26 March 2012

Alzheimer's Poetry Offers Comfort, Insight

Beyond Forgetting: Poetry and Prose about Alzheimer's Disease
edited by Holly J. Hughes, with forward by Tess Gallagher

Memory says, Guess again:
Which hand? Then switches
whatever it's holding.

It scrambles her recipes,
teaspoon & tablespoon,
pinch & cup,

steals salt from the shaker,
leaves sugar in its place
An April fool waiting for her to taste
Loss is the starting place of many of the poems in this collection. Loss of memory. Loss of personality and identity. Roles lost to the effects of disease: mothers and fathers have forgotten the children who now care for them. Poems such as She Falls for It Over & Over by Joseph Green (excerpted above) are carefully observed records of declining abilities. Taken together, they are a testament to the varieties of decline. Alzheimer's erodes personality, but each person seems to be worn away a little differently in these poems. Bruce Berger marvels that his father can still work crosswords (Across, Down), while Candace Pearson imagines her mother's life with less and less language in Another Country:

She had thought nouns might be the last
to go, naming carried that much weight.
No doubt surprised to find she had crossed over
to another country, one with no road signs, towns
without title, maps merely lines and elevations.

Most of the poems (indeed, the collection as a whole) move past descriptions of what is lost toward accounts of living with less. Some find humor, or at least irony, in the situation. Sheryl L. Nelms' short poem, Early Alzheimer's, falls into this category:
Emma set her
kitchen on


she forgot
she was cooking

but the water

gushing through
the ceiling

for the bath

she forgot
she was taking

put it
The best poems in the collection help explore what cannot be expressed by platitudes and cliches. They offer freedom from the relentless positivity family and friends may require even in the face of terminal illness. They do not indulge in nostalgia for tidy, loving relationships that may never have existed between parent and child, or demand perverse loyalty to parents who have betrayed their children. John Grey concludes The Strangers in Your Room, for example, with a bitter reflection about a family history of Alzheimer's:
You stare at me like I could be familiar,
but then you turn away.
I'm just one more flower in a vase, one more
photograph you shake your head at, one more
half-eaten cinnamon roll on a plate.
Or maybe I'm your father, the one
who didn't know you from a quilt pattern
in his last days.
You told me once how cruel that was.
So I'm cruelty.
Glad to know you. Glad you don't know me.
A persistent theme in the collection is accommodation, as the writers explore what love means when everything else is forgotten. Some poets describe attempts to find new ways to communicate with ailing parents; attempts that are sometimes futile but also sometimes joyful discoveries of what remains of the relationship between parent and child even after shared memories are lost. In We All Fall Down, Nancy Dahlberg describes her efforts as:
trying to show my mother how love is felt
through the flesh; as if by caressing her feet
I could demonstrate the way to love a child.
Relationships between parents and children can improve in unexpected ways once the child befriends the person their parent has become. In the introduction to Recognition, for example, Kate Bernadette Benedict describes her frustration with well-meaning caregivers who tried to prompt her mother to recognizer her. She isn't trying to bring the past back. Indeed, some of what has been lost wasn't worth keeping. Now, she can take comfort is simple pleasures, like brushing her mother's white hair or listening to her sing:
She does not remember her marriage of forty years.
She does not mourn the husband she cannot name.
The drunken struggles, the blaming, the carping--
nothing of severity remains.
Benedict concludes her poem:
How restful it is, lying here this August day
with my witless mother,
this mother I prize and do not recognize.
HollyJ. Hughes describes a similar journey toward accommodation of her mother as she is, rather than how she was. In doing so, however, Hughes rediscovers herself in the role of daughter. The Bath recounts first the difficulty of bathing her mother and then the author's wise decision to turn from persuasion to pleasure, as she strips and enters the bath herself. By abandoning her role as caregiver for a moment, she acknowledges that she needs care, too. She stops trying give her mother unwanted help and asks for mother's help, instead:
So much is gone, but let this
still be there. She bends over
to dip the washcloth in the still
warm water, squeezes it,
lets it dribble down my back,
leans over to rub the butter pat
of soap, swiping each armpit,
then rinses off the suds with long
practiced strokes. I turn around
to thank her, catch her smiling,
lips pursed, humming,
still a mother with a daughter
whose back needs washing.
Not all of the poems in this collection are crafted with equal success. The intensely personal nature of some poems suggest they might have been written more for the benefit of the writer than the reader, but even these may have utility. In the introduction to her own poem, Tess Gallagher explains:
“Maybe those who have met the full unreasonableness endured when a loved one suffers the effects of Alzheimer's are the best comforters of each other...Often there is no way to make the situation less painful or to change the outcome for our loved ones. The pain just has to be acknowledged and even ritualized ...”

