jmgoyder

wings and things

Volunteering 1

It has taken several weeks to sort out the red tape of me volunteering at Anthony’s nursing home. Okay, let me explain: I will now get paid a small allowance if I do 15 hours of volunteer work per week at a not-for-profit organization.

As it happens, Anthony’s nursing home is not-for-profit so last week the Events Coordinator, Ev, showed me the ropes and suggested things like playing cards with Nat, an 83-year-old woman with Parkinson’s Disease and numerous other afflictions, who is in a wheelchair. Then Ev said, “You can always bring Anthony to sit and watch.” My heart did a somersault.

Well, since I already know Nat, it wasn’t exactly difficult to break the ice on Monday, but I was still nervous. I got to the nursing home before noon and helped Ants with his lunch and explained the volunteer thing then I left my bag and scarf in his room, so he would know I was coming back. Then I went to find Ev who wheeled Nat up to the dining room so we could sit at a table for the most complicated card game I have ever played! [more about that tomorrow]

Nat: At a loose end are you, love?
Me: No! I’ve become a volunteer here and you are my first victim, Nat.

Nat cracked up laughing. She is quite famous for her huge, loud, beautiful laugh. Then she said, “Go and get Anthony.”

So I did.

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My second home

Anthony

In my last post, I wrote a bit about how, instead of taking Anthony out for drives or bringing him home for the day, I have begun to make myself home in his room in the nursing home. For those who don’t know, Ants has advanced Parkinson’s disease with encroaching dementia, advanced prostate cancer and several other conditions. He is 78 and has been in the nursing home for nearly two and a half years. I have already blogged about the heartbreak of that mutual decision, and written about the ongoing ups and downs since then.

Several weeks ago, I realized that I had to stop getting Anthony up and out, and back home, and visiting friends and relatives, and going to restaurants etc. because I could no longer lift him in and out of the car, wheelchair etc. Well I could actually, but the physical strain and emotional stress of all of this maneuvering was taxing for both of us, and Ming too of course.

You see, all of the above jobs were infused with a panicky anxiety. Will the pills work today? What if I can’t get Ants to the toilet in time? Will he try to walk around the farm/restaurant and fall again? What if I have to get the ambulance out to the farm? Will he be too cold and insist that every heater is on? Will Ming cope? Will I cope? Will Anthony cope with going back to the nursing home after being out and about? Will there be more tears than we have already cried?

So, almost as an experiment I guess, I began to spend more time in the nursing home, something I couldn’t have done even a year ago – too boring, too sad, too scary, too confined, too uncertain – I hated it. But gradually, over many weeks now, this has become the norm and the fact that I am spending several hours a day with Ants in the nursing home means that he is no longer so desperate to come home and often, by late afternoon, he thinks he is home.

I keep long-lasting stuff, wine and snacks in one of Anthony’s cupboards, bring a favourite food every day (blue cheese, chocolate, olives etc.) and sometimes it’s a little bit like a party. If the heater isn’t on, I turn it on, put a blanket on Anthony’s legs and do up his jacket up (he is always cold). Then I turn the television on to whatever our program is for the day (Master Chef, Midsomer Murders, Neighours). During the commercial breaks, I mute the TV so we can talk but lately Ants is having a bit of trouble with speech so I have to help a bit. Yesterday he couldn’t get the sentence he wanted to say out so I told him I could read his mind and not to worry. And I can read his mind.

But then his words came out:

ANTS: You make me nervous, Jules.
ME: Why?
ANTS: I’ve fallen in love with you again.
ME: Hell, Ants, we’ve already done that!

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Smiling

This afternoon Anthony was, as is usual now, in his armchair in his room at the nursing home and a bit confused. I put the heater on, zipped up his jacket, put a rug from home on him and changed the TV station to “Neighbours”. Anthony’s hands were cold, so I took the heat bag my friend Jen made and microwaved it for 4 minutes in the kitchen (staff let me come and go from kitchen area now), took it back and put it on his lap, placed his hands on it and put the rug on top.

Anthony was really drowsy – has been all week – but at one point I was able to rouse him (by punching him gently in the shoulder). His eyes were blank until they met mine and I said, “Ants, I love you more than anyone in the world.” Suddenly my eyes filled up with tears.

