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Does she know what lies ahead?

I don’t think I am alone among caregivers when I wonder exactly what Kate knows. By now I realize that she knows very little when it comes to her rational thought/abilities. Many times I have mentioned how often she can’t remember my name or our relationship. I take comfort in the fact that her intuitive thought/abilities are still working well. Through them she almost always recognizes me as someone very familiar and trusting.

For over a year, I have also realized that she no longer remembers that she has Alzheimer’s. At first, I wondered if I should tell her and, on one occasion, I did remind her. She hadn’t remembered, but she quickly forgot, and I haven’t said anything since. I haven’t see anything to be gained by it.

She has always recognized that she has problems and needs my help. It was only a year ago in July that she began to experience anxiety or panic over moments when she didn’t seem to know anything – where she was, who she is, who she was with. Within the past few weeks, I have sensed that she might believe that her problems were of a more serious nature, not just a periodic lapse of memory. Over the past week or two, she has said and done things that lead me to think that she knows she is declining and is afraid of what lies ahead.

Sometime in the past day and again today at lunch I felt strongly that she recognizes that through her intuitive thought. She was awake when I went to get her up for lunch. She didn’t seem frightened, but she was uneasy and insecure. She was especially eager for me to help her with everything. That follows signs of increasing insecurity and appreciation for my helping her during recent weeks.

At lunch, I said something about her mother and father. She wanted to know their names and something about them. When I said that her father was one of eight children, she said, “I know why.” I said, “Why?” She said, “Because in those days, they needed more children.” I was surprised that she came up with this and said, “You know, you are smart.” She beamed and said, “I think so too.” It was as though she was relieved to have me say that. Off and on she has said she is smart, but that has been more frequent recently. I have felt she was trying to convince herself that is true. It would be easy to think she is not given how poor her memory is and how little she is able to do.

During our conversation, she stopped and said, “I want to tell you something.” She looked very serious. I leaned closer to her. She said, “I know that you will always take care of me.” I said, “I will. You can count on that.” Her eyes filled with tears, and she said, “Thank you. I know you will.” I felt we were thinking similar thoughts about the future. There is no way I can be sure, but the look on her face made me think that.

I told her I loved her, and she said the same about me. We began to talk about our marriage, and I mentioned our children. She said, “Who are they?” I told her and she asked if I had a picture. I pulled out my phone and showed her pictures of Jesse and Kevin. She said, “Do you think they love us?” I said, “I know they do?” She choked back her tears.

In a few minutes, we got up to leave. She started whimpering and was loud enough that I saw people at two different tables look up. On the way to the exit she continued to cry softly. We stopped right there in the dining room and hugged for a moment and then went on.

I don’t know precisely what she is thinking, but she seems very concerned and doesn’t see a happy ending. I am glad she still knows that I will be with her all the way.

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Thinking about Stress: Part 1

There is no question that caring for a loved one can, and often does, cause a good deal of stress. Judging by the frequency with which people remind me to take care of myself, caregiver stress seems to be common knowledge. I find, however, that the degree of stress can vary tremendously from one person to another. I don’t think that variation is well understood.

That leads me to a favorite topic of mine: generalizations. All of us depend heavily on them. They are often very useful; however, applying a general pattern to a specific situation (in this case, the stress of an individual caregiver) calls for more detailed information about the specific caregiver and her/his situation.

I usually think about three major elements that play a role in stress experienced by a specific caregiver like myself. One is the sources of stress. Some things produce a lot of stress. Others produce very little. A second category is the personal experience and characteristics  of the caregiver. Some people find it difficult to deal with stress. Others find it less so. The third category involves the things a caregiver can do to reduce or minimize stress. In today’s post and the one following, I would like to comment on how those three come together in my particular case.

As Kate’s care partner I have experienced stress, and that stress has increased as her Alzheimer’s has progressed. As I look to the future, I believe that stress will likely increase. On the other hand, stress seems to be less of a problem for me than for many others. I say that based on reading a variety of online forums for caregivers as well as over thirty books by caregivers who have provided vivid accounts of their experiences. When I consider what they have been through, I see good reasons for my feeling less stress, and the three elements I mentioned above provide an explanation. In this post, I will deal with two of them.

