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Thoughts on Living Normally

A couple of days ago, I read a Facebook post by a friend whose 8-year-old-daughter has Down syndrome. She and her daughter were in Nashville to make a pitch to the legislature not to overlook children with special needs when it comes to the education budget. She talked about the importance of providing special needs children with as many “normal” educational experiences as possible. I am not an expert with respect to those with special needs, but what she suggests makes sense to me. That has been my approach to care for Kate.

Right after her diagnosis, we talked about how we wanted to spend our time. We agreed that we wanted to focus on the kind of things that were important to us before Alzheimer’s. We didn’t think of it this way, but what we wanted was to lead normal lives. We wanted to remain active for as long as we could. That involved travel, attending live performances, dining out, and maintaining contact with friends.

It has been eight years since Kate’s diagnosis, but we continue to be as active as possible. I suspect we spend less time at home than many people our age. We are reasonably active in getting together with other people for meals and outings like our trip to Flatrock Friday night. Just the social engagement we have with our servers at the restaurants we frequent provides a source of social contact and support. I am sure they would never imagine the contribution they make to our lives.

I wish I knew a way to assess the impact our social engagement has had on us. I am sure it has enhanced the quality of our lives and probably helped us maintain a positive outlook on life even at the present stage of her Alzheimer’s. My best guess is that Kate is just past the mid-point of Stage 6 of the seven-stage model. Life is changing, but we are still active and happy.

Over time, we have had to modify our activity. Our last international trip was four years ago in May. We love Chautauqua, NY, in the summer. We’ve spent at least a week there in each of thirteen summers, ten consecutive years until our last one in 2017. The past two years we have rarely gone to any evening events that start later than 6:00. Thus, we no longer attend the Knoxville Symphony. We have been able to continue going to live theater performances because they all have Sunday afternoon matinees. We rarely attend church on Sunday because it is difficult to get Kate ready in time. As I have frequently reported, we no longer make our daily trip to Panera for Kate’s muffin in the morning. We usually go straight to lunch. That has cut down on our social contact. Until ten-to-twelve months ago, we often spent more than six or seven hours a day away from home. That is now four to six at the most.

My background in sociology has made me sensitive to the variety of environmental factors that can affect us. That leads me to believe that my friend whose daughter has Down syndrome is making a good point that the value of living a normal life is good for her daughter and other people with special needs. To the extent possible, Kate and I have tried to live as we did before Alzheimer’s. I believe it has worked.

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A Big Success with the Sitter

A year and a half ago, I engaged sitters for Kate. On the whole, it has gone quite well. Kate accepted having them from the start; however, she has never been enthusiastic about them. More recently, as she has become more dependent on me, she has sometimes wanted to go with me when I leave or for me to go with her and the sitter if they are going to lunch. Each time I have managed to let her know that I needed to go to Rotary, the Y, or a meeting, and she didn’t protest.

Despite Kate’s acceptance, I’ve never felt fully comfortable leaving her. I’ve done it because I feel that it is important for me to have time away to do other things. It also sets the stage for increasing the sitters’ time in the future. Two experiences in the past five days have made me feel better about leaving her.

The first occurred last Friday. As I walked into the family room where Kate and the sitter were seated, I heard the sitter tell Kate that she would see her “next week.” Kate apparently misunderstood and thought she might not be coming back. Kate looked frightened and said, “You’re not coming back?” Mary repeated that she would be back next week. Kate said, “Good, because I need you.” I was happy to see that she not only felt comfortable with the sitter, but there seemed to be an emotional bond.

On Monday, we had a different sitter, Cindy. When I got home, they were engaged in a conversation, and Kate was playing a very active role in it. Cindy told me that Kate had not taken a nap and that they had been talking all afternoon. That was another victory. We had two good experiences with two different sitters.

