Posted on

Yesterday’s routine was a bit different, but it was another good day.

If you are a regular reader, you are well aware that Kate and I lead a very routine life. That is in large measure because that is the way I try to organize my personal life; however, it also relates to my belief that having a routine might be good for Kate. Our typical day involves a visit to Panera in the morning, out to lunch, home for a while, a visit to Barnes & Noble or Panera, home again, out to dinner, back home, relaxing and going to bed. We don’t duplicate any of our restaurants in a given week, but we do have specific restaurants at which we eat for each meal of the week. There is some variation on Tuesday night, Thursday, and Sunday night. I might add that at each restaurant we have our favorite meals and almost always order the same thing each week.

Yesterday we didn’t follow the pattern at all. First of all, Kate didn’t get up until noon. That meant that we skipped what is perhaps the most regular part of our day, Panera. She wasn’t ready to leave for lunch until almost 1:30. I decided to go to a local deli we rarely visit because it is so busy at lunch. That turned out to be a nice change.

After lunch, we came back home. I put on some music and worked on my blog while, Kate worked jigsaw puzzles on her iPad. I was prepared for her to be ready for either Panera or Barnes & Noble after we had been home an hour. It turned out that we didn’t move for almost two and a half hours. By that time, it was getting close to dinner.

We had had such a good week so far and our daily routine had been so different, I decided to do something different for dinner. I made reservations at Casa Bella. That may not seem different since we eat there the first three Thursdays each month, but those are nights we go for dinner and music. We sit with a group and have a great social and musical evening. Last night we sat a table for two in a smaller and quieter room and reminisced about the many occasions, most happy but some sad, that had brought us there. We usually order the veal piccata. This time we chose one of their daily specials, roasted pork shoulder with baked apples with fennel over polenta. Even for somebody who likes a routine, it’s nice to do something different once in a while. It was a perfect way to end our day.

Posted on

Many triggers still work.

In my previous post, I noted how difficult (impossible?) it is for Kate to remember the name for Grant Wood’s American Gothic. That doesn’t mean that there aren’t other triggers that lead her to remember things I might think are long forgotten. I’m thinking of two specific things that occurred in the past few days. Both of them involves passages from the Bible.

The first came about when I had done something to which she said, “Well done.” That triggered her to recall the passage that says, “Well done, thou good and faithful servant.” She didn’t remember the exact words, but she was close. The second occurred yesterday when I told her I was thinking about going to a restaurant we had not been to in a while. First, she said, “I’ll go wherever you go.” That caused her to remember the Old Testament passage in which Ruth tells Naomi, “. . . where you go, I will go, and where you lodge, I will lodge. Your people will be my people, and your God, my God.” Once again, she didn’t get the exact words, but she had a pretty good idea.

There are other times when her own thoughts act as triggers. Yesterday, for example, we were driving to lunch when she said, “June Allyson.” I have no idea what she might have been thinking that brought her name up, and she couldn’t tell me. This is not something that occurs a lot but often enough that it doesn’t surprise me. It just shows that like the rest of us, her brain is still working. Thoughts are going through her head all the time.

On related note, a couple of times lately, she has pointed to someone and said, “He looks like your brother.” I have looked and could see a resemblance. What makes this interesting is that she often can’t remember his name. This reinforces the opinion I have expressed before that remembering the name associated with a person is only one, and minor, part of “knowing” someone.

Two nights ago at dinner, she engaged actively in conversation with our pastor and his wife. After we said our goodbyes, she asked me their names. I gave her the wife’s first name, and she asked for the last name. I told her. Then she asked the pastor’s name. After I told her his first name, she asked his last name. The whole process of labeling seems to have come “unglued,” but she is still able to interact with amazing success. That’s another thing for which I am grateful.

