A Personal Moment

Rarely do I take two week vacations, but my adult daughters have begun their own lives, very separate from mine. This was the last chance to take one together so my husband and I indulged. Tickets were bought last September. My mother, at 84, was doing well enough though she showed signs of some memory loss.

As her memory loss became more apparent, we decided it was time for a retirement community. I began the process and as luck would have it, my vacation fell smack in the middle of planning her move, trying to sell her condo and all the attendant details involved in that. She fell apart.

Weeks before I left she began calling me five to twelve times a day. She couldn’t remember decisions we’d already made. She changed her mind a million times. Finally, I flew away for the first week of my break leaving my husband in charge of dealing with her for the first week. He did well but there was no one to help during the next week when all four members of the family were in another country.

So two weeks later, I return to find this horribly diminished individual. She looked like she had lost weight and she repeated herself over and over and over until it was all one can do to keep from screaming “STOP”. I seriously thought that we needed to change from a retirement home to an assisted living facility. Then the oddest thing happened. Thursday night the real estate agent called. She had a buyer for my mom’s condo. I gave a verbal OK, then cringed at the reality of convincing my mother. The next morning my husband and daughter went to oversee my mother’s signing of the papers. She did it, then my husband spent the day with her, feeding her twice. On Saturday I spent the evening with her and she accompanied me while I helped my daughter unload boxes into her apartment. While my mom couldn’t do that, she sat next to the car while three of us shlepped the boxes which really helped get the unloading done faster. Then she came into the kitchen and unwrapped dishes. When she returned home my daughter called to thank her for helping. I fed her again. On Sunday I returned to help her with some financial questions regarding the move. This time she looked at me and said “You know I’m starting to think this move is a good idea. I’m even looking forward to it a little. By the way, I called people multiple times while you were gone, didn’t I? I have no memory of that. It’s like I’ve been in a fog. I think I went a little kooky. Could I have had a stroke? You’ve been working very hard for me, come on and I’ll buy you dinner.” 

I was amazed. Suddenly she was remembering stuff she did five and ten minutes before. She had insight. What happened?? How was it that I had my mother back? She still has trouble remembering but she’s not the diminished lost woman I came home to. Was it just eating properly? I know she hasn’t been eating during these stressful weeks and we had fed her well for an entire weekend. Was it the socialization? She’d been interacting with people all weekend. Was it honestly being helpful to someone? I have no idea. What I do know is that pseudodementia is complicating an underlying mild dementia that she refuses to take medication to treat.  

At any rate, my belief it that moving her to an environment with exercise and social stimulation will improve her mentation. Maybe she’ll have quite a few years in her new home where socialization, activities and getting to know your neighbor is the norm. 

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A Very Personal Understanding of Aging

My todo list is overflowing, my emails are piling up, I have 17 pages to read in my book and all of these are things I enjoy doing. But my mother has just called me for the fifth time in less than 60 minutes about the new safety monitor we got her for Christmas, the 5Star Urgent Response. New things challenge her and the idea of having both a cell phone and this device is beyond her ability to assimilate. As I sit at the kitchen bar trying to concentrate on any number of items the phone rings two more times. It’s not that I don’t want to work more but my spirit is broken by the phone calls. I give up and walk toward the stairs to the bedroom. My mother must have picked up on my frustration because when the phone rings again, it is not mine. My husband picks up his phone which is playing “Mother-in-Law” (see below).  

Over the years, as my patients have aged along with me, they have told me their woeful stories regarding their parents. I knew my time would come and over the last year my 84 year old mother has diminished with each month. She refuses to take any “more” medication and, like many of the dementia patients I’ve treated, doesn’t see the problem. Since the evidence on the “Alzheimer’s medications” is not all that convincing anyway[1], I am not willing to fight over it. She limits her driving mainly to daytime and to places she knows. But if you throw anything out of the ordinary, like the new device that she needs to clip on her person and charge every night, it becomes a nightmare. Not only for her but for me and my husband as well. 

My daughter has already approached her about moving into a personal care home but she will have none of it. She has good days and bad days. My job keeps me busy and disinclined to force the conversation. It is coming. My patients have prepared me for it and I thank them for this. But just like them, there is a black hole of dread that I see approaching. One thing for sure, while I will avoid discussing what is a personal matter, my empathy will go out to the next adult child dealing with their unwilling parent. 

1. http://consumerhealthchoices.org/wp-content/uploads/2012/08/BBD-Alzheimers-Full.pdf

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À la recherche du temps perdu

À la recherche du temps perdu is a novel I have wanted to read for years. One volume of it sits and mocks me on a bookshelf in my bedroom along with the other thirty or forty books I would really like to read. In English,  Remembrance of Things Past by Proust is a classic novel about involuntary memory–the act of remembering events in the past brought on by something in one’s present. This weekend was filled with “memory”, dealing with the beginning consequences of my mother’s worsening memory as well as the remembrance of when she had this issue involving her mother, and the fear of my own children dealing with the same in the future.

Like all physicians, the issues that I face at home are frequently the same issues my patients face in their lives. Having many patients around the same age that I am, my empathy can be very acute, even painful. Sometimes I am caring for both the declining parent as well as the child, usually a daughter or daughter-in-law. Over the years I have watched Alzheimer’s disease take away the intellect and independence from a patient and helped the caretaker deal with the grief as mom or dad is whittled away to nothing. It’s a painful, frightening process, well-illustrated by William Utermohlen‘s portraits, as he traveled this dark path.

The most frustrating part of the dementia process is the frequent refusal of patients to take any of the meds that help slow the process down a bit. No cure, but sometimes a medication will keep the patient at a plateau of functioning for a period of time longer than if the patient takes no medication. Typically, it is a very hard sell. Perhaps some of the problem is that no one wants to admit it exists. Agreeing to take the medication means they have to face a fear-provoking diagnosis. My own mother becomes vehement in her refusal to take anything. She won’t even let me help her get a medical alert necklace or bracelet in case she falls. What is with that? The reasons vary from “they are ugly” “my friend had one and when she fell she was out of range” to “I’ll take care of it”. Meanwhile I feel as helpless and frustrated as the caregivers I see in my office every week.   

Some days, the Serenity Prayer is the only thing that keeps me sane.

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