Leave Your Shoes At The Door: Memory Clinic

This week’s writing challenge with the Daily Post and Rarasaur is kind of a take on one of my favourite quotes from one of my favourite books:

If you can learn a simple trick, Scout, you’ll get along a lot better with all kinds of folks. You never really understand a person until you consider things from his point of view…until you climb into his skin and walk around in it. –Atticus Finch in Harper Lee’s To Kill A Mockingbird.

The challenge is to consider things from a different point of view. 

I spent my morning in a memory clinic.  I have some choices in the current Neurology rotation I am doing, so I can pick from clinics being offered (that aren’t already occupied by other learners) to try to tailor my learning.

I chose to go to this clinic because memory issues are something that can be caused by cancer treatments I will in my future life administer.  I chose to go to this clinic because memory issues are common.  I chose to go to this clinic because memory issues are very personal for me.  I almost went to a different clinic for the same reason.

I can walk into this clinic wearing many different pairs of shoes in my mind.  These three are the most predominant.

I walk into the clinic as a part of the team. 

I don’t know these people.  I don’t know their past.  I can’t say for sure what their future holds.

I introduce myself.  He has that blank stare.  The lost look that dementia brings.  He is polite and shakes my hand.  Smiles back at me with a big grin.  I can see a stain on his shirt from breakfast.  He glances around uncomfortably as I meet his wife and daughter.  The daughter has a list of questions and a notepad in hand.

They sit down.

I ask what brings them in today.

He says, “a checkup.”

His daughter interjects, “He has been having trouble with his memory.  His family doctor thinks he has Alzheimer’s.  He repeats himself.  He doesn’t remember how to get home from his walks.  Mom isn’t coping well with him at home.  It isn’t safe.”

His wife looks tearful and ashamed.  She just nods along.

He then looks at me and asks, “Why am I here?  When can I go?”

I go on to ask questions.  How long has this been happening.  Talk about when things started, how the progressed, about safety issues, medicatons and family history.  I get to hear intimate details of their lives.  I listen to their fears and hopes, their belifs and misconceptions.  I listen to them bicker and laugh and cry.

I want so much to fix their hurt.  All I can do is offer the help that is available, a listening ear and a friendly smile.

I supported my family members as they have gone into a clinic like this. 

Unfortunately, I am aware that there is a good chance that one day I will sit on the other side of these figurative and real tables. 

I will be the daughter or daughter-in-law of the person being seen in the memory clinic.

I shake the resident’s hand and sit down with my Mom and Dad.

She explains the procedure and we laugh because we know the drill.

Mom tells her, “We’ve been here before. Plus, my baby here is a doctor.”

I am embarrassed.  “It never gets old,” I say and laugh.

The resident is puzzled, “You’ve been here before?”

“Oh yes, our Mothers were both through this clinic.  Alzheimer’s.  I guess its our turn now.”

My father sits silently, but smirks and shakes his head.

The resident looks confused at how casual we are about this.

“We have been expecting this.  It is kind of our way of coping.  Either way, we decided to come early.  Get on medication.  Plan ahead.  We have done this before.” I explain.

Later in the conversation, they are doing the testing.  I have given these tests more than I would have liked, but there is something different sitting behind your mother as they go through the questions.

She stumbles through serial 7s.  She can’t spell world backwards, but my Dad chimes in that she is “half dyslexic,” so that is probably why.  It isn’t.  She knows the season because we are wearing sandals and the date because she memorized it on the way in.

She draws the clock as I cringe when she almost mixes up the hands.  Almost.  I sigh with relief when she gets them right.

She can’t remember the name of my youngest child.  And my grandmother is still alive in a nursing home (we laugh because we joked that she would outlive us all, but in the end she didn’t).  She knows they downsized and moved to an apartment near my husband and I, but can’t recall their new address.

She glances back at us for confirmation.

The resident then asks for our help in sorting out the correct information.

I take a deep breath and give the correct information.  She smiles and nods alongs.  Agrees and laughs at her misinformation.  It is good that she is so good natured.