Sources of Stress

All stressors are not equal. The ones I confront are minimal compared to those of other caregivers. The load I carry is simply not as great as that of theirs.

In the first place, I was at a point in my career when I could retire to devote my attention to Kate. Many caregivers have a variety of other responsibilities that also demand their attention. I am especially mindful of spouses who have to continue working to pay the bills and can’t afford to hire someone to help. There are many women who are not only working and caring for one or both parents but also care for children. I am familiar with their stories and recognize the struggles they are facing.

Kate has also been easier to care for than many other people with dementia. It is true that she has been somewhat more irritable, especially as the disease has progressed, but that pales in comparison to other situations with which I am familiar.

In addition, neither Kate nor I has had to deal with any other serious illnesses. That is unusual for people our age. We are approaching eighty, and Alzheimer’s is the only significant health issue for us. I have been sensitized to this fact when Kate has had a cold. That creates an extra demand for me, but it is nothing compared to other chronic illnesses.

Personal Experience/Characteristics of the Caregiver

Many caregivers for a person with dementia have little experience with the disease. They begin from scratch. Often, they are children caring for one or both parents. They face a steep learning curve that calls for knowledge of the disease itself while adjusting to the new role of parent care. This has to be incredibly stressful.

Kate and I had been caring for our parents and my father’s significant other for twenty-two years at the time of her diagnosis. Her father had a stroke and her mother vascular dementia. My mother had an unspecified form of dementia; my dad’s significant other had vascular dementia, and my father had a stroke. I feel as though everything I had learned from those experiences prepared me to care for Kate.

I also believe my personality makes caregiving easier for me than for others. I can’t take credit for that. I thank my dad. He was the same way. He kept his sense of humor and focused on everything he could see as positive and minimized the negative. He was a problem solver in his work and in his personal life. He had faith there was a solution to every problem he encountered. I think I am a bit more realistic than he was, but I recognize many ways in which he and I are similar.

If it were only the things I have outlined above, I believe my stress would have been less than that of other caregivers, but there is more. It involves the variety of ways in which I have been able to minimize my stress. I’ll save that for another day.

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A Touching Morning Conversation

I am never sure what Kate will be like when she wakes in the morning. She is usually in a good humor, but she is often confused and sometimes irritable. Today was an interesting mix of tenderness and confusion. The prelude to a touching conversation occurred when I noticed on the video cam that she was sitting up in bed. I went to the bedroom. I found that she wanted to go to the bathroom, but she didn’t want my help. I think it was one of those rare times when she didn’t recognize me at all. I pointed out the bathroom and left to watch on the video. She made her way to the bathroom. I went back when I saw her come out. After she was back in bed, I told her I would be in the kitchen and to call me if she needed anything. She asked my name. I told her, and she tried to repeat it. We went through this routine several times. Before I left, I said, “If you don’t remember my name, just say ‘Hey.’”

An hour later, I heard a very soft “Hello.” Before I reached her, I heard it again. By that time, I was at the door to the bedroom and said, “Did I hear you calling for me?” She nodded. She smiled, and I thought this was one of those mornings when she clearly knew our relationship. She said, “I love you.” I took that as confirmation of my suspicion.

I was wrong. I sat down on the bed beside her. She said, “I want to thank you for taking such good care of me.” I said, “That’s because I love you.” She said, “I love you.” She paused a moment and said, “What’s your name?” Before I could say anything, she recognized how strange that sounded. She laughed and said, “I know that sounds funny.”

That began a 15-20 minute conversation a portion of which I recorded on my phone. The gist of the conversation was a continuation of her expression of appreciation for my caring for her as well as how she feels about me. That continued to be mixed with asking my name. She also referred to me as her daddy. Once or twice she asked if I were. The first time I hesitated and then told her I wasn’t. She was disappointed. I said, “You can think of me as your daddy.” She liked that and continued to call me her daddy, but she also talked about loving me in a way that was more like she thought of me as her husband. Of all the things she said, I was struck by one particular thing. She looked teary and said, “I don’t know what’s wrong with me, but I know you will take care of me.” I assured her that I would.

