"Mum, you are the best mother-in-law," I said to the tiny, frail woman curled forward in the wheelchair beside me. I held her gnarled hands in mine and thanked her for raising a great son and being such a good grandma. I complimented her on her cooking and acknowledged her years of loving service to her family. I leaned over and kissed her bony forehead beneath thin, wispy hair. I prayed out loud for her, and she fervently prayed with me...amen-ing my words emphatically. Then I looked into her pale blue eyes sunken deep in their sockets, and told her I loved her and said goodbye. She was tired. She wasn’t sad to see me go. She waved, and as soon as I was out of view I was forgotten. But that’s okay...with dementia it’s each moment that counts, and we had just shared a week of special ones.
I spent this last week at the hospital with my mother-in-law, who has advanced dementia, severe osteoporosis, and is recovering from a broken hip, congestive heart failure and pneumonia. She lives in Canada, 1000 miles away from us. Her care falls largely to my husband’s sister and father, and that care has greatly intensified in the last six months.
There was a day when many members of the family lived near her, and we helped share the load of driving to doctor’s appointments, going out to the mall, hair appointments, and companionship. But over the years we’ve all dispersed, and only one daughter and two granddaughters remain in the city. So with this third broken hip, my husband and I thought it would be a help if I went to Edmonton and gave my sister-in-law and father-in-law a bit of a break.
Dad is a man true to his convictions, and it is very difficult to get him to even consider—let alone change—his opinion on a matter. He was determined that Mum would stay at home and he would care for her, "for better or worse, in sickness and in health." He defended his stance through her episodes of confusion, times of wandering, moments of paranoia, frequent falls, repetitive conversations, countless messes, sleepless nights, total dependence and altered schedule. Last December she got up in the night to use the bathroom and fell in the dark. When my father-in-law found her, she was on the floor, soiled and in pain. He helped her up, cleaned her up, and put her back to bed. But the pain continued to bother her over the next few days, so off to the hospital she went for x-rays. It was a hip fracture, but not a serious one. There was no need for surgery, just rehab. And then the news was delivered: She was considered a high-risk patient because of her dementia and tendency to fall, and the doctors said it was time for an assisted-living facility. Dad resisted, clinging to his commitment. But when presented with the safety issues that his wife faced, he knew that the wisest choice that served her best interests would be to move her to a center that could provide care and protection in her fragile state.
A month or so later she had moved into the facility the family had most hoped she would get. She had a spacious room containing a bed and familiar items from home...her favorite chair, family photos, a dresser, and other homey touches that would bring comfort and beauty. Her room also had a private bathroom. This proved to be not such a great feature. Three weeks ago she got up in the night to use her private bathroom and again fell, this time badly breaking her hip. She was unable to walk and surgery was necessary. She had also developed pneumonia.
Surgery was a huge risk to her in her fragile state...sick with pneumonia, weighing probably only 80 pounds, and with very brittle bones. But the doctor said it was worth the risk, because without surgery she would be bed-bound for the rest of her life. Because of her Alzheimer’s, she would have no idea why she was in bed and would not be able to comprehend or remember that she had broken her hip, so she would spend every day and night attempting to get out of that bed.
So surgery was performed, and she began a long wait in the hospital for...rehab? moving back to her old room? At this point, no one had answers. Rehab facilities refused her because she had dementia. She was unable to work progressively towards goals of rehabilitation as she could not remember that she had broken her hip. Repeatedly she was told, and repeatedly she responded in shock, "I did? How did I do that?" When presented with a walker, she wouldn’t hold on to it. When strapped in a wheelchair, she tried getting out. When placed in bed with the sides up, she attempted to swing her feet out the lower end. She was constantly on the go but going nowhere.
At home in Oregon, I imagined how her days were unfolding...lying in a hospital bed staring up at the ceiling, unable to read or even watch TV because of her short attention span and loss of memory. She would languish there until a visitor came. I wanted to help provide a diversion to her unending days and bring her a bit of cheer and reprieve. So I packed my bags, and my daughter Anna and I headed north.
When I arrived at her hospital room, she was lying motionless in bed. So tiny, like a child, only bent and misshapen. She was asleep, with her teeth bulging out because her jaw was slack. Her skin was pale and translucent. "She looks dead," was my morbid thought at the shock of her appearance. She had always been small, and over the last few years quite thin, but now there was no flesh left. "Skin and bones" was not just an exaggerated comparison, it was truth.
"Hi, Mum," I said softly. Her eyelids fluttered and she sucked her teeth in. "Sorry to wake you," I apologized.
Instantly, she brightened. "No, no...you didn’t wake me. I was just outside in the garden." She struggled to sit up, so I pressed the button on her bed and raised her slowly.
"It’s Karyn and Anna," I said brightly. "We’ve come from Oregon to see you."
