I’m sorry to all you subscribers for disappearing so quickly. Something happened that took up a great deal of my attention. My dear wife was diagnosed with dementia, and I instinctively chose to immediately withdraw from most leisure activities to concentrate on her care. For those of you who may believe in divine providence (as I do), I was able to spot the symptoms because of my previous experience as a dementia caregiver.
Over the past couple of years, I had noticed a decline in Mary’s cognitive abilities. They all seemed to be related to short-term memory and/or subtle conceptualization. I might have missed the signs, but we’re talking about an exceptionally smart and accomplished woman. To have her turn into a “regular” sweet old lady isn’t something most would even notice. Her level of normal conversation isn’t affected much yet. She can drive and dress herself. She brushes her teeth and bathes by herself.
However, she was also in charge of paying monthly bills, because I was still working. Things began to go unpaid. We started getting calls and mail from creditors. She would apologize profusely, but it kept happening with increasing frequency, and it was completely out of character. She’s super-responsible by both nature and habit. She just plain forgot what had been paid, and what had not.
Unopened junk mail began accumulating, covering every available space on counters, tables and desks. I saw this exact symptom with her aunt, who is now in skilled nursing care for Alzheimer’s. Sometimes dementia runs in families. She was unable to sort out what was important from what could/should be thrown away. This is an indication of a loss in logic capabilities.
Then she began having a hard time finding the words she wished to say. Not the complex terms most of us might need a minute to recall (calibration, recidivism, impingement) but simple words like “remote” and “leash”.
There was an increased tendency to misplace her keys, purse or wallet. Until we were able to establish enough behavior modification (you always put “this thing” in the same spot upon entering the house, or getting in the car – NO EXCEPTIONS) these disappearances zoomed up to about 20 times per day.
By this time, I gave notice at the Urgent Care where I worked. We had appointments with neurologists, and she performed a complete battery of clinical tests which indicated a loss of approximately 30 IQ points. Her original doctor was impressed. Most dementia patients do not get spotted at an early stage. The earlier a diagnosis is established, the more effective the drugs are at slowing the process of decline. She was prescribed Aricept. She didn’t experience uncomfortable side effects adjusting to it, and it has cleared up some of the “fog”, though I know the drug is usually only effective for a few years. There are other drugs used at later stages.
Mary has had occasional depression while coming to terms with her condition, but it’s important to keep the patient engaged in the tasks that help manage their own care. So we do that. I have a history of emotional dissociation (a PTSD legacy) that helped me become a good medical assistant and tech, so I’m not as sad about this as some of our friends think I should be. I’m used to re-framing things in favor of the positives, and I am always, always fascinated to study disease processes. It’s a coping mechanism, but also a way of seeing things others can’t appreciate.
Unlike cancer, heart disease, and other things people die from, dementia doesn’t physically hurt. It’s more of an existential loss, an irreversible simplification of the adult personality. It returns the patient to their own childhood and infant self, until it causes death when the brain stops managing body functions. Mary has unrelated spinal pain issues, and that’s her focus most mornings. She’s cranky and distracted until her maintenance painkillers kick in. The rest of the time she’s pleasant and compassionate, though we do have many of the same conversations several times a day.
Because we caught this so early, Mary may take a decade or more to get to the point of 24-hour care. She’s 70 now, so other issues of decline or disease might overtake this. Or researchers might develop more effective treatments. I’m a good scientist. I’m not assuming much of anything. We work on this one day at a time, and observe what goes on, making smart choices as needed.
I waited for about a year to reveal this publicly, until she was comfortable with my doing it. One thing about me that is unusual is the fact that I definitely do NOT consider this a great tragedy, as most people seem to. We all have to die of something. All machines eventually wear out beyond repair. All that is material must pass. It could be a lot worse. I’ve SEEN a lot worse.
We still live in a community surrounded by great natural beauty, with neighbors and friends we love and have fun with. We’ve got a terrific, super-smart dog (who flunked out of the service training because he doesn’t like to share his toys). I’ve got arthritis in my hands, but it’s still manageable. We’ve got enough money to cover our medical costs so far. Life’s still well worth the effort. I’m enjoying whatever can be enjoyed.
I do apologize for having to keep my online readers in the dark though. Patient confidentiality is an old habit I was trained for.