Dementia Nights

New Year's: A Wish, and Reflections

I have one wish for 2010: I hope he doesn't survive the year.

Sorry if this upsets you.  My sense is that you'll either get it or you won't.  If you're bothered by it, here's something by way of comfort - my wishing for his death is about as effective as my wishing for the opposite.  If I wanted him to live for a hundred more years, I'd have exactly the same amount of traction.

As for my reasoning, it's pretty simple.  As long as he was able to get something positive out of life, I was in favor of his having more of it.  That was true even when he got pretty far along the Alzheimer's road.  For example, there were his several mid-stage years when he lived in the sea of love, and his dominant mode was to be happy and amazed that so many people wanted to care for him.  That compensated for several harsh previous decades.  That he could experience compassion was good for him and everybody else.

Now we're not there anymore.  The sea of love was a good region, and he may have had all that affection in him all along, but the reason it became dominant was that the forebrain failed, and took critical reasoning with it.  Now the pathways that produced the sea of love are long gone, and we're dealing with anger and stray dark impulses.  Awareness equals distress, often extreme distress, so, as noted, less is better.  And none is probably best.

It's worth noting for the record that I'd stand to gain financially if he died sooner rather than later.  This is why it's so hard, maybe impossibly hard, for society to come to any conclusions about old age and death.  Who could possibly sort out all the conflicting interests  - are the motivations selfish or altruistic? - and decide what's best? 

I suppose you'd have to look to professionals, and from that perspective in this particular case, at least informally, there's the beginning of a consensus.  I just got off the phone with P.  She hadn't yet read my e-mail from yesterday so we covered the same ground.  She agrees that the lithium doesn't seem to be reducing his hyperverbality or his agitation.  She's also concerned that lithium will dehydrate him, and getting him to drink is a major challenge, so that's something else to worry about.  But when Dr. G reviewed the charts this morning, he decided to maintain the lithium and reduce the zyprexa instead.  On Monday, Dr. A, the regular psychiatrist, will be back on duty and the odds are he'll reverse Dr. G's orders.  Which is fine.  I'm not against the lithium experiment - balancing the meds is mostly art, not science - but I think we're going to have to fold it.

I mentioned what H had said about sedation, and that I wouldn't have a problem with that.  "So you're OK if we sedate him a little?" 

"Yes," I said, "or more than a little." 

"Good," she said.  "I'm very glad to hear that.  Thank you."

I mentioned that he's still having the rages, and it's not as though he's enjoying the rages as a kind of free expression.

She said he wasn't - that he was upset and agitated.  And that we need to think about his quality of life.

I doubt, somehow, that he's going to thrive under sedation.  So it may be that I've just given him a push.  On the other hand, if there's an alternative, I don't see it.

I suppose we'll find out next year.

Other reflections - this is where he was two years ago, and this is where he was this time last year.  Clearly he's slid a huge way down - however bad things looked in 2007, that was high functioning by comparison.  The trend will continue and it seems obvious where we're going.

Concerning my own reactions - a year ago I was feeling stricken, because I knew that in the course of 2009, I'd have to get him into a nursing home and move him and break up his apartment.  The idea of that was hugely daunting.  The reality was every bit as hard as I'd anticipated.  And yet here we are.  It happened and it's done.  And in point of fact he's in much better hands - and because of that, I'm better off, too.

The way to go into 2010 is to be ready for the next set of things, and then do them or deal with them, whatever they are.

To all of you - thanks for traveling along with me through another year.  I hope next year takes you wherever you need to go.

See you in '10.

Down the Lithium Road

Saw him this afternoon for the first time since they started the lithium dose.  He's dramatically worse - though that may not be a bad thing.

Last time he was incoherent.  That makes it strange for me to to say that today he was much less coherent - but he was.  There were only a couple of recognizable words.  On top of that (and I think this is mainly what I'm reacting to), he's suddenly unable to focus.  When my wife and I got there, he was quiet - staring blankly into space.  Then he saw her and started talking.  He never really registered me at all.  Right away he wanted to get up from his chair - probably to show us hospitality.  He mistook another chair for his walker - grabbed the armrests and tried to push it, and got frustrated when it wouldn't roll.  I reached for his walker and moved him over to it - not easy, since he couldn't follow any of the instructions.  He was stooped over, almost at a right angle, and seemed to engage in conversation with anyone who was in his field of view, generally to his right and lower down - other seated residents, in other words.  As he moved, he'd shift conversation from one to another.  Since I was standing in front of him, he didn't pay me much attention.  After a moment or two, he froze, and just stood there, gripping the walker and muttering something to himself. 

