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Success With A Movie

Until the past three years, movies played an important part in our lives. That increased after Kate’s diagnosis. Movies weren’t just an amusement. I looked at them as a significant part of our therapy. For at least the past five or six years, she hasn’t been able to follow a plot. As a result, she didn’t understand what she was watching. She could, however, enjoy movies that connected with her intuitive abilities. She responded well to characters she liked or to situations she could appreciate.

As her disease progressed, she experienced greater difficulty getting any pleasure from movies. Despite this change, she enjoyed a number of movies during the past year and a half, RBG, Darkest Hour, Won’t You Be My Neighbor?, and Linda Ronstadt: The Sound of My Voice. The Ronstadt documentary was the last of our successes. I hadn’t tried any new movies since Ronstadt’s until yesterday.

The new Tom Hanks film, A Beautiful Day in the Neighborhood, has received a good bit of publicity. When I first heard about it, I thought it might be worth trying. The fact that she had enjoyed the documentary made me think this one might work. On the other hand, I had also learned that this was quite different from the documentary. That made me wonder if she would like it. Ultimately, I thought it was worth the risk.

As it turned out, I had nothing to fear. Although it has an underlying plot, I believe the success of the film rests largely on communicating its message in a way that Kate could appreciate. In fact, I suspect that most people who like the movie like it for the same reasons that Kate and I did.

The characters’ spoken words played a part in communicating the film’s message, but the tone of their voices, facial expressions, and body language are at least equally important. Hanks mastered the slow way that Rogers expressed his thoughts to children. In this movie, he speaks the same way to adults. In addition, the film was at a pace that Kate could grasp. I believe all of these things were important in making this movie a success for Kate and to me as well.

In other words, this was a successful film experience for Kate because it communicated to her through her intuitive abilities. I’ll continue to keep my eyes open for others that may do the same. That can be difficult. All movies attempt to capitalize on people’s emotions. I also need to keep in mind the kind of emotions a film elicits. There are many that Kate would not like, but It’s a Beautiful Day in the Neighborhood was a clear success.

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Change and Adaptation

Like most people, I tend to look for explanations for why “things happen.” I think that is part of our natural curiosity. In addition, I have spent a career looking for reasons that people do what they do, why they change, and what they might do in the future. Since Kate’s diagnosis, I have tried to understand everything that is happening as well how to prevent and solve problems. The most important thing I have learned is how difficult it is to know what is coming next and why.

I’m thinking about this while at Panera. It’s 8:37, and we’ve been here about thirty minutes. This is about the third time we have been here in the last few days. In some ways, this doesn’t seem unusual to those who have read my earlier blog posts or those with whom I have talked about our almost daily visits here. Those regular visits declined over a year ago. I related that to changes in her sleeping. In turn, I attributed her sleeping later to the progression of her Alzheimer’s. For months our visits have been infrequent. What has made her get up earlier recently? Is this something that will continue for a while, or are these a few isolated events?

The answer to these questions is “I don’t know,” and that is the answer I have given for most of the changes that have occurred during the past nine years. What I do know is that Kate’s changes mean that I have to change as well. My natural tendency, however, is to continue doing what I have done before. I admit to being a creature of habit. The only thing that saves me is my desire to provide Kate with the best care possible. If that means I need to make a change, I do it. I don’t mean that making a change is necessarily easy. Each one comes with a measure of psychological discomfort. I like routine and predictability.

Early on, I thought that a writer like Neil Simon could have a field day writing about a couple like us, one with Alzheimer’s, the other with OCD. It really could be comical. On the other hand, I am pretty sure that even if a caregiver were not driven by a desire for order and routine, he or she would ultimately find it challenging to deal with the unpredictable changes that take place with this disease. I feel for those who can’t. I have read many posts on Facebook and Twitter and online forums in which caregivers rant and rave over the behavior of their loved ones. I know it can be very hard. My own situation is much easier because the relationship that Kate and I have now is a pretty good extension of what it was before. The major change would be her dependence on me, but she is generally cooperative and loving.

This morning was a good example. I keep a close eye on the video cam so that I can get to her quickly if she calls me or is getting up. I don’t, however, keep my eyes on it every moment. Today, I went outside to check the water level on our pool that has a leak. When I got back inside, Kate walked into the family room. She was looking for me.

