Posted on

A Minor Bump in the Road

It has been almost ten months since I engaged the services of an agency to provide a sitter for Kate three afternoons a week. I agonized over this for several months prior to taking action. I was concerned about how Kate would respond. It turned out I didn’t need to worry. She responded quite well. During the first couple of weeks we tried several sitters that didn’t work out, but we quickly settled into the two who are with us now. Anita comes on Mondays. Mary comes on Wednesdays and Fridays.

Although things have gone well, I have never completely adjusted to leaving her with someone else. On several occasions, one of the sitters has been unable to be here. In these cases, the agency was prepared to send a new person. Each time I declined. I didn’t want a new person to come in without our meeting her ahead of time. I know we are going to need more sitters as time goes on, but to me it is important to have them come out to the house for an initial interview before I leave them with Kate. That leads me to what happened yesterday.

Last week, I received a reminder of a meeting of an advisory board on which I agreed to serve several months ago. I called the agency to see if they could arrange for either of our current sitters since my meeting is in the morning and this is not one of our regular days. The person with whom I spoke said that they were both assigned to other clients at that time, but she would see if she could do some switching. I waited until Monday and called back to see if she had been able to make a change. She said she was still working on it.

When I hadn’t heard anything by yesterday, I called again. The person who answered the phone told me they were sending a new person. Of course, I told her I didn’t want a new person and that if that were impossible, I would just miss my meeting. I felt the person giving me the news was not as understanding as she should have been. I did not have a problem with their not being able to provide the regular sitters. I did object to their not calling me to let me know. I felt the person I spoke with yesterday was being too defensive and didn’t show  proper concern for Kate’s or my feelings about the situation. That was especially true since I would have to leave for my meeting before Kate would be up. I didn’t want her to wake up and find a stranger to greet her.

This is not a big issue, but it is the second time in the past few weeks that they have surprised me. The first one was a phone call asking me if I still wanted a sitter on Monday. I told them I did but was curious as to why they should ask. She said, “We noticed that you haven’t had anyone that day in a while.” I told her that one of those days was because the sitter was sick. The other was Memorial Day. They had specifically called to see if I would need them on that day. I told her, as I have for other holidays, that would not be necessary. I felt that should not have been construed as a desire or intention to reduce our in-home care. In fact, when we began the service I had conveyed my desire to keep Kate at home. That would eventually involve 24/7 care. It just seemed like they didn’t understand our situation.

As with so many things, I believe the situation could have been handled better on both ends of the line. I should have been more specific about my desires for sitters. I depended on that’s being conveyed to the staff by the representative with whom I made the original arrangements. I think I need to go into the office and meet with each of the staff personally. Communication is always so difficult, especially when you are dealing with multiple people. There are at least 4 different people I talk with at the agency. I believe each of them has individual responsibilities and skills that are different from the others.

As I say, today’s issue is not a major one. I just want the agency to be more of a partner in Kate’s care. They need a better understanding of situation and our long-term plans. I’m going to see if I can facilitate that.

Posted on

Eating out has its challenges.

Occasionally, someone asks how, or if, I am able to maintain a balanced, nutritional diet since we eat out for all our meals (lunch and dinner). The answer is I find it challenging. Kate and I are drawn to slightly different food items. That has led me to repeatedly visit restaurants where I know she and I will both be happy.

She has a much stronger preference for carbs than I do. I don’t mean that I don’t like them. I do, but I attempt to control my diet by eating salads for most lunches and some dinners. Typically, I avoid bread except on Sunday when we eat at Andriana’s. I like their bread more than other places. We also share lots of meals. That helps a lot. For example, at the Bonefish Grill last night, we split an entrée of 4 grilled shrimp and 4 scallops. It came with a small house salad which I ate. For our sides, we got sautéed spinach and mashed sweet potatoes. I ate the spinach and Kate ate the sweet potatoes. This works pretty well for me.

