For most of the visit on Wednesday night he seemed almost completely whole. A few word choice problems and some mild confusion, of course, but he was able to complain about the aides, and talk about his schedule, and tell me he was concerned about the Mets' prospects (he's not impressed by Santana and thinks Billy Wagner has lost something off his fastball).
If you'd seen him you would have thought he was a very old man with some mild impairment -- quite frail, some speech issues, but mostly self-sufficient. That's what the Partners staff often reports and on nights like this you can understand why.
Then, about three hours into the visit, he said there was something he wanted to ask me about. He pointed to the picture of my mother that sits on the dresser -- the one that we talked about a couple of weeks ago when I managed to drag her back into his memory. He said it was very strange -- he couldn't figure it out -- but her picture had started appearing on television.
"That's very interesting," I said, in that way you say it when it really is very interesting, but not in the way you mean. "What does it look like? When do you see it?"
He explained that normally, the picture is to the right of the television (true). But sometimes -- and this is the situation he was talking about -- sometimes it's to the right of the television.
Ah. So right now it's to the right. But when you see it on TV, it's to the right. Right?
Yes, he said.
Does it appear in the frame of the television screen? I pointed to the frame.
No, it's to the right. There on the left is the thing with the green light (the television itself). And the picture is next to it on that side. The right side? Yes.
Gee, that's odd, I said. Because right now it looks like it's on the right.
Yes, he said. But when it's on TV it's different. It's on the right.
And he sees the picture in newspapers and magazines, too. How does that happen? How do they know about her? Because he didn't think that many people knew about us.
"And she was important to us, wasn't she?" he asks. "She was my wife. You told me that."
Then he speculates about how the pictures (there are other family photos, too) got put on the dresser. Who put them there? They've been there as long as he can remember.
"It must have been the mother," he says. "She lived here before I did." He means his mother. And no, she didn't. But this apartment and the one he grew up in have flowed together in the way that things seem to be flowing together now.
Then there was something else he wanted to show me -- something to do with the round things that make the light go on.
Lightbulbs? No, good guess, but the right answer is: the knobs on the stove. He takes me to the kitchen and shows me that there are four of them now. But earlier in the day there were two of them. Someone must have snuck in and taken them, then snuck in again and put them back. And when they were there, they were in different positions. He turns the knobs to show me and the ignition starts clicking and the gas starts coming out.
I tell him that it's probably best to leave them in the original position. Note to self -- need to remove the knobs next time. Gas stove plus Alzheimer's patient -- very bad combination.
We wrapped up soon afterward. I worked the next day and then called him as usual early in the evening. He was completely incoherent. I don't mean irrational -- I mean that the words and sentences made no sense at all. I think I may have woken him up -- he's usually much worse under those circumstances. But this was bad even by recent just-woken-up standards. We talked for 17 minutes (I know because of the time stamp on my cell phone) and about the only thing I could make out was a couple of sentences where he told me he'd just discovered a new part of the building -- a place where they left food out on the counter and you can take it without even paying for it.
That would be the kitchen.
When people tell you that Alzheimer's patients have good days and bad days, this is what they're talking about.
A few side notes. The discussion about the picture led me to do a little quick online research about Alzheimer's and visual perception. It turns out there's a recognized form of the condition called Visual Variant Alzheimer's Disease or VVAD. There's a short description here, and this is a much more technical one. This bears looking into. I don't think my father has the pure form -- patients who have that present first with the visual symptoms. In his case the first symptom was anomia, followed by a broader aphasia, followed by problems with numbers. That went on for years, and the visual problems didn't show up 'til about 16 months ago. Still -- a lot of his current issues seem to come under the VVAD umbrella -- even the night/day perception problem seems to start with a disconnect between what he sees and what he's able to interpret. So while there are multiple things going wrong, one area of damage seems to be moving from the back of the brain to the front, rather than the more typical front to back.
I don't know if this is valuable information -- valuable in the sense that it might make a difference in how his case is managed -- or just another set of notes to put in my amateur neurologist's field notebook. I'll e-mail it to the Partners crew, and also Dr. R, in case the former turns out to be true. And as for the field notes -- well, I've got a nice growing collection of them now, to read and pore over late at night.
At least it keeps me engaged.
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