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Growing Confusion

I can’t say that I am observing any new symptoms of Kate’s Alzheimer’s; however, I sense that she is sinking deeper into confusion. The things I report below may sound familiar to you. Just try to imagine that the way she looks and the way she says things suggest something more serious than before.

One of those things is a more consistent failure to realize she is at home. She is routinely ready to take her toothbrush and toothpaste whenever we leave the house. I think she believes we are leaving a hotel. It is becoming commonplace for her to ask where we are when she wakes up.

It also involves an increase in the frequency with which she doesn’t know I am her husband as well as the length of time it takes for her to accept that I am. As we walked from the car to the restaurant for lunch day before yesterday, she said, “Who are you?” I said, “Richard Creighton.” She said, “I know that. Who are you?” I said, “I’m your husband.” She said, “Oh.” There was no other indication of surprise, uneasiness, or enthusiasm. She got the information she wanted and accepted it. While we were eating, she said, “Are you the owner of this place?” I don’t think I have mentioned this before, but she often attributes things to me with which I have no connection. The most common one occurs when we are listening to music in the car. She often says, “Is that you singing?”

At lunch yesterday, she asked my name and then hers. Then she asked, “Who are you?” When I told her, she didn’t believe me. I decided to tell her about our first date and our courtship while I was working at the funeral home. As I recited these experiences she began recognize them. Then I told her we would celebrate our fifty-sixth anniversary next month. I don’t mean to suggest that all her memories came back. It was just enough for her to accept that we are married. Then she asked if we have children.

She is much needier now. She is comfortable with Mary, our sitter; however, when I arrived home that same afternoon, Kate was especially glad to see me. She asked where we were and wanted to get away. She was was relieved when I told her we were at home. I don’t think she feels as comfortable asking Mary where she is.

On the way to dinner that night, she told me she really needs me. She has said this many times before, but it seems different now. Her facial and vocal expressions convey a greater need than the way she used to say it.

The other night after dinner, she wanted to know what to do. This, too, is becoming more common. I told her she could work on puzzles while I watched the news. She did that for almost an hour. Then she got frustrated. I suggested she look at her “Big Sister” photo album. She did for a while but stopped when I put on a DVD of Les Miserables.

Last night as we walked along the sidewalk to Casa Bella, she said something nice that prompted me to remind her that we have been together a long time. She asked how long. I told her almost 56 years since our wedding. She gave me a funny look and said, “Whose wedding?” I repeated that it was ours. She said, “No. You shouldn’t even joke about that.” This time I didn’t try to convince her as I did earlier at lunch.

There are lots of little things that suggest her increasing dependence. One of those is wanting to hold my hand more often than in the past. She frequently says, “I don’t need to, but I feel better.” She also wants my hand to help her in and out of the car and accepts my help buckling her seat belt. During dinner last night, she repeatedly asked me if her iced tea and water was hers. This is not new, but it is more frequent now. She is unsure of what is hers and what is someone else’s. She recognizes that she makes mistakes and doesn’t want to drink one that belongs to another person.

I have been eager to celebrate the many good times we’ve had since Kate’s diagnosis. I’ve also tried to be honest about the problems we have faced. We still have many good moments, but there is no escaping what lies ahead. It saddens me deeply to watch her slowly drift away like this, but I am heartened by hearing from others about precious moments with their loved ones who are farther along on this journey than Kate. In addition, I feel a greater resolve to make the rest of her life as fulfilling as I can.

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An Unusual Start This Morning

I was taking my walk around the house this morning when I noticed Kate start to get out of bed. That was about 7:15. I went to the bedroom. She sat up straight and said, “Good Morning!” She had a big smile on her face and seemed unusually alert. She sounded as though she had been awake and up for quite a while. Of course, I knew she hadn’t. I walked to her side of the bed. She reached her hand out for mine to lift her into a sitting position with her feet hanging over the side of the bed. She said, “You know it’s funny.” Then she paused as she tried to think of what she wanted to say. I wish I could remember exactly what she said, but here is the gist of it.

