A Review of Living in the Land of Dementia by Deborah Shouse

As my wife’s caregiver, I always enjoy reading the experiences of others. While I recognize many of their experiences, there are always unique ones as well. Beyond that, I am fascinated with the ways in which the authors tell their stories. With that introduction, I’d like to say I was especially happy to read Love in the Land of Dementia: Finding Hope in the Caregiver’s Journey. The title itself caught my attention. I immediately connected with the words “Love” and “Hope.” I realize that for many caregivers these words are but a dream. In my own case, however, they capture much of the life my wife and I have lived since her diagnosis over seven years ago. It pleases me to find other people for whom they have also been a reality.

As I started reading, I quickly learned two things. First, this is a book that doesn’t disappoint. It is filled with love and hope and inspiration. Second, Deborah Shouse is a gifted writer. There are many caregivers who have rich stories to tell, but few of us are as skilled as Shouse when it comes to telling them.

Everything about her book conveys her talent. I was particularly taken with two things. One is the organization of her story into chapters that are vignettes of a particular aspect of her mother’s journey with dementia from before the diagnosis through her mother’s transition from this life.

The other thing is her beautiful descriptions in each vignette. The way she describes her mother, herself, and the situations including the physical setting and other people brings the story to life in much the same way that a movie or television production might do. What those media do with visuals, Shouse does effectively with words. I often felt that I could visualize exactly what was going on.

For someone like me who can be a bit longwinded, it is impressive how effectively the author tells her story in as short a space as she does. I take that as another mark of a professional. Her vignettes were well chosen to tell a complete story without having to describe everything that happened over the time period she covered.

I am happy to recommend this very tender and touching portrait of her mother’s journey with Alzheimer’s. You will find it packed with lots of gems as you move from one vignette to another.

Kate’s Changing Response to the Sitter

The other day I mentioned that I continue to feel a degree of uneasiness when I leave Kate with the sitter. I also mentioned that this might simply have related to Kate’s mood last week and that I would be carefully observing this week to see if there might be more to it. I’m far from saying that I know what’s going on, but today was the third day in a row that she failed to display the kind of enthusiasm she has exhibited in the past. I had grown accustomed to her warmly greeting the sitter upon her arrival and also thanking her and saying goodbye when she leaves. She hasn’t responded this way for the past three visits.

Kate has also changed in two other ways. First, she has been sleeping later. As a consequence, there has been much less time between the time she gets up and the arrival of the sitter. As her caregiver, I have felt it was a little bit abrupt to hand her off to the sitter when we had not spent much time together. I hasten to say that I don’t know that Kate feels the same way. It’s just that I have felt our spending some time together at Panera has been a good way for her to fully wake up and enjoy the day. When I wake up, I am ready to go. Kate has always liked a little time with very little talking before she is ready for the day.

The second change is that she hasn’t wanted to spend much time with the sitter at Panera. Last Wednesday and today, the sitter met us at Panera because we had arrived so late. In both instances, the sitter told me that Kate hadn’t wanted to stay long after I had left. Neither did she express an interest in going back later. This past Friday they didn’t go to Panera at all. The sitter told me she had suggested it, but Kate had not wanted to go. This is quite a change from the past. Upon the arrival of the sitter, I have often mentioned that they could go to Panera if they wanted, and Kate has been excited and wanted to go immediately.

I should add that after the sitter has left, she has been ready to go to either Panera or Barnes & Noble. That leads me to believe they are both still appealing places for her to spend some time.

These changes do not cause me to think about changing sitters. These are the same ones who have been coming for six months, and Kate has liked them. It does, however, make it harder on me when I leave.

Our Clothes Saga

This may say more about me than about Kate, but I believe that issues involving clothes have been among the most frequent issues with which I have dealt during her 7-year journey with Alzheimer’s. In the early years, the problem centered on the fact that she didn’t hang up or put away her clothes. At one point, we had three bedrooms with her clothes stacked on the beds, furniture, and floor. For quite a while, I didn’t say or do anything to change her behavior. It was frustrating for her and for me. She couldn’t find anything to wear.