I can’t tell you how many times I have wondered to what extent she grasps her problem. I am positive she doesn’t remember that she has Alzheimer’s, but she frequently expresses a concern about herself. She knows that something is wrong. Her comment this morning suggests to me that she thinks it’s something serious.

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At Stage 7 of Alzheimer’s, is there really any joy for caregivers and the ones for whom they care?

My memory of the last stage of my mother’s dementia has faded significantly. One thing I remember is that, except for his Kiwanis meetings, my dad still took her with him whenever he went out. That was the only time he sought help. He dropped her off at a senior day care for four hours to attend his meeting and shop for groceries.

I look back with amazement as I think of those days. At the time, I wondered why he did it. He was eighty-eight, and she was completely dependent on a wheelchair the last two or three years. In order to get her from their apartment (that fortunately was on the ground level) to the car, he had to roll the wheelchair 25-30 feet over grass. Then he got her into the front seat of the car, folded the wheelchair, and loaded it in the trunk of his car. From my personal experience, this was not a simple task. Yet I never heard him utter the first word of complaint. They had been married 70 years when she died. He was just expressing his love for her in the only way he knew how at that point, and he did it joyfully.

Now that Kate is closer to that stage of her Alzheimer’s, I have a greater sense of what sustained him. He could see what I didn’t. There is no doubt to me now that he could find joy in their relationship when it appeared to me that the joy had long since passed.

I believe Kate and I have some time left before she is at that same point, but I can already see that joy is indeed possible very late in this disease. I am sure that doesn’t happen for everyone. As I have said before, we are very fortunate. My point is that it can happen and should be something for which those of us living with Alzheimer’s can hope.

Moments of joy may not come as often as they did before. They may be short-lived.  They do occur for us, however. We had another of those “Happy/Joyful Moments” at lunch yesterday. As I reported in my previous post, she didn’t know my name or our relationship when she got up to go to the bathroom in the morning. I’m not sure whether she did or didn’t later when I got her up for lunch. There were times during lunch when I know she didn’t. Neither did she remember her own name. As earlier that morning, she was quite at ease with me. When she asked my name and relationship, she accepted it as naturally as she did when she pointed to her salad and asked, “What is that?”

She was very talkative. Interestingly, we didn’t gravitate to our usual conversations about family and marriage. She asked questions about the restaurant, the food, and the staff. It was unusually quiet when we arrived. Only one other table was occupied. She said, “I wonder if <using her hand because she couldn’t think of the word for servers> like it better when it is quiet like this or when it is ‘you know’ <again using her hand and groping for the word ‘busy.’>

It is always fascinating when she doesn’t “know” me but also talks about my personality quirks. She kidded me a lot during lunch, and none of the kidding had a bitter edge to it. She was having fun, and I loved it.

Because it was less busy, we got more attention from the staff. We had several conversations with our server. Another person who often serves us stopped by our table to speak. The manager also stopped by for a brief visit. During our conversation with the manager, I commented on how much I had liked the broccolini salad with a little tomato and feta cheese. Kate didn’t like it because she doesn’t like the crispiness of raw vegetables. As the manager was about to walk away, Kate said, “And don’t give me any of that anymore.” She didn’t sound offensive. It was more like a little child simply expressing her distaste for the salad, something I had already explained to the manager.

She also said or did a couple of other things that I got a kick out of. She now frequently mixes her words and sometimes says something that is just the opposite of what she meant or is a homonym for the word she wanted. For the first time, she did this with a gesture instead of a word. She dropped a piece of cheese on the table, picked it up with her hands, and ate it. She gave me a devilish smile, put her hand over my mouth (instead of my eyes) and said, “You didn’t see that.”

A little later we had dessert. When the server brought it to the table, she kidded me, saying, “Didn’t you want one too?” She took a bite or two. Then I said, “You’re going to like that.” She said sternly, “I’m already enjoying it.” I said, “I should expect that from an English teacher. You want to make sure I’m using the correct tense.” For some reason, she thought that was funny and began to laugh. I guess that was because it was something she would usually say and not “me,” Oops, “I.” <G>

Oh, yes, the meal was also very good, but that wasn’t what gave us so much pleasure. Being together, and with other people, is what made lunch special. We had a good time.