We smile and encourage her to continue but give eachother looks from the corner of our eyes.

We know.

Even more frightening is that one day, it might be me.

I’m sitting in an unfamiliar clinic room.  Something tells me I have been there before, but I just can’t place it.

Posters all around the room show pictures of human brains and nervous systems and drug advertisements.  This is my world.  This is what I know.

They come back in the room.  Patrick, my son, my daughter, two strangers one with a stethoscope around their neck.  I don’t know these people but they seem to know me.

Image from phenxtoolkit.org.

They pull out a test.  They say it was mine.

I recognize it.  An MoCA (Montreal Cognitive Assessment) test.  It is completed.  I must have done it earlier.

I don’t remember.

That is the frightening part.  I feel like I miss more and more with each coming month and I don’t even realize it all the time any more.

The resident is explaining the meaning of the results.

I know these things.  I used to do these things.

“Her level of education helps her get along.  Her scores have been fairly stable. When she first presented she got a 27, then a 25 six months later.   Since we switched her meds and started her on the trial drug, her score has  been hovering around 23.  But today, she got a 17.”

I stare at her. There has been some sort of mistake.  I have Alzheimer’s, but I am medicated.  I am a competent adult.  I am a physician and a mother and a wife.

She continues, “After all we talked about today, it seems your wife’s condition is progressing.  It is clear that she is having more difficulties with her short term memory and judgement, especially after the time she wandered out the other evening.  And that fact that she is no longer able to hide things very well any more.  Have you thought about what you are going to do when things get worse?”

I have.  I want to be put in a nursing home.  That much I know.   But, things aren’t that much worse, are they?  I try to remember getting lost.  I try to remember what clinic we are in.

Then I realize they are all staring at me.  How much time has passed?

I forgot to make my notes.  I always keep notes.  It is how I get by.  Memory cues.  I don’t know where we are in the conversation.  I feel overwhelmed.  I feel afraid.

My daughter takes my notebook from me and repeats what the doctor said about medication dosing and changes to my timing.  She says she will make sure the blister packs get replaced.

Someone from home care is coming by tomorrow to meet with us about getting some help at home.  She takes my calendar and marks that down.

Patrick is staying back to talk to the doctor.  I hate it when he stays behind.  I know what that means.  At least, I think I do, but I can’t be sure of anything anymore.

I want to stay.  I ask to stay.  I demand to stay.  It is my health and my body.  Back when I was first diagnosed, I could manage these issues.  Nobody figured it out until I was ready for them to know.  Medications are better now.  I am not my grandparents.  I just need to take better notes or add more pills or maybe take away more pills…

They tell me it will only be a minute.  I can’t understand why.  I just don’t like being apart from him.  He is one of the few people I know.  He helps me.

My daughter tells me we will go to the Starbucks across the street for lattes while we wait.

I tell her, “That sounds great, I haven’t had one of those for years and years.”

Easy cure… Not so simple

Today’s prompt from the Daily Post is called Placebo and asks you to write about the one ailment you would want to cure with no pain and little expense.

The whole thing confused me.  Placebos aren’t real.  They do fix things sometimes, but they aren’t real cures.  Cure is a strong word.  Cure with little pain, consequence and expense is, unfortunately, in my medical mind a near impossibility.

No drug is without side effect, no intervention is without risk.  Everything from your daily exercise routine to multivitamin to the strongest chemo drug and biggest surgery is a series of risks and balances.

The only thing I can think of with no risk/benefit balance is a miracle.  Seriously… The hand of God coming down and healing or taking a burden away.  That doesn’t happen very often.  We all have struggles and ailments.  We live in a fallen world.

That is life.  Risks and balances.

That being said, I thought about what I would cure because the concept sounds awesome, even if it is unlikely.

As an oncology resident, my first thought was cancer.  But, it says one ailment.  And cancer isn’t really one unique element, but a series of diseases all characterized by abnormal cell overgrowth.  So, it isn’t a fair pick.  But, I would love to see it cured in more instances and more easily  (contrary to the conspiracy theories some people believe).