She began to talk about school children. She said they are really smart, and they know they are smart. She said they wanted to learn. At first, she appeared to be talking about learning in general, but she moved into her specialty as an English teacher and use of the English language. All of her teaching was primarily with high school students, but it sounded like she was probably talking about elementary school students. It was never clear. She emphasized that their parents were eager for them to learn as well. She talked a lot about her relationship with the students and her efforts to build that relationship as a means to being a more effective teacher.

After a few minutes, I decided this wasn’t going to be a short conversation. I sat down on the bed beside her and listened. The only comments I made were facilitative ones. “It sounds like they really want to learn.” “The teachers really seem to care.” “It sounds like you’re doing the right thing.” There was a clock on the bedside table. When I first looked at it, the time was 7:20. We closed the conversation when it was 8:08. My intention was to see how long she would talk, but when she slowed up a bit, I asked what she would like to do “now.” She wanted to get dressed. I suggested a shower, and she accepted that. The conversation was over.

I found three things of interest about this conversation. The first was how alert she seemed to be from the moment I entered the bedroom. That is very unusual. She displayed no sign of grogginess at all. She was cheerful and alert. The second thing is that the way she spoke didn’t sound like the way she would talk to me. I never asked, but I’m not sure she recognized me. In fact, when I led her to the bathroom, she wanted me to leave before she took off her night gown. She apparently forgot that when I offered to start the shower for her because she took off her gown and got into the shower before I walked out.

The third thing is that the nature of her conversation was very much like what I have heard her say on other occasions. One of those times she was talking with the woman who gives her a massage. That time, however, she was talking as though she were a teacher in a school in another country. I’ve always thought it might be Africa or South America because those are both places where we have visited schools. It also reminds me of several dreams she had as far back as four or five years. She occasionally would talk in her sleep. She talked like she was speaking to a class and giving instructions.

It’s now 9:10. She is out of the shower and back in bed. I think I’ll let her rest until sometime after 10:00. I expect she will be back to normal although it is hard for me to know or say what “normal” is these days.

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A Few Things From Yesterday

Kate woke up at 5:00 and said, “Hey.” I looked over and saw her looking at me. I asked if she needed help. She said, “Where’s the thingy?” I asked if she wanted to go to the bathroom. She did. After she got back in bed, I was wide awake and decided to stay up.

Around 8:30, I noticed on the video cam that she had gotten up. When I reached the bedroom, she was just coming out of the bedroom. She seemed awake. I asked if she was planning to get up for the day. She said she was. I asked if she was going to take a shower. She shook her head to say no. Then she said, “Do you want me to take one?” I told her it would be a good idea, that she had missed one the day before. She said, “Okay.”

After the shower, she went back to bed and slept for an hour before I woke her. She wasn’t eager to get up but did so anyway without lingering or protesting.

I took her to the hair dresser’s at 2:00. I was about to offer her my hand as she stepped onto the walkway but realized there was less than a two-inch elevation from the pavement. I said, “I was going to offer you my hand, but there’s not much of a curb here.” She took my hand and said, “That’s all right. I wouldn’t know where to go without it.”  Afterwards as we walked out, she said, “Take my hand.” I did, and she said, “I don’t really need it, but I feel more secure.”

I see signs of her need for security in other things she is doing. A good example is that she more frequently asks me what she can do when we get home. I guess it is getting harder for her to remember what her options are. That is similar to her waiting to follow me each time we get home. She never remembers where to go. With few exceptions (I can’t remember any.), she always asks me where the bathroom is.

We had about two hours to pass before leaving for dinner. We spent the first hour relaxing in the family room. She started out working on her iPad. After less than thirty minutes, she put it down, closed her eyes, and rested in her chair for another thirty minutes. I told her we had another hour before dinner and asked if she would like to go to Barnes & Noble. She hesitated. It looked like she thought I might want to go. I told her I was fine staying at home. She did as well. This is becoming more common now. For such a long time, she rarely wanted to spend much time at home. Now as she is feeling the need for rest, she is less likely to accept an opportunity to go out. It’s just one more sign of how she and our lives are changing.

We ended the day with dinner at Bonefish Grill where we had a good social experience. We ran into a man who was a very good friend and admirer of my dad. They had both been students in a writing class for several years. They struck up a friendship that lasted until Dad’s passing in 2013. It was an interesting relationship since this friend is just one year older than I am and 26 years younger than my dad.