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This Morning’s Experience of “Knowing” but “Not Knowing”

Some time ago (February 18, 2018) I wrote a post entitled “What does it mean to know someone?” The answer to that question is much more complex than it sounds. I see that all the time with Kate. Like other care partners, I am very sensitive to those times when Kate knows or seems not to know me. I tend to put her level of knowing in four categories.

  1. She knows me in all the traditional ways a wife knows her husband. She knows my name, that I am her husband, and has a feeling of affection/kinship for me.
  2. She knows either my name or that I am her husband (usually the latter) and has a feeling of affection/kinship for me.
  3. She knows neither my name nor that I am her husband, but has a feeling that I am someone familiar and whom she trusts.
  4. She has no idea who I am.

I can’t put an accurate estimate on the frequency with which she experiences these categories. I do know that Category 4 is the least frequent by far. There have only been a handful of times in which she has had no idea who I am. Category 1 occurs infrequently but much more than Category 4.

That leaves the other two categories that occur most often. I’m not sure, but I think we are at a time when Category 3 is, or is becoming, the most common. Most of the time she knows me as someone familiar and whom she trusts.

I know there must be caregivers who find it disturbing when their loved ones no longer remember their names or relationships, but I find that leaves me with the most important connection that we have and have always had. Like most other couples we were attracted to each other from our first date, perhaps even before or there might not have been a first date. After all our experiences and changes in our lives, this sense remains. I am optimistic that it will continue though I recognize that, too, may give way to this disease called Alzheimer’s. In the meantime, I am going to relish moments like this morning. In the scheme of things, it wasn’t significant, but it meant something to me.

I was just finishing breakfast when I noticed on the video cam that Kate was about to get up to go to the bathroom. I went to the bedroom and could tell this was a morning when she was confused. Unlike other times, she seemed very normal in terms of her emotion. She showed no signs of anxiety or fear though I feel sure she was feeling anxiety. In a very natural tone of voice she said, “What’s going on?” I said, “Well, you just woke up, and you are in your own house. That’s your back yard that you like to look out on each morning.” She said she recognized it.

Then she said, “What now?” I said, “I think you were about to get up to go to the bathroom.” She said, “I think I was. Where is it?” I said, “Let me show you.” I took her hand. She held it all the way. That’s not something she always does. As we walked, she said, “Who are you?” I said, “I am Richard, and I am your husband.” She didn’t act surprised nor elated. She just accepted that as a label for me.

After using the toilet and washing her hands, she said, “I wish I could just be with you and nobody else.” I said, “You are. This is our house, and there’s nobody else her but us.” She seemed to like that but didn’t express any special emotion at all. She said, “What now?” I said, “You usually like to go back to bed for a while.” She said that is what she wanted to do. She said, “Who are you?” I told her again and noticed that she seemed just a bit uneasy and asked, “Would you like for me to stay in here with you?” She did, and I told her I would get my laptop and come back to the room. She said, “Don’t leave me. Take me with you.” I told her I would; however, by the time we reached the end of the bed, she had forgotten and walked toward her side of the bed.

After she was in bed, I asked if she would like me to stay in the room with her. She did. I remained with her. She fell asleep. Thirty minutes later I came back to the kitchen (my office) to write this post.

This was one of those times she didn’t know my name or our relationship, but she had a good feeling about me and trusted me. That is what is most important to me. It reinforces my desire to keep her secure and happy, and she almost always is.

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A Social Occasion That Went Very Well

Yesterday, as we were about to leave for lunch, I received a call from our pastor asking if we had lunch plans. Despite the fact that we were going straight from the restaurant to a hair appointment for Kate and then drive to Nashville, I invited him to join us. That is probably a good indication of how important social contact is for us. Otherwise, I would have told him we were on a tight schedule and arrange another time. I made the right decision.

Not surprisingly, Kate did not remember him when I told her he was coming. She took it nonchalantly with no expression of excitement or reluctance. We had already taken our seats before he arrived. When he saw us, he walked over and greeted Kate. She called him by the wrong name. He gave her his correct name and said, “That’s all right. I get called lots of things. You can call me whatever you want.” That began a beautiful conversation that went on for over an hour before we had to leave.