At the same time, she was eating more than she used to and gaining weight. That meant a lot of her clothes no longer fit. My response to that was to buy new clothes. What I didn’t count on (but should have), was their getting lost as quickly as the old ones. During one year, I bought her almost 20 pair of pants. She still couldn’t find something to wear. (Yes, I’m a slow learner.)

I decided the way to tackle the problem was to take pictures of the new clothes. I thought that would at least enable me to find them more easily. It worked for her tops, but her pants looked alike to me. They were either black, tan, or brown. I still had a hard time identifying the new (the ones that fit) from the old (the ones that didn’t). Gradually, I got better at identifying the different labels and sizes.

That prompted me to start getting rid of the clothes that didn’t fit. As Kate tried these clothes and tossed them aside, I would come behind her and take them to my closet. Little by little I gave them to our housekeeper whose church collected old clothes for those who needed them.

My problem was still not solved. Clothes were still scattered among our two guest rooms and a bedroom we call “Kate’s room.” That’s when I decided to reorganize her closet. I began to locate clothes that fit and started hanging them up. I put all of her tops on the left as you enter her closet and arranged them by color. On the right, I put all of her pants, also arranged by color. That has proven to be useful to me, and at one point, I think it helped her as well. I’m not so sure now.

To make my system work demands that I regularly pick up clothes that she has thrown on the floor or furniture and replace them on hangers in the closet. I frequently do this in the morning before she gets up. That way I can make sure that there are things she can wear that day.

One day a strange thing happened. Kate must have gotten so frustrated with clothes scattered everywhere that she started picking up her clothes and putting them in her closet. That was about two years ago. Since then, she has done a remarkably good job of not letting the rooms return to their previous unkempt appearance. That does not mean that she puts her clothes away after she wears them although she often does. Typically, she takes off her clothes in our bedroom and throws them on the floor or the chair on her side of the bed. They often stay there a day or so before I pick them up and put them away. At any rate, we do much better keeping her clothes straight and having clothes that fit.

Another clothes issue has been keeping them clean. There have been two separate parts of this problem. The first involves what she wears when she works in the yard. For three years or so after her diagnosis, she continued to wear her “yard clothes” when she was working outside. As her Alzheimer’s progressed, she started wearing her “good” clothes to work in. That was, and is still, not a problem for her, but it was for me. I wanted to know that she had clothes that she could wear to the various places we go on any given day. I didn’t want them messed up. That was especially true if they were brand new. I responded to this by giving up my efforts to get her to wear her yard clothes. That means her clothes get more messed up than I would like.

The second aspect of the clean clothes problem is keeping them clean with ordinary wear. It seems that it is next to impossible for her to wear something for even a short time during the day without getting it soiled. Almost every time she brushes her teeth she gets toothpaste on her clothes. When we are eating, she often drips food or drink on herself.

One of the things I have done that seems to have worked with these issues is to buy multiple pairs of LL Bean pants with an elastic waistband. I keep them on hand in different colors, and I can easily wash them at home. They have helped me a lot. Nowadays, I buy virtually all her clothes online. That has been a great convenience, and I have spent less money than what I was spending going to the local dress shops where she had shopped for years.

There are still other issues involving clothes that come up. They are ones that I simply accept. One of those started within the past year. For some reason, she started wearing 2 tops with her clothes, not always but most of the time. I know that layering can be a trendy thing, but Kate seems to pick tops that don’t match or complement each other. For example, this morning we attended church for the first time in quite a while. I have regretted this because we have both been so active in the church for as long as we have been members and believe it is an important connection to maintain. At any rate, I picked out something appropriate for her to wear. It is a very nice heavy knit shell and sweater combination and was pricier than things I usually buy. After we returned home from lunch, I suggested that we brush our teeth, change our clothes, and go to the Barnes & Noble Café. She liked that idea except that she didn’t see why she needed to change. I told her she was a little dressed up for a casual afternoon at Barnes & Noble. What I didn’t say was that I didn’t want her to get her good clothes messed up. She agreed to change and went back to her room to do so. When we she was ready to go, I mentioned that she hadn’t changed clothes. She said, “Oh,” and once again returned to her room. When she came back, she still had not changed. She had taken off the outer sweater but was wearing the shell with a casual tee shirt over it. The tail of the shell extends below that of the tee shirt. She was still wearing the same slacks and the shoes she had worn to church. I decided not to push it.