He was with his significant other who has dementia and just moved to Knoxville from New York City. She has been quite involved with the performing arts and had a neighbor with her who operates a ballet school. The conversation broke down into one between the dancer and me and Kate and our friends. I was glad to see Kate so actively involved in conversation. I don’t know what she said, but at one point she turned to me and asked how long we had been married. Our friends had obviously asked her, and she didn’t know. We both left the restaurant feeling energized. Eating out continues to offer us such experiences.

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An Example of Kate’s Rational and Intuitive Thinking

Shortly after 7:00 this morning, I looked at the video cam and noticed that Kate was up. I went to the bedroom just as she was coming out of the bathroom. She gave me a nice smile. I hugged and greeted her. Then she got back in bed. As I was about to leave the room, we had this brief conversation.

Kate:              “Where are we?”

Richard:        “In our home in Knoxville.”

Kate:              “It’s nice.”

Richard:        “Yes, there’s no place like home.”

Kate added: “With you.” <pause> “What’s your name?”

I didn’t try to determine if she knew that I am her husband. Based on recent experience, I would say there was a 50/50 chance, but her intuitive ability enables her to respond to me as someone she recognizes and cares about. Something very similar occurred last night when we went to bed. She moved close to me and put her arm across my chest. She said, “I love you. Good Night.”  Then she asked my name and hers.

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A Slow Day Yesterday

Kate has gotten up early on four or five days over the past two weeks. On the days when I felt I needed to wake her, I haven’t had any trouble. That changed yesterday when I tried to get her up for lunch with the sitter. She wanted me to leave her. I could, of course, have let her continue sleeping, but I felt she had slept enough. In addition, she hasn’t been as accepting of Cindy’s getting her up. On two occasions when I have done that, she has remained in bed too long. Once she didn’t get up at all while Cindy was here. The other time she got up so late that she didn’t have lunch until 3:00.

By the time I got her up and dressed yesterday, Cindy had been here over twenty minutes. When I got home, Kate was on the sofa resting. I’m not sure how long she had been there. She continued resting while I put up a few groceries and checked email.

At dinner, she asked if I knew what she was going to do when we got home. I said, “Go to bed?” She said, “That’s right.” I told her I suspected she would get her second wind after dinner. That is what usually happens. As we drove home, she said, “What can I do when we get home?” I told her she might like to work on her puzzles. She liked the idea and did so for almost an hour as I watched the news.

Later when I told her I was going to take a shower. I suggested she come to the bedroom with me. She started to follow me but went to the bathroom for the guest room next to ours. I went to look for her when she didn’t return. I found her in the guest room under the covers with her clothes on and the light off. I suggested she come into our bedroom. She came with me.

I put on a DVD of Les Miserables. She sat down in her chair with her iPad. It wasn’t long before she put the iPad down. She started to put on her night gown. Then she got in bed and lay down. She had been very lethargic all day, but she didn’t go to sleep. She was still awake when I got in bed an hour later.

It was another day when she wasn’t cheerful. She just seemed tired, but it was also a day when she appeared to know me as her husband. As we drove home from dinner, she said something about my being a creature of habit. I said, “You think you know me pretty well.” She said, “I should.” I said, “Do you know my name?” She didn’t, but it didn’t bother her at all. She just wanted me to tell her, and we moved on.

I’m hoping for a more cheerful day today.

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Confusion Over the Weekend

Saturday night, we watched the last half of a PROMS concert in London. It was an entire program of music by Rodgers and Hammerstein. We have watched it before, but this time Kate was more engaged. That was evident by the fact that she put her iPad down to watch. She enjoyed it and everything seemed quite normal.

When the program was over, Kate went to the bathroom to brush her teeth before coming to bed. When she came out, she saw me and looked puzzled. She said, “Where is he?” I said, “Who?” She said, “You know who.” I walked closer to her. She pointed in the direction of the family room and said, “Is he in there?” I said, “Who are you looking for?” She said, “Richard.” I said, “I’m Richard. I’m your husband.” She said, “No, you’re not.” I decided not to pursue it any further and gave her night gown to her. She didn’t ask any more questions.