There wasn’t much response so I tried again, more shoutingly, “Anthony, I just told you that I love you more than anyone in the world, and my eyes filled with tears, and you ignored me!”

Anthony looked into my wet eyes, and his drooping mouth (caused by Parkinson’s disease) curved upwards into a smile. I realize that doesn’t sound like much but to get a smile from this previously jovial person who is now so disabled, is a small miracle. The only thing that annoys me about this smiling scenario is that I have to work very hard to get a smile out of Anthony whereas Ming just has to walk into his room and shake his hand and – BINGO – Anthony smiles – grr!

I’m so grateful for the decades of smiling we did before smiling became an effort for Anthony – not because of sadness but because of how PD affects the muscles of the face. So nowadays I come into his room with a huge smile every single day.

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A new phase

I think Anthony has entered a new phase of Parkinson’s Disease just in the last week or so. Taking him for drives, or home for the morning or afternoon, or out to lunch, or to visit friends/family has all-of-a-sudden, it seems, become something we don’t do any more.

This new phase is partly due to a deterioration in Anthony’s physical mobility, and his current sleepiness. The transition from Anthony and Julie gallivanting off for the day to Anthony and Julie sitting in his room at the nursing home, watching re-runs of Master Chef, has been strangely enjoyable for me.

Today I had to take Ming to town to get the bus to Perth at 8.45am so I thought I may as well go straight to the nursing home and spend the day there. After seeing Ming off, I found myself in an I-can’t-wait-to-see-Anthony-mood (a mood that is capturing me more and more).

So, for the first time ever, I spent the entire day at the nursing home (from 9am – 4pm). Partly, I did this as an experiment to see if I could cope. But my other reason was to see if Anthony would like me being with him in the nursing home rather than going out; he did! I will now plan all of my writing etc. to be done in the nursing home.

I’m not blogging as consistently as before – hope to catch up soon with blog friends.

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A bit like the weather

At the nursing home, Anthony was up and about this afternoon at about the same time he was in bed yesterday. He was lucid, mobile, vocal and quite jaunty.

To me, Dementia resembles the unpredictability of the weather, about which you can do nothing. The other day, a tree was uprooted and fell down during a storm; the next day it poured with rain; the next day it was bright sunshine; and today it is a bit of both.

There is nothing anyone can do about weather fluctuations – nothing. Forecasts can be wrong and often the weather will change drastically from what was expected to something totally different. A storm may shove a sunny day aside and vice versa. And there is nothing you can do about it. Nothing.

Dementia is like this in so many ways. One day, at exactly 10am, Anthony might be able to answer the phone and have a coherent conversation with me; the next day he might be unable to do either. Despite the careful timing of his PDD medications (just like I used to do at home), sometimes he has a huge appetite and other times he has forgotten how to eat. Sometimes he can almost run, using his walker and other times he can’t even take a single step and we have to get the wheelchair.

With over ten years of nursing experience up my sleeve, and a PhD about Alzheimer’s Disease, you would think that I’d have more understanding of the kind of nuances that occur when Dementia has climbed onto the back of another disease like Anthony’s Parkinson’s. And yet, every day is a surprise for me – sometime wonderful, sometimes awful, and sometimes in-between … a bit like the weather.

So what do you do when the weather isn’t what you expected?
You accept it of course, because you have no choice.

[Note to blogger friends: I am still not receiving email notifications of your posts so have been using the WP Reader. This is a much better way for me for the time being but I am not keeping up with you all and I apologize].

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Parkinson’s Disease Dementia and FEAR

I don’t think many people recognize, and acknowledge, the kind of fear that a person with any kind of dementia can experience. Anthony has PDD but can still vocalize his fears, especially after the sun goes down (Sundowner’s syndrome).

About 15 minutes ago, I rang him on his new phone and he actually picked up (doesn’t always remember how) and he was frightened and utterly delusional, thinking that he was at his brother’s house and that a storm had destroyed it, and asking me to come and rescue him. His words were garbled and frantic. I tried to calm him down, then told him I would ring the nurse but he said I wouldn’t be able to get hold of a nurse because of all the workmen were around and it was dangerous.

