Betrayal of Mind

September 12, 2022

Whenever I would go into her house, which was several times a day, Mom was busy. Sorting mail, vacuuming, cleaning her shower, making a meal or cleaning up after it, organizing the pantry, cleaning the fridge. One afternoon, I watched and listened as she sorted through the condiments on the refrigerator door.

“This can stay here.” She said, moving a bottle from one shelf to another. “The cider vinegar comes here. That’s not what I meant. You don't even have to go back in here now because they're greens, they live right here,” she moved them to a central shelf in the fridge. “I don't have to leave that there long; this stays here. Now you have to come help. This is still, this is still the syrup… it's like a Greek puzzle,” she stated.

I um-hmm’d. After several minutes, I stepped in. “Here, Mom. Let me take over. Go sit down, and when I’m done, I’ll bring you something to eat.”

“No, no. I’m almost done.”

“I’ve got it, Mom,” I said and nudged my way in. She stayed in the kitchen and directed me.

I took Mom out for errands a few days later, and we went to CVS together. We’d done a few other things already, and she was getting fatigued. I asked her if she wanted to try the electric shopping cart. I went over how to operate it, and she was off. I couldn’t keep up, which was problematic. She didn’t have complete control, so she was taking some corners and turns at a good clip. Eventually, she slammed into an end cap. She managed to stop it before knocking the shelving down. As I picked up a few bags of chips that had fallen, I chuckled, “Coming in a little hot, huh, Mom?” She burst out laughing, that nervous laugh of relief. Pretty soon, I had tears running down my cheeks. I was laughing so hard. The woman at the other end of the aisle was grinning at me when she caught my eye. That was a good day.

Monday, September 19, 2022

I walked in to find Mom having breakfast at her trestle table. The news was on, per usual. She’d been fiercely watching CNN for weeks. She kept saying she wanted to see how it was going to end. In general, I think she was referring to politics. Queen Elisabeth had died just days earlier, so that seemed like an end, but who knew what she was referring to. She asked me to get her tissues and her phone from her room. When I rounded the corner, I stopped dead and caught my breath. Mom’s furniture had been completely moved around. The garden room wicker was stacked in the center of the bedroom, the chaise lounge was pulled up in front of her vitrine China cabinet filled with ephemera from her mother. The wing-back chair was pulled in front of the dresser. Lamps were unplugged and sitting on the floor. I just grabbed her phone and tissues from the nightstand, turned around, and walked out. When I got back to the dining room, I didn’t say a word about it. We babbled on about the news and the stock market. She had a stack of index cards with notes she’d been taking. She had solved the code, she told me. And now, watching the ticker, she could understand exactly what would happen to any given stock thanks to her secret decoder. She had a flurry of stock symbols and numbers written on each index card in front of her. She was adamant about which stocks I should be investing in. “Call your broker today and get in on this!”

“I will,” I told her. Not that I would have taken her advice right then, but I didn’t have the heart to tell her that twenty-five years after she foreclosed, I still didn’t have enough money to warrant a stockbroker. That phoenix had flown, its history burned up, its ashes blown out to sea.

“I’m sure you saw my room. I moved all the furniture into the middle of the room, away from the windows,” Mom said. “I’m ready for the hurricane, but I need you to go out to the tree and bring in the bird feeder. The one shaped like a pagoda.”

I was impressed not just that she knew she had moved all the furniture, but also that she had, in her mind, a valid reason for moving it. But the tropical depression underway that day was east of the Windward Islands of the Caribbean. Hurricane Ian wouldn’t make landfall in the U.S. until September 28. There was no indication it would be moving up the Eastern seaboard.

I walked down to Mom's room with her to help her make her bed. Did she want me to put any of the furniture back in place? To my surprise, she said yes, but then I worried that she might just try to move it all again, if not today, maybe tomorrow. I went down the hall to use the guest bathroom. Another shock: the toilet seat was up, and the bowl was full of her clothes. I turned on my heel and went back to Mom’s room.

“Um. Mom? Why are your clothes in the toilet?”

“Oh, yes. Just leave them there. I had a bout of diarrhea and need to let them soak before I put them in the wash.”

“Ok, Mom. I think I’ll just run them now. Looks like they’ve been soaking plenty.”

My head shook of its own accord. I was stymied. I called the siblings and Elisabeth. We had relied heavily on Elisabeth’s medical background for the past several months. Without her input, I don’t know where we would have been or what would have become of Mom. Even though Elisabeth’s area of expertise was in pediatrics, she still had each of us beat in medical savvy. It was agreed that we would get Mom to see her primary care doctor. One of us would call to make the appointment and to fill Dr. A. in on the State of Mom before she got there.