It turned out that she had waked up and was ready to get dressed for the day. Of course, she didn’t know where to go or what to do. She was glad to see me, but she hadn’t panicked and was in a good humor. I apologized for not being there as she got up. It hadn’t bothered her. She just wanted her clothes. I told her I could help her. Then I took her to the bathroom to get the process started. When she started to brush her teeth, she asked, “I sure am glad you are here. <pause> Who are you?” When I gave her my name, she wanted to know “Who are you to me?” I told her I was her husband. She was surprised. I said, “Would you rather think of me as a friend?” She said no. During the next twenty minutes, we repeated this exchange several times. She was always surprised, but comfortable, with my answer. When I helped her dress, she said, “You know, you’re a pretty nice guy. I think I could like you.” I think that captures well what her attitude is like.

Now what does this have to do with change and adaptation? I’m about to tell you. This is the third day in a row that Kate has gotten up early. Each time it has been before or during my morning walk. I like that walk. It is not simply a time for a little exercise. I also listen to books. For me it’s a nice way to start the day before my responsibilities with Kate begin. After my walk, I work on my blog. When Kate is up early, it leaves me to find another time to write.

My point is that I like routine, and changes like her getting up much earlier change that routine. I’d rather not change. On the other hand, she was so nice this morning that I want to take advantage of the time we have to enjoy ourselves. That is a higher priority for me, especially at this stage. I may be having a harder time getting other things done, but it is a pleasure to have time like this.

An hour has passed since I started this post. We are still at Panera, and Kate is still working her puzzles. That’s an unusually long period of time without her getting frustrated. I have been helping her throughout, but she is doing better than she has done in a while.

BREAK

Whoops, it is now 10:45. As I was in the middle of the previous sentence, Kate hit a roadblock with her puzzles. We came home where I will now close and upload this post.

Despite her having trouble and wanting to stop, she was still in a good humor and wanted to help me gather our things together to go home. Once here, she hit her recliner where she is resting. That’s a good thing because I have a noon lunch meeting at United Way. That’s an hour earlier than the sitter comes. I arranged for a church friend from to take Kate to lunch and get her back home for the sitter at 1:00. I have done that once before, and it worked well. This is a person who used to be on the staff at church when Kate was the church librarian. They ate lunch together frequently and have always had a good relationship though we don’t see her often these days.

While Kate has rested, I took care of a number of household chores. Those never end, and I am always behind. It’s been a nice morning. I am glad she got up early even if it meant no walk that I didn’t finish this post until now. Until next time, have a nice day.

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A Terrific Morning

Yesterday morning before Kate was up, I posted a tweet that said, “Feeling grateful today. At Stage 7 #Alzheimers, Kate often fails to remember my name or hers, doesn’t know her way around the house, needs help with everything, and is losing her ability to speak, HOWEVER, we still enjoy life and each other.”

I thought a while before posting it for two reasons. First, I don’t want people to think we have escaped all the negative aspects of Alzheimer’s. We haven’t. Second, I don’t want other caregivers whose situations are much different than ours to think they must be doing something wrong or they would also be enjoying life the way we have. From the start, I have wanted to provide an accurate description of our lives. It seems like being able to enjoy life while living with such a devastating disease needs to be told.

After posting the tweet, I realized that my grateful feeling could be easily followed by something that would bring me down from my perch. That could have happened. It is not unusual for us to experience such swings from high to low and back again. I am happy to say that our morning turned out to be a confirmation of our good times.

Kate was up at 7:30, in a cheerful mood, and ready for the day. We were at Panera before 8:30 and back home before 9:30. I wasn’t surprised that she wanted to rest. While she did that, I did a few household chores.

At 10:00, she had rested enough. I asked if she would like me to read a little of Charlotte’s Web. We spent the next hour reading. We both had fun, but I found my voice was getting a bit hoarse. For the better part of the day yesterday and the day before she didn’t recognize our house as ours. I’m not sure whose she thought it was. I suggested that I show her around the house. She was ready.

We spent the next hour walking first through the kitchen, then the dining room, through the living room, and back to the family room. Along the way we made numerous stops as I told her the stories behind many of the pictures, furniture, and other items some of which had come from her parents’ house. She was enthralled. As I expected, she was particularly excited about the variety of things that had been her parents. You might think that because we had so many things of her parents and that I talked about our having them in our home she would have come to realize that she was in our home; however, I never got a sense that she recognized it as ours. In fact, three or four times she asked, “Who owns this house?” Each time I told her that we did, but it never seemed to stick.

