Friday, June 8

The Demon of Dementia

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My mother has dementia. Over the past four years, I have witnessed her slowly slide into a mental oblivion. For a while she was able to put thoughts together and express herself with some coherence. While her recollections were occasionally humorously fantastic, some of her older recollections were spot on. There were times I'd take her out and she'd make comments that made me want to correct her, but I soon realized that she articulated what was in her head and whatever connections made sense to her so I let it be. In fact, there were times I learned more about her as a result of those connections that often made me want to pause and process a bit.

I went to see her a month or so ago. We don't live in the same state and I try to visit her at least every other month although I'm beginning to feel as though I need to try to visit more often. She had obviously declined further, which came as no surprise but that still didn't make it easy to witness. I sat with her while she cleaned the tines of her fork and then spent several minutes attempting to spear a piece of macaroni. She didn't seem frustrated. I found myself getting more and more tense as I tried to appear to be patient and not just reach out to do it for her.

I saw her again just after Mother's Day, a day we didn't really acknowledge in any real sense. I found myself sitting with her at the table again and found myself again clenching my hands in my lap as she fiddled with her food, though part of it was simply trying to figure out how to eat it. Early on the house caregiver picked up the half sandwich and put it in Mom's hand and did the same with another resident. She explained, "Sandwiches are easy to eat once they have it in their hands but they have a hard time remembering how to pick it up and eat it."

One of the other residents has a small dog. I have thoughts about the wisdom of a small dog, even leashed or especially leashed, in a converted duplex with 7 or 8 people most likely using walkers or wheelchairs, but the dog and her owner are there. The dog was whining and begging to come to the table; her mother was talking to her and trying to shush her. My mother turned to me and said, "I want her." I explained the dog already belonged to someone. My mother lifted that eyebrow and said very clearly and in a tone of voice I well remember from days gone by, "You wanna bet?"

So she can't really eat a sandwich by herself, but if she wants something, she can, in fact, put her mind to it. Disturbing, Daunting. Intriguing.

Some months ago I was having a weird headache and my doctor sent me to a neurologist to get an MRI of my brain. The headache thing proved to be nothing of concern (he said he could give me meds but it was hardly worth it and I should report to my doctor if the headaches in that location continued; a few weeks later they were gone). I'd asked about dementia and did tell me there were no indicators in my brain. At that time. He explained a lot about what doctors know about dementia, but also acknowledged there is a lot they just don't know.

Alzheimer's, the most common form of dementia, terrifies me. I'm fascinated by the tests, by the attempts to diagnose sooner. I'm fascinated by what I might do to try to make sure this doesn't happen to me though I also know there are no guarantees.

I have a sense of what might have contributed to my mother's descent into this particular hell of which she is, oddly, not aware. That is the blessing in disguise because I tell people how angry she would be if she knew this was happening to her. She didn't seem to go through the panic of losing her memory but mostly because she was in denial that it was happening; I realized that later. There are dozens of things I would do differently had I know then what I've learned over the past few years. Nothing prepares you for those subtle shifts in behavior so it's easy to be in denial or to delay getting any medical evaluation because you don't want to overreact. However, if I'd known sooner about her situation, I could have made plans differently and less jarringly.

I know that my living situation is very different and it's not likely that I'll repeat her particular scenario. I also know that once I hit 65, all bets may be off but that I can do particular things to try to reduce the risk.

What's interesting is that keeping the brain active and learning is not one of the main factors listed to reduce dementia risk: not smoking (check), drinking in moderation (check), regular exercise (gotta work on that), and healthy diet and weight (more exercise will help with the second of these), stress reduction (exercise will help with this, too), and good restorative sleep (huh; exercise could help with this, too). But I won't stop keeping my brain active and learning just in case researchers change their minds. ;)

I can't tell, though, which is worse: watching her decline and wondering what will happen next or wondering about my own situation. I couldn't remember the word "dustpan" the other day. Never mind I haven't mentioned a dustpan in possibly years, but I freaked a little that I could not remember the word. And then the round and round starts to happen as I do a sort of mental awareness and alertness check. Because wondering what will happen next is the best anyone can do. No one knows enough about this disease and it progresses differently for everyone.