September 21, 2022

Kimberly and I took Mom in to see Dr. A. a couple of days later.

“Most people who have atherosclerosis in their heart will have it in their brain as well.” Dr. A. started. “Over the years, she's accumulated small vessel disease in the brain, and that can contribute to dementia.” He continued as though Mom wasn’t sitting right there. “So that’s about 15% of the cases. And about 85% are just Alzheimer's, an almost inheritable disorder, but nobody knows for sure. But in her case, if she's losing her memory, it's probably due to the effect of the small vessel changes that you're seeing. On top of all that, there's the acute insult to her cardiovascular system. That could be promoting a delirious sort of state, like dementia, but it's due to just the instability of what she's going through. It accelerates the appearance of dementia, and so the main thing is to make sure that we check for other causes, which would be infections in the body and stuff like that. Okay, so she seems more confused slightly, agitated that kind of thing?”

“Well,” Mom interjected, “there’s a considerable deal of stress in the world and our family right now. There's a lot of arguing going on and it's extremely, extremely stressful for me, to the point that umm, I don't… I have interrupted sleep all the time but now I'm just awake all night and that's been going on for several weeks now. And as far as memory goes, I know short-term memory but now you're talking about memory ahead of time but I'm still pretty clear because I can remember, you know, way back all kinds of things from the time I was three years old as a matter of fact.”

“Right,” Dr. A. said. “So, all these meds that she’s taking, has this been updated?” he asked me.

“Yes, I went over it all with the nurse. I don’t think anything has changed since we were here last.” I answered.

“Let me ask you about the Ativan. Is that something that you've seen benefit from?”

“Yes,” she answered immediately. “The Ativan.”

“Are you taking it twice a day,” he asked. “And is someone overseeing it?”

“No, it says once a day,” Mom interjected, “says once a day…no, twice a day, you’re right,” she nodded, certain now.

After some discussion about meds, we got into the cognitive questions. “I do have this MoCA test,” Dr. A. said to us. “I’m sure she's probably not going to do well on it, but if you want I'll take her through this.”

“Let’s let Mom decide if she wants to take the test,” I answered.

“Okay,” Dr. A. addressed Mom, “Do you want to take a test for mental status?”

“Sure, sure, absolutely. Yeah, I want to know, I want them to know because I have plans if I have a problem.” I knew she was referring to her plans to “take the pipe,” but Dr. A. didn’t seem phased by the admission. Maybe he was used to geriatric patients saying such things or maybe he didn’t follow her line of thinking. Not hard to believe given her scatter-brained and rapid conversation.

“All right. I want to ask you a series of questions. Don't be insulted, some of them are kind of easy, but it will get progressively more difficult. Well, let's start with that question, what year are you living in right now?”

“It’s 19, no, 2022,” Mom answered.

“Okay, what season are we in, and this one is a trick question because we're literally…”

“We are on the cusp. We’re at the end of the summer going into fall and winter.”

Dr. A continued asking the standard questions and Mom continued to answer them with gusto.

“Next, I'm going to name three objects, and I’ll repeat them a couple of times. And then I'll have you repeat them back to me. I’ll have you say them enough times so that you can become familiar with them, but then five minutes or so from now I'm going to ask you the three objects again and have you repeat them, Okay? You ready for it? The three objects are ball, hat, chair.

“Ball, hat, chair.”

Okay? Repeat them one more time for me.”

“Ball, hat, chair,” Mom repeated.

“Okay, I'll come back to them. Now we're going to do a spelling test. Spell the word world backward.

“DLROW,” Mom’s faster than I could.

He asked her to subtract seven from a hundred. She spit out the answer, and leaned forward in her seat as she answered each subsequent math problem in rapid succession.

I felt like Mom won that round forty-love. Then Dr. A asked, “Can you name those three objects again?”

“Hat, ball, chair.” She said without missing a beat. She was asked to follow various written and verbal directions, write a complete sentence and copy a drawing.

After she finished her drawing and Dr. A took a look at it he said, “OK, well just because you're off by a line, but for the most part you actually did exactly what…”

Mom interrupted him, “I know exactly what happened, but I did…”

Dr. A. took back control. “She scored 27 out of 30, and that does not set off any alarms for dementia. So her unusual state can be explained perhaps by things outside of dementia, okay? Either side effects of medicine or the lack of them.”