The big problem for us is desserts. We both love them. For a long time, however, we have only eaten dessert infrequently. The major exception is when we eat at Casa Bella. Their Amoretto cheese cake has been a favorite of ours for many years. We always split a piece when we are there. That was fine when we were just going there periodically. When they started their music nights, that meant eating there three times a month. More recently, we’ve started going to another small Italian restaurant that makes its own gelato. We eat there every Wednesday night. We’ve added a single scoop of it to our weekly routine. We’ve gone to Carla’s regularly for about a year. We eat lunch there on Tuesday. A few months ago, we discovered they also make their own gelato, and we love it. We now get one scoop of it each week, and it’s a little larger than the one we get on Wednesday nights.

We’ve eaten at Andriana’s on Sundays the past three years or so. We had never had a dessert there until a few weeks ago. For some reason, our server asked if we would like dessert. She probably hadn’t done that since the first few times we had gone there. As I was about to say no, Kate said, “What do you have?” I knew it was all over then. It turns out they had a special that day, a banana pudding cake. It was a yellow cake with two thick layers of banana pudding and a heavy cream cheese icing. Since then we have had dessert two other times. I’m afraid this could be habit forming.

To make matters worse, we’ve replaced our regular Tuesday night restaurant with the Bonefish Grill. As I noted above, we split a meal there. I failed to mention that it comes with dessert.  <g>

Here’s the real dilemma for me. I could use my will power and skip the desserts; however, one of the pleasures of our marriage involves our sharing desserts. I don’t know how much longer this will last. In the meantime, I have opted to keep it going. I’ll have to figure another way to keep my weight down.

Posted on

As Expected, A Strong Finish

I am pleased to say I didn’t have any false expectations about the balance of our day yesterday. The movie, Won’t You Be My Neighbor?, was as good as it was three days ago. I didn’t say a word to Kate about its being the second time we had seen it. I just said I was taking her to a movie. She asked the name, and I told her. She didn’t show any sign that she recognized we had already seen it. She asked what it was about. I told her it was about Mr. Rogers. That appealed to her.

As we entered the lobby, we saw two people we know. One is a member of our church. The other is one of Kate’s favorite PEO sisters. It was no surprise that she didn’t remember either name. I was struck, however, as we walked away. She said, “I know that person (her PEO sister), but I can’t remember her name. I remember that I really like her.” When I told her, she recalled the name but nothing else about her except liking her. This is yet another example of her intuitive thinking in action.

She loved the movie. I am confident that she never remembered seeing it before. She talked about how good it was, but she didn’t know it was about Mr. Rogers. When I told her, she said, “And what did he do?” I told her he had a children’s TV program.

It was time for dinner when we left the theater, so we stopped by Bonefish Grill and had a nice meal. When we got home, we watched the first part of the 25th Anniversary Concert of Les Miserables. We had watched it a couple of weeks ago. She had loved it then and again last night. It is my favorite musical. I don’t know which I enjoyed more, the concert or seeing Kate so engaged. She didn’t even touch her iPad, a rarity. The day ended even better than I had expected.

Posted on

Starting Slowly, but Hoping for a Strong Finish

In other posts I’ve noted that Kate has never been a morning person. Throughout our marriage, I’ve always been up much earlier than she. The exception was when she was working. Because of that we have never had breakfast together except when we are traveling. These days I let her sleep as long as she cares to. Over the past 2-3 months, she has been quite erratic. Yesterday and today, she has gotten up much earlier than usual. It was before 8:00 Sunday and today. When that happens, she gets sleepy and often wants to rest before lunch. Today she made it until after lunch.

Until we were just about finished with our lunch, she wasn’t ready to engage in conversation. I didn’t push her at all at Panera. I always let her take time to fully wake up before saying much. Sometimes she asks me not to talk during the 4-minute drive from our house to Panera. Before leaving for lunch, she is usually wide awake. That wasn’t so today. By the time we finished dessert, she was ready. As we walked out of the restaurant, she said, “You know, I love you more every day.” As I was saying the same to her, she said, “No, I really mean it.”

She still has retained a sense of humor. Yesterday at Panera, she had a problem with her iPad. The cover folds into a stand, but she can’t ever do it herself. Each day when we arrive, she fills her cup at the drink dispenser while I do it for her and open the jigsaw puzzle app. Periodically, she accidentally unfolds the cover. That is what happened yesterday. I saw her struggling with it and asked if I could help her. She said yes. Once I set it up, she said, “You can be irritating at times, but I really need you.”