Posted on

American Gothic

Four years ago, Kate and I took our 15-year-old grandson, Brian, to Chicago. Among the places we visited was the Art Institute of Chicago. Knowing that this might not be among the most exciting places for him, we explained that we would not take a tour of the entire museum. Instead, I had found a brochure that identified about ten well-known pieces of art in the museum. This turned out to be an excellent way to engage him. Grant Wood’s American Gothic was among them. We told Brian that this was a painting he was likely to see in the future. When we said that, he recalled that one of the restaurants in Knoxville to which we had taken him has a print of it. Kate and I eat dinner at this restaurant rather frequently and always think of Brian when we see it. One of the jigsaw puzzles Kate works is American Gothic. Thus, it is a painting she sees quite often.

As with so many things, she has trouble remembering the painting’s name. Sometimes she gets “American,” but can’t remember Gothic. It seems to be prompted by seeing a print of the painting or the puzzle she is working on. A very typical experience occurred last night. She was working puzzles on her iPad and with sense of indecision asked, “American?” I said, “Gothic.” Then she repeated the full name. She looked down at her iPad and asked, “What is it again?” I told her again. This happened several times before she stopped. This is the way it always goes. I don’t think she ever gets more than American, and not always that, but she never stops trying.

Posted on

Kate’s Brother Ken

Since Kate was diagnosed with Alzheimer’s seven years ago, I have read quite a number of personal experiences with the disease. Most of these have been written by caregivers of a family member with Alzheimer’s, a smaller number by people with it. It hasn’t surprised me that despite having certain things in common, people (both caregivers and their loved ones) respond to the disease in very different ways. Throughout our own journey, I have tried to be sensitive to this fact. I’ve tried not to write as though others’ situations, experiences, and responses are like our own. Even within a family, there are often differences. Let me tell you about Kate’s brother Ken.

In October 2013, two and a half years after Kate’s diagnosis, we learned that he, too, was being tested for Alzheimer’s. They received the diagnosis in November of that year. He is a little more than two and a half years younger than she. That means he and Kate received their diagnoses when they were about the same age. He and his wife, Virginia, live in San Angelo, so we don’t see them very often. We have, however, tried to visit them each time we visit our son and his family in Lubbock. In addition, Ken and I talk periodically by phone and also exchange email messages.

From the outset of their diagnoses, Kate and Ken have approached their situations quite differently. Kate has always wanted to be very private. Other than Ken and Virginia, she has only told one other person about her diagnosis. That was her best friend. Kate hasn’t wanted to join a support group or read anything about Alzheimer’s or other people’s experiences with the disease. She has simply wanted to live her life as normally as she could.

In the early years, she experienced a good bit of frustration from her memory lapses and difficulty completing tasks like working on the computer or dialing numbers on the phone. She has thought a lot about Alzheimer’s, but she has not wanted to talk much about it. We have only obliquely approached the subject. Nowadays, we never mention it. I don’t believe she thinks about it at all except when we go to her doctor’s appointments. She had her latest appointment a few weeks ago, and nothing at all was said about Alzheimer’s. I believe she still recognizes she has the disease, but I don’t believe she associates it with any special problems she has. I never mention it to her. At this point, I don’t see any benefit in her fully understanding the disease, where she is on her journey, and what lies ahead.

Ken, a retired psychology professor, has approached his diagnosis differently. Shortly after he was diagnosed, he informed his family and close friends. He found a support group of others who have dementia and continues to participate in it. He once appeared on the TV news in San Angelo that featured his group.

I’m not sure whether it is his background in psychology or his personality or both that account for his approach. He has also been more deliberate in learning more about Alzheimer’s, ongoing research on the topic, others’ experiences with it, and exercising his brain.

Since I launched this journal as a blog in January, Ken and I have had phone conversations and emails about ways that we might include his experiences and approach to Alzheimer’s within this blog. I don’t think either of us knows exactly where this might lead, but we are going to take a first step.

With that in mind, I thought I would first give you a glimpse of him via a letter he wrote to his sons. The letter, which is copied below, was written in January 2014. This was very shortly after he had received his official diagnosis. He had previously informed them by phone of his test results. This letter was the first in a series of annual letters in which he provides updates. I may share the others in subsequent posts.

Let me point out several ways Ken has responded differently than Kate.

