Us Against Alzheimer's Read online

  In “I Won’t Forget You,” writers consider the legacy left by a parent, spouse, or friend and come to both a reckoning with and a recognition of Alzheimer’s as a symbol of long-standing absences, amnesia, distance, and forgetting. A symbol of the resilience of loyalty and unbroken bonds. A symbol of the fact that there is no forgetting, for there is always life after death in our hearts.

  In the “Fiction” section, the narratives mine the pathos, terror, and even the humor (and, yes, there can be humor) in how Alzheimer’s disease takes shape and finds expression. Fiction, with its requirement to suspend disbelief, may be the most natural home for meditations on the Alzheimer’s experience. The subject of all the stories in this section, however, is not disease or death, but the meaning of life.

  It is my hope that you will find in this book a deeper understanding of the courage of families impacted by Alzheimer’s and other dementias. I hope you are lifted and renewed by their daily witness to family, love, and faith.

  TURNING POINTS

  INTRODUCTION

  There is no one turning point for those living with dementia, for family members, caretakers, or friends. The disease evolves like an unhinged, intemperate, willful dance. A dance whose steps are ever changing. A dance that leaves those performing it breathless. The turning points are those spaces and those places where instinct and understanding unfold quietly amid the din, and an anointing somehow takes place. There is no going back, because you stand shocked and grateful that this place that promises only what is here and now feels like home. The narratives in this section capture the mysterious ways that turning points arrive and impose a “new world order” on the whirlwind and drama of dementia and Alzheimer’s.

  There is the turning to face the big picture that is embedded in visits to the doctor, medications, exhaustion, tried patience, blank stares, and the gradual inching away of memory. Where else would the big picture be if not seeded in the soil of the mundane? There is the turning to face the emotional truth that meaning springs from the ordinary. We take, and hold in our bodies and our hands, responsibility for another and for ourselves. We love the broken body and mind because we see in it the outline of our own looming fragility.

  And if we have made our own luck, by standing still and tall and standing up to the disease, by morphing into witness and not just friend or family, but witness as in “can I get a witness” for my trials and trouble and pain, there is the turning into a person who finally knows what is happening, what this disease teaches us about the deeper promises of life lived and honored in its terrible moments of reckoning.

  ALZHEIMER’S AND THE ER

  JANE BANDLER

  I received a call at 8:00 a.m. from the director of the assisted living community where my husband, Don, had been living for the past year and a half. It was a small facility, and Don was one of the most active and loved residents. He was physically strong and upbeat. He enjoyed participating in all activities, greeted everyone, and walked around as if he was the ambassador of the place. This was how Don was before he had Alzheimer’s too. I thought the day my children and I brought him to the assisted living was the worst day of my life. But that was before I had adopted the philosophy that each today was going to be the best day an Alzheimer’s patient or caregiver was going to have because the future did not hold any hope.

  On that early morning call, the director told me that Don was extremely angry and agitated. His behavior was aggressive and, as a result, they had determined that he had to be sent to the emergency room of a nearby hospital. I said I didn’t understand why that was necessary and I would prefer they waited until I got there. I had heard many horror stories about what happens to Alzheimer’s patients at the hospital. Back in 1996 when my mother had Alzheimer’s, my father and I received a call from her assisted living that we should go directly to the hospital, and the memory of that came flooding into my mind.

  Anxious and very afraid, I jumped into my car and drove the twenty-five miles I had driven almost every day for the past eighteen months. I felt reassured that they would not send Don to the hospital until I got there and I could accompany him if necessary. Mid-drive, my cell phone rang, and I heard the strained voice of the director asking when I would arrive. I told her I was almost there. When I did arrive and walked into the familiar reception area, the directors and staff were standing by the front door waiting for me. I could feel the tension. They told me Don was already at the emergency room. They simply could not wait for me as his behavior had become too violent. They said they wanted me to come to the assisted living first so they could tell me face to face how out of control Don had become. They were traumatized themselves and wanted to be sure I was prepared for what I was going to see at the hospital. Don was dangerously out of control, and for the safety of the other residents, they had had no choice but to call the police to escort him in an ambulance to the hospital. They hoped the hospital would be able to medicate him and calm him down. Now I was even more worried, and I felt angry that I hadn’t been notified much earlier. I felt I could have been there for Don at his darkest moments. I didn’t understand what had happened. But in my nine years of caregiving for Don, I had learned that I had to put one foot in front of the other and face each obstacle as it came. So I followed my instinct, got in the car, and just hoped I would somehow get to the hospital. I had never been to this hospital, and I wasn’t able to focus on the verbal directions the staff gave me. I had hoped one of them would accompany me and help me at this critical and scary moment, but they said they could not go with me. Of course, I found my way. And it was even more upsetting than I had imagined.