In Where We Have Come, Susan Ludvigson says it a different way:
...to see loss
black on white
is to be comforted
a moment
in the early hours,
not left alone
to mourn a mind
dropping its history
like Gretel's bread,
birds swooping behind.
Beyond Forgetting is a thoughtful gift for anyone with a family member living with Alzheimer's disease, and a helpful resource for social workers, doctors, nurses, and caregivers. It can be ordered through the Kent State University Press.

02 March 2012

Elders Urged to Get TDaP Vaccination

65 or older? There are two new reasons to talk to your doctor about getting the TDaP vaccine against tetanus, diphtheria, and pertussis.

First, the Center for Disease Control's Advisory Committee on Immunization Practices now recommends the TDaP vaccine for all elders 65 and older. (The old policy recommended vaccinations for elders over 64 only if they came into regular contact with infants less than a year old.) These recommendations reflect the fact that a significant number of Americans over 65 have not been vaccinated for pertussis and older people vaccinated as children may have decreased levels of immunity to the disease in the decades since being vaccinated.

Second, there has been a dramatic increase in the incidence of "whooping cough" or pertussis--nationally, and locally. Jefferson County Public Health reports 15 confirmed cases of pertussis in the past three weeks, with other cases of pertussis suspected and pending laboratory confirmation.

Pertussis is a highly contagious disease spread by coughing and sneezing. It is easily shared in places where people congregate, such as schools and nursing homes. Most people survive the disease, but pertussis can kill people of all ages. It is most frequently fatal among the very young. Pertussis is often under-diagnosed, especially among adolescents and adults, who may suffer less severe symptoms compared to infants. Having a mild case of pertussis does not mean an untreated infected person is not able to spread the disease to other people. Initial symptoms are similar to those of the common cold, so people may easily spread the disease without even knowing they have it. With this in mind, it is important to realize that the new vaccination recommendation is not just protecting older people from disease, it is also protecting their as-yet unvaccinated grandchildren.

Health experts recommend that all children are vaccinated against tetanus, diphtheria, and pertussis by 18 months, but not all children are immunized. Last July, the CDC reported that Washington was the state with the highest number of unvaccinated children entering kindergarten. According to the WA Department of Health, Jefferson is among the counties with the highest percentage of unvaccinated children. Over 10% of Jefferson county children start kindergarten without having received all of their recommended vaccinations.

Although pertussis is often called "whooping cough" because of the distinctive sound many infected people make when they try to catch their breath after a fit of coughing, it is important to know that not all infected people will make that sound. (It is possible to have the "cough" without the "whoop.") Jefferson County Public Health has issued a press release encouraging people to see their doctor if they have a cough lasting two weeks or longer, or as soon as they develop symptoms after having been exposed to someone diagnosed with pertussis.

TDaP vaccinations are available through most doctor's offices and at Jefferson County Public Health (615 Sheridan Street, Port Townsend) during their walk-in clinic from 1-4 p.m. on Tuesdays and Thursdays. Sliding-scale fees are available. Medicare does not currently cover TDaP for people 65 and over, but it may be worth checking your supplemental or Part D plan.

27 December 2011

A Milestone Attained

After a rather intense final quarter, I graduated from nursing school! This was the result of a lot of hard work on my part, but it was also due to the support I received. I could not have graduated without the material and emotional support of my good friend Marcia Lewton, for example, or the generous scholarship I received from the Jefferson Healthcare Hospital Auxillary. My instructor, Amber Hudson, was the epitome of calm reassurance and prevented many moments of panic. My preceptor, Cynthia Walker, insisted on best practices and instilled good habits that will serve as a great foundation for my nursing career. Friends at the Out to Lunch group deserve a special thank-you as well, for their regular injections of encouragement. They believed in my ability even when I wasn't so sure about it myself.

The successful completion of the nursing program is not only the result of help I received from others, but I am also not unique in my accomplishment. I am one of seven students who graduated, and each of us had to overcome challenges in order to do so. Our classes were hard enough, but it was often the circumstances of our lives outside of school that proved to be our hardest tests. Glenda, Emily, Karen, Brandy, Andrew, Megan: I'm proud to be a member of your cohort.

Graduation is a beginning as well as an ending. One of the things I like about nursing is how it requires life-long learning. I look forward to building upon the nursing education I received through Jefferson Healthcare and the RONE program.

In the immediate future, I will be preparing for my nursing license exam. After that, I'm going to be looking for employment opportunities that will help me grow as a new nurse. I'm also going to be exploring ways to integrate my passion for elder care with my work as a nurse. I'm excited about the possibilities attaining this milestone will bring into my life.