A Portrait of Alzheimer’s – And Love

The truth is, maybe I couldn’t have lost my mom any other way.

What if I was still used to our daily phone calls, habituated to her answering my call or email within hours if not minutes, used to the certainty that she would listen to whatever I had to say – a quandary, a train of consciousness, the latest good or bad news – without judgment? If that had just stopped all at once, maybe I wouldn’t have survived it.

At first Alzheimer’s presented itself in repeated dialogue, repeated questions, consternation when a waitress brought the meal she ordered but not the one that fifteen to twenty minutes later she was expecting. In those days, the synapses just seemed to not quite be firing on all cylinders. Those who loved her knew something wasn’t quite right, but we weren’t exactly sure where the line between getting older and a significant problem lay. My mom had incredible social graces coupled with fierce pride so she could get away with a lot and the rest she clearly didn’t want to talk about so we trundled along like that for a couple of years.

Over time, the phone calls and emails became less frequent, more repetitive, and more confused. Often when I asked what she had been up to it was clear she was making stuff up that sounded like things she could plausibly be spending her time doing. Eventually we just talked about the weather. Out at dinner she’d look at the menu and then say, “I’ll have what she’s having.”

And then, after a couple more years, the phone calls, unless facilitated by an aide, stopped altogether. Sometimes she would hold her TV remote to her head when the phone rang, annoyed she couldn’t get it to work. But by then I had weaned myself off of our regular conversations. They had become so stilted anyway that it didn’t hurt so much. I was mainly consumed by that point in figuring out what needed to be done to facilitate her life and her safety.

At this stage, she couldn’t follow directions when she was driving somewhere new, couldn’t help my kids navigate the treasure hunt map at a children’s event to figure out where the gold doubloons were buried in the sandbox. She would show up at events that weren’t scheduled and miss ones that were. I can’t remember the number of ATM cards that had to be replaced. Executive functioning skills pretty much altogether went out the window – though she did somehow manage to sign up for an online dating site and execute on organizing a date at the local coffee shop. SO many times during this journey I have wondered, “how is THAT the thing you remember?”

It went on like this. Ironically, I look back and see how much was still left of my mom then. I knew enough to know that the Alzheimer’s diagnosis was a shot across the bow that forced me pay attention to every minute I had with her in a way I may have taken for granted if I didn’t know she had a degenerative, terminal disease. I mean, we are all going to die, right? But that doesn’t mean we pay attention when we are busy living our own lives. That’s natural. I try to look on the bright side that this gutting diagnosis made me go back home to spend time with my mom more often than I might have otherwise during that stage of my life.

I still cry sometimes for what I have lost over the years, all the what-could-have-been’s. Alzheimer’s continues to find new and creative ways to take a piece of my mom away and reignite my grief. This slow, trickling loss is death by a thousand cuts. As a friend’s mom used to say, “It’s not easy getting into this world and it’s not easy getting out of it either.”

I started this post thinking I would show one picture from every year my mom has lived with Alzheimer’s to display how it impacts a life, slowly but surely, over time. I started collecting photos – and it’s breathtaking how I hardly noticed the shifts as they were happening but now I can barely remember when she used to be able to speak. I realized, though, that my mom would want to be remembered for the independent, life-of-the-party, no bull, devoted mother, sister, aunt, friend, and wife that she was. The last 13 to 14 years are a chapter – a long one with lots of ups and downs, granted – during which she has exuded her characteristic grace and loving spirit but has also been more vulnerable and had less agency than her prior 68 to 70 years. Since I’ve written so much about her I thought I’d share some pictures that capture her the way I think she’d like to be remembered.

She’s still here, but she’s slipping away (in her typical fashion – on her own time, doing it to the tune of Frank Sinatra’s “My Way” till the very end). We have done the best we could with the cards we were dealt, and she also deserved to get so much more out of these years than this disease allowed.

I’ve had a lot of years to figure out my role in this journey and have worked hard not to lose myself in it. There’s a good reason that I started a blog called “Put Your Own Oxygen Mask on First.” I learned first what happens when you don’t, and then spent the rest of these caregiving years trying to take care of myself, too. I am applying those lessons as my watch over my mom comes to an end. For me, that means carving out time to be with my family and friends. It means getting regular exercise and not compromising on that 1/2 hour or hour of me time. It also means trying to eat well. Or just eat. When things get really busy and/or I am really sad, I tend to skip meals. That starts a cascading effect of low blood sugar, which manifests as fatigue and irritability, and then triggers cortisol and adrenaline bursts that cause increased anxiety (all of which can reignite my Rheumatoid Arthritis). In the early days after my mom was diagnosed I was downright skinny. But not healthy. This type of rollercoaster isn’t good for my body or mind and it certainly doesn’t put me in a good position to advocate for my mom or my kids. Always put your own oxygen mask on first before assisting another passenger on this journey of life!

As I begin a more reflective stage in my caregiving journey, I put together a list of logistical priorities that, in my experience, become important fast when confronted with the overwhelm of what it means to care for someone with an Alzheimer’s diagnosis. Check it out in my Dementia and Caregiving Resources. And, please, if you have the means, support Alzheimer’s research (I personally like Cure Alzheimer’s Fund, but, mercifully, there are others and work is being done constantly to try to figure this out).