  1. Ken informed his children very shortly after he knew the diagnosis. He and his wife, Virginia, had been with us in Knoxville in October to celebrate my dad’s 100th. At that time, he told us that he was undergoing testing. That was completed in January. After we got the word from Kate’s doctor, we kept the information to ourselves for a long time after that. It was three years later that I told our children because I thought they needed to know.
  2. He was already thinking about a support group and exercising his brain with his photo albums and Lumosity.
  3. He considered some of the most disturbing manifestations Alzheimer’s and wanted to protect Virginia from any potential aggressiveness he might display.
  4. He wanted to clarify his preferences about his care and his desire that she be able to spend her summers in Michigan as she has done for most of her life.

Here’s the letter to his children.

February 2, 2014

Dear (children)

 Virginia and I had a recent meeting with our neurologist to update my diagnosis and discuss strategies for the future.

 He again went over the lab results with more detail, but you already know the general essence of the findings.  To summarize, the results show that I do indeed show clear evidence of mild Alzheimer’s.  While there is great variability and no precise predictability, he said that we are probably looking at a 10 – 12 year time span progression for the disease.

 The good news is that we caught the diagnosis relatively early and that new medications are being developed.  Also, I am in good general health.  Virginia and I are walking together, and we are looking into a “memory support” group for early Alzheimer’s patients.  I faithfully exercise my brain with my photo album projects and play “Lumosity” on almost a daily basis.  The bottom line is that we are being proactive in our efforts to extend the cognitive quality of our lives together.  We hope to have many good years left together for us and our families.

 I inquired about the possibilities of future aggressive behaviors on my part.  Again, Dr. Smith said there are no clear predictors.  It helps to start out with a non-aggressive nature, so I have that on my side.  Some people become passive and withdrawn. However, there does come a time when the disease takes over and “Ken” will no longer be in charge. I saw this with Mother and her stroke-induced dementia, when she occasionally became somewhat combative and argumentative –traits I never saw even once in her normal existence.

 I am writing this letter so that there will be absolutely no future doubt about my feelings on this matter.  If I exhibit aggressive or combative behavior toward Virginia, I want Virginia to have no hesitation to use prescription drugs to control that behavior, even if it further impairs my mental abilities.  I also instruct Virginia to physically move me to a separate living facility when she decides that it is time for that to occur – and I trust her judgment on this issue.  I hope that you will provide advice and counsel on these and related matters, but the ultimate decision will have to be made by Virginia.  I want the decisions to be in her best interests.  I have absolutely no fear of not being well cared-for, or that such a decision will be made “before it’s time”.  In contrast, it is the thought of my not being removed from such a situation that scares me more than anything else – thus, this letter.  Please save this letter and, if I later protest, show it to me as a reminder when the time comes. 

 On a related matter, I want it clear that I wish Virginia to be in Wisconsin during the summers with our children and grandchildren, even if I am unable to make the trip.  If I have to stay in San Angelo, she will get a well-deserved break.

Virginia is not aware of this letter.  I will show it to her the day after I mail it.  I want you to know that I am writing this of my own volition and that she has not requested that I write such a letter.  Please store this letter in your lock box or a safe place where it can be retrieved in future years – if need be.

 I love you all so very, very much.  I also look forward to many good years in the future before we need to face the decisions outlined in this letter.

 Love,

 Ken

Posted on

Follow-up to My Earlier Post

I was right. The day is coming to an end on a high note. As we were finishing our dinner tonight, our pastor and his wife came in for dinner. We asked them to join us and then spent the next hour in animated conversation. During that time we saw another church member and her son as well as two people the pastor and his wife knew. As often happens, a routine meal turned out to be a very pleasant social occasion. It reminds me once again why I think the decision to eat out for all our meals has been so beneficial to us.