Just before midnight, Kate woke up. She moved over right next to me. She apparently had had a dream and was frightened. I said, “It’s all right. I am right here with you. Nothing’s going to happen.” She said, “What about my mother?” I told her she was safe, that I wouldn’t let anything happen to her either. She gradually relaxed. That began a conversation that lasted over an hour.

She said, “I’m glad I have you.” I told her I felt the same way and that we had been together a long time. She wanted to know how long. I told her we had been married almost fifty-six years, and we had had a good marriage. She agreed. As we moved from  our marriage to other questions about family, she asked, “What is your name?” She was loaded with other questions. She asked about our children, their names, where they lived, what they did. She also asked what kind of work she did. I told her about her teaching school, becoming a school librarian, and working as a volunteer church librarian for nineteen years.

She said, “What’s my mother’s name?” I said, “Elizabeth Franklin. She was a special lady.” She picked up on “was” and said, “Is she gone?” Most of the time I answer honestly, but this time she really seemed worried. I said, “No, she is fine.” Then she said, “What’s my father’s name?” I said, “Carl Franklin. He’s a good man.”  She said, “What’s his name again?” I told her. Then she said, “What’s my mother’s name?” I told her. She asked where they lived. After I told her, she wanted to know where we live.

The last time I looked at the clock it was a couple of minutes after 1:00. Not long after that, we were both asleep.

Just before 8:00 yesterday morning, she started to get up. I got to the bedroom as she was getting out of bed. She looked at me and gave me a big smile. Then she said, “I’m so glad to see you.” The way she said it, I could tell she thought I was someone else. I gave her a hug, and she hugged back. I asked if I could help her. She looked puzzled. I said, “I thought maybe you wanted to go to the bathroom.” She said, “I’d like some clothes first.” I said, “I’ll tell you what. I’ll get some clothes while you go to the bathroom.” I started to walk her to the bathroom when she said, “I look forward to being with you guys.” I walked her to the bathroom and left to get her clothes. When I came back, she appeared to know me.

The rest of the day went well although there were other moments of confusion. For a while at lunch, she didn’t recognize me as her husband. I made reference to our children. She couldn’t believe we were married. I showed her a few pictures of Jesse and Kevin, and she changed her mind. I don’t know if she simply accepted that or if she really remembered. It was impossible to know for sure. I only know that she seemed more accepting.

After lunch, I watched the Master’s with the sound off. I played music that I knew Kate enjoys. She lay down to rest but never went to sleep. She enjoyed the music.

The biggest problem of the day occurred when we attended a drop-in at the home of a couple we have met at Casa Bella on jazz nights. They usually sit at our table, and I have enjoyed talking with them. Kate has not had the same connection. I accepted the invitation with the intention of putting in an appearance and then coming home. I hadn’t anticipated exactly how Kate would respond, but she has gotten along so well in other situations I decided to try. Big mistake. We were in a completely different part of town in a home in which we had never visited before. Along with that, there were a large number of people. It turned out that the primary connection was jazz. I saw several people I knew from other places in the community, but Kate didn’t know anyone. That included the people we really did know. The arrangement of the house was confusing to her. She didn’t know where she should go or what to do. A couple of times when I was engaged in a conversation, she walked away. She was quite uneasy and ready to leave almost from the time we arrived. There was nothing redeeming for her. I got something for us to eat, paid our respect to our hosts, and left. I have avoided social gatherings like this for quite some time. This experience confirmed what I suspected. It’s just too much for her.

We relaxed when we got home. She sat down with her “Big Sister” album. I asked if she would like me to look through it with her. I was hoping (and expecting) she would say yes. She didn’t. After a while, I noticed she was as excited about the album as she usually is. That’s when I discovered that she was confused about what to do with it. She had been treating it like her iPad with the puzzles app. She kept touching the photos, but nothing happened. Even after I explained the problem, she couldn’t catch on. I suggested she take a break and work with her iPad. She was glad to do that and worked on it for the remainder of the evening.

