Monthly Archives: January 2017

Inconsistent Memory vs. Nightly Rituals

I always thought that dementia sort of followed a general path. Longterm memory stayed the longest. Short term memory went, and everything in between was up for grabs. I’m finding out that it is not quite that simple.  I have found with my mother that there is inconsistent memory–sometimes there, sometimes not.  There are also consistent memory lapses that become nightly rituals.

Inconsistent Memory

My conversations with Mom generally go pretty well, albeit with several explanations and helping her with (or guessing) her intended responses.  However, I have to be prepared for the shifting of understanding from one day to another–the inconsistent memory. For example, some days she thinks she is in England. Other days she knows she is in the States.  (Click here to read “Continental Drift.”)  Some days she has the delusion that the people on TV are looking in through a window at her. Then occasionally she knows it is simply TV. It is that inconsistency that intrigues me.

Nightly Ritual #1

However, there are certain things that never change in her mind, resulting in a nightly ritual that we follow.

Mom is completely unaware of her current surroundings and the people she spends her day with. The two male residents in her care home spend the day in their bedroom. The four ladies spend the day in the living room, sitting in their own particular recliners. It is not a big room. If I pull up a kitchen chair next to Mom, I can touch ‘Betty’ in the next chair.

I visit every night after their dinner.  This time was suggested by the staff so that Mom can stay up later, and we can have an easier conversation on our own. Mom is already dressed for bed and sitting in her wheelchair instead of in her recliner.   This puts Mom next to Betty’s chair-side table. Every night Mom asks me about the two photos on that table. Every night I explain who the people are. Betty is in both.

“Who’s Betty?” My mom asks.

“Betty’s the lady who sits here.”  I indicate the recliner next to Mom.

Mom is trying to conjure up the woman who sits by her every day without success.

“Your roommate,” I try.

Mom’s expression becomes even more disbelieving. “I don’t have a roommate,” she retorts. “What do they call her? I’ve never heard ‘Betty.'” She’s annoyed and going to put me in my place.

“They call her Betty, Mom.”

“Oh.”

Every single night. I even turn the photos away so Mom can’t see them. She picks them up anyway.

Nightly Ritual #2

The other part of the ritual is:

“Suzanne, do you know if there is a toilet here?”

“Yes, it’s the first door down the hall.”

“The hall?”  I point behind her and she turns around searching.  “Do you have to go to the bathroom, Mom?”

“Yes, honey.”

“You were just coming out of the bathroom ten minutes ago, Mom, when I got here. Are you sure you have to go again?”

“Oh, I—”

“Or do you think you could wait until right before bed?”

“Okay. Yes, I can wait.”

Nightly Ritual #3

And that, of course, leads to the next part.

“Where am I sleeping tonight?”

“In your bedroom.”

“I have a bedroom?”

“Yes, it’s down the hall.” I’m pointing again.

“Down the hall?” She’s looking again.

“Yes. ‘Teresa’ and ‘Sarah’ have a room. ‘Dave’ and ‘Jim’ have a room. And you and Betty have a room.”

“Oh.”

“Do I have . . . ?” She points at her body.

“Your pajamas? Yes, all your clothes are there. You’re already in your pajamas.”

“Oh.”

She doesn’t believe me. She’ll never believe me. We do this every night, but she doesn’t recall any of it. Nothing about the hall is familiar to her, and she doesn’t remember Betty is sharing her room or even what Betty looks like. (No need to pay for a private room, people.)

Nightly Ritual #4

By this time, the rest of the residents are all in their beds. The staff are getting ready for the next day, preparing meds, doing whatever breakfast prep they can do in order for things to run smoothly in the morning. In the course of time, chopping or stirring sounds come from the kitchen.

“What is that noise?” Mom asks with concern.

“That’s Anne getting breakfast ready for tomorrow. She’s in the kitchen.”

“There’s a kitchen?”

“Yes,” pointing yet again. “Right next to the dining area.”

“The dining area?”

(I’m screaming inside, patient outside.) “Yes, that’s the table you all sit at.” I’m pointing again. It’s literally ten feet away.

She’s peering at the table. For her, it’s the first time she’s ever seen it although she sits there three times a day with the rest of the residents.