It turns out that she also was carrying two additional tops. She had taken one of them with us when we went to Panera the other day and simply put it on the table. She brought both of them with her in the car and took them into Barnes & Noble. She put one on the table and dropped the other on the floor.

Considering everything, I find that we have fewer problems with clothes now than in the past. I think there are three things that have made the difference. First, some of my organization has helped. Second, Kate has been more compliant when I suggest she wear something different. Finally, things are better because I don’t work hard to achieve my own goals regarding her clothes. I mostly let her wear whatever she wants. That is probably the most sensible thing I could do.

Expressions of Love Through Caregiving

It’s a quiet Sunday morning. I’ve had breakfast and my morning walk. As always, Kate is still asleep. Being a music lover, I have some of my favorite music playing on my audio system as I fold clothes that I didn’t get around to folding yesterday. I gather each of Kate’s tops, pants, robes, and socks and put them in their appropriate places. I return to the kitchen where yesterday I had carefully placed her underwear on a towel to dry. Now I fold them and put them in the drawer where historically Kate has kept them. Now they could make their way to almost any other place in the house. I place them neatly in the drawer even though I know they won’t stay that way long.

As I do this, I think about the fact that I didn’t even know how to run the washer just a few years ago. I think about my dad who cared for my mom who had dementia. He must have been doing these same kind of things for her though I never heard him say a word about it. I was with them almost every day, and I never imagined the things he was doing. He did it because he loved her. They met in the ninth grade and were together until Mom died at 87.

I also think about the other caregivers who right now are doing similar things for their loved ones. They, too, do it out of love. I know. I feel the same way. I am glad I can do it. What a nice morning.

Music continues to be great therapy.

An hour ago, Kate and I left the latest Live in HD at The Met production, La Boheme. We have attended quite a number of these operas that are broadcast live in movie theaters around the world. While there is nothing like the experience of being at The Met, we find that these live performances on the large screen offer an even better experience of the opera itself.

La Boheme, of course, is an emotional opera. Given the outstanding camera work, it has quite an impact on the theater audience. On and off throughout the performance, Kate reached over and squeezed my hand. As she also does at many live productions, she also expressed a few audible “Wows.” The final death scene is always moving, but I find that I am more affected by such things since I know that Kate is on that same path.

I was just as taken by the opera as Kate, but the added treat for me was getting to see her express genuine enthusiasm. There aren’t many things nowadays that elicit this kind of response. The fact that she continues to enjoy musical productions makes me feel good and reinforces my hope that she will retain her feeling for music a lot longer. It’s been another great day, and my pleasure wasn’t tarnished at all when we left the theater and she asked me the name of the opera we had just seen. She had enjoyed herself even if she couldn’t remember it.

Adapting (?) to Having a Sitter

When my dad was caring for my mother who had dementia, I tried to get to get him to use a sitter when he needed to get out. He was always resistant, but he finally agreed to a short trial to see how he liked it. He didn’t like it and didn’t stick with it long enough to become comfortable with the arrangement. Now that I have had a sitter for Kate almost six months, I have a better understanding of his feelings.

That doesn’t mean that I am going to give up the sitter. It only means that I have not fully adapted to it just yet. Having cared for Kate for the past seven years, it is not easy to turn over some of that responsibility to someone else. Kate seems to have adapted much more easily than I have. Despite that, I feel a slight uneasiness just before the sitter arrives. I begin to wonder if Kate will be as accepting this time as in the past.

That has not been a problem. The past two times, however, she has not been as enthusiastic as she has been before. Thus, I wasn’t as comfortable when I left her today. Typically, when I leave, I tell her that I am going to the Y and will see her later. She usually says, “What am I going to do?” My answer is that she and the sitter can do whatever they like. I suggest that she could work outside, go to Panera, or stay inside and work on her jigsaw puzzles on her iPad. Until today, she has jumped at the mention of Panera. Today, she just took a seat with her iPad. When I returned home four hours later, that is where she was, still working her jigsaw puzzles.