During the past couple of weeks, I have referred to how cheerful Kate has been. That hasn’t been true the past couple of days, especially yesterday. Like everything else, I can’t be sure exactly what accounts for the change; however, I always wonder if she isn’t feeling a bit discouraged about how she is doing. She is still sharp enough to recognize that she is not all right. Whatever the explanation, I know it is harder for me to be upbeat when she is not.

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Losing Two “Old Friends”

Like other people with dementia, Kate’s memory is progressively worse all the time. At the time of her diagnosis, we were told that she would remember the things that were most important the longest. I’d say that’s the way it has worked out. This week I have seen the signs that two of her favorites are now dropping from her memory.

One of those is Willie Nelson. I think her fondness for him relates mostly to the fact that he’s a Texan. For years, her eyes have brightened at the mention of his name. Recently, that has been replaced by a question. “Who is he?” I don’t mean that he is completely forgotten. I expect there will be other times when she responds the way she used to; however, the fact that she hasn’t known a few times suggests that his name is gradually receding from her memory bank.

Willie hasn’t been nearly as important as something else in Kate’s life – Dr. Pepper. That’s a popular drink in Texas and with her family. Her cousin played an important role in the establishment of the Dr. Pepper Museum. She has a variety of Dr. Pepper memorabilia at our house. It has been her preferred drink for as long as I have known her. That is now changing.

She has always been particular about the mixture of seltzer to syrup when she gets a Dr. Pepper from a fountain like they have at many self-serve locations. She likes it to match what she gets in cans. Over the past year or so and especially the past few months, she hasn’t liked the Dr. Pepper she is served in restaurants. She has asked me to taste them, and I can’t tell any difference. Although I am not as sensitive as she is, I believe it is her taste that is changing and not the drinks themselves.

The big surprise, however, came last night when we went to dinner. As she got out of the car, she said, “What am I going to have to drink?” I don’t recall her ever asking that before, especially before we have entered the restaurant. I told her they probably had Dr. Pepper and, if not, she could have her half-sweet and half-unsweetened tea. She said, “What is Dr. Pepper?” I was shocked. That was the first time she has failed to recognize her favorite drink. When the server asked what she would like to drink, I looked at Kate and said, “Dr. Pepper?” She gave a frown. I told the server to bring her iced tea.

It may seem a bit trivial to others, but I look at this as yet another marker on this journey.

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Kate’s Feelings about Things that Require “Rational Thought”

I have commented many times about the fact that people with dementia lose their rational thought processes. They gradually lose their memory of names, places, and procedures. On the other hand, they retain their intuitive abilities. They are able to enjoy music, beauty in nature and art, eating favorite foods, and socializing with friends and family. Kate and I have gotten along happily by focusing on her intuitive abilities and have minimized the importance of the rational ones that have diminished so greatly. Over time, I have begun to notice an interesting intersection of rational and intuitive thought and have been struck by this connection. Let me give you a few examples.

At lunch earlier this week, Kate and I talked about a friend of mine. She asked where he lives. I told her Columbia, South Carolina. She was curious about the name and wondered about its origin. I told her it was named after Christopher Columbus. She said, “Who is he?” I explained that he is often thought of as the one who “discovered” America. She was puzzled. That led to my trying to explain his attempting to find the East by sailing west. I mentioned that people used to think the world was flat. As you might expect, she was quickly overwhelmed by information and asked me to stop. Her rational thought processes were unable to absorb what I was telling her.

We had a similar experience another day this week. She said something funny. We both laughed. Then I said, “You can really be funny. I’ll be your straight man. We could put this show on the road.” I got a puzzled look. I could tell she didn’t know what I meant by “straight man.” Then I tried to explain it. I didn’t get very far at all. I told her about comedians who worked in pairs and that one would appear to be more serious and would say things to prompt the other person to respond with something funny. Then I foolishly mentioned Abbot and Costello, George Burns and Gracie Allen, and Dean Martin and Jerry Lewis. Naturally, she didn’t remember any of them. I told her we would look at some YouTube videos to help her understand. That diverted her attention, and we went on to something else. The important point is that she has an intuitive sense that leads her to want to know the answer to a question her rational thought can’t handle.