When I think about it, anyone affected by a certain ailment either themselves or with a loved one would want that cured.  I thought of Alzheimer’s disease.  How I would love my grandmothers back (crazyness and all).  I thought of chronic pain and migraines and depression and anxiety and how I wish they didn’t steal my friends away at times.  I think of C2 and his hearing loss and developmental challenges and how great it would be for him to not need hearing aids and not struggle with school and fine motor skills.

That being said, as terrible as illness is, it can shape us into the people we are for better or worse.  Without various ailments, we would be well, but would we find other things to struggle with?  Maybe.  Would we be the same?  Probably not.

I want to fix everything.  And yet, really, that isn’t an option.  Not to keep everyone happy.  Not to help everyone I love.

I think if I could cure an ailment, I would want to go to the root of a problem.  Not just fix something that affects some people, but a global issue.

I was thinking curing malnutrition.  It is kind of an ailment.  It is a global issue both in the starvation sense and in the sense of people in North America taking in too many of the wrong things.   Curing malnutrition with little cost would help people in financial duress, would help to prevent a number of issues and complications and make it easier to manage other illnesses.

Not a simple fix.  It doesn’t fix everything.  But, it gives a good baseline start for everyone.

Losing memory and licenses

Last week, I wrote my first letter to officially take away someone’s license.

I had been involved with these scenarios as a med student and, as a resident, I have told people not to drive for so long after a procedure or taking a medication.  But, this was a first.

We saw someone in emerg with advancing dementia.  This person had gotten lost in their own neighbourhood twice and once drove 10 minutes in reverse because it was easier than getting turned around.  They were being aggressive towards their spouse who kept suggesting they shouldn’t drive and they came in because there was a question if the new worsening in behavior was due to an infection.  It wasn’t.

I have said before that dementias are the thing that kill me inside.  I can deal with them, but I find it exceedingly tough.  This from the oncologist-in-training.  Most people say that cancer is one of those things they like to avoid.  I don’t mind it.  Not saying it is easy, but I have found ways to cope.  There is hope in the grave situation.  Chances for cure or quality of life.  And I have ways to cope with people with dementia too.  But, for whatever reason (probably because of my family) impending forgetfulness without a defined endpoint or fix is worse than possible impending death and disability for me to observe.

Any situation can have some hope.  And in medicine, you learn to process those things.  But, memory loss strikes a chord with me.  Maybe it always will.

Back to my story…

So, after we rule out all of the reversible stuff, there is a conversation about where to manage things and about safety.

I had to tell this person they can no longer drive. This person who is the same age as my grandfather who just died.  This person who has been driving their entire life.  Who lives far from everything.

But, to complicate things, their judgment is poor.  Their insight is absent.   “I just forget a few unimportant things.  Who needs to know the date or the season.  That isn’t needed for driving,” they say.  They blame their spouse.  They yell at me.  They threaten to harm themselves if they can’t drive.  To destroy the car so nobody can enjoy it.

I empathize.  I mean, I can’t imagine what I would do if someone told me I couldn’t drive.  When I had that terrible torticollis earlier this year, I couldn’t drive for a week (something about moving one’s head that is important to the driving process) and I didn’t like it.

I empathize because my family had the discussion that when my grandfather lost his license, it would kill him.  I empathize because it crushed him, even though he was so sick, to hear that he shouldn’t drive.  I empathize because I have had family members get upset because I seemed to be stopping them from doing something they thought to be harmless for their own protection.

I had to explain that I will be sending a letter to the motor vehicle branch.  That they can be arrested and fined if they are caught driving.  That they are at risk of hurting someone, even though they would never mean to.  And that if I didn’t say something, I could be fined.

I know in my head anything I say won’t make a difference. That it is still, to that person a blow out of left field.  And that they will forget as soon as they leave and their poor spouse will have to deal with their anger.

I left to get something and came back.  They had already forgotten I told them not to drive.

