Tag Archives: Caregiver Decision Making

A DIFFERENT KIND OF COGNITIVE TEST: REAL LIFE

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After writing about Ralph and my experience with organized cognitive tests, I watched Ralph in action in a different kind of cognitive challenge last Friday.

Living in the country without door-to-door garbage service, I travel weekly to the recycling center. I drive Ralph’s truck and take along Lola the dog for company. I drink a diet soda on the way and occasionally (read every time) treat myself to a candy bar afterwards. There is something oddly satisfying about coming home with empty cans and baskets.

But recently I pulled a back muscle grandmothering a bit too exuberantly and have avoided bending/lifting ever since. Meanwhile our garbage began piling up.

On Friday I couldn’t stand it any longer and announced to Ralph that after lunch we were heading to the dump. Now Ralph usually helps me load the garbage into his truck. Once or twice he has driven with me to the recycling center, which happens to be across from the location of his art classes. On those two occasions he enjoyed sitting in the truck with his dog and cigarette watching me unload, a choice I made because I figured I would be faster. He has never participated in throwing stuff away.

Recycling is does not require much detailed thought. After throwing unrecyclable garbage that’s been put in county bags, into a dumpster, I mindlessly divide everything else to toss in the marked bins. You probably know the drill: aluminum, plastic, newspaper, junk mail, cardboard, and glass by the color.

For Ralph our recycling trip was a challenge.

The dogs didn’t help. We decided not to bring them because old Zeus has trouble climbing into the truck these days so Lola needed to stay behind to keep him company. But then Zeus hid under the house so there was a bit of a kerfuffle until he showed up as we were backing out of the drive way  and we got him into the house. Ralph, already nervous—he’d called me three times while I was running to the bank beforehand to ask what he’d have to do—and now he was worrying about Zeus’s health as well as the garbage.

Usually I drive us everywhere these days, but driving Ralph’s truck with a bad back was not an option. It has been awhile since I sat in his passenger seat with him behind the wheel. He drives very carefully, going 35 in the 45-mile-an hour zone until I suggested, with mild (I hope) impatience, that he might consider the speed limit. (He does drive very carefully so if you are asking, as I do frequently, Is it safe for him to drive?, the answer is I think so as long as he doesn’t have to worry about finding his way alone. I hope I’m right)

In any case, we arrived safe and sound. But our time at the recycling center was not fun. Despite large clear labeling on the bins, Ralph could not keep track of where anything went. His difficulty was that I was asking him to combine several unfamiliar activities at once. I could feel his frustration mounting. I took a deep breath, had him bring the recyclables to me at the biggest bin, did as much emptying as I could manage and directed him hither and yon.

No stops for candy bars on the way home. But I thanked him profusely for his help. And Ralph was like a small boy desperately wanting to do well at a chore that was slightly beyond him and thrilled when he made it through.

Seeing him react, I realized that I have been letting him slide. If a situation might be difficult, I’ve avoided it. But Ralph can live with a little anxiety, and a gentle challenge enlivens him. So the next day, Saturday, I announced to Ralph that we were going into Atlanta to see the Andy Warhol exhibit at the High Museum. Painting is one of Ralph’s only activities after all.

He wasn’t thrilled but again he reluctantly agreed.

I drove.

On the way, when Ralph announced he was hungry, I got him to eschew his standby fast food choice. Instead we had lunch at the museum café. Suddenly Ralph got into the spirit. He talked about the courtyard artwork with enthusiasm, he ate with a gusto rare for him these days, he wandered through Warhold exhibit reading all the placards and studying the pieces. He tried to get me to buy stuff in the gift shop. Afterwards we paid a short visit to friends who live near the museum, and he was sharp as a tack.

Of course he doesn’t remember the trips to the dump or the museum or the friends. But I remember for us.

(PS Coming soon: The Tractor Drama unfolding as I type)

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P.S. From Ralph: What Study?

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So just yesterday I wrote about the study Ralph has agreed to participate in to study the effects of a new drug that might inhibit the plaque build up that leads to Alzheimer’s.

This morning over coffee we were having a perfectly normal discussion of the news, what to have for breakfast, etc., when I mentioned to Ralph that maybe I should cancel the check up appointment with his internist coming up this week since he would be getting checked so thoroughly through the study.

He looked at me and said, “What study?”

I have probably mentioned that Ralph’s memory issues have a silver lining, that he particularly forgets any moment that has produced anxiety or unpleasantness in his past—in other words any argument he has had with anyone, any disappointment he suffered in the past, any moments of tension or distress. Evidently, he has forgotten our trek last week because it was anxiety producing–which is fine because if he ultimately gets rejected he won’t care, and if he is accepted and has to go through more tests and appointments, each will fade as soon as it’s over.

Another win-win.

P.P.S.

For Ralph and me at this point in our journey, participating in trials and studies concerning Alzheimer’s is always win-win, but it is important to recognize that participation in experimental studies is a very personal decision and not the right decision for everyone or every situation. When Ralph was first diagnosed, we signed up for a trial that involved one and one exercises; it didn’t go well. Rick hated the questions and resented the process. Later, when he attempted an MRI for another possible study, we encountered the bb pellet problem. [For those who were curious, Ralph’s parents were very lax about firearms and allowed Ralph to have a BB rifle when he was around six. I picture him as a tow-headed little “woods booger,” as he called himself, in his favorite cowboy shirt–which he still has–chasing after birds and squirrels until he promptly shot himself in the tongue (luckily not the eye). His parents may or may not have taken him to a doctor, but nothing was done. Ralph forgot he had  the BB  until a dentist noticed it on an x-ray thirty years later. Rick said his mouth got quite hot during the MRI, and the pellet distorted how the MRI works, making it unreadable.] At some point I talked to a social worker who pointed out that no one should ever feel pressured to participate in studies and that health and emotional well-being come first.