So then I rang the nurse and told her and she said she would go and check on him and get back to me. There is now an anti-anxiety drug that has been prescribed for these occasions so I reminded her of that.

Now I am waiting for her phone-call. As I wait, I think, with great distress, about how, from time to time, Anthony becomes absolutely terrified at night. PDD and, paradoxically, some of the medications used to treat it, can cause hallucinations, paranoia, confusion of space and time, and fear.

Anthony’s bouts of terror usually only last about half an hour which is the same amount of time it would take me to drive into town and ‘rescue’ him.

When is scared like this, he becomes more articulate despite the fact that what he describes isn’t real. Very soon, I think, he will not be able to talk at all, so it is very important for me that I understand his fear, and try to reassure him. I was in this afternoon, seeing him, and there was no indication he might have one of these ‘episodes’ despite the fact that he was very confused.

I am not just spilling my guts here – I am also saying that if your loved one has dementia but has ceased to speak, they might have the FEAR thing too so your voice on a phone, your visit, your touch, a hug, a cake, a blanket or a cup of tea might just alleviate that.

My heart breaks for those suffering this kind of fear in silence. I just spoke to the nurse and Anthony is apparently okay again and he is being put to bed but what if he is still really afraid? I am so worried, but I won’t be able to see Ants until tomorrow morning by which time he may have forgotten the fear. Oh I hope so.

He is, and always will be, my hero.

[ps. not keeping up with other blogs atm – sorry]

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Ten years ago!

I just found this email draft in my files. I wrote it to Anthony’s doctor and specialist at the time, but I never sent it because I was too shy to be this upfront and personal and, also, neither of them were emailable back then. It gave me a bit of a shock to read my perspective of what was happening to Anthony in 2004, from my new perspective in 2014, mainly because I had lost track of how long Parkinson’s Disease has been part of our lives:

Feb. 2004

[Notes for Drs re Anthony Goyder’s Parkinson’s]

Hello Mike and Robert,

I want to document Anthony’s “condition” before I get so used to it I think it’s normal, whatever the hell normal is. So I am writing to you without Anthony’s knowledge because, from past experience, I have learned that to say this sort of thing in front of him only makes things worse. So this is confidential between you and me. I would hate for him to know that I am this worried and this pissed off.

He presents fairly well to you guys (bravado and all that), then, when we get home and he is back to ‘normal’, he just slumps again. I am struggling with the dilemma of whether to push him to make more of an effort, or to just let him be – ie. I am not sure anymore whether his lassitude, lethargy, lack-lustreness etc. are symptomatic of the Parkinson’s in a physical sense, or if this is a psychological thing – or if this is a side effect of the sinemet.

THINGS I AM NOTICING ABOUT ANTHONY SINCE PARKINSON’S DIAGNOSIS

He has an increased stoop, so much so that he seems to fill more space than he did before and, from behind, he is so bent over that it looks as if he is headless;
His movements are slower – terribly slow; his ability to grasp, pour, reach for, use cutlery, walk etc. – all of these are drastically reduced.
He is exhausted most of the time. He does chores like emptying rubbish into incinerator and long hours of watering garden (switching hoses etc.) but has to sit down often in between all of this. Sometimes he stands for minutes on end outside, looking at the ground. I don’t know what he is thinking.
He seems badly depressed but I’m not sure about this because we still do have a few laughs and great conversations. The main reason I think he might be depressed to the point of needing medication is that he has no energy or incentive or excitement about anything and will not come to watch Ming (our 10 year old) play basketball etc. In fact, Anthony will not go anywhere anymore except extremely reluctantly.
He often doesn’t shave, even if visitors are coming. He wears raggy clothes and he can’t pull his shirts down or his shorts up and doesn’t seem to care. He lies down a lot. He appears morose a lot – I do realise this lack of facial expression is yet another symptom, but sometimes it seems like real moroseness.
He can’t keep up verbally or cognitively with what is going on when Ming and I are having a conversation and he often misses the point of something that is said. This is not terribly noticeable except to Ming and to me. Anthony kind of goes a bit blank or preoccupied and I sometimes have to “translate” what Ming says to him.
Sometimes I may be doing something really mundane like cutting up vegemite sandwiches and he says something bizarre like, “What’s that? Is it meat?” when I’ve only just told him what I’m doing. I do realise this could be an eyesight thing and he refuses to wear glasses, so maybe I’m overreacting – ha.
He has become extremely self-conscious about his appearance (old, bent over etc. – his words, not mine) and avoids all social events.
He will not/cannot drive anymore, except to take Ming to school and pick him up on the days I am at work. The weird and worrying thing about this for me is that he was always car crazy and loved driving but he doesn’t seem to care that he’s lost this. If this is acceptance, fine, but it seems to me that this is a kind of resignation thing. I am not criticizing him – I am worried.
He is ultra dependent on me – my company, my presence. Whenever I go out (except when I go to work), I feel guilty about leaving him.
The drooling thing has nearly stopped, but is still there occasionally. I have always pretended not to notice, of course.