This morning when I wondered if her slowness might relate to the kind of confusion that led to her anxiety attack the other night, I decided we needed something to give her a boost in the afternoon. I got online and bought tickets to see Won’t You Be My Neighbor? a second time. She is resting now, but I will get her up in another thirty minutes to leave for the movie. When the movie is over, it will be time for dinner. I would be very surprised if we didn’t end the day on a high note.

Posted on

Changes in Conversation

I’ve heard other caregivers express sorrow over the changes in everyday conversation with their spouses. I’ve had the same experience with Kate. During the first two years after her diagnosis, our conversation was pretty much the same as it had always been. Gradually, we talked less and less. I think two things accounted for the change. First, I’ve always been a bigger talker than Kate. My parents were incessant talkers. I think my brother and I were heavily influenced by them. Kate has always been able to handle everyday social situations with ease, but she doesn’t have the same drive to talk that my brother and I have. When Alzheimer’s entered her life, she became quieter. We would go long stretches with silence, something that is a bit of a problem for me. I also found that when I would tell her something I was excited about, she didn’t respond in the way she would have previously. Our conversations became one-sided. Even talkers need a little encouragement to keep talking. She just didn’t provide it.

The second thing that accounts for this change is that a lot of conversation relies on memory. In almost any conversation, we refer to things that happened or that we talked about previously. As Kate’s memory declined, she lost the information she needed to carry on a conversation. Each time I would start a conversation, she would be puzzled because she couldn’t remember what I was referring to.

As a result, we talked very little. I felt especially uneasy when we were in restaurants. She wasn’t bothered at all. She could go through a whole meal without saying anything. Frequently, she would close her eyes as though she was going to sleep. Sometimes I wondered if people thought we were having some kind of marital problem. Over time, I learned to accept this, but I still missed our conversations.

Looking back, I believe I was slower to live in her world than I should have been. When she talked, her conversation related to her family. She has a deep love and admiration for her mother. Her long-term memory was still pretty good. What I have only grasped more recently is that feelings last much longer than specific facts. Gradually, we have both evolved into conversations that involve our feelings about both of our families and about our lives in general. We reflect on our friends, the places we have lived, the things we have done, our travel, and other highlights of our marriage.

This change in focus has had a significant impact on our conversation. It is still quite different than before Alzheimer’s, but it is enjoyable for both of us. It depends on my initiating the conversation. I bring up as many different things about our marriage and our families as I can remember. That provides a wealth of topics. The good news is that we can keep repeating them, and they are always new to her. I try to keep the focus on our feelings for the events of our lives rather than simply the facts. The facts provide a way to bring back the feelings. I admit it doesn’t always work the way I had intended. For example, last night I brought up her visit to the Jeu de Paume in Paris with our daughter in 1973. I told her they saw somebody special. Kate’s eyes lit up. It turned out that she didn’t remember the experience itself or that it was Julie Andrews and her daughter they had seen. On the other hand, she enjoyed the story I told her. That is true for almost all of the things I bring up. It’s not a loss, however. She experiences them in the moment I tell her. It’s the way children enjoy the stories their parents tell them. This is working for both of us.

Posted on

Our Sunday

We had a nice day yesterday despite Kate’s appearing to be a bit more confused than usual. A couple of times I was concerned that it might evolve into the kind of anxiety she experienced this past Wednesday evening. Fortunately, that didn’t happen. She got up unusually early, just before 8:00. She was walking slowly down the hall from our bedroom wearing her robe as I went to check on her. I asked if she had just gotten out of the shower. She said she was just going to take one.  Then she asked, “Where should I go?” She was standing right outside the guest bathroom. I told her she could go there are to the one off our bedroom. She said, “I’d like our bathroom. Where is it?” She uses several towels, so I got a couple of extras from the guest bath and walked her to ours.

We surprised some of the regular customers at Panera. They are accustomed to our coming later. Yesterday we got there before a group from a nearby Catholic church. We had gotten there before they did. While we were there, Kate asked me to tell her where we were (both the restaurant and the city). She also asked about her father’s name as well as those of our children and grandchildren. This occurred again at lunch and at dinner. Asking these names is not unusual. It’s just that I sensed a bit of concern on her part about not remembering them. I may be overly sensitive because of her experience the other night.