 

My Car Is My Caregiver

 

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Dear Red Prius,

My first car was a bright blue sedan that I drove to Atlanta when I was 22. I don’t remember the brand, only that I hated how visible it made me, especially since I was not the best driver.

I traded the blue bomber in for a used telephone “van” that had been refurbished by Ralph—his first entrepreneurial venture was buying and fixing  up used phone trucks, then selling them to counterculture types like me; the streets of Midtown Atlanta were full of Ralph’s trucks in the early 1970s.

The brakes went out on my van a week after I bought it. I was rounding a curve and ended up down an embankment. Fortunately I wasn’t hurt. Naturally Ralph felt terrible. He helped me fix the van and sell it.

(Actually, Ralph disputes my car history, says I got the blue bomber after the truck disaster, and he may be right. In any case I don’t remember what I drove next.)

We got married five years later, and for the next multiple decades I drove a series of practical, second-hand sedans (with baby seats), SUVs (for carpools and horse-trailering), and (once the kids were gone) compacts. They were all non-descript, aside from the dents I added, and I could care less.

A year and half ago, though, I got you,  Red Prius. I bought you for practical reasons like gas mileage and comfort, etc., and I admit that I chose your red color because you were cheaper than the silvery blue model.

The irony is that these days what I love most about you is your color. It makes you  So Visible, so easy to spot among the sea of tans, blacks, grays and whites on every road and in every parking lot.

I often find myself writing here about the difficulties, the frustrations, the borderline depression care-giving causes me. I think one of my secret worst fears is that my memory is going too. I said this to a friend recently and she laughed, “But Ralph isn’t contagious.”

Maybe not, yet I often feel as if my brain is clogged with the details of thinking for two. An adage of care-giving is that if we are tense or irritable, our cognitively impaired spouses (or parents) sense and react in kind. The flip side is that I am vulnerable to catching Ralph’s anxiety, and when I’m anxious my brain does not function at its best.

Lately I have an urge to simplify: the less I have to worry about the better. Less stuff means less stuff to keep organized and clean without Ralph’s help. Fewer commitments mean fewer complications to arrange for Ralph. But I also want to stay active and involved. Simplification can be a slippery slope that I don’t want to begin sliding down too fast.

Red Prius, you have been a godsend. It takes one item off my overloaded mental table—no more walking out of the supermarket or doctor’s office or bank or lawyer’s meeting or movie theater or restaurant or political meeting worried where I parked. One glance each way or a click of my key button and there you are, Red Prius, brightly reminding me that I am in control, at least to the best of my ability…A small comfort maybe, but it’s the small comforts that count.

So thanks for making my life better Red Prius. I promise to take care of you as well as I take care of Ralph.

Gratefully,

Alice

 

A Benefit of Ralph’s Cognitive Impairment–My Strengthened Self?

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Last week I posted information about a study concerning the impact of Alzheimer’s on women. Since then I have found myself thinking in a more deeply personal way about how I have been impacted, specifically in terms of my sense of identity as a woman.

My (even) more self-centered than usual thoughts are flowing after spending a weekend with an old college talking and eating non-stop (the eating important since the setting was New Orleans).

Jane and I explored the challenges that shaped us over the last thirty years and the directions in which we are currently evolving. We talked a lot about whom we have each become and why. It turns out that we have remained alike in many ways—our politics, our private and social ethics, our taste in food, even our TV preferences.

But there is a major dividing line: I have a husband and children. She doesn’t.

In college, despite high ambitions and avowed feminism, we shared a tendency to let men we loved take over our lives including those ambitions. (Ironically, the fact that we were at different times drawn to the same young man brought us closer as friends.)  In our twenties, we each married a charismatic if self-absorbed man with big ambitions of his own.

Then our life paths diverged.

Jane’s marriage lasted only a few years. After the divorce, she went on to have an extremely fulfilling life with an exciting career and plenty of important friendships and relationships. After Jane’s early marriage to a dominating man ended in divorce, she went on to have an extremely fulfilling life with an exciting career and plenty of important friendships and relationships. She has her regrets, but she has developed an amazingly strong individual identity, which includes confidence that she is a woman who can take care of herself. She is not certain that she could have become that woman within the confines of a marriage.

My marriage—to Ralph—has lasted and my primary identity became tied up in being a mother and a sometimes resentful wife struggling not to be overshadowed by Ralph’s powerful personality. I fought to forge my own identity, eventually publishing several books including my first novel.

But I never put my ambitions first and in our shared life, I usually let Ralph get his way in decision-making. I would rail against the decisions he made—like to move us to a farm or buy a certain car—but I always went along. And when one of Ralph’s decisions went bad, as they sometimes would, I could always think not my fault.

Jane did not have that luxury. She had to make every practical and metaphysical decision concerning her life on her own, and then she had to live with the consequences.

So now she is a woman used to making decisions for herself, used to the tension and the fear and the joy, and I am a woman learning to make those decision for myself and for Ralph.

Making decisions alone requires a mental muscle I never adequately developed and now have to exercise. Ralph no longer has any interest in making decisions. Along with memory loss, his mild cognitive impairment has caused a major personality change. He is the passive one who cheerfully, and without the resentment I used to feel or any questioning, goes along with whatever I say.

I am not downplaying the reality of Ralph’s cognitive impairment and its negative aspects. But learning to cope with Ralph’s condition has created a potential for growth for me as a woman. It is scary and intimidating to be the decider, also liberating. I am learning what Jane learned over the last thirty years: to be strong-willed, self-reliant, independent, and in charge of my own happiness.