Kate was in one of her talkative moods, and our pastor is a good facilitator. She was immediately very comfortable. In fact, she was “unleashed.” Early on I mentioned something about his being our pastor. She was surprised. She looked at him and said, “You are? I didn’t know that.” That was one of many things she said that were clear signs of her Alzheimer’s. She had to ask lots of questions to understand what he and I said. Many of them involved the definition of words that we used. Her aphasia is definitely becoming more pronounced.

There were two things I especially liked about our time together. One is that she was on equal footing with the two of us in the conversation. In fact, she may have talked more than either of us. Another is that she conveyed so well what she is like as a person as well as a person with Alzheimer’s. I don’t recall our ever having been in a social situation where she has been this way before. I attribute that heavily to our pastor. She was very comfortable with him and even said so. I don’t recall her words at all, but she took two or three minutes to comment on his ability to put people at ease.

The conversation illustrated her heightened emotional state. Our pastor said something very early about some of the mass shootings that have occurred around the country. Kate was very sad and in tears. When the conversation drifted to our relationship, she noted that we are a team and work together well. She wanted to convey how fortunate we have been and couldn’t think of the word she wanted. Our pastor said, “Blessed?” She said, “Yes, we’re blessed.” That led her to say, “I wish everyone could have what we have.” She was in tears again.

We also talked about several members we thought had made special contributions to our church. The pastor looked directly at Kate and said, “And you are one of those people.” He went on to talk about her nineteen years of volunteer service as the church librarian. That brought more tears.

When we got to the car, the first words that Kate spoke were, “I feel happy.” I said, “I do too.” It was a beautiful experience in which she got to be a significant part of the conversation, and, amidst the stumbles she made because of her Alzheimer’s, she was able to convey the depth of her insight even now. It was a very special time for me. It was another “Happy Moment” for us.

It was a good example of Kate’s intuitive abilities. Although our conversation included factual information that she didn’t fully understand, we talked largely about our feelings about our lives as well as the people and world around us. That is something she can still understand. She was quite open about her feelings. She even responded negatively to our pastor when he tried to pay her a compliment. I don’t remember what he said, but she thought he was criticizing me. She quickly responded and said, “Don’t you say that about him.”

It was also an illustration of the way someone can put her at ease. She connected quickly with him. I had seated her so that he and Kate were directly across from each other. I think that helped. The key factor, however, was the way he related to her. From the outset, he made her feel she was an equal partner in the conversation. She knew he was listening to her.

I think most people are a bit unsure about how they can best relate to someone with dementia. The easiest thing is to hold back. I was reminded of two other successful encounters we have had with Twitter friends of mine. When I introduced Kate to them, they immediately gave their attention to her. That made Kate comfortable and led to a very good conversations. It strikes me that this is a good way to begin with anyone we meet, not just someone with dementia.

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Kate’s Final (?) Appointment with her Ophthalmologist

We may be reaching a point at which we no longer schedule routine medical appointments for Kate except for her primary care physician. It is becoming a matter of assessing the risks vs. the benefits.

Yesterday she had a routine appointment with her ophthalmologist. This is one in which I had a special interest. I have commented many times on her eyesight problems. Kate is unable to recognize that she has a problem, but she seems to see some things and not others. For example, she may not see a large object on a counter but notice a small spec of dirt on our carpet or small particles of food on a restaurant table. Until recently, I had attributed her vision issues to her Alzheimer’s rather than a physical problem with her eyes. Two particular issues, however, have made me wonder if it could be something like macular degeneration. In a phone conversation with her ophthalmologist I confirmed that at the time of her last check up in February, there were no signs of a physical problem and that it was unlikely that it would have developed since then. Nonetheless, I wanted to know for sure. Yesterday’s visit provided the answer. It was just what I thought. Her eyes are fine. Her vision problem must be related to her Alzheimer’s.

There is more to report, however. Appointments themselves are becoming a problem. Kate has little patience, and waiting is a normal process in most health-related professions. The notable exception is her primary care physician who is associated with a gerontological practice. The wait time in the lobby is not usually more than 5-10 minutes. The appointments are not scheduled as closely together. Her doctor, and the others we have seen, always take a lot of time with their patients, many of whom have dementia. They know how to relate to patients like Kate.

