Dr Alemayehu Part ll

Continuing with his exam, Dr Alemayehu asked Miss Cathy to spell “world” backwards.

“D, W,R,L….no, that’s not right.” Then she started over again.” D, L, R, R, O,W”

Nodding at her effort (but still making no judgment or comment) he said, “read these words for me” and then he had her repeat “apple, book and key” three times out loud before asking her to move from her chair to the examination table so that he could have a better look at her and administer a series of quick “hands on” tests that lasted about five minutes.

He had her open and close her eyes, follow his pen with her eyes only, tap her fingers then grip his hands firmly with hers and squeeze. After one of these texts he put his pen/pointer back in the breast pocket of his doctor’s jacket and asked.

“Do you remember the three things I had you repeat to me?”

“Yes,” she said, pondered, then started to recite,” Apple….uhhh, gosh, I had it right a the tip of my…..apple and key.”

Miss Cathy tried a couple of times to remember the third item, looking up and around the room as if it were somewhere to be seen, a visual clue somewhere in the small sterile exam room. Finding nothing to help here (and knowing that I’d be of no use) exasperated, she gave up.

After writing some notes in her file the doctor looked at her and reported, ”I’m very pleased with where you are, you remembered two out of three things. That’s very good.”

Hearing this unexpected praise she sat on the exam table, legs dangling in the air like a child sitting on a dock on a summer day who’s just received a Popsicle.

He told her that she could get down from the exam table and once they were reseated in their chairs the doctor asked if she had any questions for him.

Yes doctor I do, “Will the Aricept improve my memory?” she asked.

“No”, he answered, “it keeps your memory ‘where it is.” He went on to tell her that the Aricept buys a patient time because it manages to keep a person from progressing any further in the disease (for awhile anyway, until it doesn’t work anymore) but the doctors have no way of knowing how long that will be.

“Will I be able to determine when my memory is failing me?” she asked.

“It’s a gradual process”, he explained, “and I cannot give you a time frame. But, I was concerned about your memory and after seeing you today I can tell you are in the same place you were when you came to see me last. So, your memory so functioning well.”

“Drawing the clock is abstract thinking, which is difficult but you did very well except for putting the numbers in the middle of the clock.”

“I’m very pleased with how well you’re doing so why don’t you come back to see me in six months.”

I helped Miss Cathy gather up her things and drove her back home where she couldn’t wait to get on the phone to call and tell all about her “glowing” report from the doctor.

Who could blame her for being ecstatic, a year ago we sat with the doctor at the beginning of her diagnosis and were full of questions and uncertainty. Six months after that we (all, as a family) had made adjustments in lifestyles and expectations as to what the future could hold.

And now we are in this holding pattern, a “grace period” if you will, life settling into the new normal with no idea when change will occur of how it will manifest. Until that day, Miss Cathy and I will just take it one day at a time and before you know it, another six months will have passed and we’ll be back sitting with the neurologist again.

Hopefully, she’ll be drawing clocks just as well and remembering just as much.

Dr Alemayehu Part l

A Friday morning appointment with Miss Cathy and her neurologist, Dr Alemayehu:

“How has your summer been?” He asked her after we were seated in the examination room.

“Oh fine, fine”, she replied, eager to update him, "it’s been wonderful ever since you said that I could stay at home by myself; gosh, you don’t know what a blessing it’s been not to have to go anywhere when my son goes out-of-town. It feels wonderful so I truly thank you.”

“So”, the doctor said smiling at her, “you’ve declared your independence! Well, that’s very nice, I want you to know that I prayed for you.”

“Did you, oh bless your heart, thank you doctor.”

“Now”, he said suddenly becoming more doctor and less old acquaintance, “ I want to ask you a couple of questions.”

“How do you function? “How is your memory?”

“Well”, she said,” I do alright, but I get nervous.” When he asked what she meant she told him about the earthquake and having to go to the emergency last month because she was so upset over her granddaughter being in the hospital.”

He listened but didn’t comment right away, then he said, “I want you to take this pen and paper and I want you to do something for me but I want you to listen carefully before you start.”

He told her that he wanted her to draw the face of a clock and to put in the numbers where they should be, then put the hands of the clock on 10:45. Satisfied that she understood what he was asking of her he got up from his seat and left the room.