The positive news is that when we arrived, he was peaceful.  But it became obvious pretty quickly that our visit wasn't doing him any good.  We left after five minutes or so.  I tried to tell him, as I have in the past, that we'd be back soon, but that didn't seem to get any traction so we just stepped out.

Earlier, just before we said hello to him, H, the charge nurse, pulled me aside for a discussion.  She said that twice in the past couple of days, my father has exposed himself to the other residents.  So the pattern that started with my wife seems to be continuing.  I told H about the previous incidents, and she seemed relieved that I wasn't upset.  The reason for the sidebar meeting was this: she wanted my authorization to buy him a set of jumpsuits.  He can wear them in place of his current wardrobe (mostly lounging clothes from The Gap) and they'll keep him from getting into his pants.  I said yes, of course.

Afterward, as we were leaving, I told H that he seemed to have taken a hit as a result of the lithium.  She agreed, but said that he was still hyperverbal and still aggressive.  She added that the alternative to lithium would be sedation, which they didn't want to try just yet.  I said I understood, and again she was relieved that I knew that they were trying to balance his treatment - both for his sake and for the benefit of the other residents. 

About that: long before we got him to the nursing home, and again soon after he arrived, I used to worry about whether they'd want to medicate him for their own convenience - just make him docile and more manageable.  I don't think that's what's going on here.  They do, legitimately, have a lot to juggle, and I'm sure convenience comes into it - they can't interact with him every minute of every day.  But they also have to think about the welfare of the other 20 or 30 patients on the floor, and they can't just give my father free rein to curse at them or flash them as a matter of self-expression.  And beyond all that, there's the fact that when he curses and flashes, he's not particularly happy.  So medicating him might be good for the staff, but it's probably good for the other residents, and it's also good for him.  Relieving his distress is a perfectly good use of pharma and I'm fine with it.

That said, I'm not sure about the lithium.  Frankly, I'm wondering if sedation wouldn't be the better way to go.  True, he'd be less aware.  But as I've said in the past, awareness isn't his friend.  And if that was the case a year or two ago, imagine how it is now.  So if we send him off into the fog - more quiet, more blank staring, less anger and less angst - that could be a good thing.  Which is why I said at the beginning of this post that in some respects, the worse his condition gets, the better.  Moving him farther away from consciousness would really be helpful to him now.  The hard truth is that we're parting ways with him now and he's parting ways with us and it's probably better to speed that process up, not slow it down.

I sent an e-mail to P about the visit, and we'll see what she and Dr. G want to do about the lithium, or about any meds they're thinking about.  We'll talk, and I'll go up there next week, and we'll see where we travel from there. 

The Holiday Spirit, or, Making Friends with Lithium

He had a brief episode of emotional stability.  It didn't last.  It wasn't going to.  The brain damage is too profound, and the emotions just aren't going to smooth out.

The sequence was this: by the end of my last visit, he seemed calmer.  The optimistic interpretation was that the Depakote and Neurontin were taking hold.  Then, the following Saturday evening - the Saturday before Christmas - I got a call from one of the staff on the unit, telling me he'd fallen.  No injuries - they phoned because that's part of the official reporting requirement.  I found out later that he'd wandered out of his room but left his walker behind.  It can happen.  I guess he fell relaxed, and they got him back to his room and that was that.  Once again I had the instant shock/relief reaction.  His falls always used to be big events.  Several of them led to ER visits.  But this one was over before I even found out about it.

After that, by all accounts, he was OK for about 48 hours.  Then, Tuesday, another call, this time from P, in charge of behavioral assessment.  He'd had a massive rage episode.  Worse than the ones during the first week?  "At least as bad."  Yelling and cursing at one of the residents.  There'd been a staff party on the unit, with outside visitors, and she thought the noise might have set him off.  They'd decided to put him on zyprexa, as needed - a Seroquel alternative, I suppose - and that smoothed him out again.

Thursday my wife and I went up there for the Christmas Eve visit.  He was cheerful - very happy to see us, whoever we were.  In his most lucid moment he asked my wife if she was married and asked me if I could arrange to have Alan stay over.