I found both of these experiences encouraging, but the biggest victory came yesterday with Mary, our Wednesday/Friday sitter. Normally, I would leave for the Y as soon as s arrives. We had just returned home from lunch, and I wasn’t going to the Y but a dental appointment at 2:00. I didn’t need to rush, so I talked with Kate and Mary about ten minutes. I think that worked better than my leaving as quickly as I usually do. When I told Kate goodbye, she didn’t show any sign of disappointment that I was leaving or that she couldn’t come with me. The big surprise came when I arrived home. I found the two of them were still seated in the same chairs they were in when I left. I asked if they had gone out. Mary said they stayed at home and never left the family room. They talked and listened to the music playing on my audio system when I left. She added that they both rested in their chairs a short time. After Mary left, Kate said, “She is really nice.” It wasn’t just the words. It was the emotion she expressed as she said them. She had a really good time with Mary, and I felt better about having sitters than at any time since we began a year and a half ago. That was a victory.

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Examples of Kate’s Intuitive Abilities

Kate continues to amaze me with her intuitive abilities. For example, today as we walked from the car to the restaurant for lunch, she said something to which I responded differently than she expected. She was surprised, and I said, “You mean you think I’m predictable?” She laughed and said, “Are you kidding?” I don’t know that predictable is quite the right word, but I do have rather predictable patterns. She regularly makes comments about my personal quirks/behavior, and she is always right even when she can’t remember my name or who I am.

Another incident happened after we returned home. It was preceded by my playing an album of choral music that she likes. Sometimes she likes to sing along with the music though neither of us can remember all the words. One of the songs on the album is “Comin’ through the Rye.” She wanted to sing it, but we couldn’t make out enough of the words. At home, she wanted us to sing it. I told her I would have to look up the lyrics. When I did, I found the original Robert Burns poem on which the song is based. Of course, it had the Scottish expressions. That didn’t work. She asked me to sing something else. Without thinking, I started singing “Amazing Grace.” We sang a few bars before she said, “That doesn’t sound very appropriate.” I felt the same way. It just popped in my head, but it didn’t seem like the most appropriate song for us to sing at that moment. Now, I’m glad I did because it shows how sharp she can be when it comes to her intuitive abilities.

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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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What a Difference a Smile Makes

Several times I’ve mentioned Kate’s smiling as I enter the bedroom to check on her in the morning. I love that smile. It reminds me of those days before Alzheimer’s. Even now as I understand that the smile doesn’t mean that she remembers my name or that I am her husband, her smile gives me a good feeling. I think “What a great way to start the day.”

It’s not always that way. Take yesterday for example. She wasn’t smiling. Instead, she looked as though she wished I hadn’t come in. Now that I am more aware of her ability to learn intuitively, I suspect she knows that when I walk in, I am probably there to get her up. Yesterday she told me she wanted to stay in bed a little longer, perhaps a lot longer. So it is understandable that she didn’t smile. It was only when I told her Mary, our sitter, was coming and that I hoped I could take her to lunch that she decided to get up. As usual, she was appreciative and thanked me for helping her get to the bathroom and dressing, but she expressed her independence and was irritated at my attempt to help.

She joked with me as we prepared to leave the house. It was one of those times when her jokes had a little bite to them and, of course, at my expense. I didn’t joke with her. Kate has never been one to joke. I have often joked with her. Like all jokers, I sometimes go too far. A year or two ago, I felt our joking with each other was getting out of hand. I stopped. I started responding more lovingly all the time even when she joked with me. I think that had a great impact. She still likes to kid me, but it seems less bitter.

She didn’t say much as we drove to lunch. As I helped her out of the car, she said, “I love you.” For the balance of the day, she was just fine. When we went to bed, she said, “It’s been a wonderful day.” I agreed. I like her smiles. Even when she doesn’t begin with a smile, she ends with one.

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A Tender Moment This Morning

I looked at the clock. It was 5:45. As I rolled over to get up, I heard a soft chuckle. Kate often does this when she recognizes that I’m awake. I think it’s her way of saying, “Hello, I’m awake too, but I’m not ready for conversation.” I reached over and touched her arm. She pulled my arm around her. It was a loving response. She didn’t appear to be afraid. She just wanted to be held. Neither of us said a word. I held her until 6:15 when I got up.