“Okay,” Mom said.

Dr. A. turned to Kimberly and me. “What do you guys see is the greatest issue with Mom right now?”

I squinted up my eyes at him hoping he’d recognize my uneasiness glanced at Mom, took a deep breath, and broached the answer delicately as Mom looked on. “I see some confusion and…”

“Oh, most of my confusion is caused by mostly the same thing, and it’s by each of my children.” Mom jumped in. “I understand it all perfectly, however. I can make a statement which they immediately will interrupt with ‘but you don't remember it really was thus and so’ and then I'll say, well, that's your truth. My truth is my truth, and let me tell you why I am saying my truth and then really, really listen to me and don't interrupt because I'll be off somewhere else if you interrupt me. So they'll say ‘but’, I say ‘no words.’ So, I repeat the sentence and then I will say, I just feel this way because I've lived for a very, very long time and I find out that many of the truths that I grew up with weren't truths at all. Our books did not teach us about slavery, we didn't understand what slavery was at the time. The people who signed the constitution themselves were slave owners. We know people, children especially, today and many many people who have no particular interest in history other than what's happening now. Don't want to know about it, they don't care. But I said some of these things that are happening now that we are hearing about and not just political things but just things that we've always, all of us believed in, suddenly that they're teaching in our schools we have books that are teaching them wrong now we have these people who are trying to you know back in the day we used to have civil rights in the school. We don't anymore. They don't allow that anymore, it's against the law? Well, we know now that's wrong. No. Good schools are teaching, they are now teaching the children and I said we thought that our children were going to be really great linguists perhaps because now we are global and we have all these languages. I said, guess what? They can't even speak English. If they are asked a question in class they answer in logo, and the teachers are worried. They said these children will never learn to read. I said, well they won't need to because they're going to throw the books away anyway. So, what is going to happen? Well now we have computers, well, guess what? Computers are going to be obsolete in a year or two. They're going to come out with some other new technological thing that we haven't figured out yet… but people have but we the common people, we don't know.”

Dr. A’s demeanor never changed. When he was finally able to get a word in, he started asking about medications. The Ativan Mom had earlier claimed to be taking twice a day as prescribed had never been taken. It was up in the cabin in my fridge. Mom had no idea we had asked Dr. A to prescribe it; Elisabeth had suggested it be on hand for us if things got really bad. Mom would have been on it for days if we’d had the twenty-twenty vision and the distance from the situation then that we have now. I believe her fierce intellect and the authority with which she said everything made her believable, to Dr. A., to us, and to herself. She seemed so in control, so sure. Her financial advisor called Jay one day asking if Mom was all right. “She called me yesterday and seemed…revved up. And she kept talking non-stop,” Susan told Jay. Jay apologized and tried to explain…but how?

Mom’s mental decline had gone from measured to alarming in the thirteen days after she lost her car in town. Now I could wake up at any time of the night and see her lights on. Initially, I thought it was a random coincidence until I saw the rearranged furniture. The Ativan was intended to help her get some sleep. But just how we were going to get her to take it was a mystery. Mom was a big believer in pulling yourself up by the bootstraps. Depression was a weakness, and willpower was the solution.

“But what were the other two I missed,” Mom asked Dr. A.

He was momentarily taken aback, “Oh, the questions you missed?”

“Yes,” Mom said. “I want to know what I got wrong.”

“Oh, well, the date. It’s the twenty-first today.”

“No,” Mom said matter-of-factly, “It’s not. You’re wrong. I’m sorry.” Her fingers drilled on her leg. An almost imperceptible sucking of air through teeth followed.

Other than a muffled chuckle, Dr. A. didn’t respond, just changed the subject. During the prescription discussion, Dr. A. asked Mom if she was depressed. “You’re anxious, I know that, but are you depressed, too?” he asked. Her hands had been fidgeting, and her feet were busy. She’d been licking her lips. She acted like someone on cocaine: dry mouth, incessant need to talk, nervous, and jittery. And talking like she was really onto something, an epiphany in the clearing.

“I'm very depressed right now. I am, but I don't let it pay— I don't pay attention to it. I know it's there; I don't pay attention to it and if, you know, I thought I was going to be in a completely depressed state, I would kill myself because I'm 91. I've had a pretty crazy life, but a darn good one, and a special family. So, no. No. I'm not depressed, I love every day, I watch the birds, I have fun. No, you know, I’m good,” she said in her circular way.