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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 Taste of This Morning’s Conversation

At almost 9:00 this morning, I saw that Kate was getting out of bed. I went to her and asked what I could do for her. She asked me to get her clothes. I asked if she wanted to take a shower first. She did, and we walked to the bathroom. As I started to get the shower ready for her, she took off her night gown, and we had the following conversation.

Kate:              “What is your name?”

Richard:        “Richard.”

Kate:              “What’s your full name?”

Richard:        “Richard Lee Creighton.”

Kate:              “What’s my name?”

Richard:        “Katherine Franklin Creighton.”

Kate:              “That sounds right. And who are you?”

Richard:        “I’m your husband.”

Kate:              “Noooo.”

Richard:        “Let’s talk about that later. Why don’t you take your shower now.”

Kate:              (Getting into the shower) “Who are you?”

Richard:        “Do you think I’m a friendly guy?”

Kate:              “Yes.”

Richard:        “I’m your husband.”

Kate:              (Puzzled look) “Okay. <pause> What’s your name?”

Richard:        “Richard Lee Creighton.”

Kate:              “What should I call you?”

Richard:        “Richard.”

After her shower, she went back to bed for about forty-five minutes. Then she got up to dress. She didn’t ask my name or who I am. She acted as though she knew. I wanted to ask but didn’t. I think she knew.

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Sunday’s Lunch Conversation

Just a short note to say that Kate and I had another interesting conversation at lunch on Sunday. We ate at Andriana’s. Before we reached our seats, she pointed to a photo of Frank Sinatra. I told her who he was. That began our customary conversation about him. She asked if I had told her about the time she and her mother had eaten there. She hadn’t. No surprise. Her mother died before we started eating there. She pointed to a photo of Sinatra and proceeded to tell me that her mother looked it and asked who it was. Kate told her it was Sinatra. She said her mother was vaguely familiar with him. She told her about his relationships with women, and that was all her mother needed to know. They didn’t go any further.

It is interesting to me how much she is drawn to his pictures. There are other pictures and art work in the restaurant. The only other thing she has been curious about is a large poster of a bottle of Cinzano vermouth. Even that has only come up in the past six months. It came up again Sunday. She always wants to know what it is. I tell her, but, of course, it is impossible for her to remember.

Kate is at least occasionally aware that she frequently asks me about Sinatra. Yesterday she said, “I know I’ve asked you before. I don’t know why I can’t remember.”

Apart from Sinatra, we had another interesting, though brief, conversation. It grew out of something one of us said about our having grown up so far apart. That led to a discussion of how the choices we make can open or close doors for us. Before choosing to go to TCU, I had considered going to college in Florida where I grew up. Kate chose to go out of state her freshman year but returned home and to TCU for the rest of her college education. From there we talked about other choices that we and others make about our life styles and health and nutrition. This was not a deep conversation, but it was another reminder of the kinds of things that she is still able to do without a memory.

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Yesterday’s Mid-Day Conversations

Before, during, and after lunch yesterday, Kate was quite talkative. Not just talkative but engaging in conversation that might surprise someone who knows that she has Alzheimer’s and that her diagnosis was over eight years ago. Even I was a bit surprised. It began in the car when I played a Louis Armstrong album, What a Wonderful World. I said, ‘Isn’t it ironic that he sang that song while most of his life he couldn’t even stay in the same hotels where white celebrities stayed.” She asked why, and I explained about segregation. That led to a conversation about the civil rights movement. I knew she couldn’t remember any details, but she did have a recollection of that period of time and had strong feelings about it. She couldn’t understand why life was so segregated. We talked about the integration of public schools and how frightened the first black children must have felt as they entered their new schools. She said, “We’ve come a long way, but there is still a long way to go.”

At the restaurant I ordered the same salad I get every Saturday. It has mixed greens that I like, but yesterday it was different. It was overwhelmingly one particular type. The good news was it was one I like. One of the first times I had the salad I asked our server what it was. She didn’t know and asked several other staff who didn’t know either. Yesterday we had a new server. I asked her if she knew what it was. She didn’t and said she would ask the kitchen staff. Before she got back with their answer (No.), I googled types of greens and thought it might be endive. Then I googled “pictures of endive.” Bingo! That was it.

