June 02, 2005

It's Starting

My mother is 84, which isn’t so very old nowadays, and has no major illnesses and comes from a long–lived family. (Her older sister is 90 with no dementia.) But gradually during the past decade she has become crippled – literally – by the effects of a negativistic attitude. She has lived a life of physical inertia and of querulousness, bitterness, hostility, defeatism, learned helplessness, and envy. Because of lack of exercise her legs have become weakened and her spine twisted to the point where shed can no longer even negotiate her way around with a walker. (During a hospital visit for self–induced dehydration, a handful of years ago, she received, as usual a clean bill of health for all her systems, but I saw the diagnosis “disuse myopathy of the legs” written on her chart.) Minor falls over the years have led to a broken wrist and numerous bruises and lacerations, which have made her more anxious about falling, and thus more inactive, and thus more debilitated. Habitual attempts, by my brothers and me and by physical therapists, to get her to exercise have been fruitless: she always has an excuse. Her attitude toward her neighbors in the old–age apartment community is so distrusting that, despite a basically vivacious and interesting personality, she has become isolated and friendless.

From most of my life, I have consciously used my parents as negative models.

In the past three weeks she’s suffered a noticeable, rapid decline. A minor fall in the dining room of her old–age community, causing bleeding from a small scrape on the scalp but no other damage, led to an overnight hospital stay and an intensive series of tests (CT scan, EEG, EKG, etc.) that as usual led to a clean bill of health but traumatized her psychologically.

At some point, we believe, she probably has had a series of transient ischemic attacks – small strokes – that have begun to impair her cognition. My youngest brother, who lives in the same town as my mother, has over the years been patient and responsive to her, and extremely helpful in finding good care for her, in the midst of pursuing a busy life and career. This week, she began calling him approximately fifteen times a day with trivial complaints and questions. As the week went on, these progressed from being silly annoyances to being disturbing warning signs. The other day, sitting on her couch a few feet away from her dinner tray (she is no longer mobile enough to go downstairs to the community dining room), she called him because she was unable to lift herself from the couch to get to her dinner. Later that evening, an aide called him on my mother’s behalf because my mother could no longer remember his phone number – a number she had called approximately fifteen times that same day, and thousands of times over the years.

Although she has no major ailments, she can no longer walk, feed herself, bathe herself, dress herself, or toilet herself. In the past few weeks, she has had episodes of incoherence for the first time. She is still lucid and intelligent when discussing external, objective issues in person, but when discussing her own situation, especially over the phone, she sounds pathetically feeble and digresses relentlessly as if to avoid the fear and humiliation she must be feeling. She is receiving the highest level of care her community offers; the next stop will probably be a 24-hour aide in an apartment outside the community, and after that, a nursing home.