I can’t imagine what it must be like.

I wrote the letter and dropped it off with the admin assistant to be sent.

I keep thinking of that person.  Their family.

My parents take care of both of their mothers.  Both of whom have Alzheimer’s .  They present very differently.  One is relatively easy, childlike.  The other is difficult and can, at times, be downright nasty.  They are both (as of yesterday) in facilities to keep them safe and help with their care.  Where we don’t have to worry quite as much about them getting hurt or lost.

Because really, keeping people safe is important.  But, sometimes it is more of a struggle to balance the safe and happy.

When I see people coming in, especially when these changes are new, I recognize the scared looks.  The uncertain questions.

I find it hard to not see it from their eyes.  Maybe because I am living it from the other side (when I can be there or at least vicariously).  Also maybe because I fear that one day I will be that family member or even that person.

I know it won’t be the last letter I write.  Or the last person with memory deficits I see.  I hope it will get easier, less personal.  But at the same time, I hope I keep the empathy.

Delirium

Something I have had a gift at acquiring lately… Patients with delirium.

Okay, I am an oncology resident.  And many of the patients we wind up admitting onto the Rad Onc service are those who are elderly and with multiple medical conditions, two things that predispose you to a delirium at baseline, then you add admission to hospital and one other little thing happens and poof… Delirium.

In fact, I have been so stuck with delirium, I did a presentation at rounds about it.

Delirium, for those of you who may be wondering what the blankety blank I am rambling on about, is a condition in which patients develop acute onset of fluctuating changes in their mental status accompanied by all kinds of sequelae that is due to an underlying medical condition.  People who are older are more at risk for this.

There are a ton of theories as to the cause of delirium, mainly involving changes in neurotransmitter caused by various chemicals due to disease and the body’s response to disease.

The biggest thing is that delirium sucks.  Very profound.

Delirium increases the odds of death in age and disease matched people.  It increases the length of stay in hospital and risk for complications.  It increases the risk of cognitive impairment in the future.  People who stay delirious for a long time can have significant deficits.

People who are delirious are confused and can be very drowsy or agitated.  Some of them have hallucinations or paranoid ideations and all kinds of other miserable things.

It is sad to see someone who is very delirious.  Especially if you know them at baseline.

The people who are agitated and paranoid are the most distressing to me.  If you are drowsy and such, it is sad, but people who are agitated and paranoid and hallucinating are so terrified and endanger themselves in all sorts of ways.  Non-ambulatory old ladies trying to leap out of chairs to “defend herself.”  People refusing medications because they are poisoned.  Hearing screaming children and seeing animals in the corners.  That is scary stuff.

From the outside, it is easy to try to redirect them or say things aren’t real.  But, for that patient, it is real.  So real.

I can’t imagine what I would do if I heard screaming children and thought people were out to get me.  I would freak out too.  Especially when they respond by telling me it all is not real and pin me down with a tranquilizer.

There is a good chunk of research into delirium.  We now know restraints make it worse.  That it is good to redirect, but not argue with these people.  We know that the best treatment is to fix the underlying problem (though, sometimes it isn’t easy to find).

But still, so many people become delirious.  And the fear in their eyes when you really look at them can be heart breaking.

Not everyone is so bad off.  Some people are “pleasantly confused.”  Better than being paranoid.  Still, it is hard for the family to see.

Patrick’s grandmother was delirious and it was miserable for everyone involved.  She recovered from the delirium, thank goodness.  But not after arguing about the lion in the corner and seeing all kinds of weird stains on our clothes.

I wish there was something sunny I could say other than most people recover.  But, really there isn’t… Aside from the fact that people say funny things sometimes… Like looking for a mailbox to mail their underwear…. Naked except a towel… In a hallway.  Not funny at the time, but entertaining in retrospect (to the person included).  Or the time my grandmother powerwalked away from her special care home and made it to the town border before people caught up with her.

At least we can treat it, for the most part.  And provide comfort the best way we can.

On a lighter note… An MGMT song with Delirium in the title.