The jigsaw puzzles she works on her iPad represent the most relevant example in our lives. She loves working her puzzles. She often asks me what she can do after we come home from lunch, dinner, or other outing. I give her the same choices almost every time. No matter what options I give her she almost always chooses the puzzles. Once she starts them, she inevitably runs into a problem. Every problem arises from a failure of her rational ability. One of the most frequent ones is getting stuck in the store to buy more puzzles. There is a small green button with a shopping cart in the upper right-hand corner of the screen. She frequently touches it instead of the button that will take her to select the next puzzle. Similarly, when she is on the screen with the choices for her next puzzle, she often forgets that all she has to do is touch the puzzle she wants to work. She often asks me how to get to the next puzzle. Other times, she chooses the “Store” button instead.

This can be frustrating for her. She wants another puzzle, but she can’t remember how to get it. In other words, her intuitive thought exhibits a feeling of desire for a puzzle, but her rational ability doesn’t function well enough to do it consistently.

Another incident illustrates this intuitive desire to know without the rational ability to remember. Not long ago, she couldn’t remember my name. I said, I said, “That’s not important. You know who I am.” She quickly responded. “It is important. I should know your name.”

Now let me return to my comment about an intersection of rational and intuitive thought or abilities. It has been almost a year since I first read The Dementia Handbook in which the author, Judy Cornish, defines these concepts and explains their relevance for people with dementia and their caregivers. When I first learned about these concepts, I thought of them as completely independent abilities unrelated to each other. I am now discovering that is not so.

My error was failing to recognize an important intersection between the two. Our intuitive thought leads us to get the answers to questions or problems. That’s something every parent and school teacher observes on a daily basis. Very early infants and toddlers use their intuitive abilities to explore the world. Think about a young child who picks up an object, looks at it, puts it in his mouth, and/or bangs it against the floor. In each case, he is learning something about the world around him. The curiosity of children always intrigues me. Everything is new. They have very little in the way of rational abilities and want to learn about everything. Our rational abilities develop over a lifetime, and much of learning involves our intuitive thought that tells us this learning is important or interesting or both.

Kate was an English teacher for three years and a librarian for the balance of her career. Like other educators, learning (and this means a lot of rational thought processes) is something she values highly. She admires and respects people who have achieved high levels of knowledge in any field of study. Even at this late stage of her Alzheimer’s, this feeling about knowledge is strong. She expresses it when she overhears a report on the evening news and wants me to explain it. The sad part is that she is no longer able to learn the way she did before. The surprising thing is that she isn’t frustrated all the time.

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Another Good Experience with the Sitter

I don’t have a good explanation, but Kate has seemed to accept the sitter happily over the past three weeks or so. Yesterday’s experience was the best yet. It reminded me of another experience in that I didn’t leave immediately after Mary arrived. I was trying to take care of some last-minute tax business and continued working at least another thirty minutes. I was in the kitchen and could hear the two of them talking but had no idea what they were talking about.

When I was ready to leave, I walked into the family room where Kate and Mary were seated side by side on the love seat. They were looking at one of Kate’s photo books. I assumed it was one of the family books. When I got closer, I could see that it was a photo book I had made two years ago with photos taken during several of our summer visits to Chautauqua. I stopped a minute and just listened. Kate was telling her about the beauty of the places in the photos. She came to one and said, “I don’t know what this is?” I told her.

Knowing that recently Kate has been unable to remember Chautauqua, I couldn’t help but wonder what she had been telling Mary. It was clear that she was saying something about the various pictures. I was just happy to leave her while she was having such a good time.

When I got home, they were seated in exactly the same place. This time they were looking at photos from an old album that I believe her father had put together. Kate said, “You should have gotten here earlier. We needed you.” I said, “What for?” She said, “To help us identify who all these people are.” I identified her mother and father. Before Mary left, she told me that they had taken a break during the afternoon. Kate took a nap. Then they went back to their photos. I felt good knowing that Kate had been perfectly comfortable while I was away. The way I saw them interacting was just like two friends talking. I consider that a real victory.

After Mary left, I sat down with Kate. We spent the next fifteen minutes looking at photos before she said she was getting tired. It was getting close to dinner time, so I suggested we get ready for our Friday night pizza.