After the sitter left, she looked bored. That didn’t surprise me. I would have been bored if I had been working jigsaw puzzles for four hours. It does, however, play into my apprehension about leaving her with a sitter. She often thanks the sitter and tells her goodbye when she leaves. She didn’t do that today.

I think I’ll approach this the way I do most things that come up. I’ll wait to see if this was just a bad day for Kate. Maybe when the sitter comes on Monday, she will be in a different frame of mind. Regardless, I am sure I will be uneasy when Monday arrives.

More Things I Can’t Explain

Kate has been with the sitter this afternoon while I went to the Y and ran a couple of errands. When I returned, I discovered that they had not been to Panera, something they almost always do when I am gone. When I expressed my surprise, Kate said, “We could go now.” I asked if she would like that. She said she would.

While I was putting my gym clothes in the laundry basket, she went to her room. She met me in the family room in a few minutes. She was carrying an extra top and a pair of shoes although she was already wearing a top and shoes. I didn’t say anything. I wanted to see if she planned to take them with her to Panera. As I turned out, she did. When we arrived at here, she left the extra pair of shoes in the car, but she brought her top in with her. She tossed it on top of the table where she and I are seated. That’s just one more thing I can’t explain. I wonder how many other caregivers have had a similar experience. I suspect a lot.

The Importance of Having a Team

The other day I read a tweet by Ian Kremer noting the importance of having a team to aid the caregiver and the person with dementia. I asked myself, “Do I have a team?” It didn’t take me long to answer affirmatively; however, the members of our team don’t know they are on it. Let me explain.

In the typical usage of the term, a team suggests a number of people who work or play together to achieve a common goal. If we begin with this concept of a team, I think most caregivers would have to say they don’t have one. I certainly don’t. In fact, one of the most significant problems experienced by many caregivers is social isolation. I don’t believe it is because people don’t care. I think they are just unsure of what to do for people with Alzheimer’s and their caregivers. I have read a number of things that point to the need to give others a better understanding of how they can help, but I believe this is a long-term solution. Caregivers need something right now.

My own approach has been to take the initiative to engage others in helping rather than waiting for them to take the first step. Some of this has come about by asking directly. For example, on numerous occasions I have invited different friends to have lunch with us. Some of these have been members of the Sunday school class that I taught for ten years. I had already been in touch with them by phone and in class for years. It was only natural. I knew that they wanted to maintain some contact and also that it would be good for Kate.

We have several very good friends who live in Nashville, especially Kate’s friend, Ellen, who moved there following a stroke. We have paid more visits to those other friends than we might have done otherwise. None of these people would think that they are doing anything special to help us, but they are.

Some of these visits occur right here in town. Two days ago, for example, a childhood friend and his wife from West Palm Beach drove over from Gatlinburg where they have a condo. They come to Tennessee about four times a year. Almost every time they come, we get together either in or near Gatlinburg or in Knoxville. We always have a good time, and they have been very supportive since learning about Kate’s diagnosis.

There are many more members of our team in just about every place that we go. These include all the servers at the places we eat, the other customers at Panera or other places. That happened at lunch today. As we were leaving, I heard someone call my name. It turned out to be someone we know from church and my Rotary club. We stopped and chatted about fifteen minutes before moving on. He wouldn’t think of his having done something to lift our spirits, but just engaging in conversation did the trick. Because Knoxville is not a large city, we have these kind of experiences wherever we go.

Finally, I would say that when I decided to be more public about Kate’s Alzheimer’s, that served as an implicit invitation for people to ask how she is doing and how I am doing. Thus, when I see people without Kate’s being along, I find myself telling them how things are going. All of the volunteer activities in which I have participated have also generated additional support for me. Of course, those activities are fewer now, but they have been significant.

