Like A Tree Shedding Leaves

Soon the time will come when I can no longer play the recorder.  Well, maybe not soon, but the time will surely come, if I keep on living.  And it seems unfair and sad that, having finally found a way to enjoy playing music, away from the tensions and compulsions of my early experience with the violin, I have only another ten or at most fifteen years in which to do it.  

I went to a memorial the other day for a woman who had lived a life brimming with gardening,  dancing, and art.  She had excelled at all these things, but one by one she had had to give them up--first the gardening, then the dancing, then the art.  By the time I met her she could barely hold a conversation.  She kept shaking her head, apologizing, wanting me to know that she knew what was happening to her.   

How the old apologize!  For a while, in college, I played violin/piano sonatas with an old colleague of my father's.  After a lifetime spent in some exalted music circles, he was losing his grip.  He would forget our appointments, couldn't remember which piece we were playing, lost his place over and over.  And he apologized, and lamented, and insisted on telling me that he knew what was happening to him.  All his pride was focused on his awareness of his decline, on the one thing in the core of his being that was not affected by dementia, not diminished by his inability to find his place on the score or to remember what he had said two minutes ago.  He may have been losing his mind, but he clung fiercely to the awareness that he was losing it—and that was both his torment, and his only consolation.

On my therapy dog visits with Bisou, I watch the various ways in which my fellow Wake Robin residents deal with the myriad losses that age brings, and I feel an urgent need to build a large reserve of humility to see me through the coming years.  I had better make peace with the idea that I am not my writing, or my music, or my hair, or my ability to walk the dog or use the bathroom by myself.  Like a tree shedding leaves in the fall, I will probably live to see each of these abilities leave me, one by one.  How, I wonder, to find a way to do this well, to submit with grace, and to say, with deep acceptance:  yes, this is who I am now?

Bluebirds

Right outside my window, in the little nest box that in past springs has sheltered families of wrens, a pair of bluebirds are building their nest.  Blue, orange, and white he perches, exuding authority, on the little apple tree whose leaves are barely unfurling, while his paler, browner wife thrusts beakfuls of stuff into the box.

(Photo:  Ed Cobb)


On the other side of the glass, I talk on the phone with my sister.  We are discussing whether to put an IV into the arm of our dying mother, to hydrate her.  I Google "hydration for late-stage dementia patients" in hopes of guidance, but that girl bird keeps stealing pieces of hay from the blueberry mulch and stuffing them into the nest hole, and I keep looking up from the screen to watch her.

I find the following and cut-and-paste it to my sister who, unlike me, is on the scene:

"Patients at this stage often refuse to eat or drink, even though they are offered food. This is due to the patient's sense of hunger and thirst diminishing as dementia advances. Once families realize that the patients with Alzheimer's Dementia (AD) often do not experience hunger or thirst, they may be able to remove the guilt they feel associated with "starving them to death" and accept the natural progression of end-stage AD. It is also important to explain that patients with poor food and fluid intake who become dehydrated typically do not express pain or discomfort. It is generally believed that dehydration in end-stage dementia is not painful."

Old Lexi limps into the room, dragging her hind legs, and laps at the water bowl.  At least she's not  dehydrated.

Bluebird of happiness, you ornithological cliche, could you have picked a worse time to visit?  Those little brown wrens in their modest clothes would have been far more appropriate for this season.

And yet, the breeze is cool, the air is clear, the evening light is bright.  For an instant, the bluebird is happiness. 

Old Ladies

One is ninety-four.  The other will soon be fourteen.  One is my mother;  the other, my dog Lexi.

Every time I step over Lexi's recumbent form on my way to or from the kitchen, I think of my mother.  And often, as I worry about and mourn my  mother, my thoughts return to Lexi, lying on her spot in the middle of the kitchen.  Both my mother and my dog amaze their doctors and vets, respectively.  "Her vitals are better than mine!"  the nurse practitioner at the nursing home exclaims about my mother.  "I can't believe she's still walking around," the vet said the last time she saw Lexi.