As I was finishing up in the bathroom, she came in. When she was ready to go back to bed, she said, “What do I do now?” I told her it was still early and that she should go back to bed. She said, “Where is it?” I walked her to the bed. She sat down and said, “Thank you.” I said, “I love you.” She smiled and said, “I love you too.” Then, as so often happens, she said, “What’s your name?” This is just another example of the loss of her rational abilities while retaining those that are intuitive. In this case, her feelings for me. Tender moments like this continue to sustain me as her life and mine keep changing in ways I wish I could stop.

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A Winning Streak

We often hear about winning streaks in sports, but all of us have streaks in our everyday lives. We just don’t keep statistics in the same way. In the first place, we don’t usually categorize the various aspects of our lives. In sports we have such categories as consecutive wins, completed passes, passes without an interception, games with a hit, etc. Even if we did, we don’t go to the trouble of keeping records.

I’m thinking of streaks right now because Kate and I have had a streak of good days for over a week since she got over her cold. She’s still asleep, but I am optimistic that we will continue that streak today. A lot of little things make me feel a day has been good. Her happiness is probably at the top of the list. Something that goes along with that is the nature of our relationship. I work to avoid days when I have to push her to get places. Fortunately, she is good-natured. We work together well. Each of us wants to please the other.

The other day I saw something on Twitter that suggested a caregiver would do well to foster a sense of teamwork between himself and the person for whom he cares. I think that is very much the way Kate and I have worked together. When I push too much, she resists. She has her own sense of time and cannot hurry no matter what. Two days this past week, she had appointments with her ophthalmologist at 11:00 or shortly thereafter. For months, getting up that early has been a problem for her. This week I had no trouble at all. She was very cooperative even though she couldn’t remember why she had to see the eye doctor.

In addition to being cooperative, she is most appreciative. Those qualities are great reinforcers for me since I want to make her life as happy and trouble free as I can. Twice during the night we had experiences that illustrate how well this can go. The first occurred at 10:45 when she got up to go to the bathroom. I got up with her and walked with her. Then I did something that I haven’t done before and won’t do again. I usually wait with her. This time I decided to wait for her in bed. I didn’t expect to go back to sleep before she was finished, but I did. At 11:00, I looked up at the door to the bathroom and noticed that the door was closed. I got up to see if she was still in there. She wasn’t. I found her on the sofa in the family room. She couldn’t have been there long and was still awake. She was very glad to see me and said she didn’t know where to go. I said, “You must have been scared.” She said she was and thanked me. As we walked back to the bedroom, she thanked me again. All of this happened in the span of fifteen minutes, but it was an emotional experience for each of us. Each was glad to see the other, and we were happy as we got back in bed.

She got up a second time just before 6:00. I had just waked up myself and was about to get out of bed. I helped her to the bathroom and got her back to bed. As she always does, she repeatedly thanked me for showing her the way, helping her, and getting her back to bed. As she continues to decline, she is developing a greater sense of dependence on me. Her appreciative response makes me want to do the very best I can to make her life as easy and frustration free as possible.

So, after a string of good days, I don’t see any signs that it should be any different today. I won’t be keeping any statistics. They don’t really matter. What matters is that we are working together to make the very best of a diagnosis that no one wants. We’ve been successful thus far. I plan to keep that in mind as we approach the remaining part of our journey.

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Remarkably Upbeat and Alert

I’ll never know what caused Kate to be frightened yesterday morning or unusually upbeat and alert by the time we got to Panera for a muffin. The upbeat part made for a very nice day. I have already commented on our conversation at Panera. It was a special time for the two of us.

I should make clear that there was no difference in her memory. Her behavior was upbeat and normal, but her memory was essentially the same. Except for a few questions she was asked at her eye doctor’s appointment, she was never put on the spot to say anything related to any lost memories. She continued to ask where we are though she only asked my name and hers a few times during the whole day. In fact, she called me by name several times.