I should add that one thing Kate has lacked the past four years is a close friend. Prior to that she and her friend Ellen ate lunch every Monday while I was at Rotary. They also got together one or two other times during the week. Ellen’s stroke changed everything. The stroke occurred while she was visiting her daughter in Nashville. She was never able to return to home and has been in memory care for almost two years. Kate and I visit her regularly, but that is very different from the kind of relationship the two of them had for so many years. Thus, the development of a closer relationship with the sitters could go a long way in filling the vacuum that Ellen left behind. I don’t expect the relationship to be the same as it was with her, but I feel encouraged by the way things are going.

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A Different Day Yesterday

Kate has been unusually cheerful the past two weeks. Yesterday was different. It’s not that she was in a bad mood. She just wasn’t especially cheerful. Getting her up earlier than usual may have had something to do with that. On the other hand, it may have been one of those things that we can never explain.

We had a busy day that started with my appointment for labs prior to seeing my doctor next week. Until the past year, I have always had the earliest appointment I could get. Since Kate sleeps later than she used to, I have changed to 11:00. That is still early for Kate, but I am eager to eat as soon as I am up. I woke Kate at 9:15 in order to give her time to get ready without rushing too much. It was one of those days when she didn’t want to get up. She told me to go on without her. I told her I didn’t want to leave her alone. I apologized for getting her up and explained the reason. She still didn’t get up. I asked her to do it for me. She agreed and did so well getting ready that we had time for a quick stop for a muffin at a Panera not too far from my doctor’s office.

From the doctor’s office we went directly to lunch with one of our associate pastors. We had a nice time, but Kate was not very talkative and cheerful. She actually snapped at me as I offered my hand to assist her in getting up as we were leaving. She had a hangnail on her left thumb and thought I was going to grab it. It was a nice lunch, but Kate wasn’t at her best.

We had a couple of hours before taking her for a massage. She rested at home most of that time but got up easily when I told her it was time to go. The past couple of times she has said she didn’t want to get a massage. This time she didn’t say a word. She went happily.

Two weeks ago when she had her last massage, I talked with one of the staff in the front office. I told them I thought we might be coming to the end of her massages. I told them I would like to try at least once more. We talked again this time. Kate had been so accepting that time, I thought it would be good to try again. I scheduled yesterday’s appointment. When I went back to pick her up, I waited a few minutes. Then the woman who gives her the massage came out and told me that they had finished, and she had left Kate to get dressed. When she went back, Kate was lying down on the table and had not dressed. I went back and helped her. She was confused. I don’t think she realized that she was supposed to get dressed. When she was ready, we walked back to the front desk where I discreetly cancelled the next appointment. I don’t plan to schedule any more.

The highlight of the day came when we returned home. Kate noticed the photo of her and her brother on the cover of her “Big Sister” album and said, “I just love that picture.” She commented on the smiles of the two children. I said, “Do you know who they are?” She did. I asked if she would like to look through the book. For the next hour we went through most, but not all, of it. She expressed more enthusiasm than she had all day.

I continue to find mystery in the way her brain works and doesn’t work. As we looked at pictures of her family, she sometimes recognized her mother, father, and brother. Other times, she had no idea who they were. Often she looked at two pictures of her father that were side by side on the same page. She asked, “Who is he?” I told her, and she asked, “What’s his name?” I told her. Then she looked at the other picture and asked the identical questions. We went through the book for an hour repeating these questions and answers. Of course, some of the confusion involves the fact that the way people look changes significantly over time, but the big problem is Alzheimer’s. I’m just glad she had that hour to really enjoy herself.

Last night we went to Casa Bella for jazz night. That is always a hit. She enjoyed it, but the experience wasn’t as good as usual. We always sit with the same couple. Often no one else joins us. If so, it’s just one other couple. Last night we were at a table with seven other people three of whom we hadn’t met before. This made conversation a bit more challenging. Kate was quieter than usual. She enjoyed the music, but I am sure she was uncomfortable in the larger group.

Looking back, it wasn’t a bad day at all. It just wasn’t like the ones we have had recently. Most days are very good. I’m sure we will have many more in the days ahead.