Mom’s journey with dementia, at least from the point of factual diagnosis and not just a suspicion on my part, has been ongoing for two years now. It was August of 2014 when I accompanied her to an appointment with her primary care physician, mentioned that she’d had a prior ‘cognitive’ exam and perhaps an updated one was a good idea as there were some ‘gaps’ cropping up. Two years since she was referred to the geriatric medicine center of Maine Medical Center and diagnosed with dementia. Two years since her life as she had known it for so many years began to unravel before her eyes.
Her carefully built wall of defenses was crumbling. The explanations and assurances she had given for so long for repetitious conversations and grasping for names and details more and more were no long holding up to mask what was really going on with her. Her memory was disappearing. Her ability to figure out a process or to pull a word from her 80+ years of building vocabulary were becoming more and more compromised.
I can’t pinpoint an actual date or month or even a seasons when this began. I can say it was within the past ten years….more than five, less than twelve, but there’s not one single occurrence or ‘slip’ or concern that arose and gave me pause and led me to think ‘maybe things aren’t quite 100% with her’ for the very first time. It was lots of little things that in and of themselves were able to be justified or overlooked without much distress and anxiety – but when strung together they became a procession of clues that Mom’s cognitive ability was on the decline. It came without fanfare, without signal, without omen or caveat, and without mercy – much like Christmas in Whoville, ‘it came without ribbons, it came without tags, it came without packages, boxes or bags.’ There was no overcast sky or bone-chilling wind; no cautionary background music or telling sound effect, no blaring horn or raid siren going off.
None of this preceded dementia.
It just ‘came’.
It’s a quiet thing.
Ever since Mom’s journey started, the decline has been, to me, relatively rapid. For several months she still maintained an apartment, yet all the while I was noticing greater chasms in the years and details she was losing. I noticed her growing more frail. I noticed her getting more and more anxious having new routines introduced into her life. New doctors, new medications, new diet, new home…..all these things, every one of them necessary to her overall well-being and safety, brought upon her like shouting back at the dementia raising my staff and shouting ‘GO BACK TO THE SHADOW – YOU SHALL NOT PASS!’ like the grey wizard Gandalf to the Balrog on the bridge of Khazad-dûm.
And yet over time she still lost names, and places, and dates, and other details – little by little, one by one. The names of her parents, the circumstances of their deaths – even the fact of their deaths as she asked me recently if she’d told me what her mother said to her on Mom’s 80th birthday. Mom’s mother passed away when Mom was in her early 30’s…a full 50 years ago now.
I’ve been doing all I can to ease her through this process. Acting as if all the repeated conversations are being heard for the first time – all the answers I give her for the repeated questions are being given for the first time. When she brings up the anxieties that seem to plague her either daily, weekly, or on a six week loop (lately that has grown for many things), we talk, calmly, and I do all that I can to explain things to her in a way that will mollify her. In a way that will smooth the rough spots out and de-escalate her worries somewhat. It’s not any kind of special trickery or shrewdness. It’s a calm voice. A reassuring tone. Talking to her in a way that is respecting that she’s an adult, not a child; not telling her what to do, but rather rationalize with her what is in her best interests and what she knows she should do for herself.
In my mind, it’s also the decades of talking to her and listening to her about her thoughts, her family, her life, her fears and building a trust between us that I would take care of her no matter what. It’s the 47 years of her being my mother and my being her son that she is still able to process that if I tell her she’s safe – she accepts it. If I tell her that although she is remembering something differently than I am, what I am telling her is the truth. In my mind it’s been all a combination of these things.
In the past few weeks Mom has called me and left me a few messages in between our daily calls (she often forgets we’ve spoken already or that I’ve told her I’ll call in the evening the next day, which is fine, understandable) and on my voice mail she’s said hello and then said, “this is….” and then paused for a moment before she identified herself as ‘Aunt Carrie’, rather than as ‘Mom’. She leaves me a message, I call her back, I don’t correct her on the ‘Aunt’ thing. She’s talking to a machine, not me, she slips, it happens. She knows who I am when we actually speak, calls me by name, calls me honey when we’re talking, same as always. Sure, she doesn’t remember where I live or what my age is (it goes back and forth, some days she does, some days she doesn’t) but the basics are still there, I’ve told myself for weeks now.
Amazing what we can convince ourselves of when we want to. Just over a year ago she told me she promised she’d never, ever forget who I was. I told her that even if I wasn’t in her head, I knew I’d always be in her heart, and let her off the hook from the promise immediately. I knew she couldn’t keep it – through no fault of her own. She knew it too, I know. I think she was trying to convince me more than herself at the time.
Four nights ago we were talking and she thanked me, again, for making the time to call her every day. The conversation was a bit different than usual – just a slight modification in the way she carried herself on the call – something in her tone that was not the norm for her. Something less ‘familiar’ and a bit more ‘impersonal’ about how she spoke.
Something that, knowing her the way I do, as well as I do – I knew immediately what it was.
I replied, again, that calling her every day is my pleasure, that I enjoy talking with her and look forward to it each day.
“Yeah,’ she said, ‘but you do it every day – you call and talk to me and make me feel special every day…and who am I to deserve that? Who am I?”
“You tell me, who are you?” I asked.
“I’m Carrie.” She said.
“Right, but who are you to me?” I asked.
Perhaps she didn’t hear my voice crack slightly, but I noticed it, as I went toe to toe with my own denial ready to face the consequences, ‘ready’ being a relative term – full of caveats and cautions and forewarning.
“Well – we were neighbors for a long time, and we’ve always been good friends.” she replied.
Dementia creeps up on a person without warning. It submits no proposal and awaits no committee approval. It arrives on our doorstep and invades our home without auspice or invitation. It just appears one day and stays there until it carries first the mind and then the body away.
It’s stealthy and voiceless; predatory and reticent. It skulks around for a while before it takes a person forcefully yet silently.
It’s like the tears that roll down your cheeks as you sit in a chair in a room in your house that you sit in every day while you talk to someone that you talk to every day. It’s those tears that you cry, without wailing and sobbing, just a stream of tears coming out of your eyes and you feel them there, making their way down your face wet and bothersome, while you sit in your chair stoically and compose yourself so that you don’t betray the anguish going on inside of you, anguish you convinced yourself you were prepared for just because you knew it was coming, and yet now you find yourself realizing how naive a thought that was, because right now, in this moment you have no idea how to process the realization that this woman who you speak with every day, who bore you and raised you and taught you many, many things and was a constant in your life for forty-seven years and yet suddenly you know, just by a slight variation in the timbre of her voice, no longer knows she’s your mother.
Dementia is like that as it pillages a life and a mind. It’s just like that – feline and bucolic just like those tears that you cry and keep yourself from sniffling or letting your voice break as you say goodnight and give the assurance that you’ll call again tomorrow, as usual. Just like the moments after you hang up and you realize that your life is forever altered now and there’s nothing at all you can do to change it so why scream and wail and carry on at all in the face of incapacitation? That’s what dementia is like when it trespasses into our lives and takes and takes and takes from us. It’s just like that.
It’s a quiet thing.