Nightly Ritual #5

More kitchen noises.

“What’s that noise?”

(Aggggggh!!) “That’s Anne cleaning up the kitchen.”

“Who’s Anne?”

(Give me strength.) “She’s the main lady here who takes care of you. You like her very much.”

“Oh.”

Every night. We go through Rituals 1-5 every night. So, when the night comes when she asks, “Why are those people staring at me through the window?” it’s a welcome variation.  I can leave wondering why her concept of tv changes from day to day instead of focusing on the frustration of the nightly rituals.

And no, it doesn’t help that I’ve pulled the drapes and there are no windows uncovered. That would require logic. Something in short supply these days.

 

For other posts related to memory, click here to read “Mom Discovers I Am Her Daughter,” click here to read “Continental Drift (Where Am I?),” and click here to read “Dealing with Delusions and Memory Loss.”)

Continental Drift (Where Am I?)

Memory is an illusive thing, and when you visit assisted living facilities or care homes, you get used to residents not being quite clear on where they are or where they go on any given day.*

One of Mom’s fellow residents thinks the care home is her own home and that everyone else is visiting. There is nothing in her memory telling her that she moved here to receive the round the clock care she needs.  The staff jokes that they are the maids.

Another resident thinks I can drive by her house to check on it and does not remember that it was sold long ago or that she is not in the same city.

Where Does My Mother Think She Is?  

We moved my mother some 440 miles away from where she has lived for fourteen years to a care home near me in Southern California over the Thanksgiving weekend.  Ever since, my siblings and I have all been wondering what Mom understands about where she is. Although I’ve explained it to her many times, it doesn’t stick in her memory.  A conversation I had with her the other night was somewhat illuminating.

We were talking about her brother who spent Christmas holiday in Scotland with his granddaughter and her baby.  Mom asked me, “How would you get from downtown London to here?”

“Well, you would have to take a plane to either San Francisco or Los Angeles and–”

“A plane?”

Uh-oh.

“Well, yes, because we are in a different country, and you would have to fly across the Atlantic to get here.”

Mom is looking at me as if I’m mad. This information is obviously not what she expected.

I soldier on. “And then it would be a matter of renting a car to drive to here.”

“Oh. What does it cost?”

“Oh, gee. I don’t really know right now.”

“Well, what do you pay?”

“Mom, I’ve only been to England twice in my life, and the last time was about thirty years ago.”

“Oh.”

At this point I think, what does it matter? Say anything. “Maybe 800 dollars or so?”

“Oh, well. That’s not going to work,” she says looking disappointed. I suspect she was envisioning a bus ride, and I have burst her bubble.

It seems Mom thinks she’s in England and has been planning an outing either for herself or for her brother so that they can get together.  I can now tell my siblings Mom thinks she is in England.  (And here we were just wondering if she understood she was in a different part of California, not if she knew which country she was in.  Boy, were we way off!)

Memory Loss:  No Passport Needed

The very next night I tell Mom about an article I read about how to stay warm at night without a huge heating bill. I describe the various suggestions, including adding curtains to windows that just have blinds or wearing a nightcap. Mom does not remember what a nightcap is so I try to evoke illustrations of “The Night Before Christmas” or A Christmas Carol. Nothing registers with Mom. I try the women’s version of the mop cap which seems to trigger her memory. I then confide that I cut off the toes of single socks and wear them at night over the sleeves of my pajamas and up over my wrists.

Mom likes that idea and suddenly comes out with, “Well, yes. People think it’s warm here in the States, but it gets cold.”

I am so impressed. Tonight she knows what country she is in.

In the space of 24 hours Mom has placed herself on two different continents. I’m wondering if she’s on to something. Maybe this is Pangea coming back to us, making crossing an ocean unnecessary. Or, as close to the “Star Trek” transporters as we are going to get. Whichever, it is a very exciting prospect and definitely lessens the importance of an unreliable memory and remembering where you are.

*Click here to read “Swiss Chalet, a Sweet Delusion” which describes Mom’s belief that she had bought two chalets and went to one when she got tired of the assisted living facility.

For other posts related to memory, click here to read “Dealing with Delusions and Memory Loss” and click here to read “Inconsistent Memory vs. Nightly Rituals.”