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.

Comments

[Shu]

yes. yes. total recognition of your situation. It is disconcerting going from primary to tertiary.

And it is also a challenge to begin to see the other residents as people 'who once were' - I had some off-put reactions (as did my mother) when she first became resident in the nursing home, but with all the visiting we did, we quickly came to become tolerant, amused, and then genuinely fond of so many of the denizens, and wished we'd known them when.

As always, you are doing really well transitioning. And you'll find and ease more comfortably into the new rhythm.

Admiringly,
Shu

[Trish]

I really enjoy reading your blog. After spending two months in the hospital with my husband, three months in a NH, and now 5 months back at home, I can relate to many of your observations.
Thanks

[K Lee]

I too grew up with parental rages. I admire your ability to stop your fear from ruining your visit. I have trouble separating her dementia behavior from her basic personality because there isn't much difference in so many areas. Postpartum depression sounds like an apt description. I'll remember that for later.

[Alan G. Ampolsk]

Thanks, everyone - and Shu, good to see that you're in the neighborhood in every sense of the term.

Trish - I can imagine that the transition from nursing home back to in-home care was difficult. That's a lot of changes of setting in a short time.

K. Lee - managing my own reactions is never easy. I'm not a great meditator, but the time I've spent in meditation helps. The reactions don't change, but the way you act on them (or don't act on them) changes. It's made a difference for me. But that doesn't mean that the next visit isn't going to be an adventure...

Thanks again to you all for visiting and commenting.