What she remembers and forgets sometimes surprises me. In the car yesterday, she said, “Nineteen thirty-six” and nothing more. I guessed correctly that she wanted me to tell her the significance of that year. I said, “That was the year my parents moved to West Palm Beach.” She said, “That’s the year my parents got married.” She was absolutely right. She surprised me.

Yesterday afternoon, I asked if she would like to look at some of our old pictures. She said yes, and I picked out pictures from a trip to Spain and France that we took in 1973 when our children were 4 and 2. We were gone six weeks, and our son was still in diapers. I should add that they were cloth and Kate washed them by hand every day. When I mentioned the trip, she immediately said, “People thought we were crazy, but it was great.” That is something she has said many times when we bring up the trip. It is obviously embedded in her memory.

Then I reminded her that she and our daughter had seen Julie Andrews and her daughter at the Jeu de Paume in Paris while I was taking care of our son. She has talked about this experience many times over the years. Kate described how no one else was in the room but the two mothers with their daughters. Kate was careful not to invade their privacy but took great interest in how Andrews was explaining the art to her daughter. Kate wanted to tell Jesse that was “Mary Poppins,” but that was before she had seen the movie. Yesterday, when I re-told the story to Kate, she didn’t remember a thing about it. Three or four years ago, we had seen Andrews and her daughter at Chautauqua talking about a children’s book they had co-written. She enjoyed reliving her original experience with the two of them in Paris. Even that more recent encounter wasn’t enough to overcome the changes that Alzheimer’s brings with it. I was crushed.

Posted on

Kate still enjoys movies (if I pick the right ones).

Kate and I have enjoyed movies throughout our marriage. They’ve been especially important since her diagnosis. It gave us another bit of pleasure that was a complement to our other activities. A little over a year ago, I found that Kate wasn’t enjoying them the way she used to. Not wanting to let go of this source of entertainment, I worked a little harder to find ones that she would enjoy. Ultimately, however, we’ve been going to fewer movies. Recently, we’ve had two successes. The first was RBG, the documentary about Ruth Bader Ginsburg. The second was yesterday, Won’t You Be My Neighbor. It’s another documentary. This one, of course, is about Mr. Rogers.

When you know that Kate hasn’t been able to follow a plot for years, you might wonder how she could enjoy a movie at all. That’s because we can easily fail to appreciate the variety of ways in which all of us derive pleasure from life. Authors like John Zeisel (I’m Still Here) and Judy Cornish (The Dementia Handbook) have sensitized me to the many ways people with dementia (PWD) still enjoy life. I had already observed that with Kate, but their writings have made a great impact on my understanding of why this is true.

In particular, Cornish distinguishes between our rational and intuitive thought. Rational thought deals with the kinds of things we learn from parents, teachers, and many others we encounter. These include the rules of behavior as well as the factual knowledge like language, history, math, spelling, names of people, places, and things, etc. Intuitive thought involves experiential learning that occurs directly through our senses – touch, taste, smell, sight, and hearing. We put so much emphasis on rational thought that we underestimate the significance of what we learn experientially. I believe that is a major reason we believe a PWD has lost everything that makes life worth living. That’s a big mistake. As Cornish points out, intuitive thought provides us the ability to enjoy things like music, art, and interpret and respond to the feelings of others.

I find Cornish’s distinction between the two kinds of thought helpful in my understanding of why Kate can enjoy a movie she doesn’t fully understand. Her ability to think “rationally” has deteriorated substantially. She can’t follow a plot because that requires her to assemble pieces of information to make a coherent picture. On the other hand, she is able to experience things she likes and dislikes. She can formulate an impression of Ruth Bader Ginsburg without remembering that she that she was a good student, that she was a lawyer or a Supreme Court Justice. She obviously liked what she was seeing and hearing about her but wouldn’t recall any of the specific bits of information about her.