That led to another brief conversation. I said, “That’s a good illustration of how many things we don’t know, but we encounter every day.” That made me think about the curiosity of little children and how quickly they learn about the world around them. I mentioned that to Kate, and she agreed. Then she went on to talk about how children touch or pick up things that are new to them. She also talked about their asking questions of their parents. It was fascinating to listen to her. Her memory for names and places is virtually gone, but she clearly retains a memory for some general patterns of behavior like those of children. It’s no wonder that people with dementia can get along for such a long time before others recognize the problem.

On the way home, she kidded me about something. Then she said, “I think I’ve been around you too long.” She obviously remembered that I joke a good bit. I said, “Do you know how long?” She didn’t. I said, “In two months it will be fifty-six years since we married, and we dated a year and a half before then.” She said, “And I still love you.” I said, “And I love you.” There was a pause as I thought about the fact that she hadn’t asked my name since she got up. I rarely test her, but I said, “And I bet you remember my name.” It was her time to think. She finally gave up and said, “What is it?” I said, “Richard.” Then she said, “Richard Lee Creighton.” It isn’t often that my first name is all the prompt she needs to get the rest of my name, but it worked this time.

In our conversations, I see what Kate can (intuitive abilities) and can’t do (rational abilities). I am grateful that we derive so much pleasure from the intuitive ones.

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An Early Morning Conversation

Kate got up at 4:30 this morning to go to the bathroom. As I walked her back to bed, she started a conversation that lasted about fifteen minutes. Here’s an excerpt.

Kate:              “What’s the name of this place?”

Richard:        “This is our house.”

Kate:              “Really? It’s a nice place.”

I got back in bed.

Kate:              “What’s the name of this place?”

Richard:        “This is our house.”

Kate:              “It is?”

Richard:        “It really is.”

Kate laughs loudly when she realizes she hasn’t recognized her own house.

Richard:        “I love you.”

Kate:              “I love you, too. <pause> What’s your name?”

Richard:        “Richard.”

Kate:              “What’s my name?”

Richard:        “Kate, and we are a pair.”

Kate:              “We’re a good pair. Where are we?”

Richard:        “We’re in our house in Knoxville, Tennessee.”

Kate:              “I like it. We’re lucky.”

Richard:        “We’re very lucky.”

Kate:              “Where are we?”

I love our conversations. We are lucky.

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Yesterday’s Lunch-Time Conversation

At lunch yesterday, Kate asked my name and hers. I told her and then mentioned that we were married and have two children. Thinking that she might envision our children as little, I said, “They’re not really children now. Our daughter is fifty.” She was surprised and asked, “How old am I?” I told her we were both 78, and I would soon be 79. She said, “Well, you look it?” I said, “You think I look old?” She pointed at the hairline above my forehead and tried to say, “Look how your hair is receding.” She just couldn’t figure out how to say it.

Then she mentioned my glasses and asked if I always have to wear them. I said, “Only when I want to see you.” Then I told her I was getting new ones. She said, “Are they going to be bigger?” I said “The better to see you with, my dear.” She recognized the phrase and said, “Where did that come from?” I said, “Little Red Riding Hood” and recounted the portion of the story of the wolf in bed dressed up like Grandma. As I was telling it, I mentioned that the wolf had eaten Grandma. Kate reacted with horror and, rather loudly. said, “What?” Then I had second thoughts about the wolf’s having eaten her. I pulled out my phone and Googled “Little Red Riding Hood” and brought up the full story. I started reading it aloud to her. When I got to the part about the wolf, I quickly learned that I was right. The wolf really did eat Grandma. When I read that, she reacted exactly as she had before. It was quite noisy in the restaurant, so I don’t think anyone heard her. I didn’t see any need to get out “My Wife Has Alzheimer’s” cards. I continued to read. We were reminded that the wolf also ate Little Red Riding Hood, and the hunter cut open the wolf’s stomach and saved both Grandma and Red Riding Hood.