I looked on from my chair in the corner as she drew the circle, then the number “6”, then the “12” and the numbers 1 through 5 down the right side of the clock (pretty good so far) then she put the number “9” almost in the center of the circle and the rest of the numbers were in the right order but they were more or less vertical instead of following the left curve of the circle that represented that side of the clock.

“What time did he say,” I heard her ask herself,” was it 10:45 or 11”45?” Then she looked at me and asked me, “What time did he tell me-11: 45?”

I mimed zipping my lips and she said, “Come on now, hurry up and tell me so we can get out of here.”

“No can do,” I said, “ It’d be like helping you cheat on a test.”

Since she drew a very short hand that went from the middle of the clock to the eleven and another verrry short hand that pointed toward the nine it was hard to tell what time she was trying to indicate. But when she was finished she wrote “11:45” at the top of her page so that her intent wouldn’t be misinterpreted.

Dr Alemayehu came back into the room, sat down in front of her once again and studied her drawing. “Do you think this right?” and when she said she thought it looked like a clock he said, “ I’ve never seen a clock with numbers running up the middle and the time was supposed to be 10:45.”

But he seemed satisfied (enough) with the drawing so he continued with his questions.

“What floor are we on?”

“First”

“”What kind of office is this?”

“Neurology doctor”

“What’s the date?”

“Eight, August, twenty-eleven.”

“Who’s the President?”

“Dr….uhh, Obama.”

“The one before?”

“Oh, I will never forget him-Bush.”

Then he showed her the word “world” written out on a piece of paper and asked her to spell it backwards.

Next week: Part ll

This 'n That ll

Routine and structure seem to be the anchors that ground a person with Alzheimer’s and this is definitely true of Miss Cathy. She has a set routine and it (more or less) seems to work for her on a daily basis. Most days she’s content with being at home, talking on the phone, taking her nap and watching television. But even within the confines of that familiarity there are the occasional mood swings (usually misplaced anger) that can erupt within the course of a routine day and they are (still) surprising and hurtful but (now) it is about as bad as an unsuspecting pinch on the arm.

I’ve noticed that having a routine can be a double-edged sword because with each day being the same it becomes hard for her to distinguish one from the next. So, occasionally she will forget what day it is but let’s face it, who wouldn’t-living like one of the characters in the movie “Groundhog day”.

Days when she has to venture outside of the condo like a trip to the doctor’s office or to the market can be very stressful for her. Even after a seemingly good day, being out with her girlfriend, Adele she’ll come home pretty much worn out (no matter how “good” a day she’s had). More often than not she’s visibly drained, agitated, and grumpy, leaving me to wonder sometimes how long it will be before she stops venturing out all together.

She does like to busy herself with “projects”, some big, some small. It could be anything from organizing her calendar to going through old paperwork or looking through her closets to find things to donate to charity.

Miss Cathy doesn’t want for much and seems to me to be content to complain just for the sake of hearing her own voice most of the time (and that’s cool, because most of the time I’m only half listening anyway).

Lately thought I’m finding that she will start a project but I’m the one who ends up finishing it, or if I don’t have to finish then I need to make sure that the project’s completed and there are no loose ends to tie up.

The other day I came into the living room to discover that she’d “re-potted” a plant but when I looked down into the new, larger pot I could see that she’d done no more than stuck the plant (crooked) in the larger pot, leaving the roots exposed.

When I called this to her attention she said, “I know, it needs some more soil to fill it in but the bag was too heavy.”

I’m thinking, “Okay, that makes sense but the bag has always been heavy so why even bother?” Unless of course she knew that I would have to finish re-potting the plant in which case that would make her a pretty clever duck.

I'm Okay, You Okay Part ll

I was on my way out the door but feeling uneasy about leaving Miss Cathy by herself, even thought the earthquake had long since passed. I had my metro card in one hand and the other reaching for the doorknob. I knew I’d heard what I wanted so that I wouldn’t feel guilty but I also knew that my gut was telling me something else and I’ve learned (after so many times of not listening) that “gut” trumps whatever I’m thinking so I said, “You know what, I’m not going to work, I’m going to stay here with you.”

Although she said she’d be “fine”, I could see that Miss Cathy was visibly calmer.

