My mother died with dementia. She didn’t know her husband, her grandchildren, her name, and she didn’t know me, her only child. Shortly after Christmas 2010 her hip fractured, dropped her on the floor and sent her to the hospital. Though the hip replacement operation was a success, to the extent the bones were screwed together, she emerged from anesthesia with far greater confusion than before. This happens frequently to the elderly. She died roughly 90 days post-surgery, which is not at all uncommon for patients with dementia undergoing any sort of invasive surgery. Most surgical patients with even mild dementia, especially women, simply die off at about 90-day intervals.
One study put the one-year post-operative mortality at almost 80%. A non-surgical approach – not favored by surgeons – is to render palliative care only, since the risk is so high and imposes a long confusing period of time on the patient before death. I would have favored the palliative approach, but my father, then 91, believed the surgeon.
Dementia patients descend ever deeper into a mental thicket hardly recognizable to them, one so deep they can no longer feel hunger. They cannot remember yesterday, they make no plans for tomorrow. They live only in a hazy and frequently agitating never world. That is how my mother died.
I had a parishioner back in my Lutheran pastorate days, nice guy, who just dried up and left us. He became less and less of himself until he wasn’t himself at all. He shriveled; his world shriveled with him.
He had a plain garden-variety dementia and that was all. Not Alzheimer’s, not the sexy one everybody knows about and even jokes about (blame “half-heimers” if you come home from the store with the wrong items).
What happened to them, my mother, my parishioner? Who were they when they no longer could remember who they were? Where were they? Who had they become? These issues are taking on more interest for me.
My wife noticed a few odd things about me (well, odder than normal) beginning a while back. I was generally dismissive until this one really big thing. Was it late fall, 2020, the school year just underway? That seems right. I had a serious memory hiccup involving live worms that turned out to be dead worms by the time they turned up. She ordered them for a science lesson with her fifth graders. I was to retrieve and refrigerate them. I do not remember them being delivered. It was clear they had, though I had no recollection of it, yet there they were, some days on without refrigeration, in their full and by now odorously decaying glory. In fact I had no recollection of the day at all. On the day they were delivered a small stroke sent that day down a memory hole. I remember the next day quite well; I bought replacements from a bait shop and delivered them to the school. I don’t remember what else my wife had been noticing but she was concerned, and with some reluctance I became concerned too.
She sent me to my doctor, who sent me for an MRI. It showed lots of “white matter” involving both hemispheres of the brain. I was aware of it from an MRI 10 years previous. No one said much of the white matter, not at the time. But then it wasn’t as extensive 10 years ago. It was once thought that, like tonsils, white brain matter was benign. It isn’t. I was unaware how serious it might be. Not that there is much to be done about it; it indicates a variety of brain damage caused by numerous abrading factors (old age being only one) that prevent blood from reaching the entirety of the brain. Some folks go on through life, white matter and all, with hardly a bother. Others do not; I am one of the bothered.
Diabetes is my deal; it restricts blood flow through the small vessels (gum disease is often one result of diabetes and constricted blood flow; and, thank you, my gums are just fine). My doctor sent me on to a psychologist who put me through a battery of tests that confirmed a decline in cognitive functionality.
I am said to have a “reduced physiological and brain reserve. …” The phrase “brain atrophy” also pops up in the health literature I’ve read. I hate it when that happens. Though it is known by other names (leukoaraiosis or “white matter disease”) it is generally called “small vessel brain disease” and for short reference it goes by SVD, which to me sounds faintly like an STD. Along with cognitive troubles,
SVD has produced so far small, thoroughly aggravating difficulties in walking (sometimes lurching in my experience), maintaining balance (wobbling while standing or standing while wobbling, whatever fits), and walking pace, which means slow walking. SVD also diminishes my capacity for “doing more than one thing at a time.” “Talking while walking” is a cited example. You wait; eventually chewing gum will be in there. It also goes by “vascular dementia.” Those characteristics are ongoing and will likely worsen. Vascular dementia turns out to be much like every other sort of dementia.
I find myself sometimes doing an old man shuffle to get my feet going, negotiating travel by launching a series of small, small rapid steps until reaching speed, which is still, you know, slow. I find that more publicly embarrassing than forgetting to raise my zipper to its “Full Upright and Locked Position.” I’m old; so who’s looking anymore?
But shuffling, it probably means I’m delaying a line of impatient people who would happily trample me if permitted by law. Slow old people can be just so, so irritating.
Worse — I find it worse — this is the first piece I have been able to complete since April 2020. I believe I started struggled with this six weeks. I go up to my study with my mind brimming with ideas and notions. I sit down before the screen with fingers poised above the key board and I have walked into a room where I cannot remember what I was coming after.
I wonder what I shall know when I am unable to know myself. How are we ever again ourselves if it is one’s self we can no longer remember. Is it that boomer rock song line? Are we all just “slip-siding away”? When our daughters were young my wife would every morning make the Sign of the Cross on their foreheads and say, “Remember you are baptized.” I think in the coming indolently loitering days I may visit, it was a demand of God that He remembers. If scripture is true and He is a God of the living and not of the dead, perhaps it will be so that if we forget, He remembers.
A former Lutheran pastor, Russell E. Saltzman lives in Kansas City, Missouri. His latest book is Speaking of the Dead. He can be reached at email@example.com and on Twitter @RESaltzman. This piece is slightly revised from two previous version originally appearing at the Catholic Herald UK and at Aleteia.