figuratively), pacifier

Drug Dealer doling out correct medications at right times and right amounts

Administrative Assistant

Primary Personal Care aide

Archivist or keeper of memories

Mood assessor, Ego booster

Entertainment Manager and Cultural attaché

Detective and finder of lost articles

Domestic cleaner

Fashion advisor and dresser – no clown outfits or black left shoe with brown right shoe allowed.  “You need a coat and scarf.  It is cold outside.”

Language expert, Translator, Interpreter

Dietitian – Chief Cook and bottle washer

Information Research Scientist to wade through the massive amount of information.  It is continuous learning.

Child care worker, Psychologist

Financial manager and banker

Transportation service provider and personal taxi service

Ghost buster when as example you are told: “There is a man outside the bedroom with his wife and children.  Are they sleeping with us tonight?”

Playmate

Logistics clerk – you will be making appointments with many professionals you never knew existed.

Record keeper-Careful notes result in better care.   You work with your care providers and medical professionals so there is no guess work.

And other duties as they arise

Special Skills needed:  Flexibility, Quick learner, Decision Maker, Comedian, Political skills aka therapeutic lying/ deflection/distraction/redirection.

Patience, patience and more patience

A thick hide is a real bonus

Emergency services coordination in knowing when and whom to call on a list you have created that is easily accessible when needed

Wages:                 $0.

Benefits:             The complete and total trust of your loved one

Recognizing the awesome responsibility of having complete control over another human being, your loved one

Unconditional love, which is sometimes hidden but is always there

Acquiring enumerable new skills, whether you want to or not

No experience necessary.  You will be given full, free tuition and fast track your career through Dementia and Alzheimer Disease University.

We guarantee a full and rewarding life though we cannot guarantee your sanity

Date of Hire:      Immediately

Hours of WorkThe 36 hour day – This book is a good resource as well as your daily work hours

Contract duration:  6 to 20 years or more.  Think “Until death us do part.”

This is an equal opportunity employer – age, status, wealth, race, colour, creed, education, health status, relationship, sex, ethnicity, the good, the bad, the ugly, the beautiful or other does not matter. This company will take on anyone.

The Meander:  So often this phrase is uttered “I did not sign up for this”.    We do not choose this job.  It is thrust upon us.  On my dark days I console myself with this: “Love guides me; Empathy empowers me; Patience is my best tool.”   It is my mantra.   My Bert, love, empathy and patience keep me going.

Note – As I was about to publish this post a call came in from a friend.  I mentioned the content of this post and her immediate response was: “You left out one very important duty- Search and Rescue.”  True.  Not wanting to change the original post I decided to add this note.  I also invite all who read it to comment and add any other duties I may have missed.   It may be that no one person can cover all the changes and activities that will come out of a brain with dementia.   Individuals exhibit different behaviours  even though they all have dementia.  Writing the ones we each encounter may help many of us already on this journey and others who may find themselves walking it in the future.  Forewarned is forearmed.