The conversation was mostly at a whole new pitch of incoherence.  There were great arcing flights of speech cadences and word-like sounds, and for the most part I had no idea what he was trying to express.  I threw random cues at him - "Wow, that's really interesting" and "they're really like that, aren't they?" - and he'd pick them up and run with them.  For a couple of years, talking with him has been jazz, but now it's free jazz.  A few patterns repeat.  At one point he went on a more-extensive-than-usual exploration of the conceptual geography of his knee - he'd say, "You know what I found out?  There's this right here..." (points just below his left knee) "...and now they come up this way..." (traces finger along leg to just above the kneecap) "...and we have to meet them here."  It means something to him that I can't work out.

Then all at once he called out to Nice Befuddled Elderly Man - wanted him to come over and meet us.  Nice Befuddled Elderly Man looked at him warily and sat down at a table halfway across the room, facing away.  "I think I might have called him all kinds of son of a bitch," my father said, and all at once it was obvious that Nice Befuddled Elderly Man is the person he'd been yelling at.  So it makes sense for him to be on his guard.  It could be argued, of course, that my father's rage signifies that there's a bond between them - rage being a form of emotional connection.  I looked at Nice Befuddled Elderly Man and realized that he's more closely contemporary to my father than anyone else on the unit.  This could be someone he served with during the war - you could see them standing a midnight-to-four watch together, or later, working together, maybe in the late 50's starting a business together.  So from a certain perspective, this is the last stand of the Greatest Generation, or whatever you want to call it (they never called themselves that).  And the last stand is bound to stir up all kinds of emotions.  Of course, generational connections aside, the reality is that Nice Befuddled Elderly Man thinks my father is actively dangerous, and I can see where that's a reasonable conclusion, at least when it comes to avoiding emotional abuse.  Maybe it's best for the members of the Greatest Generation to keep their distance from each other.

I stepped away for a couple of minutes and had a sidebar with P and with Dr. G, a covering psychiatrist.  He was in the process of upgrading the zyprexa from "as needed" to a daily dose, and writing an order for lithium.  He thinks the bipolar disorder - longstanding bipolar disorder, I should add - is compounding the effects of dementia, and that managing the one might help with the other.  I'm game.  He liked my one-minute family psych history (bipolar grandfather rages, then there are days of silence; father copes by talking compulsively to relieve silence and dread, finally becomes a reporter, a job where you talk compulsively to draw people out; is still talking).  Dr. G talked about the number of dementia patients who present with ADHD symptoms, and who turn out to have been stockbrokers and traders.  We're all of us all about adaptation - something to think about, and it make geri-psych an interesting territory.

After the conversation I went to my father's room and dropped off his Christmas presents - some colorful clothing from The Gap.  The idea that it was Christmas didn't register with him at all.  While I was away, he tried to expose himself to my wife.  He'd done this the last time she and I visited together.  There doesn't seem to be anything sexual about it - it's more that he's concerned about something that from his perspective isn't working right, and he wants a visual check on the diagnosis.

With that, it was the end of the last holiday visit - holidays aren't a graspable idea for him anymore - and we went home.  He wanted us to stay over in the downstairs bedroom, so we told him we'd be right back after some errands so we could do that.

A couple of minutes ago, P called.  They've started him on lithium.  It doesn't seem to be making him less verbal, she tells me, but it's making him less comprehensible.  She said he was indefinably different somehow.  When I pressed, she said that before, he was able to produce a few recognizable words.  Now it's just a sea of sounds.  She's concerned about over-medicating him.  I agree that that's an issue, but pointed out to her that his speech wasn't much better last week, before the lithium.   I appreciate the need for close monitoring - and the fact that they're willing to do it - but at this point, it's unclear what's caused by the meds, and what's caused by the ongoing collapse of brain function.  She said they'd had to feed him today because he'd been caught up in his talking and he'd forgotten to eat.  That's a new one, and it could be medication-related.  But in all, it's part of the pattern.  This year's holiday story is all about progressive collapse.

I'll try to get up there Wednesday or Thursday for a New Year's visit - or failing that, for a visit that coincidentally happens to fall around New Year's.

Postpartum Depression and Other Alzheimer's Challenges

Was talking this afternoon with a fellow caregiver and she nailed exactly what I'm going through - postpartum depression.  After months and years of intensive effort, I've given birth to my-father-in-a-nursing-home.  Now what?

Alternatively - I feel like I'm out of a job.

Nevertheless am trying to settle into new routines.  I've visited twice in the past week.  Both times, his recognition was better than before (during the Mr. Visitor episode).  Beyond that, the roller coaster continues.