I confronted Anthony about some of these things during our recent row (not really a row, just me upset and him defeated) and his attitude was a silence of sorts – an inability to voice what he must be suffering. Ok, fine, and – yes – I do have empathy and 99% of the time I’m fine with this whole situation. But….

Anthony is worse, in most of the above ways, than when he was diagnosed. To me, this indicates that the sinemet is not quite keeping up with the progression of the disease. He is terribly reluctant to take more pills so it would be great if there were a pill with a higher mg content so he wouldn’t feel as if he were taking heaps. Someone has scared him re the fact that eventually he will become resistant to the drugs.

Once again, I do not want him to know I have said all this to you. It is very important that I seem calm and cool to him and I very much regret being upset and nasty with him the other day. Anthony is not a fighter, once attacked. He is strong, he is resilient, but he seems to crumple in the face of adversity. I do not want him to know any of the bad stuff that may be coming, so please don’t tell him.

Thanks

Julie G

It just feels like yesterday….

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Parkinson’s disease dementia and life expectancy

Okay so I googled this today with a mixture of guilt and curiosity. In watching Anthony’s physical and mental abilities diminish over the last year, I have become increasingly concerned that (a) he will become very depressed; (b) his confusion will cause him anxiety; and (c) he will suffer physical pain.

Some of these things are already happening of course but, so far, he is not in physical pain and – remarkably, in my opinion, – is not depressed in any clinical sense. He is plagued by bouts of immobility and incontinence but we have both accepted these aspects of PD. Recently, however, the confusion of dementia has caused us both anxiety. For example, if he is home for the day, he will often talk to Ming and me even when we aren’t in the room. And sometimes, in the nursing home, he will think we are all home on the farm, and can’t understand where Ming and I are going when we leave him.

It is over seven years now since Antony’s PD diagnosis, and just over two years since he has lived in the nursing home. He is sad a lot of the time, mainly because he misses me, Ming and home, but mostly he is resigned and heroic in the way he has accepted now that he is too heavy for a single person to lift (in and out of bed etc.)

As much as possible, I have tried to inject a daily dose of joy into our equation but sometimes that isn’t enough and visiting him yesterday with my youngest brother and his youngest son, although wonderful, gutted me when we had to leave him, leaning on his walker, waving goodbye, with two nurses ready to take him back to his room.

How long will this go on? I catch myself wondering if sudden death would be better than this excruciatingly slow journey into an illness that has no cure, that ends with severe dementia, and that robs us of the energy we once had to adore each other. Of course the love is still there – maybe more than ever – but it is no longer a gleeful, adventurous, exciting love; it is more like a needy, obligatory, remembered love – not quite real in the here and now.

My grief and love for Anthony are in equal proportions and every single day it’s as if they draw straws to see which one will win – usually love, but not always….

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Anzac Day

Today is Anzac Day (fyi http://www.awm.gov.au/commemoration/anzac/anzac-tradition/) so I went into town this morning to join Anthony for the nursing home’s memorial ceremony. Many of his forbears fought in various wars and he has always become very emotional, as his mother used to, on this day of remembrance, so I wanted to make sure he was okay.