I put my shoulder bag down and went to call my boss only to discover that my cell wouldn’t call out (still not realizing the extent of the damage done by the quake). But I realized that I could still text so I sent him a message, changed clothes and joined Miss Cathy on the sofa to watch the news coverage.

We sat watching the television as the full scope of what occurred unfolded before our eyes; there was no loss of life (yet reported) but the quake was felt from the Carolinas up to New Hampshire with varying degrees of impact depending on where you were. Every federal building in Washington DC (where I was headed) was evacuated and most businesses shut down for the rest of the day. The metro (which I would probably have been riding into the city) was slowed down to 15 miles an hour so they could check all tracks for damage. I listened as the newscasters did there best to report the news “ live” without the teleprompters to give them the cool, impersonal polish they usually have during regular broadcasts.

I text'd family and friends asking how they were (if they were on the East coast) and to let them know that we were okay.

One of the reporters commented that we’re lucky to be living in a time when technology has advanced to a place where even if land lines were down and you couldn’t get a strong enough signal on a cell phone to call, one still has the ability to communicate via text. To illustrate his point the camera pulled back and you could see most people on the streets were busy texting on their cell phones.

The same was not definitely not true of the earthquake in I experienced in Manhattan in the early 1980’s or even ten years ago when I was still living in New York City on 9/11. I don’t think I had the ability to text on my phone that day or if I did it was so new (to me anyway) that I didn’t know ‘how’ to text. No matter, the events of that day are buried deep, no need to dredge them up now, suffice to say, I don’t think texting was as prevalent as it is now.



I sat next to Miss Cathy wondering, “what was I thinking?” to even debate whether or not to leave her alone. I was disappointed in myself that my first (and only) response wasn’t to stay and support her. And (during the quake itself) when my first instinct was to make sure my IMac didn’t topple over (granted I was standing right in front of it) instead of immediately rushing out to take care of Miss Cathy, I had to wonder (again) if I’m seriously cut out for this job.

I’m like that overwhelmed parent that leaves the baby in the car seat “on top” of the car and starts to drive away before realizing that ‘something is missing’ AND then remembering his primary obligation and purpose.

I hope whoever is keeping score won’t deduct too many points from me for that day.

I turned and asked how she was doing and she said, “I was heading into the bedroom to take a nap when it happened but I’m wide awake now.”

“I guess that earthquake fixed you for sleep”, I said smiling.

Miss Cathy said that “if’ it happened again she would go downstairs to a neighbors apartment. I told her that the best place to be if an earthquake ever happened again (and I’m not around) is to move away from all windows, especially the sliding glass doors, and stand under a doorframe in the back of the apartment.

I held her hand and made her promise she wouldn’t go outside the apartment and risk falling down the stairs. I told he that her balance isn’t good on her best day and in a panic with the ground moving it was a recipe for disaster.

She promised she would heed my advice (but she also promised to stop talking on the telephone in the living room while she was cooking) so I knew to take any pledge she made with a grain of panic.

The phones were back in service an hour or so later so mom jumped on the horn to call family and friends, expelling some of her nervous energy.

I took the time to go back to my room to do the same. The news reports said that the last earthquake to hit anywhere near Washington, DC was more than 100 years ago-an amazing little factoid.

Less than a week later most of the East coast was battened down bracing for Hurricane Irene. Again, we were spared any major damage by the time it hit our area as Irene had been downgraded to a tropical storm but holy moly-that’s a lot of Mother Nature for one week!

Since there had been so much coverage on the weather channel about the impending hurricane Miss Cathy was mentally fully prepared. She wasn’t nervous at all, just concerned as she watched the coverage.
Hurricanes and earthquakes can be traumatic for the most stalwart of us, making it all the more difficult for anyone with cognitive and/or behavioral issues. Special attention must be paid during and after to keep them calm and to explain the unexpected in a manner that is reassuring to them in a way that they can understand.

The experience taught me that like other aspects of our life living with Alzheimer’s that have had to be adjusted, it’s best to be prepared in the event of a natural disaster and I found some great tips on the Alz.org website at: http://www.alz.org/nca/

So, thanks to what I’ve learned I’m okay, do yourself a favor. Learn what you can do so that you’ll be okay, too.