Both, at their advanced age, look forward to their next meal, and instead of shrinking are putting on weight.  For a long time I kept Lexi skinny because of her arthritic hips, but for the last several months I've let her have (almost) all the food she wants.  Why deprive her of her one remaining pleasure?  Since her bout of encephalitis almost two years ago, my mother has been immobile.  Lexi too is practically immobile, though she does still manage to get to her outdoor bathroom.  I used to think that lying down for months on end spelled doom for man and beast.  But apparently there are exceptions.

Their minds are fading, along with their sight and hearing.  For a while this meant that they gradually and gently withdrew from reality, my mother into a place that held her long-dead husband and parents, with whom she would have long chats, and Lexi into wherever old dogs go to remember.   For a long while, things were peaceful in our kitchen and in the room in the nursing home in Mobile, Alabama.  But that has changed.  Now we give Lexi Valium at night, so that she won't spend it in anguished, wheezy, endless barking.  My mother has become aggressive towards the people who take care of her, and is having to be sedated.

Sedatives seem to take the edge off mental misery.  They also keep my  mother's caretakers safe from her teeth and, I hope, more disposed to treat her kindly.  But sedatives are not good for the body, and the pace of her deterioration is increasing.  Are we, her family, by condoning the use of these drugs allowing a kind of gradual euthanasia?   If Lexi's dementia were to take an aggressive turn there would be no doubt as to the next step:  we would take her to the vet who would gently and quickly put an end to her distress.  But there is no such clarity where humans are concerned.

Through all this, some shreds of their former selves still cling to my mother and my dog.  In the last photo of my mother, her mouth looks oddly crooked, and I worried that she'd had a stroke.  "No, no," my sister, who took the picture, said.  "She told me that she didn't want to smile because she was afraid she had food between her teeth." 

On her part, Lexi still reigns over an invisible territory that the other dogs dare not cross.  If I call them and they don't immediately appear, or I hear them whining in the kitchen, I know that it's because they're stuck behind Lexi, and I have to go liberate them.  "Lexi, I'm watching you," I say, and they sprint past her.

But lately her domain has been shrinking, and Wolfie and Bisou can get past her almost any time they choose.

Weird Blessings

My mother turned 93 last month.  Last spring, after a lifetime of robust health, she became gravely ill.  If someone had told my sister and me then that nine months later she would be in a nursing home, immobile, incontinent, and deeply into dementia, we would have mourned, and despaired, and prayed for a quick, merciful end.

Nine months later, she is indeed in a nursing home--immobile, incontinent and demented.  She is also...happy.  My once hyper-critical mother now loves everybody:  her caregivers, the visitors with whom she cannot communicate unless they speak Spanish (English being a casualty of her decline), the teenage grandchildren who a year ago she thought would come to grief.

When she first became incapacitated, my sister and I most dreaded her loss of dignity.  Would she beg to die when she needed help with...could no longer...?  If, God forbid, she were somehow aware of her dementia, how would her pride, her sense of self tolerate the loss?

In the early days of her illness, my sister and I pored over her advance directive;  speculated about what she would want if things came to "the worst," as in fact they quickly did;  hoped against hope that she would qualify for hospice so we could  benefit from the advice of people knowledgeable about these issues.

But, against all her doctors' predictions, our mother never did qualify for hospice.  To do that--in the absence of intolerable pain--you need to have lost a substantial amount of weight (instead she has gained ten pounds) or have stopped communicating (she talks constantly, to everybody, though never in English).

Strangest of all, she has a sense of humor about her dementia.  On a recent visit, my sister decided to call me so my mother and I could speak.  She handed the phone to my mother. 

"Say Hi to Lali," my sister prompted. 

"Who is this?" I heard my mother ask her. 

"It's Lali.  Tell her who you are," my sister said.

Then my mother said, "Lali, this is your mother.  And I'm calling to wish you a Merry Christmas."  Whereupon she burst into gales of laughter at her mistake.

These days, my mother loves to watch black-and-white Westerns on TV, loves greeting cards (which she has no trouble reading), adores food.  Her religious ties have loosened considerably. On the whole, she has taken a turn towards frivolity.  She is, for the first time in living memory, content.

My sister and I don't quite know what to make of this new mother.  Perhaps we should just enjoy her?