Like I said, she is still here, but I know I’ll love and miss this woman for all my days. I already do.

Behind Closed Doors – The Silent Struggle of Caregiving

Caregiving is the great, unseen work of a lifetime, whether it’s for aging parents, young children, or a person with a disability. It often goes unnoticed, uncelebrated, and un- or under-paid. It typically requires sacrifice of self in multiple ways, from dialing back career aspirations to a different look to retirement to shouldering physical (adults who are deadweight are heavy and those who are combative make care tough), logistical (ever tried to get someone who doesn’t understand words or can’t sequence directions to sit on a toilet?), and emotional (it may not be personal but some days you can only take being told to go away or shut up so many times) weight. In short, caregiving is a challenge that comes with a side of detriment to one’s emotional and sometimes physical well-being at various stages whether the caregiver is a family member or a paid aide.

Is it because we are taught not to stare when we see someone with a disability that we collectively generally don’t see or acknowledge caregivers? Is it because a lot of care happens behind closed doors so it’s simply not in our view very often (until we experience it ourselves and then suddenly we see these quiet laborers everywhere – driving cautiously on the highway with an older person in the passenger seat, pushing a wheelchair through the supermarket, waiting at the bus stop)? Is life just too busy to occupy ourselves with imagining what it’s like to give everything you have physically and emotionally at work and then go home to care responsibilities there, too, from one’s own kids to one’s own parents? Is it just too hard to face it so we ignore it? That is, until we are in it or need it ourselves?

Bradley Cooper recently produced a new Caregiving documentary that sheds light on this enormous blind spot and need in American society. It highlights different stories about caregiving and caregivers. It tells the story of paid and unpaid caregivers navigating the challenges and joys of this deeply meaningful work. By intertwining intimate personal stories with the untold history of caregiving, the documentary reveals the state and the stakes of caregiving in America today.

So much is broken about the medical system in the US, and caregiving is a separate but related dimension of that brokenness. Everyone needs it or does it at some point and yet there is nothing about long-term care that is straightforward or easy. It’s a big, complicated, expensive system. Reform is plodding – at best. Link here to my prior musings and stats about long-term care – Don’t You (Forget About Me)

Some strategies to make immediate improvements for paid caregivers:

  1. Pay workers a living wage. That should go without saying, but it needs to be said because it is not in any way a given; one cannot show up as one’s best self at work if one is barely able to cover rent and perpetually stressed about making ends meet even while working full-time;
  2. Create pathways for career advancement. Professional development and the ability to grow into better roles at work matter tremendously for worker satisfaction. By giving motivated employees a career ladder for upward opportunity, they will be more willing to stay, thus reducing turnover while increasing the quality of care;
  3. See the hard work these people do and acknowledge them. Like really notice them. Say their names, take an interest in who they are, and thank them for the non-glamorous and often grueling work they do. We’d (hospitals, assisted living facilities, and families) be so screwed without them.
  4. Check out organizations like the National Domestic Workers Alliance who work to highlight these disparities and change the status quo.

Some strategies to make immediate improvements for family caregivers:

  1. Show up. No one should have to take on the burden of caregiving alone. It’s way worse when a caregiver realizes that they haven’t been forgotten, but actually that no one has thought about them at all;
  2. Frequent check-ins: Even if it’s just a short text or phone call, regular check-ins can help the caregiver feel supported and not alone. It’s a small but meaningful gesture that can have a big impact;
  3. Be proactive, not reactive: If you notice the caregiver is struggling, don’t wait for them to ask for help—step in. Take on specific tasks – offer to assist with hands-on tasks like cooking, cleaning, running errands, or handling paperwork. The more you can take off the caregiver’s plate, the better. Often, caregivers won’t reach out for support until they’ve already hit a breaking point;
  4. Acknowledge their sacrifice: Caregivers often go unrecognized for the enormous amount of work they do, so it’s important to make them feel appreciated.

Besides working for policy change that can positively impact the care industry, as with all things: treat every living creature with respect, dignity, love, and curiosity. Everyone has a story to tell. Everyone deserves to be seen and heard. If you are interested, you can add your own caregiving story at Well Beings, an on-going, multi-platform campaign to address critical health needs in America. Lots of resources to learn from there as well.

Take care of yourself. If you are a caregiver, take extra care. Caregiver Syndrome – also known as caregiver burnout – is real. It is “a state of physical, emotional, and mental exhaustion experienced by individuals who provide care for a chronically ill, aging, or disabled person.” Symptoms include: feelings of overwhelm, sadness, anger, irritability, anxiety, depression, guilt, resentment, fatigue, body aches, physical ailments, and neglecting personal needs. Mel Robbins dives into this subject in her podcast Overloaded, Exhausted, and Ready for a Reset: 3 Doctors Give Their Best Advice. It resonated with me completely. I have BEEN THERE. You know what one of the doctors recommends at the end? Putting your own oxygen mask on first. Huh, I wonder where I heard that before?

Take a deep breath and maybe a couple minutes of quiet for yourself.

Photo by Artem Podrez on Pexels.com