When we returned home, Kate commented on how much she likes our bedroom. Then she got dressed for bed and sat in her chair in the bedroom working on her iPad. I turned on PBS Newshour that I had recorded earlier. Like almost every evening it was a very peaceful end to what had been a good day. Then a few minutes ago, she asked, “Where are we right now?” I said, “Knoxville.” She responded, “So we’re still at home.” You may find it hard to imagine that she could sit here in her own house that she enjoys so much and then ask where we are. I hear enough things like this that I am no longer surprised. And because she has been so happy and we have been enjoying our time together, I don’t feel sad either. I’ve known for over seven years that we were coming to this, but I didn’t expect that we could find happiness within the context of such a radical change in the way her brain works. I also know that this will not last forever, but we will enjoy it while we can.

Posted on

Three in a Row

After two very good days during which Kate has seemed very upbeat and cooperative, I wondered what today would be like. It is now 5:30, and we’re about to stretch the good days to three in a row.

This morning she slept a little later than I had expected, so we didn’t leave for Panera until almost 10:30. When she came into the kitchen (where she meets me each morning when she is ready to leave), she was cheerful and joked with me a bit while taking her morning meds I had set out for her. She usually takes several of the pills and turns around toward the sink. I have to watch because she generally forgets about the pills she has left on the island. This morning she said, “I know you. Don’t worry. I’m not gonna forget the others.” She finished taking the first few pills and started walk toward the door to the garage. I looked on the island. The other pills were still there. I hesitated but reminded her about them. I hated to do it because I didn’t want to embarrass her for just having let me know she wasn’t going to forget them. She had apparently forgotten having said anything and simply took the remaining pills and wasn’t bothered by my letting her know about them.

We spent an hour at Panera and then went to lunch. We got back home about fifteen minutes before the sitter arrived. As she has the past three days, she brushed her teeth and then got into bed to rest. When the Mary arrived, I took her into the bedroom to say hello to Kate and told her I was leaving for a meeting and then to the Y. Kate told Mary she was glad she was here. She asked me what she could do. I told her she could rest as long as she wanted and then the Mary would take her to Panera if she wanted to go. She liked that idea. I left her resting.

When I returned home, she and Mary had been to Panera and were in the family room. Kate was lying on the sofa. After Mary left, Kate commented on how well she takes care of things. I said, “And isn’t it nice to have company?” She agreed without any hesitation. This is good for my own comfort level in leaving her. She is still resting but not asleep. We’ll go to dinner shortly. I know the balance of the day will go well. Afternoons and evenings consistently go well. I’m feeling grateful.

Posted on

Another Good Day

This is a short follow up to my previous post about our good day yesterday. I closed that by saying, “We’ll see what tomorrow brings.” Now I know. It’s been another good day. Once again it was a day without any special events. We just went about our daily routine. Kate has also been unusually good humored all day.

I won’t detail exactly what we did as in the previous post. I would just like to make two observations. First, and more important, it has now been two days that Kate has not complained about the arthritis in her knee. Except for how slowly she walks and gets in and out of the car, I wouldn’t know that she has a knee problem at all. I don’t believe this was because of any lessening of pain. I believe it relates to her mood. She has simply been more positive in her outlook today. The only sign of annoyance she displayed all day was at Panera this morning when a young child screamed a couple of times. As I have said before, she is very sensitive to sudden and/or loud noises. As much as she loves seeing young children, she is often bothered by the noises they make.

The other observation is not directly related to her mood. It relates to her use of hand signals to communicate with me. I have mentioned that she uses hand signals to ask things like, “Should I get put on my night clothes?” Or “Should I take my iPad?” Or “Should I take my cup into the restaurant with me?” I don’t believe, however, that I have said anything about her responses to me when I say things like, “I love you.” “If I had the chance, I would marry you again.” Or any other loving or complimentary words. Instead of verbalizing her response, she points her index finger at herself and then at me to say she feels the same about me. This is not something I had known to be a characteristic of someone with dementia, but it may be. I do know That someone I follow on Twitter recently mentioned that his wife used a hand signal to indicate she was ready for their nightly orange for dessert; however, his wife has some impairment of speech. Kate does not.

