TITLE: Janet Had Alzheimers Disease
By Constance Bronson
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Janet Had Alzheimer's Disease
One day two men came to the door, wanting to place their mother with us. When Dennis met them at the door, he recognized one of them as Dale, someone he had trained with for respiratory therapy. His mother had been a nurse at the same hospital when Dennis was there. His mother, Janet, had just two days before lost her husband to a heart attack. He had been her primary caregiver and now the children needed to place her quickly in order to be able to take care of final arrangements for their father.
It was a large family and many of them still lived in the area. Janet had been a nursing supervisor for many years but now was in the middle stage of Alzheimers. At the moment that her husband died, her nursing skills took over and she tried to resuscitate him after she had called 911. She had handled it very well, but as soon as George was out of her sight, she couldn’t remember any of it.
Janet was friendly and cooperative, asking others about the reasons they found themselves at Providence House. She behaved much like a nurse. She needed the phone number for the hospital where she had worked. She was concerned every day about who was coming on duty and if there was enough staff for the number of “patients”. But she couldn’t find anyone in the phone book, which frustrated her immensely.
Many of our residents enjoy watching Animal Planet on TV and Janet was interested, but as soon as Emergency Vets came on she would get fidgety and ask us to turn if off. She seemed to get agitated by television programs. Sometimes she would absorb something from TV and it would become part of her thought process as she considered her position as “staff“. Watching a litter of puppies being born, she worried about who was going to assist in the delivery and did we have enough nurses to do that and take care of these elderly patients, too.
Since she did not remember about her husband’s passing, she would often ask us to call George to the dinner table. Or she simply asked us where he was. We told her the truth every time. She could only say “I forgot about that. It makes me sad.”
I’d remind her that she had been there for him during his crisis and now he’s waiting in Heaven for her when it’s her time. “Until then, you’ll live here with us and all of these nice ladies and one amazing man who crows like a rooster. (That was Ollie, our 99 year-old resident) We’ll have fun and we’ll do all the work for you so you don’t need to worry about a thing.”
Janet smiled readily if someone cracked a joke or an interesting play on words, which Dennis is good at. It is actually a good test for the residents to see if they follow the meaning of the words. Like Dennis at the dinner table will say something like “These apples in this pie came from the first crop of my apple trees, picked them this morning.”
Makes sense, except for the two feet of snow visible from every window in the house. Or if the main course for dinner was received well, he would respond to their comments with a “thank you, I found a new recipe and it took me only an hour at the stove, sweating and slaving”. Most of them figure out that he’s just telling stories to get some laughter at the table.
When there was no jokester in the house, Janet’s expression was very glum. She sat with her eyes closed much of the time, sometimes with her faced distorted. She suffered from the evening agitation commonly referred to in medical circles as “sundowner’s syndrome”. She was very restless from dinner time until her evening medications took effect. Sometimes she couldn’t settle down for several hours, when she would wander into the other bedrooms looking for George or something else. Once she was in bed to stay, she was still able to get up to use the bathroom if necessary.
Janet would crawl into bed knees first, which is all right for limber people. She would crawl in and not be able to straighten her legs. We coached her to sit first, then bring her legs up. She practiced it for us, but when she went to bed she was knee first again. She could not retain any instructions at all.
Janet could walk very well when she first came. As her disease progressed she could only shuffle. She would try to get where she wanted by reaching for the furniture without moving her feet, as if they were glued to the floor.Then she would shuffle her feet to catch up with her hands. That’s why we gave her a walker. We tried to intercept her and ask her to take big steps. She could do that for only a short distance, then she slipped back into the shuffle.
Eventually we could only use a wheelchair with her. But when evening came, she was very agitated and tried to get up and walk. She fell often when she did that because her feet “froze” as if they were stuck to the floor. We needed to strap her into the wheelchair for her own safety. She didn’t like it and asked everyone she could to take it off for her. She would also ask visitors if they could give her a ride home. She’d sit in the chair and cross and uncross her legs over and over again. It was overwhelming watching her lose her functions and her mind. She actually had shown signs of the disease while she was still working as a nurse supervisor. Her daughter said she had been very clever at compensating for her confusion.
As she declined rapidly, she began trying to get up at night and wander about the house. We had placed a door alarm on the bedroom door so we would know when she was up and about. She never tried to go outdoors, but she would sometimes be found seated at the dining room table, waiting for breakfast.