Kate was quite taken with the story and how gruesome it was. It’s hard for me to remember exactly what we said after that, but I said something about the changes in the way people look at such stories for children these days, that we take a more sanitized approach to them. It was not a conversation of great depth, but we did talk about how children generally accepted the gruesome elements as part of a fairy tail and focused on the entertaining aspects of the stories and their messages of morality. I was really taken by how engaged she was.

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A Note on Conversations

One of the things that caregivers of spouses say they miss most is everyday conversations with their loved ones. I understand that. Even in the early years after Kate’s diagnosis, conversation became more difficult. That’s because so much of our conversation involved specific pieces of information about other family members, friends, events, and other personal experiences we had shared recently and in the past. Because of her memory loss, Kate had less to talk about. One additional problem was how much more slowly she could process what I said. It required my repeating almost everything. I suspect that extra effort may have led to my talking less.

As recently as a year ago, I would have thought we might not have conversations at all. The truth is that we spent a lot of our time together in silence. Since then Kate has talked considerably more than she did before. That is closely linked to the time she stopped taking Trazadone. So many changes take place over the course of this disease, I can’t be sure that the change in her medication is responsible for her talking more. It does remain a possibility. I can say that her talking more has significantly changed the quality of our lives, and I am grateful for that.

There is another possible explanation for the increase in her talking. It was shortly after eliminating Trazadone that I read The Dementia Handbook in which the author, Judy Cornish, presents her ideas about rational and intuitive thought processes. She argues that caregivers need to focus on what people with dementia can do (things that involve intuitive abilities) rather than worrying about what they can’t do (things that involve their rational abilities). If you are a regular follower of this blog, you are well aware this has had a big impact on the way I approach caregiving. It helped me understand why Kate and I have gotten along so well. We had followed her advice without even knowing about it.

Once I became aware of her ideas, I began to apply them with greater intentionality. Now, I look at almost everything she and I do with a conscious effort to pick up on her intuitive abilities. As many people say, I try to “live in her world” not mine. What that means for conversation is that I support Kate’s ability to talk about feelings as opposed to facts. This narrows the range of things we talk about, but I find it rewarding to be able to converse with her again. I have every reason to believe that she is enjoying herself more because she is playing a more active role in our conversations.

So what do we talk about? Well, the kinds of things I have reported previously. They fall into several categories. She has strong feelings of respect and admiration for her parents and her extended family. She talks more about her mother than anyone else. She also has feelings of gratitude about her life with her family growing up and her life with me. She has feelings about others who have been less fortunate than she has been. She is kind-hearted, something that seems to have increased since Alzheimer’s entered our lives. This leads her to say more good things about people she encounters, friends and strangers alike. Our conversations are like a litany of expressions of these feelings, and they occur over and over again.

As I reflect on what I have said, I believe that almost all of the special moments we share involve these kinds of conversations. I like seeing her happy, and she is very happy when she expresses her feelings on these topics. That is why we have so many good days. The feelings she has are strong feelings. They endure. It makes me hopeful that we will be able to continue our conversations for a good while longer.

I suspect that those who haven’t spent time with someone with dementia might think it strange or boring to engage in conversations like this. I look at it the way most of us do when talking with young children. Parents and grandparents normally love to enter the world of a child. I feel the same way about entering Kate’s world. Thus far, it doesn’t involve a lot of “make believe.” Almost all of our conversations relate to real feelings about real people and experiences. More importantly, I share Kate’s feelings, and I believe the expression of these particular feelings are healthy, even therapeutic, for us. They maintain our focus on all the positive things in our lives and not the negative and help turn what is ordinary into something special. That is one reason I say we have so many good days.

Yesterday was another one. Her memory wasn’t much better than usual. The key was her engaging in conversation with me. We had a very simple lunch at Eggs Up. She had a chicken sandwich, and I had a Greek omelet, but it wasn’t the food or the ambiance that made it special. It was the simple pleasure of a husband and wife talking about little things that mean a lot to us.