I shouldn’t overlook the power of a team of people with whom I communicate via email. I have two college friends with whom I exchange as many as fifty emails a day. The longevity of this connection and the variety of interests we explore have been invaluable. In addition, I have established contacts with a few friends and family who have their own personal experiences with Alzheimer’s. Those relationships provide communications that deal more specifically with issues related to dementia and caregiving.

I almost forgot to acknowledge the team of professionals who are more obvious members of our team. They would include Kate’s doctor and dentist as well as the sitters who are here at home with Kate three afternoons a week.

Except for the exception of these professionals, none of the people I mentioned would think they are part of a care team working to make our lives better. But that is just what they are doing. They have been important sources of encouragement and support without having to make any special commitment to visit us, to send food or cards, or anything other than relating to us when we meet. It is easy for them, and it is easy for us. Best of all, it works. Yes, we really do have a team of people working to make our lives better. They just don’t know that is what they are doing or how important they are. I am grateful for their presence in our lives.

Could she be forgetting my name?

After we ordered our lunch today, Kate looked across the table at me and asked, “What is your name?” I misunderstood her and thought she said “her name.” She said, “No, your name.” I made some lighthearted comment, and she said, “No, seriously, what is your name?” I said, “Richard,” and she said, “Creighton.” Then she asked if I had another name, and I gave her my middle name.

This is the second time in the past few weeks that she has asked my name. In each case, I first thought she was just playing games with me. My second thought was, “Could she really be forgetting my name?” Today it seemed clear that she might be doing just that.

I do know that when we were in the waiting room of her dentist’s office this morning that she asked, “What are we doing here?” I explained that she was there to see her dentist. She said, “I don’t even remember who she is?” I also know that I had to wake her up at 10:00 to get her ready for her appointment and that she was quite groggy when she got up.

I know, of course, that there will be a time when she forgets my name and then forgets who I am. I am already witnessing that happen to close family members. I just hadn’t thought we could be approaching the time when her forgetting would include me. I’m not ready for this.

Dinner With Friends

Last week at Casa Bella, one of the couples with whom we shared a table invited us to join them for dinner last night. They are originally from Ohio where they graduated from Kent State. They lived in Buffalo for several years as well as Fort Worth. That gave us a variety of similar experiences to talk about. We fly into Buffalo every year when we go to Chautauqua and Niagara-on-the-Lake. Since Kate grew up in Fort Worth, and we met at TCU, that gave us more common experiences.

I was not at all surprised that Kate did not remember them when I told her we were meeting them for dinner. On the whole, she got along quite well although she said a number of things that may have seemed strange to them. Very early in the conversation, they brought up something about the time they lived in Fort Worth. Only moments later she started to tell them she was from Fort Worth. She stopped when I looked at her. She must have thought I was going to contradict her in some way and gave me a funny look. Then she couldn’t remember what she was going to say. I stepped in and said something about their having lived in Fort Worth. She looked surprised.

A little later, the wife asked Kate where her children live. She couldn’t remember and looked at me. I jumped in and told her and told them about the grandchildren as well. I am sure they both wondered why Kate didn’t answer for herself. At one point in our conversation, she brought up her cousin who lived in Alaska.  Her timing was off, but she had said this in response to the mention of an Alaskan cruise the couple had mentioned earlier.

Before we left the house, Kate did something else that was strange. We had a warmer day yesterday, so Kate didn’t need to take a sweater or jacket with her, but she did. In addition, she brought a pair of socks even though she was already wearing socks. Even more surprising is that she took the pair of socks into the restaurant and put them on the table beside her fork. I am not sure our friends noticed, but if they did, I am sure they wondered why she had done this. The only explanation I could have given was Alzheimer’s.

It was a short day for Kate. She didn’t get up until after 11:30. We didn’t get to lunch until after 12:30, and the sitter met us at Panera at 1:00. When I returned just before 5:00, she asked me what she could do. I told her it was about time to think about dinner but that we could stop by Panera if she wanted. She did, and we were there about 15 minutes before heading to meet our friends at the restaurant. This was the first time I have sensed that she might have been getting bored just being at home with the sitter. It is another indication of how much she likes to get out of the house. I still hope that our spring-like weather will get her out in the yard again.