What gets harder is to know how best to handle medical situations. Earlier this year my mother had an infection that required hospitalization followed by time in a rehab facility because of the antibiotic that had to be administered. That little jaunt did nothing good for her liver. When she seemed to have another flare-up of that particular bacteria, the nurse practitioner wanted to put her on a heavy-duty antibiotic that would require home health care and would nothing good for her already battered liver. The infectious disease doctor agreed with me that because my mother wasn't symptomatic, there was no point in stressing her liver and, given her age (88), palliative care made sense. The nurse practitioner was not happy with me, but we're now with hospice palliative care. Mom is visited weekly by a chaplain, a social worker, and a nurse.

At this point in my life, the best I can hope to do is keep her as comfortable as possible, do a better job of taking care of myself, and not let the concern about her or me consume me.

Monday, April 14

Savoring a piece of quiet

Last week a friend of mine told me the story about how her daughter would say "piece of quiet" because she was too little to recognize the homonyms of "piece" and "peace," so "peace and quiet" didn't quite make sense to her.

I like the idea of a piece of quiet. Especially last week. It was been a chaotic and emotionally taxing week for a number of reasons. I had little time to write the past two weeks or so because much has been in turmoil. When I did have time, because of the turmoil, it was hard to focus so this blog and my other blog, among other things, have been sorely neglected.

What I needed to do is savor a piece of quiet. Rather than feel as though I needed to get something accomplished in that brief sliver of time, I needed to savor that piece of quiet. Savor: to enjoy completely.

Years and years ago I joined a group of folks for a day of prayer. The idea was that we would spend time together, but alone. That is, we each found a place to be as we read, meditated, listened to music, prayed. At the end of the "day" (I think it was a period of about 8 hours), we were supposed to be spiritually and emotionally refreshed. I think I lasted about two hours and then I was done. I wasn't really bored, but the books I had weren't capturing my attention; meditation and prayer were leading to snoozing. Perhaps I didn't have the right mindset for the day, but it's also possible that I hadn't yet learned how to savor a piece of quiet. I certainly had no idea what to do with an abundance of pieces of quiet.

Americans tend not to be very good at relaxation. We know that most Americans do not take all of their vacation time. Apparently most Americans don't vacate the work place as much because of fear as anything else, and that makes sense. People are worried about falling behind in their work so the re-entry is even more exhausting because of all of the work that has piled up. Others are worried they will not be missed and someone will decide that position is no longer necessary. I get that as I was one of those people: afraid to fall behind and afraid I wouldn't be missed. So I was always connected which meant that I got only half a vacation day every day I was gone. Sometimes I did relax and did savor any pieces of quiet I had; other days I was more tense because of whatever was or wasn't happening at the office.

We aren't good at relaxing and that wears on us. Eventually we burn out and we're just not as productive. Working without opportunity to relax sets us up for failure in ways we might not see coming. It's not just entrepreneurs who need to build relaxation into their work flow, but anyone who feels as though their work life is a constant stampede of demands and expectations.

There are ways for the non-entrepreneur to tailor these relaxation tips to their own situations. The key, I think, is flexibility. “The reality is that balance is out of my control. . . .Working hard is inevitable.”

But there is always a sliver of time, even if it's going to the coffee room or to the restroom, when you can stop, or at least muffle, the voices of the madding crowd. Savor that piece of quiet. Think about something fun you did over the weekend or something a loved one said that made you laugh or something fun or engaging or interesting that is not work you hope to do one evening or soon. Or just be thankful for something. Or breathe deeply and focus on a favorite scent or color or place you've been or whatever. Or just breathe deeply and savor that piece of quiet.