Posted on

A Good Day Even if We Didn’t Do Anything Special

Kate and I have a lot of good days. Yesterday was one of them. Often they are good because of things we have done together, things like attending musical or theatrical performances or spending time with friends or family. Yesterday, we didn’t do anything special; we just did our usual things.

Kate started the day in a very good humor. When she came into the kitchen she showed no sign of being tired. She was just ready for a nice day. She was wearing a very nice jacket that didn’t match her everyday clothes. I started to suggest that she wear another sweater or jacket, but I decided against it.

As we drove to Panera, she teased me about something. Sometimes it doesn’t sound like teasing. In this case, it was just very natural playfulness. While at Panera, she brought up the names of two people whose names she often forgets. One is my brother, Larry. The other is our good friend, Tom Robinson. She asked me the names of their wives, and said, “I don’t know why I can never remember them?” I hear this periodically. That is one of the reasons I believe she no longer connects her symptoms with her Alzheimers, and I see no reason to point it out.

I had arranged for the sitter to come an hour earlier so that I could attend a United Way lunch meeting. We didn’t get to Panera until thirty minutes before the sitter was to arrive at home. I called and asked that she meet us at Panera. It wasn’t until about ten minutes before the sitter arrived that I told Kate I was going to be leaving. I explained that the sitter was coming to be with her. She took that very naturally without any appearance of disappointment or dissatisfaction. Of course, that made me feel good about leaving. When the sitter walked up to our table, Kate greeted her warmly. I left them to decide how long they stayed and what they would do after that.

When I arrived back home, Kate was resting on the sofa while the sitter was watching television. I chatted with the two of them for a few minutes. When the sitter got up to leave, I thanked her. Kate thanked her as well.

I asked Kate if she would like to go to Barnes & Nobel. I knew she would say yes. She didn’t disappoint me. As we prepared to leave, I saw that she was wearing a pair of brown shoes and carrying the black shoes she had been wearing. I asked if she were going to wear the black ones. She asked what I thought. I told her I thought the black would look better. She accepted that without any hint that she resented my telling her. She changed, and we left. We stopped by the bank for me to make a deposit. I left Kate in the car. The people in line ahead of me had some special situations that required a good bit of time. I apologized to Kate for taking so long. She said it didn’t seem that long.

After leaving Barnes & Noble, we went to Chalupas for dinner. We’ve had a good bit of rain yesterday, and I wondered if it might rain again today. I tried to check the weather report on my phone, but it took too long for the app to open. I decided to check Facebook just to see if it might have been a problem with the cellular connection. When I did, I saw that one of Kate’s cousins had posted something about an arithmetic book that their second grade teacher had written and is now available on Amazon. Before I could read the name of the teacher, Kate said it. Her eyes brightened and she said she wanted to get the book. I told her we would. Then she started talking about her teacher and that she had remembered the teacher’s taking an interest in her. She has been losing many of her long-term memories, so I enjoyed seeing this memory come back to her and that she felt so good.

Just before we left Chalupas, she pointed to her glass and asked, “Ours or theirs?” I told her the glasses belonged to the restaurant. On two or three other occasions she has started to leave with one. The first time the owner followed us outside and diplomatically asked if she would like a cup to take away cup. The other time or two I caught her before we got out the door.

In the car on the way home she started talking about our marriage and how many things we shared in common. Then she said she was tired and thought she would crash when she got home. She asked if that would be all right. I told her that would be fine, that she could do whatever she liked. She could just relax. She said, “That’s what I like about you. You are so understanding.” And she wasn’t being sarcastic. (I realize that when I report things like this, it can seem very self-serving. My intent is to convey her own perceptions and that she is still able to respond to the way she is treated. When she says these things, to me it is like saying, “I’m still here. Please don’t forget that.”

After we got home, she walked through the family room. Just before she going through the door to the back of the house where the bedrooms are located, she asked, “Which way do I go?” I walked toward her. Before I could answer, she said, “I usually go this way.” She was pointing to our bedroom. I said, “That’s it.”