Once again, we had had an experience that can be looked on with sadness – sadness that she doesn’t recognize her own home or the many things that should be treasured memories for her. I am just glad that with my help she can experience them in the moment. Yesterday morning was a very Happy Moment for her and for me. I am grateful.

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Update on Reading

I am glad to report that Kate and I have continued reading together. We have now read The Velveteen Rabbit four times. Each time she has enjoyed it just as much as the first time. We have also read more than 100 pages of Anne Frank’s diary. Yesterday, we started Charlotte’s Web and have read more than 100 pages of it.

It has been exciting to see how much she has enjoyed everything I have read to her. She audibly expresses her reactions which seem to be appropriate to the things I am reading, for example, laughter at something funny, sadness when something bad happens.  I have been very careful not to overdo it. I stop after chapters in Charlotte’s Web and  daily entries in Frank’s diary and ask Kate if she would like to continue. So far, I have been the one to reach a stopping place. One of those times was with the diary. Kate was getting too sad, and I suggested we take a break. She agreed.

It is a special pleasure for me because I actually enjoy what we are reading as well. I’ve always liked Charlotte’s Web and had never read Frank’s diary. It is nice to add a new activity that involves both of us. The down side is that it takes away from my personal time, but I believe it is a net gain in pleasure for me.

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Little Things from the Past Two Days

Each day brings with it a variety of little things that characterize our lives. For example, Kate is losing more of her vocabulary. That leads to her saying things I may understand but are not precisely what she meant to say. Yesterday morning as we walked through the family room, she once again took note of her ceramic cat. I had walked ahead of her a few steps and heard her say, “Kitty Pat. Kitty Pat.” I looked back and said, “What?” She pointed to the cat and repeated enthusiastically, “Kitty Pat.” This is just one example of changes in her speech. She continues to forget common words like salmon, steak, and sweet potato fries. There are many more. By the way, when she stops to look at the cat, she seems to understand that it is not real. Other times I’m not sure. As she looked at it yesterday, she said, “He’s looking at me. Now he’s looking at you.”

At the same time she loses certain skills, she continue to amaze me with her self awareness and, especially, her insights about me. She was a little uneasy when we went to lunch yesterday and asked me to sit beside her in the booth rather than across from her. In a few minutes, I said, “It looks like you are relaxed now.” She said, “Not quite, but I’m getting there.” Then she surprised me. She put her hand on mine and very gently said, “If I were really upset, you would say, ‘You’re going to be all right. Just relax. You’re going to be all right.’” These might not have been my exact words, but they were pretty close. Her tone of voice was “right on.”

Later in the day, she asked where we were. Before I could answer, she said, “I must make you miserable asking you the same question over and over.” She forgets many things, but she clearly remembers things of which I thought she was unaware. It’s not only that she remembers, but she also grasps that it could be irritating. Of course, I told her it doesn’t, and it’s true though I’m not sure she believed me.

She is often concerned about what she should do or say in social situations. This usually comes up before we are going somewhere, but other times it is out of the blue. That happened yesterday as we got in the car after lunch. She said, “It’s really good to see you.” She wanted to know if that was correct. I told her it was. Then I said, “As a former English teacher, you could appreciate that there are different ways you could say the same thing. Some could have slightly different meanings.” I went on to say, “For example, you might simply say, ‘It’s nice to see you.’” I explained that it wouldn’t convey the same degree of pleasure or emotion. Then she asked what she had said. I said, “It’s really good to see you.” She immediately said, “Or I could say, ‘It’s so good to see you.’” Because there is so much that she doesn’t remember or understand, it is easy to think that she wouldn’t be able to grasp something like this. That would clearly be wrong – at least this time.

There is something else that has occurred regularly for a long time. I don’t think I’ve ever mentioned it. She has ridden with me a lot over the eight years since I bought it. We’ve had only one car since December 2013. For the past three or four years she has been unable to identify it at all. The fact that I point and say, “That white car is ours.” doesn’t help. In addition, she doesn’t know which side of the car she is to enter (even when I take her, and I always do.) or whether to get in the front seat where I have opened the car door or the back seat with the door closed. It’s a good reminder of just how much her rational thought processes have diminished. I should add that she has never had any interest in cars. That was long before Alzheimer’s. I know that she knew she drove a Volvo station wagon for a few years, but I’m not sure she ever knew what kind of car I drove.