We had a special treat at lunch when our friends, the Greeleys from Nashville stopped for lunch on the way to visit friends in North Carolina. Kate handled the situation unusually well. Scott is Kate’s longest standing friend. Their relationship goes back to the cradle. When I told her that we were going to have lunch with Scott and Jan, her eyes lit up. She had a strong positive reaction, but she couldn’t really remember any specifics about them. Before meeting them, she asked me their names two or three times. After they arrived, we chatted briefly before they went to the restroom. Kate asked again what their names were. She did the same thing after we left the restaurant. On the other hand, she responded to them as warmly as ever. She clearly recognized them as good friends. They never put her on the spot to answer any questions. She also seemed to be unusually alert. She participated in the conversation and responded appropriately to things we talked about. Sometimes she asks a lot of questions because she can’t hear or follow the conversation. That did not happen at all. It may have helped that we sat in a relatively quiet section of the restaurant. I believe our conversation was very relaxed, not rapid paced as it is sometimes at our music nights at Casa Bella. She was obviously very comfortable and poised.

Another couple we know stopped by our table on their way out. We hadn’t seen them in quite a while. I am sure Kate didn’t know who they were, but I am equally sure she recognized the woman. She was just as natural and poised with them as with the Greeleys. Once again, she wasn’t put on the spot to test her memory. It was just a brief encounter with expressions of pleasantries that didn’t call for anything but a facility for light conversation. That is something Kate has always had.

We came back home where she rested on the sofa. She always likes looking at the trees and greenery in our back yard and the neighbor’s. She was unusually taken by them yesterday. As I do when she is enjoying music, I take great pleasure knowing that she finds such satisfaction in the beauty of nature. How grateful I am that she is able to enjoy life so much while living with Alzheimer’s.

After resting, she got up and said she was going outside to water her plants. I was stunned. I think it’s been two years since she expressed any interest in her plants. Prior to that it had been a passion of hers. She stopped during the winter two years ago and has never shown any interest until yesterday. Late this past spring or early summer, I had someone replant several pots on our patio. I thought that might rekindle her interest, but she has never shown the slightest sign that she cared about them.

As she prepared to go outside, I noticed that she had put on a pair of brand new shoes that I had received in the mail that very day. I suggested that we might find an older pair, and she gladly consented to change. Then she said, “Where shall we start?” That was the first hint I had that I might be a participant. I didn’t ask any questions. I said, “Why don’t we start out front. There are some things on the front porch that need water.”

When we got outside, I turned on the water. She did the watering. A lot of her watering was the bare dirt where I had some dead shrubs removed this past summer. The other focus was the grass and a few shrubs that were beginning to blossom. We had both gone out without jackets. It wasn’t long before she felt it was too cold to stay outside. I was glad because I had made dinner reservations and knew that it was about time for us to leave. The real accomplishment was not getting the plants watered. It was seeing her enjoying herself outside once again. As the weather improves, I wonder if she will want to do more of this. I hope so.

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From Fear to Joy in 60 Minutes

At 9:45 this morning, I saw on the video cam that Kate was awake and went to the bedroom. When I got to her, I discovered that she was scared. It turned out that she had been awake for a while and wondered where I was. She never called for me, or I would have gone to her right away. I also did not detect any movement that would suggest she was at all worried. When I apologized, she said, “Don’t ever do that again.” I told her I wanted her to know that I would never leave her alone and that I wanted her to call me if it happened again. She said, “I didn’t know where you were or where I was or what was happening.” Her memory of this fearful experience lasted a much longer time that I would have imagined. After she was dressed and taking her meds before leaving the house, she mentioned this again. This would have been about thirty minutes later. She said very sweetly, “I know you didn’t mean it, but don’t ever do that again – whatever your name is.”

Before leaving she saw a piece of ceramic tile that one of our grandsons had painted as a marker for our dog Chico’s ashes. We used to keep in a flower bed in our back yard where we had scattered his ashes. She didn’t know what it was, but she thought it was pretty and asked me if she could take it with her in the car. Of course, I said she could. We had enough time to stop by Panera for a muffin before an 11:20 appointment with her ophthalmologist . She asked if it would be all right to take it in the restaurant. I told her that would be fine. We put it on our table.

At Panera we had one of those nice conversations that occur periodically. She was in a very good humor and talkative. We talked about our lives and how fortunate we have been. She again showed how perceptive she can be when she said, “If you are with someone you like, it doesn’t matter where you are.” I agreed. After all, this was one of those moments that are special. We were just at Panera having a blueberry muffin, but it is the kind of moment I will treasure in the days ahead. How grateful I am that this is possible so late in her journey.