Communicating with Mom: PSP and Talking

“Maybe I would have listened. But maybe, too. I would have just closed my eyes. Maybe I would have tried to memorize the smell of bug spray on my mother’s skin, or the way she absentmindedly braided my hair, tying it off on the end with a stalk of green grass” Jodi Picoult

When I make pie dough I mediate. I pile a cup of flour on my counter, cut up a stick of butter into tablespoon size chunks, and I cut it in. Slowly, and deliberately. I cut the butter into the flour until it is time for water. Pouring from a small measuring cup by tablespoon increments I slowly mix in the water until magically I have a ball of dough. Making pie dough reminds me of my mom. Not my mom who is in the nursing home, trapped in her own body, increasingly struggling to communicate. No, making pie dough reminds me of my Mommy. My Mommy, who made balloon buns every Christmas, who loved reading and going to the beach. My Mommy, who always knew what to say when I felt tired and sick and didn’t know if I could keep on keepin’ on.
The thing about PSP is that I still have glimpses of my mom. I still have pieces of her, but, in between these pieces is a woman who I don’t know anymore. Just when I think my heart can’t take anymore, PSP delivers something else on our door. Another new memory of my mom that I have to place beside all the other memories of my Mom. The woman who was and the woman who is. But, just like PSP has left me reeling from the losses, the despair, and all the bad memories the PSP has also given me gifts.

Communication

One of the many horrible parts of PSP is that it robs people of the ability to communicate. But, despite the lack of ability to communicate, the person is frightenedly cognitively aware. For those persons reading this that know me or who have read other things, I have written- the lack of ability to communicate with my Mom the way I used to is for me, one of the worst parts of PSP.
I miss talking with my mom. Hell, as an adult, I did it almost every day for an entire decade. Of course, I miss talking with my mom. But, I also hate that my Mom can’t talk with us. There are days when I spend hours trying to figure out what she needs, what she wants. The trying to figure it out is defeating. It is worse when she or I give up. Somedays, Mom is able to talk, whole sentences. On these days, I drink in her words because I know it could be the last time Mom tells me she loves me or the last time I hear what she is thinking. But more and more I am losing this gift, and more and more I sit as close to her face as I can and try my best to figure out what she needs. I watch her face as I guess…sweater? Bathroom? Smoke? And when her eyebrows lift to the sky, and her face turns into her new PSP smile I know I got it.

We now communicate in yes and no questions, thumbs up for yes, thumbs down for no. We now communicate in mumble jumble. Luke and I in her room, she is in a recliner, he is in her wheelchair, I am seated next to her chair on the floor…

Mom tries, ”your mumble jumble.”
Luke leans closer he says, “Ma, your what?”
She tries again, ”your mumble jumble.”
I start guessing, “you’re going somewhere? You’re in pain? Your…”
She doesn’t smile.
“Ok Mom, try again.”
”your mumble jumble.”
“is that a g? your g…” I reply.
I look at Luke, Luke looks at Me, Mom looks at both of us.
“I’m sorry Mom we are trying…try one more time.”
”mumble jumble gur mumble jumble.”
All of a sudden, I look at Mom, “yogurt! You want a Yogurt.”
Eyebrows raised, PSP smile, nodding.
Luke looks at me, “How did you figure that one out?”
“I am the Mom whisperer.”
“No you’re not, I am.”
“Did you figure out yogurt?” And I run from the room to get my Mom a yogurt.

Other times, simple communication takes longer. Before the nursing home, she was trying so hard to tell me something. If I had to guess I would have said it was probably the nuclear codes or something equally important. I worked at it for over thirty minutes and was getting nowhere. Then from the kitchen, Luke pipes up (yes, for some reason it is always Luke and me), “Jenny, you like word puzzles this should be fun for you!”
I look up, “umm…”
and he looks and me and says, “yeah when it is your dying mother not so much, huh?”