Unlike Ginsburg, whom she didn’t recall when going to the movie, she did have some recollection of Mr. Rogers. I am sure it was a very vague memory, but she probably began with a positive feeling about him. The documentary beautifully captures Rogers’ personality and feeling for children. The very sound of his voice communicates this feeling. I have no doubt that Kate could sense this. Of course, the film contains lots of scenes of Rogers with children. She loves watching children wherever we go. Seeing the children in various situations with Rogers was appealing to her. Moreover, the things that he was doing as he interacted with them, as well as his facial expressions and tone of voice all convey important information about him. These are things that Kate could easily understand.

I should make it clear that she hasn’t lost all rational thought. She is able to understand and respond appropriately to most of the things that people say in ordinary conversation. Watching a movie, she hears and usually understands what is said; however, it is gone in seconds. That keeps her from understanding many of the events that follow. The trick for me is to select a movie that contains people and events that she can enjoy simply because of the qualities of the people and events she is seeing and hearing without having to understand “the facts.”

That is particularly easy to grasp with documentaries like RBG and Won’t You Be My Neighbor. It may be less obvious for a film like Darkest Hour. That is another movie she liked. In that case, I know that before entering the theater, she recognized that Churchill was a person of historical importance and that WWII was a major event in our lifetime. What she saw and heard in the movie conveyed that as well. Without understanding any details about Dunkirk, she was able to identify with the film emotionally. That continued ability to enjoy life experientially has allowed us to maintain our quality of life even as she loses her rational thought. I am grateful for that.

Posted on

Yesterday’s Conversations

We had another good day yesterday with a couple of interesting conversations. After taking our seat at lunch, Kate asked where we were. I told her. Then she asked my name. I told her. She followed that with “What’s mine name?” I said, “You tell me.” She thought a moment and told me.

A few minutes later, she asked where we were again. I told her. Then I said, “We’ve lived here 47 years. As usual she was surprised and said, “That can’t be.” Then I told her we have a daughter who will be 50 in October. She looked even more surprised and said, “We have children?” I told her we have a daughter and son and gave her their names.

I also had a brief conversation with Mary, our sitter. When she arrived, I told her about Kate’s anxiety attack on Wednesday night. I just wanted her to know in case anything similar happened while I was gone. She told me she was impressed with how well Kate handles herself with people. She specifically mentioned how easy it was for her to make conversation with people she saw at Panera. She specifically noted how much she enjoys the children she sees. Although I often I talk about how well she does in social encounters, it was nice to hear it from someone else.

I’m happy to say that we had no signs of the anxiety that Kate experienced Wednesday night. The more I think about it, the more I believe that was the clearest sign of sundowning we have had. I hope it was the last but know it could happen again.

Posted on

Making a Good Recovery

I am very happy to report that yesterday Kate didn’t show any of the signs of anxiety that she experienced night before last. She got up a little earlier than usual and acted like nothing had ever happened. Of course, I didn’t expect her to remember. That’s a good thing.

I was especially happy that she got up without my waking her. Two church friends had invited us to meet them for lunch at 11:45. As it turned out, Kate was awake early enough for us to spend an hour at Panera before leaving for lunch. We had a good time. These kind of social encounters are good for Kate as well as for me. As usual, Kate handled herself as though she doesn’t have Alzheimer’s.

After lunch, we came home for about an hour. Kate rested a while before I got her up for her 3:00 appointment for a massage. The massage therapist mentioned that she was very talkative. I was glad to hear that. I started arranging one massage a month about three years ago. At the same time, I arranged one facial a month as well. I space them so that she has one or the other every two weeks. Kate doesn’t say much about them although she often wants me to feel her cheeks after the facial. They are always so smooth.

From there we went to Barnes & Noble for an hour. Then we came home to change clothes and leave for Casa Bella. It was Broadway night. One of the men with whom we sit was celebrating his 94th birthday. His daughter and husband, who now operate the restaurant, arranged for 16 of us to sit at one long table. We were served family style. The music was terrific, and it was another great social occasion. I sat next to a woman who told me she thought Kate does a remarkable job at these musical evenings and that she would not have guessed she has Alzheimer’s if I had not told her. Last night Kate discovered the woman sitting next to her is a former librarian. They had a good conversation about their common background.

Even though we had a good day yesterday, I do wonder if or when Kate might have another experience of anxiety. I hope that was an isolated incident, but I’ll be on guard for more.

