Tag Archives: Alzheimer’s smoking

One Very Bad Day In Memoryland– A Blip or Ralph’s Future?

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IMG_0470This is the view I went to sleep and woke up to this morning and will again tomorrow, a far different view that I posted, was it only yesterday morning? And was it only yesterday that I mentioned a niggling suspicion that something was more “off” than usual with Ralph? It seems like ages ago.

After I posted those concerns yesterday, I went to wake Ralph up for the second or third time in the morning and this time I made him get out of bed. He’d slept for about sixteen hours and although he was not as spacey as the night before (including symptoms I realize now that I downplayed in my post) he still didn’t seem quite right to me.  I couldn’t exactly say why, but intuition kicked in and I called the Brain Center at Emory. They took my symptom description extremely seriously and told me to head to an urgent care. Urgent Care listened to the symptoms and immediately sent me to my local hospital emergency room. It freaked me out a little that Emory was so concerned.

Even as we drove and I repeatedly retold Ralph where we were going and the reason, I wasn’t sure if I was over-reacting. Was there something actually wrong or was Ralph just exhibiting his new level of cognitive impairment (that scary word dementia swirling in my head)? And which would be worse—that he’d had a small stroke (or that a large one was about to come) or that his Alzheimer’s had progressed?

Actually, at this point in real time (real time interrupted every two minutes as I jump up to turn off his malfunctioning hydration buzzer) I don’t know which is true. The hospital admitted him because the tests run yesterday showed his white blood cell count seriously elevated, but the doctors are puzzled because the tests so far show no sign of the infections that usually accompany this kind of count. The count itself  has come down somewhat today, perhaps because Ralph has been getting intravenous hydration, but the numbers are  nowhere near normal and the hospital is keeping him at least another night while waiting for some more testing results.

Meanwhile, again perhaps thanks to hydration, he seems lucid when he is awake. But, except when a couple of close friends visited, he has mostly been asleep. I’m not sure if he is exhausted by this experience, if he is ill, or if this is about how much he’d like to sleep most of the time at home if I let him. Similarly, is illness or being in the hospital or some combination of both the reason he has no appetite and is generally shaky weak and without a modicum of energy? More worrisome because so out of character, Ralph has not asked about his dogs; nor, amazingly, has he voiced any interest in smoking.

The doctors have said that cognitively compromised individuals are more prone to becoming disoriented as a result of what would seem minor illnesses or health issues, including anxiety, for others. Given that we are moving in three weeks, (and don’t let me get started on the practicalities that threaten to go awry now) Ralph is certainly under stress. But has the stress caused him a temporary physical and mental set back or has his new normal dropped a notch or more. The doctors tell me I did the right thing in bringing him in, and given his blood count I guess they are right, but I wonder if he is now on a slope that is only slippery but also more steeply downhill than I am ready to handle.

And there goes that damn buzzer again!

 

 

BOP AT THE BEACH

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beach

 

When my daughter in New Orleans, who loves sun and surf, brought up the possibility of a family week at the beach, I wasn’t surprised, but then my son in New York, who hasn’t let the sun shine on him directly since he was 18, jumped on board. I was thrilled. We were going on one of those three-generation beach vacations I’ve always heard about never thought I’d actually get Ralph to do. But he did.

Ralph agreed the plans seemed doable: not too long a drive; an area of north Florida he knows well; a house big enough for all of us to have privacy; most important, a covered porch with a beach view.

Of course, as the date approached, he grew less and enthusiastic.

 

Ralph: I can’t leave the dogs.

Alice:  They’ll be fine. Pedro will feed them and walk them every day.

Ralph: I hate the beach.

Alice:You don’t have to go to the beach. You can sit on the porch.

Ralph: I won’t have anything to do.

Alice: You can do exactly what you do here, and you will even have someone to drink beer with (unfortunately)

Ralph: How long are we going again?

Alice: Four or five days(actually seven but who’s counting)

 

After multiple (in the hundreds at least) variations of this conversation, I started getting nervous. For one thing, I remembered our last car trip months with its multiple stops for Ralph’s nervous stomach, with cigarette fumes blowing in through the open passenger window despite my requests that he not smoke, with his constant complaining how much longer. For another, I was secretly worried about the dogs, or rather about whether Ralph could survive a week away from them.

 

In fact, the drive was blissfully uneventful; I’d loaded the car the night before to give Ralph maximum pre-drive sleep time in the morning; he needed only three stops in five hours, and he was willing, most of the time, to vape instead of smoke. Since we were the first to arrive, Ralph helped haul the supplies inside before settling on the porch with a real cigarette while I unpacked and organized supplies. Then I had about twenty minutes to sit down myself before the others showed up and the week began in earnest. Those were the last peaceful twenty minutes I had for the week.

For the next seven days there were seven of us eating together, beaching together, laughing and/or arguing together, playing with BabyRalph together. There was also lots of me cleaning up and cooking and organizing the troops, and also biting my tongue and going along for the ride. Let’s face it; family vacations are like childbirth and marriage—universally the same while observed from outside, but intensely individual while going through the experience.

The group high of the week: a hilarious game night of charades and identity games, in which even Ralph got more or less involved

The group low: not the semi-frequent rain but an expensive, mediocre restaurant dinner that took forever and left everyone grouchy with everyone else.

My private low: The stress of maintaining a balance between involving Ralph in the life of the family and letting Ralph relax his way, ie by sitting alone smoking endlessly on the porch and drinking as many beers as possible. Not once did he venture to the beach, not even to see his grandson’s first experience of the seashore. And controlling his intake of beer was more difficult under vacation conditions although I found it bittersweet, the way the adult kids (including son-in-law) took turns sitting with him evenings on the porch, reminiscing and philosophizing beer after beer.