There is one other thing I should add. I’ve mentioned a lot about her poor eyesight. She frequently will not see specific food items on her plate at meal times. She has salmon and sweet potato fries every Saturday for lunch, but she often doesn’t see the salmon. When the server put her plate in front of her, I am careful to turn it so that the salmon is right in front of her and the sweet potato fries above that. I feel certain her love of fries is part of the reason she sees them. When I point out the salmon, she has great difficulty seeing it even when I use a knife as a pointer and touch it. The surprising thing is that she frequently sees small specks on the table or floor or in the car. They must stick out because there is usually nothing around them, but it is a reminder that her eyes are working. It is the brain that has trouble differentiating different items that are close together.

Let me close with something I’ve said before. We still enjoy ourselves. Yesterday and Friday were especially good days. These days may be waning, but, obviously, it is possible for a couple “Living with Alzheimer’s” to derive pleasure even at this late stage of the disease. I know that everyone’s experience can’t be like ours nor would I deny the low points that are a part of everyone’s journey. From the memoirs of other caregivers, however, I know that our experience is not unique. That should be encouraging to people who have recently received their diagnosis. It’s good to know that life after Alzheimer’s is possible, at least for a while. For us that has lasted almost nine years.

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Another Success with Reading

Having been successful with The Giving Tree and The Velveteen Rabbit, I decided to try another book that I bought at the same time, Anne Frank: The Diary of a Young Girl. I knew this could be a more challenging read for Kate but thought it was a worth a chance. I tried it Sunday evening after dinner.

I began by telling her a little about the book and that we had visited the place where Anne Frank and her family had hidden for two years. She was interested from the start. I am sure this was a book that she had recommended many times to her students when she was a librarian, but, of course, has no memory of it now.

When I finished the first entry, I asked if she would like to stop or if she wanted me to read some more. She wanted me to continue reading. After each entry, I asked if she wanted me to go on. We read twenty-five pages before I suggested we stop for the night and pick it up later. I was quite surprised she retained her interest for so long. Once again, I was encouraged about my adding reading as a source of pleasure for her.

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The Velveteen Rabbit

One of the major themes running through “Living with Alzheimer’s” is change and adaptation. That has been continuous since Kate’s diagnosis. Of course, it really started before that, but I can’t pinpoint a specific date. I can for the diagnosis, so I always use it. At first, our lives changed very little. The primary difference was a focus on the bad news and how we were going to handle it.

Over time, we dropped many things that we had done in the past. Most recently, that has involved Kate’s difficulty working jigsaw puzzles on her iPad. For several years that has taken up 6-8 hours a day. That is now less than an average of an hour a day. This past week there were three days when she didn’t use it at all.

That has put me in the position of creating more activity for her. The sitters and I have been doing that with the aid of her family photo books. That is going well, but I felt the need for something else.  She tries reading magazines, but she doesn’t see well enough. Since she enjoys my reading the text that accompanies the photo books, I began to think about reading other things to her. Several things increased my motivation. One of my Twitter friends reads to her mother and said her mother enjoys it. I also have a colleague at the office who read to her mother in the latter stages of her life. It meant a lot to both of them.

In addition, our Rotary club has recently adopted a new project that involves placing children’s books in public places frequented by children. It made me think of buying several children’s books and trying them out with Kate. Two weeks ago, I took Kate with me to Barnes & Noble to browse the children’s collection. It was right after lunch, a time when she almost always wants to rest. I didn’t have much time to do any serious looking.

Last week, I had a conversation about reading to Kate with my colleague. She mentioned The Velveteen Rabbit and The Giving Tree as good possibilities. I went back to Barnes & Noble on Wednesday and looked for them along with other possibilities. They have a pretty large collection, but I didn’t see either book. The next day I checked Amazon and got them along with two other books.

Prior to their arrival on Friday, I looked on some of our book shelves to see what I might find. I saw a book by Erma Bombeck, Family: The Ties that Bind . . .and Gag! I read the two short introductory chapters to her Friday morning. In her humorous way, she first relates what her own birth family was like when she was growing up. Then she describes her present (present being some time ago) family as they take their annual Christmas photo. It’s a funny contrast of the generations. I wasn’t sure how Kate would react, but she enjoyed it, and I plan to read more at another time.