Don’t Forget the Lyrics: Music and Memory

I love music… In case you didn’t already know.

The only proof he needed for the existence of God was music. –Kurt Vonnegut

Well, in relation to this music love, I saw that one of my Facebook friends posted this video.  And generally I don’t watch videos people post on Facebook.  But, this one related to two things I love… Music and old people.  Oh yes.

Take a moment and watch this.  Seriously.

I almost cried when I watched it.  The transformation of people listening to music can be amazing.  Especially if it is familiar and loved.

It gives me the feeling of love… I figure right now the world needs to come into music. -Henry

The change in Henry is so apparent.  You can tell he loves music.  You can tell it is genuine and that he is still affected by his underlying disease process, but when he sings, it is almost as if nothing is wrong at all.

In high school, I had to take this course called “Theory of Knowledge.”  I preferentially thought of it as “knowledge of eye gouging.”  But, despite that, I learned a fair bit.  One part of the course involved doing a half hour presentation on a way of knowing.  I did my presentation on music as a way of knowing.  I also ended up doing one of my big biology research projects on music as a memory tool.  Both of these looked at the ways in which we remember things based on musical sequences and talked a bit about why we like music and remember music.  Interestingly, by using music, we tend to remember things better because it engrains both the verbal information, as well as the pattern of the notes and the rhythm.  Different brain bits working together.  And our music bit of brain is one of the last to atrophy.  Therefore, it takes more work to break up the bits from communicating and thus we remember music longer than a lot of other stuff..

Bach gave us God’s word, Mozart gave us God’s laughter, Beethoven gave us God’s fire. God gave us music that we might pray without words. -Unknown

Music therapy is a popular technique in medicine today.  The children’s hospital where I did pediatrics has a music therapy program.  Some of the very profoundly disabled children respond more to music than anything else.  It can be used to help with reaching developmental milestones, including various physical skills and cognitive skills.  Plus, it is fun!

Hospitals and nursing homes, like the one shown in the video also employ music therapy…. Generally, this is done informally in many of the places around here… Playing music for people who like it, having groups come in to perform and encouraging participation.  But, it can be done more formally by music therapists, who are trained to reach out to people using music.

A great description of music therapy is found in the Jodi Picoult book, Sing You Home.

I think music in itself is healing. It’s an explosive expression of humanity. It’s something we are all touched by. No matter what culture we’re from, everyone loves music.
-Billy Joel

Anyway, being a part of some of the more informal music groups involved with hospitals and nursing homes, I have had a chance to see the difference music makes.  Generally for the better (though, there was this one time my high school band was at a nursing home where one of the residents repeatedly yelled at us “go home!”  To which the conductor replied, “Sorry, we don’t take requests.”).  I have seen people bob and dance.  Smiles on those who rarely move.  People singing and laughing.  It is just fantastic.  The med school choir has gone in to the ICU to sing at Christmas time and it was great to see the reactions of both patients and families.

Even more informally, during my rotation in a Hospice, I had informal jam sessions with one of our more musical patients.  We even did little mini-shows for the other staff and residents (see post here).  Good times.

When words fail, Music speaks. – H.C. Anderson

One of my grandmothers has Alzheimer’s and it is interesting to see her when the “oldies” are on the radio, particularly old fashioned country music.  She sings along and looks quite content… Rather out of character for her (given that she once claimed to hate this music and would try to convince my grandfather to listen to the nice new country).  She doesn’t always know who she is driving with, or at least how she knows them, but she remembers the words or at least the tune.  Pretty interesting.

Music, after all, is the background score to our lives, not merely surviving in our memory banks long after so many of our seemingly stronger memories have faltered, but serving to remind us of who we were at a given moment of our lives, where we were, what we dreamed of, what we feared, and of course who we loved. –Unknown

I also had a patient who had meningitis in her teens and was minimally responsive.  She was admitted for sepsis and her care worker from her nursing home told me on history that she loved music  It seemed irrelevant.  But, every day I would go in, she would look terrified… In a “bair hugger,” a private isolation room and alone, I would be terrified too.  So, I decided to give it a try.  I sang her songs during my assessment.  Whatever was in my head.  Once she was improving, she would smile and make eye contact (maybe she was laughing at me, but whatever works).  I like to think our music moments made her stay a bit better.