My private highof the week and going forward forever: BOP. For a while now BabyRalph has been calling his mother Mama, his father Papa, his 14-year-old sister Dada (no clue why but he refuses to call her anything else), and me Nan (sounds more youthful than Gramma or Nanna, don’t you think?). By the first day at the beach his uncle had become Jaak. And then Ralph became BOP.

Where BabyRalph came up with BOP is anyone’s guess, but it is genius. BabyRalph would run around the house calling BOP BOP BOP. And BOP would be dragged from the bed where he was napping or the porch where he was smoking to sit for a few minutes in the big blue armchair by the window so BabyRalph could climb into his lap and chatter away for a few minutes before one or the other drifted away.

On the last day I was the one ready, despite the allure of beach and waves and family, to leave behind the cleaning and cooking and organizing (and family), while Ralph/BOP was in no hurry to leave at all. As for the dogs, he asked about them exactly once.

So, whether he knows it or not, more trips are in the works.

 

 

 

 

 

 

 

 

Physical and Cognitive Health Collide:  Dentistry the New Tractor in Ralph’s Life

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shutterstock_Untitled design.jpg

 

Last Wednesday, the day after I congratulated Ralph and me on our comfortable status quo, I received a reminder from the gods—Never get too comfortable!

First thing that morning, Ralph fell down the stairs. He made it to the bottom step before he tripped so it was not a long or serious fall. But it was the second time he had fallen on that same bottom step in less than a month. Just before Christmas he had tripped and fallen, hard enough to dent the wall with his head. On both occasions he did not appear to hurt himself, although he has been complaining of some back soreness this time. But twice in a month! The possibility that he is no longer sure-footed, that he is fragile and at risk has freaked us both out.

Then that same afternoon, I took Ralph for his regular dental cleaning and check up. The dentist solemnly announced that she had found gum disease. Also a tooth that needed pulling. And another tooth that needed a crown. These are not big health issues in the large scheme of things, but to Ralph they became major crises. All the way home and throughout the evening he kept repeating, “This is a very bad day.” And I couldn’t help thinking he looked like the little boy in Judith Viorst’s classic Alexander and the Terrible, Horrible, No Good, Very Bad Day.

By Thursday when we returned to the dentist for the tooth-pulling, Ralph was a wreck. He didn’t understand why he needed to have a tooth pulled if it didn’t hurt, and he was convinced that having a tooth pulled was a major medical event. He also understood that he would have to see a different dentist, a periodontist, for the gum disease, and he swam into a state of anxious confusion over where he had to be treated (as if it matters, since I drive him there anyway)— the fact that we might have to drive to another town got lodged in his memory although he couldn’t remember why we were going there. But then he charmed everyone the way only he can, singing Dylan lyrics as they were about to inject him with Novocain.

It was afterwards that the real crisis sunk in. The dentist casually mentioned that Ralph couldn’t drink through a straw or smoke for 72 hours without risking a painful “Dry Socket.” I had her write on a sheet of paper in large letters THE DOCTOR SAYS NO SMOKING UNTIL SUNDAY AFTERNOON. Fat good it did.

As someone who has never smoked I realize that 72 hours would be a long time for any smoker to go cold turkey, but cognitive impairment compounded the problem for Ralph and made the next three days a Groundhog Day-like comedy. We enacted the same scene over and over. Picture Ralph walking in from the bedroom (where he’s been half napping most of the day) wearing a heavy jacket and a hat with ear flaps.

“Where are you going Ralph?” I say putting down my book and looking up from the living room chair I’ve chosen because it gives me a good view of both in the porch where Ralph usually goes to smoke and his car parked just outside.

“To have a cigarette.”

“You can’t smoke, remember.”

“Why not?”

You had a tooth pulled.”

“I did? Well it doesn’t hurt so it must be fine.”

“No, it needs more time to heal or you will have terrible pain.”

“How do you know?”

“The Dentist told us.”

“She did? Why did I have a tooth pulled?”

“It was creating a problem for your other teeth.”

“So I’m fine now.”

“Just one more day.”

“Then I’m done?”

“Well, no, you have gum disease. We have to go to the periodontist.”

“What will they do?”

“I don’t know.”

With a defeated shrug Ralph heads back to take another nap. Ten minutes later I catch him about to light an e-cigarette he’s found in some pocket or drawer.

xxx

For months Ralph’s memory has been holding steady. But now he was confronting a specific demand to remember. What concerned me was not just his inability to remember that he couldn’t smoke. Or why he couldn’t smoke. Or that he’d had a tooth pulled in the first place. (“What did I have done to my ear,” he asked more than once.). But a more general cognitive melt down. He became foggy about everything. Hang dog depressed and beaten down.

I hid all the cigarette and e-cigs I could find. I also hid his car keys—if he could drive he would head up the driveway to his “office” in the barn to smoke. (Given his lethargy and the cold weather he wouldn’t walk even for a cigarette.) Sure enough while I was on the phone, he headed out to his car. And a moment later came back wild eyed.

“I’ve lost my keys.” His tone was frantic. I realized that hiding his keys might have been a mistake, one more sense of failure for him to face. So I pretended to find them. But an hour later I came out of the bathroom and had to rush outside out to stop him from taking off in the car.

“Where are you going?”

“I’m out of cigarettes.”

“You can’t smoke.” …And so the scene repeated and repeated every few hours.

We made it to Sunday at 4 pm. when restrictions lifted. I was/am exhausted. He was/is still groggy. Tired. A little more confused than he seemed a week ago.

Physical and mental health are so wound up in each other, I don’t know if there’s been a real slide or if this is a temporary glitch. By the time I figure it out, we’ll probably have moved on to the next stage anyway.