Sunday morning she was up a little earlier than usual. I didn’t want to go to Panera for a muffin and the quickly go to lunch, and Andriana’s wasn’t going to be open for almost an hour. I didn’t want her to feel my reading children’s books to her was, well, too “childish.” I explained about our Rotary project and that she might help me decide if the books I had bought would be suitable for me to give to our project. She, of course, was happy to do that. My first experiment was reading The Giving Tree. It didn’t take long for me to discover that she liked it. She audibly expressed her feelings as I read. I was encouraged by her reaction.

We still had plenty of time before we needed to leave for lunch. I picked up The Velveteen Rabbit and read it. This was a blockbuster. She was touched the whole way and in tears before I got to the end. I admit that I was touched as well, especially by her response, and shed a tear or two myself.

When I finished reading, I put the book down in my lap. We were seated side-by-side on the sofa. She picked it up and started to look through it from the beginning. She looked at the title page and the page of illustrations. I hadn’t paid much attention to the illustrations as I read, so we looked at them. Then I suggested we go to lunch. She held the book up to her chest with both arms around it and asked if she could take the book with us. I told her she could. She said, “Should I take it into the restaurant?” I said it would probably be better to leave it in the car. Then she decided it was best to leave it home. I mentioned that we could read it again if she would like. She said she did.

It was a beautiful experience for both of us. I was hoping she might enjoy my reading to her since she has enjoyed my reading from her photo books, but I wasn’t at all sure she would understand the stories well enough to appreciate them. I feel sure that she missed a lot, but it was clear that her intuitive skills were working. She was clearly moved. Her reaction encourages me to try more. Wouldn’t it be nice if her love for reading that seemed to have been lost could be rekindled in this way? How appropriate for someone who was a lifelong reader until Alzheimer’s entered our lives.

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Ups and Downs This Week, Mostly Ups

It’s been a busy week. My daily schedule has been interrupted more frequently than in the past. That means I’ve been less regular with my posts. Several times I have started one and not been able to finish because of something else I needed to do. Kate has required more attention than usual, but that doesn’t explain everything. The other things have involved household chores.

Tuesday was one of those days about which I didn’t say anything. I was especially interested in writing about the events of the day as a follow up to Monday when she had a rough beginning. Fortunately, I jotted down a few notes so that I can cover the highlights.

The day started like the day before. Her brain seemed to be “blank.” She was very dependent on me; however, she didn’t appear to be disturbed the way she was on Monday.

I don’t know that my own behavior played a role in the way she responded. I do know that I tried to be more careful in waking her than I had done the previous day. I played a full 20 minutes of relaxing music before going to the bedroom to wake her. When I entered the bedroom, she was awake. I said hello and sat down on the bed beside her. This wasn’t planned or intentional, but I think it may have played a role in conveying a relaxed morning, not a moment when I was eager to get her up.

She didn’t know her name or mine nor our relationship. When I said I was her husband, she couldn’t accept it. As I have done on other occasions, I suggested she think of me as a friend. She liked that. I mentioned a shower, but she didn’t want it. I didn’t push.

I told her I loved her. Though a bit unclear, she responded with what she meant to be “A Bushel and a Peck.” I pulled it up on the audio system, and we sang it together several times. Then I suggested she get up so I could take her to lunch. She got up easily. I had started to wake her with plenty of time for her to take a shower. When she didn’t shower, we were left us with additional time to get ready.

As a result, we got to lunch earlier than usual. She was very talkative and initiated a conversation as though we had never met before. She asked me what I did for a living. I explained that I had started out as a college professor. She wanted to know what I taught. When I told her sociology and social psychology, she asked me to explain. I did, and she said that sounded interesting. I went on to say I ended up with my own market research company. She didn’t know what market research is. I explained that, and she also thought that was interesting.

When I finished, I said, “Why don’t you tell me about yourself.” I knew this might put her on the spot but thought my question wasn’t especially threatening. She handled it well and said, “There really isn’t much to tell.” I told her I knew a lot about her. Then I recounted her academic background and teaching career. I pointed out that she had been a good student and had earned two masters degrees. Then I told her about her volunteer career as our church librarian. She was quite interested and added her own comments.