I don’t mean to suggest Kate’s eye doctor and/or staff are insensitive to the needs of patients with Alzheimer’s. They aren’t, but the system is set up for non-dementia patients. That means waiting times exceed Kate’s patience. Her appointment was at 1:15. She didn’t see her doctor until 2:15. To be fair, she was only in the waiting room about fifteen minutes. She spent another 15-20 minutes with the doctor’s assistant who was getting information, checking her vision, and giving her the necessary drops before the doctor arrived. That left about thirty minutes before she saw the doctor. Kate has trouble understanding the instructions anyone gives her, so that complicates every portion of the examination. Neither does she understand why she needs the exam in the first place. Yesterday’s exam was particularly difficult for both Kate and the assistant.

The good part is that she took it somewhat good-naturedly. She joked a lot, and both the assistant and the doctor got a kick out of her comments. Sometimes she was quite serious. When the assistant checked her eye pressure, Kate was startled, pulled herself away, and told the assistant to stop. Then she did something that surprised me. She looked at the assistant and spoke to her  as though she were a teacher. She said, “Talk slowly. Go one step at a time, and give me clear instructions.” That is exactly what she needs. Of course, not even that will insure that she understands. At the end of the visit, the doctor looked at Kate and said, “Well, I have good news for you. You don’t need to come back for a year.”

When we checked out, it was a challenge finding an afternoon appointment at our preferred location. We finally found one at 11:55 on August 28 of next year. I can’t imagine that Kate will be up to another visit when the time comes around. I feel sure her doctor felt the same way, but, like so many other things, we will see.

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Sleep and Rest

Until a year ago this past April, Kate’s sleeping pattern had been pretty steady. I’m not at all sure that she sleeps any less today than she did, but the time she gets up often varies. More than half the time I get her up between 10:30 and 11:30 depending on whether we have any special obligations. Sometimes, as she has done in the past couple of weeks, she gets up as early as 8:30 or 9:00. It is not uncommon for her to be awake when I go to wake her. She usually goes to bed between 8:30 and 9:30. I don’t think she is usually asleep until 10:00 or later. She must get about 12-13 hours sleep a night. Eighteen months when she was on Trazadone, she slept about 13-15 hours.

The major difference now is the amount of time she rests without going to sleep. Yesterday, for example, I got her up around 11:00. It took an hour and a half for her to shower and dress before leaving for lunch. We got to lunch just before 1:00 and arrived home at 2:30. I suggested that she and I look through one of her family photo albums, but she wanted to rest which is typical when we get back from lunch. She immediately went to rest on the sofa in the family room. She rested until 5:30 when I suggested we go to dinner. There was a short period, no more than 15-20 minutes, when she appeared to be asleep. Otherwise, she was just relaxing.

I am guessing that the strain of social interaction, looking through photo albums, and working on her iPad wear on her in a way that is hard for me to understand. She doesn’t usually show any special signs of fatigue until after we head home from the restaurant. During lunch, she sometimes tells me she wants to rest as soon as she gets home.

As I have mentioned before, the amount of battery life left on her iPad is a good indicator of the amount of time she uses it. Though it remains her primary self-initiated activity, she clearly doesn’t use it as much as she did. That is a result of her resting more because she hasn’t replaced the iPad with another diversion.

The most significant change brought about by her current pattern of sleep and rest is our getting out to Panera in the morning and to Barnes & Noble in the afternoon. That had played a major role in our social engagement. That makes our lunches and dinners our primary means of social contact. That continues to work well for us.

The mornings are times for me to take care of all the routine household chores and other personal obligations I have. I now wash as often as four times a week. A year ago, washing was just once a week on Saturday morning. I also find that the afternoons are pleasant times for us. When she is resting in the family room, I always take my laptop or iPad and stay in the room with her, and, of course, music is always playing. Since Kate is not asleep, we also engage in intermittent conversation. It makes for a very relaxing afternoon for both of us.

Life is different now, but we still get along “remarkably well.” I certainly expect more challenges like the ones we have faced recently, but I am also optimistic that we will handle them well and be grateful for Happy Moments past, present, and future.