  As soon as the emergency room doors opened, I could hear my husband, a French Legion of Honor recipient, a lifelong diplomat with the US State Department, and a former ambassador to Cyprus, screaming vile obscenities at the top of his lungs. I was shocked to see that there were both police and hospital security stationed outside his room. I walked up to the door to Don’s room and said, “I’m his wife, what’s going on?” One of the security guards said he did not think I should go in the room as my husband was violent and they were trying to get him under control. The guards told me Don was speaking nonsense, which they called “word salad.” I nervously asked questions but could not concentrate when they answered because of the barrage of violent and ugly swear words Don was screaming and shouting. How was he finding these words, I wondered, as very little recognizable language had come out of his mouth in months?

  I said I would like to go in, and they again advised against it. I knew I had to help Don. Since his diagnosis of early onset Alzheimer’s, I’d been the only one who could console him. He could no longer speak for himself. He could not advocate for himself. He must have been crazed with fear, and I now know he was incapable of making his brain pull back from his aggressive behavior.

  It was as if the hospital staff was unaware that Don had Alzheimer’s, even though he had been picked up in an ambulance from a memory care assisted living facility. When I opened the door with my shaking hands, I saw my naked husband handcuffed to an ER bed, writhing and screaming, held down by six strong police officers and security guards. I didn’t look at them. I looked at my husband. I wanted my voice to sound strong for him, so I willed myself to hold back my tears and fear. Don was a big, strong, six-foot-one, two hundred-pound man, and despite his mind being consumed by Alzheimer’s, his body had remained strong. He was only sixty-nine years old, having been diagnosed with early onset Alzheimer’s at the age of sixty-one.

  When I walked in, Don didn’t see me. He was too caught up in his fear, anger, and screaming, and the guards’ attempts to put him in hand and leg restraints so they could remove the handcuffs that kept him in the bed only seemed to outrage him more. I walked the length of the room, squeezing behind several of the security guards, and went right up to my husband’s face. I have no idea what words I said. But Don stopped mid-scream and turned his head to look at me. He immediately relaxed his tense body and silentl
y collapsed. I started to stroke his arm and reassure him and tell him that I wasn’t going anywhere. My voice soothed his exhausted mind and body. After a few minutes, I exchanged a quick glance with the one female police officer. She then quietly told the other five security guards to back off and give us space. The officers released Don and stepped back. He lay limp, looking at me in relief. A few minutes later all the guards left the room and it was just me, Don, and the ER nurse.

  It was then that I knew I was Don’s caregiver, his security, and that our bond of love could not be broken. I was the one who knew him better than anyone else in the world. I was the one who had to guide him through the rest of his life because Alzheimer’s disease had destroyed his beautiful mind. Throughout this nine-year battle, my husband’s heart and soul were still very much intact, and his love for me and trust that I would be there for him never faltered. From such an ugly and unfortunate situation, I was able to feel his love and trust. I will forever carry with me the feeling that Alzheimer’s took almost everything from him but not our love for each other.

  The hospital ER nurse told me I was his hero. The police officers came back to the hospital two days later to check on Don and to tell me that they had never seen anything like the reaction Don had when I arrived. They wanted to personally apologize to me that I had to see my husband being restrained like that.

  I appreciated their words and their care, and it always made me proud when people acknowledged my caregiving role. But what I really wanted from them was an apology for what appeared to be their lack of knowledge and understanding that Don had Alzheimer’s disease. For not seeing or feeling that he was scared out of his mind, felt physically and mentally threatened, and needed reassuring. I wanted them to apologize for not treating him with the dignity and kindness he needed and deserved. I wanted them to apologize for the fact that hospital staff and police officers are not trained to see and understand someone with Alzheimer’s, a disease affecting millions of people and the sixth leading cause of death in the USA.

  Sadly, my love story ended in the same hospital setting I had walked into several weeks earlier. Don spent three weeks in that hospital because he was labeled violent and none of the geriatric psychiatric hospitals would accept him. It took three weeks of constant phone calls and research before Don got transferred to a psychiatric hospital. It was there that I hoped they could adjust his medications to help his demented brain and his behavior.

  But it was too late. In those three weeks, Don forgot how to walk and lost his will to live. One day, Don sat up and looked me straight in the eye and said the only clear sentence I had heard in months. “Jane, I can’t do this anymore.”

  As a family, we followed my husband’s wishes and his lead, and within a week he was transferred to hospice care in Rockville. Don refused food and water and died peacefully, surrounded by his two daughters, his son, and me, on February 24, 2017, at the age of sixty-nine.

  EVERY 68 SECONDS

  An Excerpt from Slow Dancing with a Stranger: Lost and Found in the Age of Alzheimer’s

  MERYL COMER

  The man I live with is not the man I fell in love with and married.

  He has slowly been robbed of something we all take for granted: the ability to navigate the mundane activities of daily living—bathing, shaving, dressing, feeding, and using the bathroom. His inner clock is confused and can’t be reset. His eyes are vacant and unaware—as if an internal window shade veils our access.

  Before I grasped what was happening, I was hurt and annoyed by my husband’s behavior. Those feelings dissolved into unconditional empathy once I understood the cruelty of his diagnosis: early-onset Alzheimer’s disease. He was fifty-eight.