A few minutes later she went to her room, got her robe and asked (using hand signals) if she should put it on. I told her she could. She took her nightly meds that I had put on her bedside table. Then she asked again in hand signals if she should put on her robe. Again, I told her that would be fine. In another minute, she called to me for help. I noticed that she was struggling with her robe. She asked if she had it inside out. As I went over to help, she said she had figured it out. It turns out that she had put her right arm in the left sleeve of the robe. She worked on her iPad for 10-15 minutes, and then called it a night.

We hadn’t done anything special, but it was a good day for both of us. She was in a good humor every minute of the day. I hope my account of our communication properly conveys the change that has been in process over a long period of time. She seems to be looking to me more as a partner in her journey. She displays an element of trust that reinforces my efforts as her caregiver. I know that not all caregivers are as fortunate. So as I’ve said before, if Kate’s had a good day, it’s been a good day for me. We’ll see what tomorrow brings.

Posted on

Recognizing People with Dementia (PWD) as More than Patients

The first book I read following Kate’s diagnosis was Jan’s Story by Barry Petersen. I remember thinking it should have been entitled Barry’s Story because it didn’t really tell the story of Alzheimer’s from Jan’s point of view but from his. Since that time (7 years and 3 months), I have had a good bit of personal experience and have read about the experiences of other caregivers and a few people with dementia. That has led me to see that caregivers receive a disproportionate share of the attention. As a caregiver myself, I certainly believe we need and deserve attention. I just don’t want us to forget or neglect the people with dementia.

My first personal glimpse of this came when I tried to locate a local support group for people with dementia. I couldn’t find one. I contacted national and local offices of the Alzheimer’s Association as well as my contacts in the field of elder care and social work. I discovered many opportunities for groups for caregivers, but nothing available locally for Kate. This did not present a major problem for us since she preferred to be private about her diagnosis. A couple of years ago, however, I asked if she might be interested in finding a group. She said she would. That is when my search failed to come up with anything.

Since then, I have read books by people with dementia and found that they, too, believe they don’t receive their fair share of attention. I’m currently reading a book entitled The Lewy Body Soldier by Norman McNamara. He is particularly outspoken about the need to include people with dementia in all planning for programs and facilities for people with memory problems. Kate Shaffer and Rick Phelps are two other people with dementia that have been strong advocates for people with dementia.

I believe there are reasonable explanations for this disproportionate attention on caregivers. I think it all begins with an image of a PWD. The tendency is to think of someone who is in the later stages of the disease. Most of us don’t think about the long period of time before that when one can function pretty well. I believe Kate is now in Stage 6 of the 7 Stage model of the progression of Alzheimer’s. Yet, she functions very well in our social interactions. Most people would never guess that she has Alzheimer’s. It makes me think about the large number of people around us that have dementia and who could contribute in many ways to help us better understand this disease.

As I think about it, I believe that even caregivers often misunderstand the abilities of those for whom they are caring. I know that happens to me. It is evidenced in the struggles that Kate and I have over her independence. I want to help her, but I have a tendency to help where help isn’t needed or wanted. She lets me know. As I pointed out in a recent post, this is a challenging situation. It requires keen observation and ability to adapt as the disease progresses.

Beyond this misunderstanding of the abilities of PWD, it is much easier for people to see and understand their own problems. I can easily see my own problems in adapting to Kate’s behavior, but I have little knowledge of her problems. She has never talked much about hers. I can only infer from what I see. I know she must struggle in ways that I do not recognize. I wish I did. Thankfully, she is not shy in letting me know when I say or do the wrong thing, and it is normally done with an element of love and respect.

Of course, caregivers have considerably more opportunities to make their own needs known. There are many support groups in local communities where they can share their experiences and frustrations. There are also many online communities like those sponsored by the Alzheimer’s Association or a number of groups on Facebook. In addition, there are many books addressing the needs of caregivers and tons of advice for making their role manageable.