Last Thursday he was relaxed and genial.  Lack of sensory input probably helped.  When I got there, he wasn't in the common area - he was lying down in his room.  Without much else to concentrate on, he was able to place me immediately, and tell me how much he's been hoping I'd visit, and offer to set up the bed so I could spend the night.  I led him out toward the nursing station and we sat and talked for a while.  It was mostly word salad, but peaceful word salad at least.  He continued to be fascinated with the green border that runs around the edge of the tables.  Beyond that, there wasn't much I could make out. 

At a certain point, we were joined by Southern Belle - one of the residents who's pretty far gone, but always impeccable (hair nicely done, well matched sweatsuits, something faintly aristocratic in the way she carries herself).  She doesn't have much speech left but gets out the occasional question (out of nowhere: "What do you think of them?"  "I think they're pretty good," I said, not knowing who "they" were).  Then she began kicking my father lightly on the sole of his slipper - aggression?  More likely flirtation (she had a faint mischievous smile).  And why not?

Tuesday morning I got a call from the nursing home.  I always jump when I get the calls, though there's no reason to.  The staff always seems to be on top of things.  My reaction is a throwback to the New York days, when I was responsible for his safety and the staff was marginal and a call usually meant that something had come loose and I had to act on it.  Things come loose now, but now the professionals are first on scene.  This is a huge relief and very disorienting, and afterward I have to find something useful to do with the surplus adrenaline,.

Case in point - the Tuesday call was about his latest rage episode.  He'd come unglued during the morning - thundering and cursing again.  So they'd upped the Depakote and Neurontin.  Should I visit as planned or cancel?  Sure, no reason not to, they said.  So calmed myself down and drove over.

When I got there he was sitting in a row of chairs that faces outward from the nursing station, and having a furious conversation with the empty air in front of him.  I turned the corner and sat down in front of him and saw immediately he had his rage face on - eyes hollowed and hooded, brow lowered, jaw slack, a whole different aspect than he usually has.  I remember it vividly from my childhood and, as I've mentioned before, I have a ghost reaction to it now - an echo of pure fear, which I processed in the background this time while sitting down asking him to tell me what's up.

Once again he recognizes me immediately (emotion seems to drive this).  And he has to tell me, urgently, what happened.  Which he does.  I'm completely unable to make it out.  As near as I can tell, some dream material filtered into his waking consciousness, and somewhere along the border between the hallucination and the reality, something set him off.  He said he'd been with his/my mother, and we were angry about something these people were doing, look at them, they're doing it again (points to staff member with a rolling bucket and a mop), why the hell do they keep coming in here like this, they're none of them any good...  and so on.  From time to time he'd rope in passers-by and ask them if he was right, and so we wound up with an audience of Bowing Woman and Contemporary Guy (the one who upsets me because he's about my age) and Nice Befuddled Elderly Man (the one that, a couple of weeks ago, my father was trying to help get back home to Pennsylvania).  They'd listen, or not, then agree with him because that was their reflex or it seemed to be the safest thing to do.  Down at the end of the row was Angry Asian Woman, who was muttering something fierce in a language I didn't understand.  I got a whiff of irritation and impatience, and for a moment she seemed like an irritable Zen master who'd heard enough: "Everybody talktalktalk!"  I told her she was right, but I don't know if that registered.

After a while he began to calm down.  It always used to be like this - back in his prime, when he had rages, he'd eventually exhaust himself.  It was as though he needed to blow off steam by yelling, and finally all the tension would be gone and he'd collapse back to normal.  Ghost images, again.  And at this stage?  I could try to get psychological about it but I'm not sure that makes sense anymore.  Most likely, it's just that the rage/paranoia pathways are well established and heavily reinforced (thanks to history? thanks to survival value?), and they remain mostly intact while the rest of the brain shuts down. 

By the time I left - about 45 minutes later - he was mostly back to baseline.  Southern Belle came over and sat down next to him in her impeccable lavender jumpsuit, and the flirtation (is that what it is?) picked up again...  I drove home and slipped back into extreme fatigue...