I was surprised to find that he wasn’t particularly interested. The ceremony was an abbreviation of those held elsewhere, probably due to having to fit it in between breakfast and lunch routines, and the usual under-staffing on a public holiday. I sat next to Ants with my hand on his arm during the service but now that he is so bowed over (partly due to Parkinson’s disease and partly due to his spinal condition) he no longer looks up so I had to kind of hold his head up when the flag was raised.

By 11am we were back in Anthony’s room and he was very wobbly (‘wobbly’ is the term we coined some years ago to describe what happens when PD is in full force; his eyes become glazed, he begins to dribble, and he can’t move, talk, focus without prompting). A nurse came in at 11.10am to give him his 11am pill but none of his meds seem to work like they used to so I had to feed him his lunch using a spoon. Like all of the residents in the high care wing of the nursing home, he has to wear a bib. We bantered a bit (well I did) about me having to feed him like a baby and that garnered a small smile from him.

By 1pm, I wanted to go home to my chores and said so. Anthony briefly rallied asking why he couldn’t come too and (for the zillionth time) I explained that, as it was already the afternoon, he would just get more wobbly and too heavy for me blah blah, and he gave me the usual stony look. I then reassured him that I would bring him home tomorrow morning because my youngest brother is visiting with his youngest son.

Tonight I rang Ants at about 6pm and he answered it (yay!) but I had to shout because he has forgotten that he has to hold the receiver to his ear, despite how many times I have showed him how. I could hear his voice saying ‘hello’ but as if from a great distance, so I yelled, “PUT THE PHONE NEXT TO YOUR EAR!” He finally did so and this was our conversation:

Me: It’s ME, Julie, your wife!
Anthony: I don’t know where Julie is.
Me: I’m Julie – it’s me, Ants!
Anthony: Oh, Jules ….
Me: I’m just ringing to say good night.
Anthony: Tonight?
Me: I’m ringing to say good night, Ants.
Anthony: Oh that’s very sweet of you.
Me: So I’ll see you tomorrow morning, okay?
Anthony: Where are you?
Me: I’m home.
Anthony: Is Mum with you? (He meant his own mother who died decades ago).
Me: No, but Ming is. So I’m saying good night and I love you.
Anthony: I … you … bye….

Next year will be the 100th anniversary of ANZAC day and I wonder if Anthony will still be here. If he is, I know for sure that he will not remember what the day commemorates because once dementia kicks in, it kicks hard and that is what is already happening.

The photo below was taken by Jane, one of Anthony’s nieces, at his 75th birthday party here, over three years ago. He doesn’t look like this anymore.

Anthony listening to speech

LEST WE FORGET.

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Macular degeneration

My mother doesn’t like to be written about because she is very private about her life, but, as I’m not so private, I would like, here, to salute her for the following:

When my mother was just in her 40s, Dad died of a heart attack. Not long after that, she developed breast cancer and had to have a mastectomy and chemotherapy. Then, about ten years ago, she began to lose her hearing. Two years ago, she fell and broke her hip and then, just as her hip had healed, she fell off her bicycle and broke her pelvis and wrist. And now she has macular degeneration and has to have six-weekly injections into her good eye to prevent it from getting worse (I took her today for one of these).

Despite all of these situations, my mother is an absolute inspiration to all of us and is as active now, at 79, as she was when Dad died and before. She will do anything for anyone and her volunteer work is beyond belief. She has more energy and compassion and generosity than I will ever have!

After the car accident, six months ago, my mother and my brothers’ families had to deal emotionally with repercussions, injuries and enormous anxiety and yet she always remained calm and in control and absolutely supportive of all of us. My own pain of regret had nowhere to go except to my mother and she helped me to figure out how to keep going. (AND she visited Anthony on all of the days I couldn’t when I had the rotten pompholyx condition).

This kind of mother is rare – the kind of mother you would dream of having – and it doesn’t seem fair that she would now be afflicted with macular degeneration, but she is. A fact. Life. Age. Hardship.

And what is Mother doing tonight? She is probably going to ignore the pain in her injected eye and work on the scrapbook she will give Ming when he turns 21 next January She has done this for each of the grandchildren preceding Ming and she has done it for my brothers and me when we each turned 50.

She is funny, clever, artistic and an absolute legend. And she is NOT old!
She is always NEW!

My/our mother xxx

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