I believe there are two guiding principles that could be a starting point for those of us who want to enlarge the focus on PWD and make them a greater part in providing better care. One is to recognize that PWD have a broad range of abilities well into the later stages of the disease and to capitalize on this knowledge. There is much that a person can do and contribute long after the diagnosis. Second, is to recognize there is great diversity among PWD. One approach to working with PWD is unlikely. I have tried to keep Kate and me as socially active as possible. We spend the better part of every day away from home. In some ways, I wish that weren’t so. On the other hand, I believe the kind of social interactions we have at Panera, Barnes & Noble, the restaurants we frequent, the live performances we attend, and our various day trips to visit out-of-town friends have gone a long way to maintain Kate’s ability to get along as well as she has. These things appear to have worked for us. Caregivers and loved ones have to make their own decisions concerning what is best for them. And as I have said before, many people have more complicated and challenging situations than Kate and I. Some are working full time jobs while playing the role of caregiver. Many have a variety of other health issues to deal with. In addition, some face more challenging symptoms like anger and aggression. All that any of us can do is give our best under the conditions we face. I wish everyone the very best as you negotiate this path.

Posted on

Surprise, Kate worked outside with her shrubs yesterday.

It has now been several months, since Kate has shown any interest in working outside in the yard. That is a dramatic change from the past when she worked through even the coldest months. I’ll never know what accounts for that. My guess is that the shrubs were so denuded that there were no longer any leaves for her to “pull.”

Yesterday that changed. When I came home after going to the Y and running errands, I found Kate pulling the new growth on shrubs along our driveway. I had two immediate reactions. The overwhelming one was a burst of happiness. It’s been a while since I have written about her work in the yard, so let me summarize why I felt this way. Since her diagnosis, more than seven years ago, Kate has had three primary activities other than those I provide for her.

One was working on family photo albums. She was introduced to this by her brother, Ken, who has completed numerous albums. He and Kate worked on one together, an album about their mother’s family. It represents a beautiful family history. She wanted to create her own albums for us and our children and grandchildren. She got her start after she was diagnosed with Alzheimer’s. Even though she worked on one for several years, she never got beyond selecting photos and editing them. Two years ago, she just stopped working on her computer altogether. She didn’t even continue with email. I think it got too challenging for her.

That left her with only two other activities. The major one was working in the yard. That meant pruning and “pulling leaves.” She had learned about the value of pruning long ago. As her Alzheimer’s progressed, I think she did it for herself more than here shrubs. It was a kind of therapy. It required little effort. When she had pruned back about as much as she could, she started pulling off the leaves. There were days when she would spend as much as 6 hours outside. It was great because she enjoyed it, and it was something she could do on her own without anyone’s telling that she was doing anything wrong.

This past fall she stopped working in the yard. I suspected that the colder weather played a part. In addition, we both had colds and the flu during the first of this year. When the weather began to improve, she didn’t get back to her yard work. I began to think it was a thing of the past, so I was much relieved to see her working yesterday.

I said, however, I had two immediate reactions. The first was elation. The second was apprehension related to the condition of the shrubs. I knew there was a chance that some of the shrubs could be permanently damaged by what she had done before, but I felt it was worth it for Kate. As spring has approached, I have been eager to see how many, if any, of the shrubs would come back. As I expected, it appears that some of them are dead. Others appear to have dead branches, but there is new growth coming from the base of the trunks as well as the roots around the base. In addition, there are some that look like they are going to be just fine.

So why the apprehension? That arises from the fact that the ones that look fine have new leaves that are sprouting. Those, of course, would be the only ones with leaves she can pull. It is still too early for them to have an abundance of new leaves. Many of them have only a handful. This means that the very ones that seem to be living may not ultimately make it. My hope is that enough of them survive to keep her busy until next winter.

Yard work is important to her and, thus, to me as well. If she loses that, she will have only one activity of her own, working jigsaw puzzles on her iPad. Right now she spends 5-6 hours a day, and sometimes more, doing that. It has become harder for her in the past year, but I see no sign that she is about to drop it. I never imagined how important an iPad be could. She doesn’t use it for anything other than jigsaw puzzles. I am thankful she has it.