She had long ago given up on reading or working crossword puzzles. She couldn’t make lists anymore. No one could read her handwriting. She knew when she was hungry and when she needed to use the bathroom. But she couldn’t see the connection of asking to go to the bathroom and being wheeled to the toilet. When we got to the bathroom she’d say “While I’m here I need to go to the bathroom.”
One night Janet had tried to get out of the bed and fell face first on the floor hitting the closet door on her way down. When we got upstairs to her, she was huddled on the floor between the bed and the closet, with blood pooled on the carpet. I said “Janet, what happened?”
She answered, “I don’t know, but I have a really bad cold all of a sudden. My nose is really stuffy and keeps running.” She had smashed her nose on the closet door. It appeared to be broken but it was so swollen. We cleaned her up and put fresh pajamas on her. We were authorized to use only Tylenol for pain. We called her son to come see if he wanted to take her to the ER. He was surprised at how rough she looked, but he knew that doctors wouldn’t be able to do anything until the swelling went down, so she stayed with us. We gave her an ice pack and tried to make her as comfortable as possible. She recovered slowly, sporting dark bruises under both eyes and her nose.
After that incident we placed her bed and box springs on the floor so that if she tried to get up at night she had nowhere to fall. The State of Michigan does not allow us to use rails on the beds, so that was our only option. Whenever Janet got out of the bed on the floor, she crawled on her hands and knees or scooted on her bottom. It seems a bit demeaning, but it was for her own safety and her family understood. Usually in the daytime someone was around or in that vicinity to see her moving about and then we would get her into the wheelchair. She seemed to be accepting it all very well. Tillie, the hound often noticed Janet moving around on the floor and she went in to give her a greeting.
Janet was able to use silverware fairly well. Later on she ate with her fingers more often. Her appetite remained hearty and she enjoyed listening to the conversation among the other residents. We made an effort to include her but she wasn’t very responsive.
There could not have been a nicer family to work with than Janet’s. Most of her children visited often and they were so gentle and patient with her. They brought photo albums with photos from Janet’s childhood and early married life. They knew that she still retained some memory of times long ago.
They took her to their homes for holidays and picnics when it was convenient for her. I know that some of those times while she could only sit in a wheelchair, her very large family celebrating noisily around her, she seemed to be overly stimulated and extremely exhausted. But the family needed to keep making memories with her for their own sakes.
I had never seen such loving children and in-laws. They all very openly expressed their love and appreciation for Janet. Since I did not have that kind of relationship with my parents, I was fascinated by theirs. They would visit for quite a while, sharing stories about their children and the trials of a busy household, just like the one they grew up in when they were small.
Janet had worked full-time third-shift at the hospital, then went home to get nine children off to school before she could get some sleep. She would get up in time to make sure they had an evening meal. She kept it all together for a long time. She made sure everybody went to church regularly and practiced the Catholic faith she had given them.
Even when she was with us, Janet prayed her rosary and crossed herself at mealtime. She wasn’t able to keep up the prayers after some time, but she always crossed herself until the last days of her life. Whenever we played videos of Christian music she sat in her wheelchair with eyes closed and softly sang along.
She told me often about how she and her sister Ginny had played and sung before the Knights of Columbus or at other events. Their father frequently volunteered them as entertainment for gatherings. Janet played a guitar and Ginny played an accordion. She had some fond memories still of her own childhood.
Then one day Janet seemed to lose interest in most everything. Her appetite waned and she spent more time in bed. Soon after, her kidneys began to fail. She was then admitted to hospice care while still with us. They made the decision to discontinue her regular medications, give her whatever liquids she would take in, and she kept slipping away. She went through an extremely agitated period so they gave her pain and anxiety medication and oxygen. She was ready to go to Heaven to be with her Lord and her husband. Her children and older grandchildren came to say good-bye one last time. They loved her so much. If only everyone had such a loving family. Soon she slipped away for the last time.
It was a very difficult time for Dennis and me as well. We had grown to love Janet and admire her for the courage she displayed in just meeting the demands of each new day. She was one of several residents who passed away that spring and summer. It seemed to the remaining residents that everyone was dying. One of our ladies said of a woman who was hospitalized and then returned to us with hospice, “They sent her home to die, didn’t they?” Sometimes it feels like that.
It’s very difficult to realize that half of our residents are currently in their nineties. We have no way of knowing when any of them might pass on, but realistically, it could be one right after the other again. We keep praying that it will be easier the next time, on us and on the others. But we trust God to take care of all the arrangements, and all of our hearts.
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