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A Rocky Start, But a Grand Finish

When I went in to wake Kate yesterday, I wasn’t sure what kind of day it would be. She opened her eyes as I approached the bed and gave me a very warm smile. It looked like a time when she knew me. I said good morning and told her I loved her. Then I said, “I hate to get you up. You look so comfortable.” Her face turned to sadness, and she said, “This isn’t easy.” I didn’t know what she meant and asked what was wrong. She hesitated and said, “It’s hard to put in words.” I encouraged her to help me understand. Then I said, “I want to help you.” She said, “What can you do?” I said, “I can be your friend and comfort you.” She said, “I like that,” but she didn’t say anything more. I let it go. I suggested she get up and take a shower. She accepted the suggestion and seemed all right for the balance of the day.

She periodically has these moments of worry or anxiety. When she says things like “This isn’t easy,” I can only wonder if she is talking about her Alzheimer’s. It always sounds like it, but I can’t be sure. I am confident that she no longer knows she has the disease; however, I know she recognizes her memory is gone. She sometimes expresses concern about it. More frequently, she says, “Don’t tell me more. I won’t remember it.” Sometimes she stops working her puzzles when she knows she is not thinking clearly. She says she is tired. Yesterday she had a similar experience with her “Big Sister” album. She can only process so much information. These moments are the hardest ones for me.

I am often amazed at how quickly she can forget. At lunch, she said, “What is your full name?” I said, “Richard Lee Creighton.” She said it and then tried to say it again and couldn’t. She asked me to say it again slowly. After I did, she said, “Now let me say it.” She said it twice, took a slight pause and said, “What is it again?” She had forgotten again in a split second. It’s like turning a light switch on and off.

I don’t know if she knew me as her husband earlier that morning, but I know she did when we returned home after getting haircuts. She wanted something to drink. I told her we had apple juice and water. She eagerly said, “Can I have apple juice?” I told her she could and added, “I only let my best girl friends have apple juice.” She quickly said, “I better be your only girlfriend. We’re married you know.” A quick response like this is not uncommon. I was playing a CD of A Chorus Line. I know that she enjoys the music, but I was surprised at her laughter at the lyrics of one of the songs. Apart from that I had no sense of her listening to the lyrics. I thought it was just the music she paid attention to. There are also moments when she does something that I don’t like. She will say, “I know that bothers you.” Then I say something like, “No, that’s just fine.” She follows that with “I know you’re just trying to be nice.” She is still insightful.

The highlight of the day for both of us was our weekly dinner at Bonefish Grill. As the host was showing us to our table, we passed someone I hadn’t seen in several years. He and my dad were good friends who met in a seniors’ writing class. Dad was 26 years his senior and he (like many others) took an interest in the fact that Dad seemed so much younger than his years. He introduced us to his lady friend and told us that she was moving from New York City to live with him. We chatted a few minutes. Then they invited us to join them. We accepted their invitation and had an interesting time catching up and learning about his new friend. They had been college sweethearts at the University of Illinois in the late 50s and early 60s. They had lost touch since college, and each had married other people. Their spouses had died, and he looked her up and found her. That was several months ago. Kate and I have traveled to New York quite a few times. That and the warmth of the couple enabled her to feel comfortable in participating in the conversation. We had a great evening together and talked about our getting together again when she makes her move in March. At one point while the two women were talking, I had an opportunity to ask my friend if I had told him about Kate’s Alzheimer’s. He said I had and told me that his friend is facing the same thing. It’s just one more reminder of how common this disease is. I plan to stay in touch with him.

It was a week ago yesterday that Kate had her cataract surgery. It is clearer to me that she is able to see more easily now. Her vision is far from perfect, but now I am reasonably sure it is the Alzheimer’s and not her actual vision that is the problem. Yesterday she picked up her “Big Sister” album. The cover photo had caught her as eye as she walked by it in the family room. She thought the picture of her brother was our son, but that is definitely related to her Alzheimer’s. As she leafed through the pages, she tried to read the text. In the past, she has just looked at the pictures. I feel good about our going ahead with her surgery. I am sure it will continue to have a payoff even as she declines further. Our son and his family are coming for a visit during their spring break. Her improved vision should enhance her experience with them. It is difficult enough to have lost memory, but to lose her ability to see could have made a major difference in her quality of life.