It had been almost a year and a half since she had had a cortisone shot for the arthritis in her knee. Over the past couple of months, she has complained about it periodically, so we went directly from the restaurant to the orthopedic clinic. She was very childlike throughout the visit but handled herself well. We waited in the lobby for about fifteen minutes. Assuming we might have to wait a while, I took along her “Big Sister Album.” I thought that would occupy her for a longer period of time than her iPad. She enjoyed looking at it and made a lot of comments. There were only a couple of others in the room. I am sure they wondered a bit as they heard me identify all the people including Kate herself as she responded much like a child listening to a parent read a book.

We didn’t wait any longer after going back to one of the examining rooms. We met with two different people. Kate didn’t understand a lot of what was said and asked for clarification. I helped interpret what they said. She never understood, but she was satisfied. As we left, she thanked everyone including those in the waiting room.

The most important thing I should say about the day was that it was one of the nicest days we have had in a long time. I think that relates directly to her mood. She was very happy and quite at ease. Her memory wasn’t any better nor was she any less confused about things like whether we were in Texas or Tennessee, but she enjoyed herself. I couldn’t understand everything she said in our conversations, but she was surprisingly sharp in terms of her understanding about the importance of values and the role of parents in teaching them to their children. She has lost so much of her rational ability that I really enjoy hearing her express her opinions, beliefs, feelings, and values that remain intact. It keeps me in touch with the Kate I have always known.

Recently, especially this week, our lives have vacillated between highs and lows. The highs have been very special, and we experienced them every day. They far outweigh the lows. I know greater challenges are on the way. I am counting on the Happy Moments to sustain us.

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Two Happy Moments

As Kate continues to decline, I expect that we will experience more sad moments than we have had in the past. I hope that I will be able to say that we still have happy ones as well. That is certainly true right now. Two days ago, for example, she got up early. She seemed to be in a good mood. She did ask my name and our relationship multiple times before she got dressed. Each time I mentioned that I was her husband she was surprised but accepting.

When she was dressed, she asked if she could lie down. I told her she could and then said, “I love you.” As I said it, I remembered the old song “I Love You a Bushel and a Peck.” When I mentioned it to her, she also remembered it. Then she said, “We could sing it together.” I took out my phone and searched for the song. Then I played it through our audio system. We forgot most of the lyrics, so I pulled them up on my phone. We must have sung the song five or six times. It may have been a little silly, but it was fun. Kate really got a kick out of it. I think it also made it easier for her to get up since her already good mood got better. I just know that right after our singing, I said, “Now, I’d like to take you to lunch.” She got right up.

We had another Happy Moment at dinner that night. We were having dinner at Chalupas when I mentioned how nice it was that we enjoy the simple pleasure of being together. She picked up on that and began a conversation about how fortunate we are in so many ways. From there, she gravitated to talking about the people who are not as fortunate as we are in our marriage and many other aspects of our lives.

I enjoy hearing her speak so naturally. She didn’t seem to have a care in the world. She is often concerned about what she should or shouldn’t do or say. She isn’t that way a lot of the time, but she does frequently ask me to watch her or to keep her from doing “something wrong.” She knows she does a lot of things that aren’t right. It’s good to see her at moments when doesn’t have those concerns. They make for quite a few Happy Moments for both of us.

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An Example of Kate’s Self-Awareness

Over the past few days, Kate has snapped at me several times. As in the past, she quickly apologized with tears in her eyes and said, “I shouldn’t have said that.” I’ve been struck by her awareness that she has spoken to me in a way she hasn’t done before Alzheimer’s entered the picture. Two nights ago, I was even more surprised.

We had just finished a very pleasant dinner at Bonefish Grill. I started the car, and she said, “May I tell you something?” Her tone of voice made me think she was going to say something nice about my caring for her as she often does. I was surprised when she said, “I know I’ve been hard to deal with lately, and I want you to know I’m sorry.” I was both touched and stunned. Here she is trying to adapt to the changes taking place in her brain, and she feels bad about the way she has treated me. Apart from that, I was amazed that she said this “out of the blue.” I think it had been more than twenty-four hours since she had last snapped at me. That tells me this is something that really disturbed her. That matches her other concerns related to not knowing “anything.” To me it is a remarkable example of her kind heart and self-awareness. It also increases my desire to see that she gets the best care I can give her.