In closing, I can still say that Kate continues to do very well to be so far into her journey. I am grateful.

Posted on

Facing Reality

Yesterday began pretty much like most days. Kate’s sleeping pattern has been somewhat erratic. I started to wake her up just before 11:00 so that we might have lunch before the sitter arrived at 1:00. It took her longer to get out of bed than usual, but I didn’t think much about that.

I decided to go to Panera for lunch since we were a little late getting away. I called the sitter to meet us there. As soon as we sat down, Kate said, “Does this place have a name?” That, too, is not unusual. Then she asked, “What’s the name of this town?” I told her Knoxville and that we had lived here 47 years. She was as surprised as she usually is. She asked the same question several more times.

When Mary arrived, Kate seemed perfectly normal. When I left, she didn’t show any reservations about my leaving. When I returned home, Kate was in the back of the house. Mary said Kate rested a little while I was away. Although she had plenty of sleep the previous night, I wasn’t too surprised about that.

After Mary left, Kate was ready to go as well. We went back to Panera for about 30 minutes before going to dinner. When we got out of the car, she asked, “Where are we?” During dinner, she must have asked another five or six times. As we left the restaurant, she asked again. I told her again, and she said, “So, we’re not in Fort Worth?” I said, No, we’re in Knoxville. We’ve lived here 47 years.”

The previous night we had watched half of the movie South Pacific. We had enjoyed it. All the music was so very familiar. We watched the second half last night. Kate started out working puzzles on her iPad but became engaged in the movie. She put the iPad down.

When it was over, I started to get ready for my shower. A moment later, she had a look of concern on her face. She called my name, and I went over to her. She said, “I don’t know what’s going on. I don’t know who I am or where we are?” I’m unable to find the words to adequately express her emotion. It was a look of puzzlement or fear. This was different from simply asking her name which has happened a few times recently.

I said, “Let’s take some time to talk. I think I can help you. I could show you some pictures of your family. Would you like to stay here in the bedroom or go to the family room?” She wanted to go in the family room. We sat on the love seat. On the table was a photo book that her brother Ken had made with photos of their father’s family. I picked it up and showed her pictures of her grandparents. She didn’t remember them at all. She has gone through this album many times. I might have thought the photos themselves would have jarred her memory. They didn’t. A moment later, she said, “Why don’t you show me tomorrow when I am thinking more clearly.”

I put the book down. I looked at her and said, “Can you tell me how you are feeling?” She said something like, “I don’t know. I just don’t know where I am and what’s going on.” I said, “Are you afraid?” She said, “No.” I asked if she was confused. She said, “Yes. I just don’t know what’s happening to me?” At that moment, and right now as I write, tears welled up in my eyes.

We haven’t spoken about her Alzheimer’s in years. It isn’t something she has wanted to talk about. Recently, I have wondered if she even remembered that she has the disease. Over the years, I had decided there was little reason for me to bring it up. Faced with this particular situation, however, I said, “What you are experiencing is caused by Alzheimer’s. It’s a natural part of having this disease.” Very calmly, she said, “I knew I had it, but I haven’t thought about it in years. I had forgotten.”

I didn’t go on to say any more about Alzheimer’s. Instead, I said, “I want you to know that I will always be here for you.” She said, “I know that. I’ve never doubted that.” She went on to say how fortunate we are to have had such a good marriage. As she often does, she also said how fortunate we are that our children have turned out so well.

I reminded her that we have been married 55 years and said, “During that time we have had so many great experiences.” She asked me to tell her some of those experiences. For the next fifteen minutes or so, I talked about the places we have lived and the special things we have done. We both enjoyed having this moment of reflection. It wasn’t that we don’t reflect. We do that a lot. In that moment, however, it seemed more special than usual. When we finished, seemed seemed more relaxed though probably still confused. I think we both felt comforted by our conversation.

Over the course of the past six months or so, Kate has been on a gradual, but noticeable, decline that is a sign of what will be the hardest part of our journey. Her experience last night brought the harsh reality of Alzheimer’s to the forefront of our lives. We have lived as if this day might not come. I knew it would, but it’s painful to watch someone you love go through it.