  At first, I ran interference and fought for him because it was the right thing to do. He was slipping out of control—confused, childlike, and helpless, his social filters stripped away. He shadowed me because I was familiar and safe, even when he could no longer remember my name.

  I always loved him, but during our marriage, he was often aloof and unreachable. In illness, unlike in health, he made me feel needed and important to him.

  Neither a scientist nor neurologist, I have spent close to two decades trying to decipher what’s going on in my husband’s head. How hard and unfair it is for such a smart man to lose pieces of his intellect and independence as the circuitry of his brain misfires and corrodes. No new short-term memories stick: his internal navigational compass has shut down. His disease is my crossword puzzle.

  Harvey has long forgotten me, but I am constant as his copilot and guardian. Every conversation is inclusive and respectful even though he is often unintelligible or mute. It is a charade that never ends. I bear the burden of all decisions for us both. The demons and terror of his world define mine. Any challenge is self-defeating. I play into his reality and pretend that his fate and our life together are not doomed. Unfortunately, I know better.

  Alzheimer’s distorts and destroys shared memories that bind family ties. Caregivers are not unlike victims who survive a hurricane and find ourselves sifting through the rubble to rescue faded, storm-drenched photos or sentimental objects. We piece together what’s left of our past and struggle to put down building blocks for the future. I need to make some sense of my journey through this storm.

  My bookshelf is lined with tomes on dementia care, yet the page I need always seems to be missing. Each brain unravels in its own quirky and idiosyncratic way. I have learned firsthand that there is no single solution to taking care of someone with dementia.

  Many times, personal stories involving Alzheimer’s gloss over the unseemly details of care. They are written as love stories of unquestioned devotion or living memorials to honor someone during better times. Why not? As spouses and caregivers, we deserve to do whatever works for us. It is our version of pain management. But I never wanted to embellish or soften the edges around the truth. It does not do justice to the cruelty of the disease. I offer you my own experiences from a position of hard-won humility. I hope you will thread them with your own.

  When I say I have cared full-time for Harvey in our home all these years, many ask me why. Even now, there is always an initial reflex that makes me want to say, “Do I really need to explain myself after all I’ve been through?”

  I realize that the question is a natural one, a human one, a social one. The interlocutors are not judging me, but rather vicariously checking themselves. In questioning me, they are testing their own capacity to deal with a diagnosis of Alzheimer’s disease and the potential impact it might have on their relationship with a partner or parent.

  When people hear my story, they sometimes tell me they wouldn’t make the same choices. I do not hold myself up as an example to follow. No one who has been on the frontlines of care ever questions when someone says “I can’t do this anymore.” But I do want to be part of the last generation of caregivers trapped by a loved one’s diagnosis, and a troublesome lack of quality care options.

  When it comes to Alzheimer’s, caregivers are frequently too worn out or isolated to protest. Perhaps this is why advocacy around the disease has often lacked the passion and energy that characterize the cancer and HIV communities. But how will people understand if we do not tell our stories without apology?

  Alzheimer’s disease today affects a reported 5.4 million people in the United States and 44 million worldwide. Like a stealth invader, it is quietly dementing aging populations globally all while quickly pushing past cancer and HIV/AIDS as the most critical public health problem of our time. Every sixty-eight seconds, another one of us falls victim. Yet, 50 percent of those with dementia never get diagnosed.

  My greatest fear is that mine will be the family next door by mid-century.

  There is not a single FDA-approved drug that actually slows the progression of Alzheimer’s disease. There have been too many failed late-stage clinical trials with promising drugs that seemed to work—until it became clear that they did not.

  Sometimes I think w
e would be better off if Alzheimer’s disease was a brand-new emergency instead of a century-old threat to which we somehow have become inured. Perhaps people would understand that when it comes to disease, everyone is a stakeholder, because everyone is at risk.

  There are also fifteen million caregivers just like me; unintended victims and not among the official count. Add to our legions those caring for loved ones—young and old—with diseases of the brain, traumatic brain injuries, and other chronic diseases complicated by a memory disorder. We speak the same language. Our numbers amplify the collective pain that makes it impossible for me to rest.

  The only way to minimize the effects of Alzheimer’s disease is to get out in front of it; delay its onset or even reverse its devastation of the mind. We need to move toward early diagnosis and study adults who do not yet show symptoms. People like you and me.

  Such a decision entails hard personal choices, risks, and emotional discomfort. It means demanding safe and clinically valid genetic tests that let us learn if we are at higher risk for getting Alzheimer’s disease. It requires managing our lives and choices under the shadow of the possibility of disease.

  Those of us who are fifty years and older must stop viewing ourselves as ageless. All of us should track our cognitive health, just as we do cholesterol levels or blood pressure. We need to overcome fear and stop cowering in the shadows of stigma.

  I write for all of us who are still well, but have seen the devastation of Alzheimer’s disease firsthand. The emergency is with us and in us.