One good thing about music, when it hits you, you feel no pain.
-Bob Marley

So, there you have it.  Music is good for people.  No matter what state their mind is in or seems to be in.  When I am old and demented, I want people to play me music.  Because maybe something inside me will switch on, at least for a few moments.

For more information on music therapy and the project to bring ipods into nursing homes to help more residents, please check out Music & Memory.  They even have resources for caregivers!

Related posts: An Old Man and an iPod Shuffle (cucumberjuice.wordpress.com), The Magic That Is Music (ninedegreesbelowzero.wordpress.com), Power of Music (amysreallife.wordpress.com), Music: The Most Powerful Medicine In The World (metalstate.wordpress.com), Music & Memory.

Nursing home Christmas surprises

Earlier this week, I went to a Christmas party at my grandmother’s nursing home. She has been in the home now for a bit under a year and has settled fairly well.  She has a group of friends who she eats with and such.  She has her own room (she didn’t for the first few months), so she has stopped thinking her roommate is stealing her stuff.  There is a cat in the home.  Who she feels likes her best.  She hates the food half the time.  Complained about her mattress until they bought another one.  But, she is the most settled and happy I’ve seen her in years.  She has never really been a happy person.  She lived in the hospital for almost a year waiting for a nursing home… Not a good place for a mobile Alzheimer’s patient.  Prior to that she lived in a special care home… Until she ran away.    She hasn’t been in her own home since just before we got married.  She shouldn’t have been living alone even then.

The nursing home staff are fantastic with her and all of her ups and downs that come not only with her disease, but her premorbid personality.  They encourage her to participate on days when she would prefer to stay in bed.  Its great.  The home takes them to the malls, they had a Christmas bazaar and all of that good stuff.  She is more active now than she has been for years.  They have many events that include family, one of which is the Christmas party I went to.   I often can’t go because I am away.  My mom pretty much always goes.  I find her care for her own mother remarkable, given all that she has been through.

The party was a hit.  We got there early, to get parking.  We were lucky enough to get seats at my grandmother’s regular table with her friends… One is a 90-something year old lady who was living at home independently and decided to move into the home electively, as everyone she knew was “either dead or dying.”  She is physically and mentally well.  She helps a lot with my grandmother.  Makes sure she finds her room at night.  Another lady has Alzheimer’s too.  They sometimes grate on each other a bit.  A third is deaf as a post and seems quite frail.  There is another lady who wasn’t there that night.  She is quite depressed, but very nice when she comes out.

My grandmother still knows who I am… Usually not at first, but once I tell her, she remembers that I am going to be a doctor.  And repeats that.  She tells everyone I have wanted to be a doctor since I was small… Not true.  But we go with it.  She hasn’t recognized me without prompting in at least 6 months.  She doesn’t know who Patrick is at all.   I have never been her favorite grandchild.  I am far too much like my father.  I am far too blunt and independent.  I have embraced that.  Recently, she has shifted and thinks I am quite lovely.  Its nice.  Unusual but nice.

At the party, I snuck up on her.  The surprising thing was, she, after only a few seconds, called me by name and gave me a hug.  She introduced me to her table people.  She didn’t know it was a Christmas party, despite the signs and the music, but she knew her granddaughter was home.  We sat with the table gang.  She complained the music (a live saxophone player) was too loud (on an aside, he was AWESOME), then she liked it, and then she hated it again.  She re-introduced Mom and I to the table people every 5 minutes or so.  She pointed out a few of the staff.  She talked about how she felt bad for “all of the old cripples” and we hushed her.  She pointed out her favorite, “the lady in the pink blouse, in the wheelchair” who “can’t talk at all, but she smiles so big when she sees me.”  Over and over.  But she was happy.  We saw Santa and she had her picture taken with him.  We saw cute babies (who were pointed out to us a million times).  We ate appetizers and cookies and cakes.  Mom and I got the whole table singing along with the saxophone player.  We laughed.  One time, my grandmother kept bellowing at her friend to take another tissue because they are cheap.  Despite her friend taking a couple already.  It was more funny when it happened.  The whole thing was fun.  Much more fun than I anticipated.

