At sundown

The disintegrating physical and mental situation of an elderly best-beloved recently has led me back (after a brief pause) to readings in neurology and consciousness. It has also led me to reflect on the tasks memory accomplishes for us and how the need to tell a story seems to reside deep in whatever “makes us human.” Many poems, perhaps most of them, are “inspired” by memories and a need to tell. So I will indulge myself by giving a narration here, and perhaps poems will follow later.

paintdaub copy

The best-beloved has been in and out of hospitals, rehabilitation centers, and so-called independent living placement and appears to have developed a very common but not-commonly-talked-about cognitive disarray, or hospital-induced delirium, that medical personnel call “sundowning” when it occurs in Alzheimer’s patients. But my patient does not have Alzheimer’s disease. Her meshing of realities must have been triggered by something else, but the possible factors are many. We may never figure out what it was that pitched her into delusion and lack of compassion, turning her into a person we barely know.

She took good care of her body. At 90, her physical self is in better shape than many people 20 years her junior. Her brain–and hence, her mind–has not stayed as healthy as the rest of her. Several small strokes deep in her brain began to alter not just her gait but her personal focus. Long years of hearing loss no doubt altered how her brain processes input. The reading I have been doing (most recently Carr’s The Shallows, Sacks’ On the Move, and Damasio’s Looking for Spinoza) indicates that the human brain is “plastic” but not necessarily “elastic.” It can modify in response to damage or training, but that does not mean it will spring back to the way it was before. In extreme old age, the process of adaptation slows. The brain becomes less resilient. For reasons no one really understands–a host of possible culprits includes hormones, glutamates, serotonin production, medicines, genetic predispositions, and environmental factors among others (a perfect storm…)–persons who have been sharp and cogent may suddenly experience delusions, often leading to paranoia, confusion, loss of affect, lack of social filters, violent and contrary behavior.

And we ask, “What happened to the soul I love?”

alice-heart1 copy

If we believe in souls, we have faith that somewhere under the changeling is the best-beloved. In flashes, she may return to us. If we believe that the brain is the person, the transition from best-beloved to aggressive complainer is harder to accept. Damasio seems to believe the brain is the person. I find it hard to agree with him fully, though I have been learning a lot about neurology in the process.

Metaphors or analogies for the situation seldom seem, to me, quite to capture the wrenching feeling I have when encountering sundowning. The idea of disintegration seems inappropriate in this case, because she recalls who we are and her mind is not collapsing so much as morphing in unaccountable ways. Threads unraveling? No, not really; the metaphor of a quilt coming undone, maybe, or an intricately-woven tapestry shredded apart–but that’s far too simplistic.

Think of the mind: it encompasses the brain with its regions for motor, somatosensory, auditory, and visual processing; the body, which takes in those physically-produced inputs; memories; thoughts; feelings, which are thoughts spurred by emotions; and a host of complex inter-relationships we cannot even begin to map. Somewhere in all of this is the person, the “self.” At least, as far as we have so far been able to speculate (though not everyone agrees; see my post on Hofstadter & Parfit. Parfit suggests personal identity is an invalid construct).

Perhaps an environmental analogy would suffice, being complex enough for comparison. She is the planet Earth, aging and adaptable, but not endlessly adaptable; her healthy balance has been thrown off by things she may not have had any control over. In whole regions, she becomes inhospitable. Poisoned. Dry. Hot. Overrun with invasives. She seems not to like us anymore, but that is not what’s going on at all. In fact, she’s dying.

Maybe that’s taking the metaphor too far. But in difficult times, one reaches far. There is hope she may recover at least some of her Self, and in the meantime, we have stories in which she plays a role. Mnemosyne–awaken in the consciousness of those who know her. Telling the stories is a step toward letting go.

 

Advertisements

6 comments on “At sundown

  1. Barbara says:

    So sad, Ann. Thanks for writing about this situation so eloquently. This was a very moving piece.

    Like

  2. KM Huber says:

    My own mother is experiencing something similar; she is 85 but her physical health has been poor for years. I am not able to visit her–we live thousands of miles apart–ours is not a close relationship but we have the respect for one another, which is its own kind of love. For years, we emailed one another weekly; after her series of slight strokes, I started mailing a weekly letter. My siblings tell me she enjoys them. My mother finds it difficult and frustrating to talk on the telephone. Thus, ours is a one-sided correspondence.

    After reading your post, I realized I am telling my mother stories, present and past. But best of all, you have given me metaphor: “She is the planet Earth, aging and adaptable, but not endlessly adaptable; her healthy balance has been thrown off by things she may not have had any control over.” Your metaphor provides me yet another perspective on my mother’s dying. Already, I am thinking of this week’s story to send. Thank you, Ann.

    Karen

    Liked by 1 person

    • I know so many people going through this life-transition or whatever you want to call it, as extremely elderly or unwell loved ones slowly and sometimes painfully (and sometimes, unrecognizably) reach difficult stages in cognition. A weekly letter is a marvelous choice of communication. It may seem “one-way,” but the stories you write to her confer validity on her experience and yours as connected human beings in the world. That’s a gift, Karen.

      Liked by 1 person

  3. Susan Ashman-Smith says:

    Lovely, and relatable, if that is a correct usage of the word. In fact, I read your piece this afternoon and referred to it this evening while talking with a friend about a an elderly in-law going through a sad decline.

    Like

Thoughts?

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s