Maybe the challenge is this: on the one hand, I don't have to live my life in a state of emergency, and I'm not the first responder.  But on the other hand, I have to do a lot of adjusting.  There's the basic disorientation of visiting him in a nursing home, as opposed to his his apartment.  There's the radical shift from long home visits (my New York day trips) to quick nursing-home drive-bys.  There's getting used to seeing him with the other residents, and interacting with them myself.  I brought myself up short the other day when I realized that until I placed him in the nursing home, I'd never been around any other demented people - let alone a couple dozen of them.  Now I have to find out how to relate to them - how to recognize them, how to talk to them, how to realize - not just intellectually but on a gut level - that each of them used to be a whole person with a complete life and a web of relationships, just like my father.  It's all obvious but it's all completely new. 

I guess that's my work now - adjustment.  If so, that might mean that I'm not unemployed after all.

I'll try to take some comfort there.

Mr. Visitor and Mr. Funeral

Many times, my wife has asked me how I'll react the day my father no longer knows who I am.

I've always answered that I don't know, but that it probably won't be clear-cut - he'll retain some details and lose others, and it'll be a long journey across a blurry line.  In practice, it's been like that.  It was nearly two years ago that he first told me about his visit the night before with Alan.  Since then, as you know, I've been many different people, sometimes simultaneously - son, brother, uncle, friend from the war, father of Alan, age 9 - but always a friend and helper and a significant person.

Today we may have taken another step farther from earth.  I'm not sure - it could also have been just an episode.  We'll have to see how it plays out.

I went to see him at the nursing home.  When I got to the dementia unit, he was sitting at one of the tables in the common area, deeply engaged in a conversation with another gentleman - a resident about his age.

"Oh," my father said, pointing at me.  "Here's a young woman who can help us.  Hey, Alan, can you tell us what you think about this?"

And that was the last I was Alan.  "See, what we've found here," my father said, pointing to the olive green border that ran around the edge of the table, "is that this goes all the way around here (he runs his finger along the border, toward my side) and it connects with 'visitor.'"

As he says this, he's pointing at my visitor's badge, which is a lighter version of the green used in the table border.

On several previous visits, my father has been very impressed by the visitor's badge, as though it represents some kind of authority.

"And I think you can help us with this, Mr. Visitor," he says.

OK, fine, it's a quirk, let's ride with it.  What does he need help with?  Long riff begins.  It goes around and it connects to the red (his shirt, which he spends some time trying to take off) and this here, which is right this way (his watch again), and that way, this gentleman can go home and be with his children.  You're from New York, aren't you sir?

Pennsylvania, says the other gentleman, who's marginally more together.

"Pennsylvania, that's right in New Jersey, and you go across the water, and it's right there, and before the rain starts, I think you should get ready to leave right now, and that way you can be home with your family, and Mr. Visitor can help you with that.  I know him, I know Mr. Visitor and he's a great guy..."

No, not just a quirk.  I've clearly become Mr. Visitor.

Conversation with other gentleman follows.  He's intrigued by the idea of going home to see his children, but he's confused because they came in this morning with the cough medicine and another medicine, and he wants to know what's the relationship between the two?

I tell him that it can be hard to follow, because they often change the dosage of the cough medicine, so the relationship keeps changing, and the best thing is to get one of the nurses to tell us.  He thinks that's a good idea.

The other gentleman is clearly a bit better organized.  He's puzzled, but he's puzzled about things that in reality are somewhat connected with each other - the dosages of medicines and the instructions for taking them.  My father is another story.  He has less information to work with, and he's trying to create connections between things that are barely related (like the table border and the visitor's badge, or his shirt and his watch).  But the brain works with what it's got and keeps generating patterns.  It's the same way that people who don't have Alzheimer's, but who have an overwrought sense of cause and effect and an aversion to randomness, develop conspiracy theories.

There are more long riffs, mostly repeats and variations on the same motifs.  Eventually themes start to emerge.  It's important for the other gentleman to get on the road before the rain starts.  There's no point in his sitting around here.  Mr. Visitor can arrange everything.  He can get the truck.  Did you come here by truck, sir?

Of course, my father came here by truck - a big Escalade, to be specific.  And leaving and going home to see the children?  That's probably something he's like to do, too.  He's projecting his identity and his desires onto the other gentleman.

As soon as I realize this, he makes it explicit.  "So you should really get ready to go now, sir," he says.  "And then we can go, too.  Mr. Funeral - I mean, Mr. Visitor - can make that happen."

Mr. Funeral.  OK.  Now we've got it.  No translation needed.  Visitor equals escape equals funeral.   It's all about leaving and going home.  I don't get the sense he thinks that a funeral is a bad thing.  It's another way out.  All of it comes down to leaving in a big truck.