When the usual methods failed, I started with the alphabet. One letter at a time, give her time, nod yes if this is the letter and don’t if it is it not. It didn’t work. I moved on. Ok, Mom, I am going to try again. A…nothing, B…nod. Then, A…nothing, B…nothing, C…nothing, D…nothing, E…nothing, F…nothing, G…nothing, H…nothing, I…nothing, J…nothing, K…nothing, L…nodding. Then A…nothing, B…nod. Then, A…nothing, B…nothing, C…nothing, D…nothing, E…nothing, F…nothing, G…nothing, H…nothing, I…nodding. And again and again, until we had B-L-I-N-D S-P-O-T. I was still confused. Until from the kitchen, “Blind Spot, she wants to watch Blind Spot”

Eyebrows raised, PSP smile, nodding.

But then, there was the day I visited after she recovered from the flu- almost six months after the alphabet incident. I walked into her room, and she looked up at me from her recliner, “Hi Jenny, what is new with you?” We had entire conversations that day. Driving home I wanted to scream from my car to anyone who would listen, “I talked to my Mom today.” Sadly, no stranger would really understand what this meant. So, I sent texts to the people who have loved me through this. Ryan, L.R., Kate…”Mom said seven whole words in a row today! She was talking so good.”

Yeah, I miss talking with my mom. Even now, I will be at home living my life far removed from my Mom’s daily existence, and something will happen, a thought, an article I see, a political event, news from my doctors, something funny, or something sad and I will ache for her, I will reach for my phone and get ready to push the “mom and dad” button. Then it will hit me, a.) mom doesn’t live at home anymore, and b.) she can’t really talk anymore. So I pace the house, I talk to Ryan, I send Kate a message, sometimes I will go to Ryan’s moms house just because she is a mom, sometimes I text L.R., mostly I pace and I talk to everyone but my Mom, and while it is a nice distraction- it is not my mom. Then the next time I go to see her, which these days has been two or three times a week, I will tell her whatever it is I wanted to tell her. Depending on the day, my mom will answer, or if she can’t or if she is having a bad day the PSP will answer.

When I learned that more than likely I was heading for intestinal resection, I didn’t know how I was going to do it without my mom. Not that I don’t have support- I do. I have so much support and love it could fill entire cities. But, none of that support or love is my mom’s. I talked to everyone I could think of, and I just wanted to talk to my mom. But, it was not a good week for mom, and I had to tell her what was up. So outside, I knelt down next to her wheelchair as she smoked and explained, “I got my MRE results. Things are not so good. Benson said that I have some small fistulas and an abscess. I also have some serious inflammation and narrowing. He said that we can do Stelera and see but that I might need surgery anyway.” Mom listened. Then with all of her strength, “oh Jenny.”

I just wish I could process with her; I wish she had been with me when I had the test…but, my Mom has PSP, and I have to be strong for her. My mom has PSP, and somehow I have to figure out how to replace her with everyone else. Kate drove me to the illeoscopy, Ryan’s mom was the first to know about my MRE results, I am planning for surgery recovery without the reliance on my Mom, and it will be okay.

I am my mother’s daughter as are Kate and Emily. Luke is my mother’s son. I would like to believe we all got the best pieces of her in different configurations. Luke has her kindness. Emily has her sensibilities and politics. Kate, like Mom, was born to be a mom. Me, well I have her love for reading and her philosophies. I also look like Mom. Emily and I both do.

When Mom dies, she will live on in the four of us. She will live on in Jazzy. She will live on in the stories I tell, the way I live my life, and the love she radiated into the universe. She lives on today in each of us and in each of the pieces of her she gave to us. That is why when I need to talk to Mom, I talk to three other people and the combination of their support, love, and advice equals the one person who gave us each the best pieces of her.

On The Outside Looking In

“Yesterday is gone. Tomorrow has not yet come. We have only today. Let us begin.” -Mother Teresa

A perspective of PSP and the heartbreak of the family by Ryan.

Jenny’s parents were young when they brought her into the world, and the short gap between their ages helped to form a bond that might not necessarily have been there if a more profound age difference existed. Jenny always said she was thankful to have such young parents because growing up they were very active and did things that not all the other kids’ parents were doing. For example, Jenny often talks about her mother and how she would pull over to the side of the road as they were driving when coming across a patch of wildflowers. Together with her mother, she would examine the find, and her mother would encourage her to identify them. That’s how Jenny now knows the names of most of the flowers in Vermont.