No matter how large or small the piece of quiet, savor it and I bet you'll feel the difference.

Saturday, November 23

Only the (mentally) strong survive

Not too long ago I was on a hike with a friend and we were having one of those series of random conversations. One of us would say something that would lead to a tangent that would lead to another tangent. It was quite fun. One of the tangents included Darwin's theory of evolution, that idea of natural selection or what became "survival of the fittest" which led to discussing what "fittest" meant. So that conversation came to mind when I came across this article Mentally Strong People: The 13 Things They Avoid. I believe that many of today's fittest are, in fact, the mentally strong.

I love the concept of "failing up." Because sometimes we do fail. Yep, we fall flat on our faces, metaphorically speaking, and we have a choice as we lie there. We can do a few quick push-ups before we get up, or we can just roll over on our backs and whimper. Except for the push-ups part, I try to opt for the getting up. By getting up we say, "This failure does not define me. I will learn from it and I will move on."

What mentally strong people don't do makes sense. They don't:
  1. Waste time feeling sorry for themselves. There could be a moment or two of aggravation, frustration, and those normal emotions that people experience. But there is also a time of reflection--"what can I learn from this and how can I build on the good experience and insight I've gained?".
  2. Give away power. This one can be harder, but it's remembering who you are and what you're capable of doing. Failing can feel like rejection of your talents, but failing in that situation might not be at all related to anything you've done or are capable of doing.
  3. Shy away from change. . .or be okay with your cheese getting moved and perhaps a lot. Here's another thing about change: it's an opportunity to learn that much more about yourself--your capabilities, interests, limitation. I was recently in a position that was clearly not to my strengths. I was all but set up to fail (though not deliberately), but I opted to work towards my strengths to see how I could make the best of the situation.
  4. Waste energy on things they can't control. I was just on a business trip that was fraught with challenges. Weather caused delays which caused missed connections, etc. I could have complained, but that would have accomplished nothing. Instead, when I got to talk with the rebooking agent, I was pleasant with her and thanked her for her help. She was doing her job as best as she could and really didn't need to be hassled.
  5. Worry about pleasing others. I think this can be a tough one, even for some of the mentally strong. There is a fine line between pleasing someone else and being kind or not hurting someone else's feelings, but that is often situational. The flip side is focusing too much on pleasing ourselves, which is a different kind of problem.
  6. Fear taking calculated risks. The key word is "calculated." It's important to envision and even plan for worst-case scenarios, but not get mired in analysis to the detriment of progress.
  7. Dwell on the past. That was then, this is now. Learn from then, and apply it to the now and the future.
  8. Make the same mistakes over and over again. "Research shows that the ability to be self-reflective in an accurate and productive way is one of the greatest strengths of spectacularly successful executives and entrepreneurs." I think the hard part is being accurately self-reflective: acknowledging our true strengths and determining how best to manage our weaknesses.
  9. Resent other people's success. Others have talents we don't. We cannot resent that others have taken advantage of presented opportunities or made good choices. That is a waste of energy (see #3) and can lead to wasting time (see #1) and giving away power (see #2).
  10. Give up after failure. Failure is an option. It has to be an option in everyday life. We will not always be successful in every single thing we do. So learning from failure is an important life skill.
  11. Fear alone time. See #8. Being alone, away from all of the noise and white noise, gives you the opportunity to reflect, to do those self-assessments, to examine those risks, and to make those decisions about what can and will change in your life.
  12. Feel the world owes them anything. The "world" has never owed anyone anything. Ever. That victim mentality gets you nowhere fast.
  13. Expect immediate results. Sure, sometimes a new possibility presents itself almost immediately. But sometimes the first thing isn't the best thing (see #6, #8, and #11). That could be rebound option, which might not bode well for you. As you contemplate your next steps, spend that time being self-reflective and examining the possibilities.
As I reflect on this, I think it's important to consider that it's not always the being strong. Sometimes the becoming strong is what matters most.