"Yes," she said, equally as brightly, "It’s so good to see you!"
I couldn’t tell if she really knew it was me or if she was just responding to her visitors as she always had...with true pleasure at having company. But it didn’t matter. She was ready to visit! We talked about everything. And when I could think of nothing more to say, I started at the beginning and talked about everything all over again!
"Look outside, Mum. The trees are blossoming. Aren’t they beautiful?"
"Oh, I know. Ralph and I were just out this morning walking in the trees."
"I’m so glad we get to spend a little time together!"
"Yes, it’s so nice to come here and see all you guys."
"What have you been reading, Mum? I see you’ve got the newspaper on your tray."
"Oh, I was just reading...you know..."
"Yes, I know. It’s good to read and keep up on what’s going on." "Did you know I brought some fresh strawberries from Oregon? I am going to make a strawberry-rhubarb crisp this week."
"That will be nice. I’ve been doing a lot of baking lately too."
"I’m sure you have. You’ve always got yummy treats for us to eat!"
"Well, I’d best be getting the dishes done now."
"It’s okay, Mum. It’s our turn to wait on you."
And so our conversation went. We talked about the past and the present and events that only took place in her imagination and mixed them all up until they formed this nice rhythm of "visiting." The more we talked, the more lively she looked. How she loves people! They bring such life and energy to her!
Each day I returned, and we settled in to a little routine. I planned my visits around mealtimes, so I could assist her. They said she wasn’t eating very well and also that she did funny things to her food, like sprinkle sugar on her pancakes and spread butter on her meat and pour fruit juice on her potatoes. She ate with her fingers. I realized the tray of food was nothing more than a jumble of very confusing items to her...each dish had a lid, the silverware was wrapped, the salt, pepper, sugar and butter came in little packets...it was too much to process. I took her tray away and set it behind her on the window ledge. Then I took just the dinner plate and a fork and set it before her. She picked up the fork and began to eat...more than half a plateful before she was full! Then I took the plate away and gave her the little bowl of fruit and a spoon. Done! Then I stirred a little sugar in her tea and swapped out fruit bowl and spoon for cup, and she contentedly sipped tea while we visited. Success! The only problem with mealtimes after that was that she kept offering to "fix a bite" of something for everyone else in the room or share what was on her plate. She never let anyone go hungry at her house!
Activities were a lot of fun too. One day it was Bingo. Everyone was handed a card as they took their spots around the table. To my surprise, the very first number that was called, Mum quickly found...on the card belonging to the man next to her! We all laughed, and he graciously handed over his card to her so she could finish playing.
Another day it was Hymn Sing. We were just about to enter the activity room when the first chords were struck on the piano. Instantly Mum’s hand was up in the air, swinging back and forth in time. She was ready to go. We opened our hymn books and she dutifully tried to follow the words on the page. Suddenly, the melody stirred a memory and her brain shifted from recent to remote (or maybe from flesh to spirit!). She looked up from the page and began singing from her heart. The words and the melody were there! She sang perfectly along with everyone else, her eyes shining, her fingers tapping, and my throat tightening! How to worship has nothing to do with memory. Though our flesh may fail, God is our strength and our portion forever!
What I enjoyed most about hanging out with Mum was watching her obvious delight in the constant activity that took place in her hospital room. She was in a room of four, and each patient there had had hip surgery. The turnover rate is quick...they arrive post-op and have about three to four days of stabilization before being transferred out to a rehab facility to continue their recovery. The patients require a lot of assistance, so there is always at least two nurses present when it is time to move someone, and they bring a lot of gear with them. Out of respect for the privacy of Mum’s neighbors, I would turn my back and face Mum when the nurses were caring for one of them. But not her. No, she looked on with great interest, offering a running commentary or advice as they attached lifting devices, raised up wobbling patients on weak legs, put people to bed, started IV’s, helped them walk to the potty, and took their blood pressure. At one point when a team of three was busy preparing to move one woman from wheelchair to bed, Mum leans over to me and says (quite loudly), "Looks like they’re harnessing up a horse!" I snickered, and so did those who had overheard. Then, once the harness was on securely, the machine lifted the woman out of her chair to a standing position and Mum called out gleefully, "Hi-dee-ho, and away we go!" Everyone roared.
One thing that Alzheimer’s does is remove filters. Etiquette and tact often go out the window as patients simply say what they think or feel. The woman next to Mum had very short hair that was cut in a boyish style, and Mum didn’t like it a bit. She kept telling me, "Her hair is too short." Then a cute young nurse walked in and was busy caring for the woman, with Mum watching her every move. When the nurse was done she left the room and Mum called over to her roommate, "You are a lucky man to have such a nice lady like that!" She had fixated on the short boyish hair until, in her mind, her woman roommate had morphed into a man!
