A Remarkably Good Visit: a Gem in the Midst of Alzheimer’s

“Boy am I glad to see you!”

This was an unexpectedly cheerful greeting from Mary, along with a bright smile and a wave of her amethyst-be-ringed hand. Ducking his head under the EXIT sign at the juncture of hallways, Mary’s youngest son smiled too. In the two years I’d been coming with him to visit, neither of us had seen this type of effusive greeting.

It was a lovely visit, with Mary cheerful and animated. We talked, laughed and she held up her end of the conversation with a couple of quips, this woman who had loved words and who had always had an appropriate adage or a bit of poetry, especially a comic line from her favorite, Ogden Nash, for any situation. It was an answer to a prayer.

By this visit, Mary had been wrestling with Alzheimer’s disease for seven years. Most visits found her slumped in her favorite wing-backed chair in front of the TV in the lovely common area, dozing through the innocuous programming of the Hallmark channel. The combination of pain meds, mood-levelers, and the inexorable advance of the disease, rendered this type of pleasant animation most uncommon. Paul once said to me after a particularly bad visit, “You know, if God came to me and said, you can have one more visit with your mother as she was, have a real conversation but, she’s not going to wake up the next day. That will be it, I would take it, rather than see her like this: confused and miserable.”

Most visits had devolved into a polite exchange of her short litany of sentences, “It’s so good to see you,” “I love you,” “You look good,” to which Paul responded in kind, or tried to reach some part of her remaining memory with details about his brother or children, a photo of the snow in Boston, her hometown. She was unfailingly polite and, I think, on better days covered her lack of understanding with pleasant, feigned interest. Many times we left and Paul said he wasn’t sure she really knew him any longer, she just went along with the situation because it was pleasant to have company.

When we were planning our wedding, I felt a cold shot to my heart when she looked brightly up at Paul and said, “You’ve not been married before.” Calm and gentle, Paul said, “Well, yes Ma, I was. You remember Jackie?” Crestfallen, Mary thumped her forehead with a delicate fist because clearly, she did not remember Jackie, Paul’s first wife for whom she had grieved when she died. In my mind’s eye, I saw Jackie and all that had come with her, the four now-adult children and their children, popping away like balloons in Mary’s memory, all these lovely people whom she had loved. But we steered the conversation to more pleasant topics and prattled on, Paul saving his reaction for the driver’s seat of the Mustang when we left. “I know it’s the disease….. but it just doesn’t get easier.” I comforted as best I could, anything I could think to say woefully inadequate to…. this. This slow disintegration of the mother he had loved and respected.

The evening after that remarkably good visit, from the kitchen table as I cooked dinner Paul sheepishly confessed, “You know, all day I was sort of waiting for a call from Bethesda…. “ I agreed that I, too, had wondered if that was it, that was his answer and Mary would wake the next morning not in Fort Worth, but in the arms of the husband who proceeded her in death, and in the presence of the Lord in whom she never lost faith. It was not to be; instead, the next few months brought a steady, relentless deterioration.

Mary lived in the memory care unit of a fantastic assisted living facility. It was not inexpensive but Paul, Sr., had provided well for his widow and we were thankful he had. His namesake managed her money well enough to keep her there, in beautiful surroundings and cared for by attentive, gentle, loving staff. One day the manager rang to say Mary needed more help than they could give, and it was time to call in Hospice care, fortunately covered by her insurance. There was a meeting on a bright Friday afternoon and we listened attentively as the Hospice manager explained the care she would receive from their visiting nurses, modifying her medications to keep her calm and anxiety-free while eliminating those that were clearly no longer of benefit, and what all of this meant for the long-term.

It was not a good day for Mary. She was agitated, angry even, and kept telling me, “I’ve been a naughty girl.” She seemed to think this meeting had been called to discuss her poor behavior, as she had been increasingly angry and nasty with staff. She had a tendency to vocalize, including a repetitive vocal tic which I had found conveyed her mood, by tone and inflection, better than any human being could. I sat with her while Paul discussed the details and she was calm and happy with me, though she had no idea who I was. I assured her, as one does a child that she had not been naughty, but merely in need of some additional help, which Paul would make sure she got. “I’ve been a naughty girl….” When the meeting was over and Paul stood to wheel her back to her room, she looked up at him and said, “Who are you?” Nothing, nothing prepares one for that and this time we both shed tears in the front seats of the Mustang.

She began retreating further away, drifting someplace we could not follow. One day, a terrible visit, she was anxious, agitated, and worried. She remembered Paul and the only thing she could seem to get out was, “I love you,” and then she’d slump, seeming to gather herself to say what she needed to say, rising to look me dead in the eye and say, “I love my son so much.” It seemed to cost her a great deal of effort to tell me that, like she was struggling to get to where we were; I imagined her trying to tear away an ever-thickening veil separating her from us. I felt she was somehow aware she was slipping away and she was desperately entrusting Paul’s well-being to me while she still could.

The last time Paul saw her before the end, she stared into space, never acknowledging him. It was the Sunday before Christmas, and on Christmas Eve as I chopped and cleaned in preparation of the big day, Paul got the call that Mary was leaving us, in hours rather than days.

The Hospice nurse was there and she or one other RN would remain with Mary until the end. She explained that her blood pressure and respiration had increased, even though she was unresponsive to outside stimuli, as the body made a last-ditch effort to save itself. Unfortunately, the insidious bastard of a disease that had taken Mary Theresa away from us long ago was now attacking all her vital systems and they were shutting down; the nurse explained what that would look like over the next hours.

Unable to get the Roman Catholic Church which had provided communion to this deeply Catholic woman for the last several years to come grant Last Rites (“we don’t go to nursing homes – only hospitals”), our own Episcopal priest dropped everything and came. The attendants of Bethesda Gardens gently, lovingly tucked her into bed for the last time, placing a pillow here, an extra blanket there, ensuring her comfort as silent tears ran down their cheeks. By ones and twos, other attendants slipped in and kissed her goodbye. My sister-in-law, Donna, arrived and while Paul discussed matters with the medical personnel we sat on either side of her, taking her hands in ours and promising we’d look after her two tall sons. I whispered it was ok if she needed to go.

When Father Bill arrived, all of us joined hands and prayed, as he commended her to the God she loved and to whom she remained ever faithful. Eager to wish the birthday boy well, Mary passed on Christmas Day, her youngest son at her side.

We buried her on a snowy January afternoon, laying her to rest with her husband at the beautiful Veteran’s Cemetery on Rhode Island. Her sister, Claire, was there and in her I got to see Mary as she might once have been, bright and funny, with twinkling hazel eyes and humor to spare.

Of course it hurt Paul to lose his mother. Now, he’s an orphan and that’s a feeling I understand very well indeed. But that remarkably good visit, an answer to a prayer, in showing us a glimpse of who Mary Theresa was before Alzheimer’s claimed her, somehow made it easier to let her go. Now she is well, now she is with the God and the husband she loved, now she is no longer confused.

Rest well, Mary. I wish I had known you and your little quips, your poems and wit, before Alzheimer’s claimed you. I will see you, many years hence, and in the meantime, I will look after the son you loved, “… so much!”

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