We went back to her room after where she showed me around.  She has many Christmas cards from people that she doesn’t know anymore.  Pictures of family on her shelf that she doesn’t always recognize.  She showed me how each of her ornaments work.  The nursing home cat, Molly, visited us.  We had to get ready to leave and she wasn’t sure if she wanted to go back to the party.  We took her back and sat her down.  She went back to gossiping with her friends.

It is wonderful to be at a party like this.  With all of the families and residents.  To see people having fun and enjoying the season.  It was sad to see some people alone.  A few people who were profoundly handicapped had no visitors.  A few very elderly people as well.  I wanted to bring them all to our table and have them be with us.  I figured that wouldn’t go over so well, but that is what I would have liked to do.  I wish everyone had families who could visit.  Friends who cared to stop by.  Sometimes circumstances get in the way and maybe they have visitors at other times.  But I have been in the system long enough to know, that is not always the case.  People get abandoned to nursing homes.  I pray that is not the case here.  I am glad that they were still a part of the festivities.  It was nice to see smiles during the songs and the odd bobbing head.

This was not only a great party, but also one of the most positive experiences (despite the talking about the other residents) I have ever had with my grandmother.  She doesn’t really know who she is anymore or where she is.  She isn’t the same person she was when I was a kid…  It was nice to see her happy.  It was nice to know she is proud of me.

Patrick said to me when we were talking about it that night that God often gives us those moments with loved ones that we need.  A time where they rally and show glimpses of themselves.  Because their loved ones need it.  You see it often in people who are dying.  They get better before they get worse.  I think this was my moment with my grandmother.  I am truly grateful for it.

Alzheimer’s is a cruel disease.  My grandmother is not a sunshine and rainbows person, but it changed the bit of nice she did have.  Its like you loose the person you love and yet they are still right there.  My other grandmother also has Alzheimer’s and is being cared for at home by my grandfather.  She was a nice person, but was strict and stern… not huggy or cuddly.  She is a different person too, but in a more pleasant way.  She plays with my little cousins.  She has hugged me more in the last year than she has in my life.  She is lost but happy.  I wish they weren’t lost, though.  It is difficult when you remember them and when you see them they are nowhere the same.  When you remember a favorite thing they used to bake and they don’t even remember that they made it, let alone the recipe.  When they meet your spouse for the first time every time.  It hurts families.  But you still love them.  And you still have fun.  My French grandmother (the one still at home) enjoys watching simple game shows, she likes to cut up cardboard boxes, she goes for a drive with my grandfather every day… The same route.  My other grandmother likes to go to bingo, especially when she wins.  Mom takes her bowling once a week and she finds that absolutely thrilling (she mocks my Mom’s lack of bowling ability).  Sometimes it is like having a little kid.  Someone to take around and play with.  But they are your grandparent or parent or spouse.

The beauty of Christmas is that traditions go back for many years.  We can talk of Christmas past.  We can admire ornaments on the tree.  We can bake and eat and open presents.  It is a season for Christmas parties and remembering that our Savior came to earth.  It is a time to remember that because of Jesus’s birth, we will all one day be together again in heaven.  And know who everyone else is.

I am grateful to have my grandparents.  To know them.  I am grateful that they are still alive.  I am grateful that my grandfather still knows me.  I am grateful that my grandmothers are well cared for and happy.  I know not everyone is so fortunate.  I long for a day when they remember.  But I am thankful for the little things, like when they recognize me or when they talk about the old days in a happy light.

Alzheimer’s is cruel.  But love conquers all.