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Remembering Texas

Although Kate has always valued her Texas roots, it has never been as significant as it has been in recent years. Part, maybe most, of this feeling for her home state is tied to our reflections of the past as we get to our senior years. I know of lots people who find themselves reconnecting with friends from their childhood and sharing old memories of their time together. I suspect that Kate’s affection for Texas also relates to her Alzheimer’s. Like other people with dementia, she lost her short-term memory quickly. Now she retains only long-term memory, and most of that is gone as well. The fact that she is a Texan has stuck with her though she sometimes forgets her birthplace and has to ask me.

After returning from a trip to Texas several years ago, Kate’s feeling for the state got a significant boost. It wasn’t long after we were home that I discovered she thought we had discussed and decided that we were moving back. At first, I thought I was the only one she said anything to. Soon friends were asking me about our move. At the time, I didn’t want to burst her bubble, but I also didn’t want to reinforce her thinking. I supported her desire and explained that I would enjoy living in Texas as well. I also told her it would be a while before we could make the move because there were a lot of things we had to do to get ready. I was hoping that her memory of a move would drift away like so many other things.

I was wrong, but I was successful in getting her to think the move would be sometime in the future. Gradually she said less and less about a move. During the past couple of years, she has rarely said anything about it. Now it is coming back. This time she is expressing it as a desire to live in Texas, not something we have decided to do.

I have been quite interested in how she has brought it up. It almost seems like a calculated way to spark my interest. For a while, she would say something like, “I know we aren’t planning to move to Texas, but do you think that could happen?” In the past few days, she has also gently brought up the subject. Yesterday afternoon at Barnes & Noble, she asked where we were. When I told her, she said, “So we’re not in Texas?” I told her we were in Tennessee. She paused and then said, “Where do you think we will end up?”

I told her that depended on a lot of things, that we might stay right here in Knoxville. I explained that we were happy here, like our home, and were comfortable getting around the city which offered a lot of the things to do. Then I added that a lot might depend on our needs as we got older. I suggested that if our needs became significantly greater, we might move to Texas. I reminded her that our son Kevin has spent his whole career working with seniors and has access to all the resources that seniors need. She was pleased to hear that.

I must have been bolstered by her response because I mentioned a possible trip to Texas. Our granddaughter graduates from high school in June. I would really like for us to attend, but I have felt it is very unlikely. I considered our trip to Texas for Thanksgiving to have been our last visit. At the moment, I am keeping an open mind though I still think it is doubtful. One of my memories of our last visit was that she didn’t respond to being in Texas the way I expected. It didn’t seem to mean anything. She didn’t recognize anything and never knew where we were. I am torn now and will probably be the same way when I have to make a commitment to go or stay here. I definitely don’t want to deprive her of one more trip home. It’s just too early for me to make that decision.

There is one thing in the back of my mind that might tip the scale. It’s the apocryphal story of a man who pays daily visits to the nursing home to see his wife who doesn’t remember him. Someone asks, “Why do you visit everyday if she can’t remember you?” He answers, “Because I remember her.” As I consider that story, I think that even if she couldn’t full appreciate the trip, I would know that I brought her back home one last time for a special moment with family.

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“Are you my Daddy?”

After being up at 1:30 and again at 7:45 yesterday, Kate got up for good before 9:30. She seemed rested and didn’t show the same degree of confusion she had shown earlier. She still didn’t recognize me as her husband but wasn’t disturbed by it. She was very much like she was the previous night when she thought of me as a good friend.

We made it to Panera for a muffin just after 10:00. Soon after getting into the car, she asked if I were her daddy. I told her I would be happy to be her daddy. She frowned and said, “So you’re not gonna tell me.” I said, “Do you think of me as your daddy?” She said she did. I said, “Well, I am.” We had a similar exchange at Panera. When I told her I would be happy to be her daddy, she said, “You’re not my daddy.”

A little later at lunch, she said, “What is your real name?” I told her and she said, “You could be my adopted daddy.” I said, “I like that.” She asked my name again. Then she told me that she could introduce me to our server as her adopted daddy. That didn’t happen. By the time the server came back she had forgotten altogether. My interpretation is that she was accepting that I was not her daddy, but she didn’t think of me as her husband. To her it must have seemed appropriate to think of me as someone close enough to be her daddy, hence the idea of her adopted daddy. That may be a nice transition from being her husband. I could live happily with that.