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And More Emotional Experiences

When I arrived home to relieve the sitter on Friday, Mary heard me open the door and told Kate I was home. I walked into the family room. Kate had been resting on the sofa and gotten into a sitting position when she saw me. She had a big smile on her face but immediately burst into tears. She couldn’t stop and continued until after Mary had left. I sat down with her and we hugged. She said, “I’m so glad to see you. I was so worried.” This was the way she had reacted when I returned two weeks ago. There was one big difference. She didn’t recover as quickly. Over the next thirty minutes, she continued to express how happy she was to see me. It wasn’t until we went to dinner that she had fully calmed down.

Last night Kate had a very traumatic experience involving a delusion that I had had a fight with her mother who died in 2005. The way she described it this was something that she had just overheard. She had been in bed for about an hour, so I suspected that she had had a dream. After reflecting on it, she probably had never gone to sleep. On several previous occasions, I have noticed that she has had similar experiences, but this one was definitely the most intense. She was angry with me. As I tried to calm her, she shifted her story. Then it sounded like the fighting was between her mother and father. A few minutes later, she settled into its being between our neighbors.

Several times she said she wasn’t going to talk about it anymore. Then she would continue. She kept talking about the “foul” language they were using and how sorry she felt for the children. She was so upset that she said she wanted to move out of the neighborhood. Trying to calm her, I played along as though I believed what she said and suggested that we might talk about moving in the morning. I knew that it would all be forgotten then. I also diverted her attention by talking about how fortunate we have been to have a marriage that has been free of the kind of fighting that she had observed. That seemed to work. She settled down, and we called it a night. The entire episode lasted about an hour and a half.

On the way to lunch today, I played some music. She cried during “Try to Remember.” This is a song she likes, but I don’t recall its leading to tears before. Then at lunch our server approached the table to give Kate a hug. As she did, she said, this is a day when I really need a hug. Then she proceeded to tell us that her neighbor’s dog had killed her cat this morning. That was all Kate needed to hear. She was in tears, and the server felt bad about having said anything.

It’s not just the tearful emotions that are elicited so easily. This morning as well as other times recently, Kate has responded to me with anger when I tried to help her with something that she wanted to do on her own. She is very much on edge now.

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Kate’s Insecurity

Last night, Kate and I ate a sandwich at Panera. As we prepared to return home, she wanted to take her cup of iced tea with her. She started to pick it up when she asked if I would carry it for her. She said, “I don’t want to spill it.” I told her I didn’t think she would spill it but that I would be glad to carry it for her. She thanked me and said, “I just don’t want to do anything stupid.” I tried to assure her she wouldn’t, but she wouldn’t believe me.

I put her drink in the cup holder between my seat and hers. Before I backed out of the parking space, she wanted a sip of tea. She started to pick up the cup but decided against it. Again she mentioned that she didn’t want to do anything stupid. I said, “You won’t do anything stupid.” She said, “I do all the time.” Once again, I tried to boost her confidence. She dismissed what I said and said, “I could think of some things, but I can’t remember them right now.”

When we got home, she continued to be concerned about doing “stupid things.” She wanted me to tell her everything to do or, at least, ask my permission to do things like taking her shoes off and lying down on the sofa. I told her I was going to brush my teeth. She didn’t want me to leave her and said, “Just so that I can see you.” I told her I would get my toothbrush and bring it back to the family room. When I got to the bathroom, I just quickly brushed and went back to her. She hadn’t worried, but she mentioned that she felt better when I am with her, that I keep her from doing stupid things.

Because her memory is so poor it is easy to think that she doesn’t understand anything about what she is doing. This particular experience is just one of many that remind me that she understands a lot more than it may appear. I don’t think it is something that lingers. She doesn’t think about it all the time, but she definitely has some knowledge of how hard it is for her to do the simplest things. She is right that she is inept at doing many things that were previously easy tasks for her. Now everything is a challenge. The other night at Casa Bella she knocked over a full glass of water. I am sure she was embarrassed. I think the people at the other end thought I had done it, and I was glad to take the blame. In fact, it could have easily been me, but it is the kind of thing that piles on top of other experiences that let her know she does not function very well at all.