December 30, 2015

This was a particularly challenging morning. After 3 weeks of birthday gatherings—6 of them, with a total of 20 visitors—mom has reached her limit. I wanted to make her 99th birthday a special time. I thought having friends and relatives come visit would bring her joy. After all, there are no guarantees that mom will have a 100th birthday. But the festivities came with a toll. Over the past few weeks, mom’s anxiety has increased measurably. It is possible that the changes in routine and the numbers of visitors played a role. It is also possible that her disease is progressing of its own insidious volition. Dementia places the unwary on a perilous slope. The only way out is downhill.

This morning, mom awoke at 0400, brushed her teeth, and insisted that daddy told her to pack and that he is taking her back to Jersey City—of all places! She accused me of taking her towels. The towels are neatly stacked on a chair in her room for ready access. For hygiene’s sake, these are kept separate from family towels. As I have often had to do, I remind mom that the person she alluded to has been long gone. But this morning, she was angry.

Why didn’t anyone tell me my husband was dead? Why do you keep these things a secret?

But mom, dad has been gone for 18 years. You knew this.

What do you take me for? Do you think I’m stupid? Do you think I’m crazy? I am not stupid and I am not crazy.

I tried explaining her condition—even though I knew it was to no avail. I wanted only to assuage her anger. I told her I loved her and would not lie to her. She wanted to call my brother, but it was too early. Our CNA suggested calling our hospice nurse, who suggested Ativan.

My heart broke. As a veteran medical writer and editor (30+ years), I have long been averse to medication—with the exception of antibiotics when required. In fact, after mom’s brush with death and pneumonia, which resulted in a mild heart attack several years ago—completely attributable to her physician-wary sister, who dragged mom to Atlantic City while she was very ill—I have refused to give her drugs. Mom’s hospital physicians gave me the requisite bag of drugs when she left the hospital 6 years ago. I allowed them—beta-blocker included—for 2 weeks. Then I disposed of them—thoughtfully, of course. Hospice, hospitals, respite care services—all—are amazed when I tell them that mom is not on any drug. I realize this is partially a function of good genes and the absence of serious disease and debility, normal blood pressure (usually low), no cancer, healthy appetite, excellent oral hygiene… Visits to the podiatrist every 7 weeks usually wind up with discussions about venous insufficiency, but little can be done about that. We visit mom’s GP every 3 months or when an emergency requires it. She is current on vaccinations—influenza and pneumonia.

But Ativan! When T. handed me the phone to talk with our nurse, I could barely speak for crying. Thus, L. came to administer the initial quarter dose of Ativan. I felt I had sold out, but mom relaxed. She stopped talking about dad and grandma and how we didn’t tell her that they died. She stopped talking about her brother John and sisters Mary and Rose. She’s is now addressing her friend, the cat on the fan, wondering how it is he has not fallen off and remarking on the heavy rain—no rain today. Still, she is also not packing and getting ready to go home. They are no longer coming to pick her up. Mom’s breathing has returned to normal. The anxious rasp is gone. She is more relaxed, but she is gone.

Every doctor and nurse would tell me that having her relaxed is preferable to having her anxious. I have no argument with this, but the Ativan also took what was left of her memories, however unsettled, and packed them away more deeply. I am reminded of Nurse Ratched in “One Flew Over the Cuckoo’s Nest.” How far do we go? Do we grab the Ativan every time we want a minute’s peace? Or is mom given a bit of respite from unsettling thoughts, too? I don’t know.

I know only this: Mommy’s gone and daddy’s gone again.