On my last day there, I wanted to do something for the family. It was Sunday, and Sundays in the Wells’ household for decades have meant a big Sunday dinner after church with family, friends, and even strangers gathered round the table to share a meal. Although Mum served a varied menu over the years, roast beef was probably everyone’s favorite and the meal that best defined, "Family Dinner," to those who remembered it. I also thought it would be nice for Dad to have the family gathered around his table, since over the years of Mum’s mental and physical decline, we girls had taken over the role of hosting meals and holidays. Today would once again be Sunday Dinner at Mom and Dad Wells’.
While I was excited to prepare and host this meal for everyone, I was totally unprepared for how it would affect me. I put the roast on timed bake before leaving for church, so when Anna and I arrived home that afternoon and opened the front door, the aroma of rich, roasted beef greeted us...and sent us back in time on a wave of nostalgia. "Ohhhh," we both exclaimed.. "It smells just like Grandma’s!" Wow. We were there...in the kitchen 15 years ago, Mum busy at the stove calling out, "Come in, come in!" as her five children filed in family by family, with spouses and grandchildren in tow. The girls headed for the kitchen to help with last-minute preparations while the guys headed downstairs to watch whatever game was on, and the kids ran around like little crazies, playing with their cousins. Then Mum would call down, "Supper’s on!" and the men would emerge from the dungeon with an extra chair each to place around the double-leafed table. Dad was always last, having to squeeze behind half the seated family to reach his spot at the head of the table. Much bickering and bantering would be taking place as the kids were settled and everyone was up and down for a moment to grab the juice or the missed napkins. Dad would rest his head in his hands, waiting until he felt there was a respectable silence, and then he would pray. Inevitably, someone would do something funny during the prayer and those who saw or heard it would choke back laughter, so that by the time Dad said, "Amen," there was a burst of hysterics, and Dad would look up at everyone, shake his head, and mutter, "Cut that out and pass the potatoes."
Enjoying the memories but with work to do, Anna and I busied ourselves in the kitchen, trying to find where Grandma may have put the gravy boat or the china the last time she used it. Many things were missing, but no one seemed to mind eating off the mismatched plates someone scrounged up in the depths of the old china cabinet. We counted bodies and then called the guys up to put in not one leaf but two to expand the dining room table, and then they hauled up the odd assortment of chairs so we could seat a crowd. It was amazing to watch as each family member entered the house and sniffed...and then slipped into the same nostalgia we had. More than one said they felt moved almost to tears by the palpable emotion of the moment.
The crazy last few seconds of getting everything on the table and every person in place happened just as it always had....up, down, laugh, scold, bicker, banter, and then..."Let’s pray," Dad commanded a bit impatiently. We all obediently bowed our heads while he prayed, and then someone giggled, and Dad said, "Amen," and everyone burst out laughing. Dad shook his head and muttered, "Cut that out and pass the potatoes."
What a great meal.
We were missing half the family and, of course, Mum. But everyone’s presence was keenly felt. It was the best Sunday dinner we’d shared as a family in a very long time, and everyone reveled in it.
That evening I went up to the hospital to put Mum to bed and say my goodbyes. Her fatigue was evident in how she had trouble forming sentences that made sense. It was difficult to engage her because most of her responses were disjointed and gave me nothing to bounce back on. I had to resort to my own mindless chatter. At one point I was talking about her grandbabies and spontaneously I asked, "Mum, remember the Danish rhyme you would say to the kids when they were little? You helped me learn it once. I’ll say it for you, and you can correct me if I’m wrong." She stared at me blankly. I began reciting the absolute only Danish I knew:
Ride ride ranke!
Hesten hedder Blanke
Follet hedder Abildgra
Det skal Ruth ride pa
Hesten hedder Blanke
Follet hedder Abildgra
Det skal Ruth ride pa
She began whispering the words along with me, so I said, "Let’s do it again!" She smiled, and together we said the little rhyme with enthusiasm. She remembered all of it.
But she was tired and asked to go to bed. I was happy she was tired. She had had a lot of visitors that day and so had her roommate, which Mum thought were her visitors as well!. Back in her room she said to me, "This is a nice little hut. I feel at home here."
I left her that night knowing that she had been prayed for, visited, fed, and mentally stimulated. Although she wouldn’t remember any of it, she had had moment after moment of feeling loved and appreciated. Now she would sleep and enjoy her dreams of walking in the trees with her husband, gardening, and cooking yummy meals for her family and friends. She was young in her own mind and strong and slender, with the blond hair and light complexion of a Dane. She was rich with family and friends. And to me as I observed her all week, she was still alive in spirit and vibrant in her faith.
"They shall still bring forth fruit in old age; they shall be fat and flourishing."
We all had had a most wonderful week.