I should mention that I have an audience for all this.  My father is very energetic and very loud - his voice fills the whole common area.  A couple of tables away, there's another visitor - a woman in her sixties or seventies working with a much older mother.  The daughter is trying to get her mother fitted with sandals, and the mother keeps making rhythmic raspberry noises with her mouth.  Not surprisingly, the daughter wanted to pull back from that a bit and couldn't help overhearing my conversation and came over to tell me that Mr. Visitor was sure going to be busy.  Then there was a young guy who walked by toward one of the rooms and left a few minutes later, nodding at me knowingly both times.  There's the beginning of a secret society here - the real-world equivalent of our blog community, I suppose.

The whole conversation took about 10 minutes.  Then my father was eager for Mr. Visitor (aka Mr. Funeral) to leave.  As in, right now.  So I could make arrangements to get everybody on the road.

I said I'd get right on it.  And I left, feeling slightly stunned, as though I'd never arrived.

Which, in a sense, I hadn't.  It's been nice the past couple of years, being several different people.  But today they all seem to have been left outside the door.  My new identity is less personal - Mr. Visitor is clearly an official person with particular powers, but he's less of a family member and more a background element of the broader caregiving establishment.  As is Mr. Funeral.  All of which is fine, by the way.  As I was saying yesterday, I've done the hands-on caregiving thing and it's time for a change of scene.  Or a change of self, as the case may be.

So to the question - how did I react to my own disappearance?  And to my emergence as the messenger of death?  Lightly, as it turns out.  I was actually laughing to myself a bit as I left - because it was over so quickly, and I felt like I'd been spun around in a revolving door, and because it's a little odd to have yourself transformed instantly into Mr. Visitor, who someday will be Mr. Funeral. 

But as with everything else on this gig, I suppose I'd better get used to it.

My Weariness Amazes Me

...though there's no reason why it should.  You'd expect it after the whole move-him-to-a-nursing-home, close-the-apartment thing.

Nevertheless - there's no fatigue like the fatigue you get when you've been in a state of extreme tension, and suddenly the tension drops.  Adrenaline crash, which I've experienced before on this gig, doesn't begin to describe it.  It's worse because, in spite of your intellectual awareness, you really didn't understand the state you were in. 

I find I'm mainly sleeping a lot, and working, but not very efficiently.

Objectively, everything is going well.  I saw my father last Sunday.  My wife joined me for the first time.  What with our move and her work and the fact that I did my New York visits on weekdays (so I could fold in some business and control the costs)... what with all that, she hasn't seen him in two years.  Her main reaction, apart from noting the obvious, which is that he's slid a long way in that time, is that he looked good and seemed happy.  He seemed that way to me, too.  He went off in long looping riffs about the guy who clearly works for me because he's really sharp, he's really got it (the guy in question is another dementia patient - one who unsettles me because he's roughly my age.  He doesn't speak, and mainly wanders up and down the corridor).  And that's good, because it connects to this (his wristwatch) which is really great, it's straight up here and straight over there (the hands).  And here's somebody else who's very good (a patient again, this time a woman who bows obsessively - she stood behind me most of the time I was there)...

I was only peripherally aware of the other residents (you get used to them) and focused mainly on surfing his conversation and finding things to react to.  This was much the same as it used to be when I saw him in New York - I was sometimes successful, sometimes not, and had to filter the same amount of word salad.  But it was much easier because his mood is lighter (more attention?  Better meds?  Does it really matter?)  Once again, he was OK with our leaving after about 40 minutes.  We're just one set of people among dozens now.

Which is the point, and I'm having a hard time getting used to it.  The sense of emergency is gone.  The close listening for cues about his mental state, that's gone.  The vigilance-slash-anger about the caregiving staff, that's finished.  The hours-long phone calls are over.  The cavalry is here, so I don't have to be the cavalry any more.

But all of that - being the cavalry and such - those were the props that were holding me up.  Pull them out and I collapse, apparently.

There's still maintenance to do.  Every day I make one phone call, and change an address or cancel an account.  Other than that I try to read and do photography and listen to music, none of which I'm very good at at the moment.  I'm out of practice.

Every time I write about things getting routine, and the end of emergencies, something else breaks loose.  So I'm not going to get too far ahead of myself.  I'm sure there's something out there - medical crisis or financial crisis or something else that'll put me back on alert.

Either that or I'll begin to learn how to be a human being again.

All I can say for now is my plan is to forget about today until tomorrow.