Jenny also remembers with fondness how as a child she would never leave the house in the summer without her swimsuit. Her mother would insist on a change of clothes being kept in the car just in case in their travels they uncovered a beautiful swimming hole. The randomness of her parents’ ways and their attentiveness and participation in her daily activities is something she attributes to her parent’s age. “They were always involved with me and my siblings,” she says. The look in her eyes as she glances back into the past and once again relives those long-ago moments is indicative of the love she has for them. Jenny considered herself lucky because most kids do not get the opportunity to grow up and have parents who still have their entire lives in front of them, too. The chance to spend so much time with them, and to enjoy all of life with them, is something she holds near and dear. However, when her mother was diagnosed with a rare and fatal brain disease, everything changed.

Progressive Supranuclear Palsy (PSP) is a rare and fatal brain disorder. Jenny says all the time how a diagnosis of PSP is “like winning the lottery.” This disease, however, is not the lottery anyone wants to win. The comparison of the lottery stems from the rarity of the disease.  She fights back the tears and shakes her head. Suddenly, a slight smile forms on her lips and she sighs and laughs in a way that suggests this is simply her family’s typical bad luck. “Leave it to someone in my family to get a rare brain disease,” she says. She takes the news about as well as anyone can. Jenny was slow at first to process what the diagnosis meant. Back then the “scary stuff” was still somewhere down the road, and it was tomorrow’s problem and could be dealt with in the future.

Time is unforgiving, and reality began to set in with her mother’s loss of mobility. The progressiveness of the disease started to show its ugly self. Simple tasks, such as walking, became more of a struggle and eventually impossible. Jenny now has to assist her mother in and out of a wheelchair to get her to the bathroom or anywhere else around the house. Conversations that once filled the silence of the house are not as familiar anymore due to the loss of her mother’s speech. The words are slurred and at best difficult to understand. “She’s trapped in her own body” is how Jenny explains it. That is what PSP does to someone. The mental faculties are still fully in place, but the disease takes away the victim’s ability to move his or her own body. Jenny often talks to her mother without expecting a response. “I’d give anything to hear my mom’s voice again,” she says. “Not the way it is now, but the way it used to be, you know?” She regrets not ever having recorded her mother’s voice for prosperity. She only wants to talk to her. She understands her mother is there inside, even if on the outside it appears she is not. Jenny will sit in a chair next to her mother and knit while talking about the events of the week and fill the silence with her own words. The time they spend together is cherished.

Time is of the essence. Jenny acknowledges that there are so many things she would like to do differently if she could go back and do things all over again. She would record her mother’s voice. She would talk to her mother and ask her questions and seek advice. Jenny says she is guilty of thinking there would always be a tomorrow. For all of her life, Jenny has been comforted by her mother, and now she is losing her. “This is so unfair,” she says. Jenny spends the remaining time she has with her mother trying to give her comfort and searching for ways to fill the emptiness she feels by this devastating loss.  You never know what kind of obstacles life will throw at you, and Jenny will be the first to tell you to “enjoy every minute you have and don’t ever take anything or anyone for granted.”

And They Lived Happily Ever After

“’So what’s the point, then, if we can’t be happy? Why are we doing any of this?’ ‘Oh, there’s definitely happiness,’ Jack said, turning his back on the ocean and looking at her. ‘But it’s just about moments, not ever-afters.” He grinned. “Like when you’re right in the middle of the ocean with your friends, with no one trying to kill you in any kind of horrifying way. You have to appreciate these moments when they happen, ’cause obviously we don’t get many of them.’” -James Riley

I recently had the opportunity to reflect on the idea of “happy ever after” as it applies to my families’ future. At times during this experience, it has been easy to get lost in the hopeless, living one crisis to another. In my reflection on this I wrote, “For months, I had been in a state of survival. Living one crisis to the next and waiting for the damn phone to ring for the next one. From medication reactions to aides getting lost and Mom having to be trapped for hours without any assistance to falls that brought Kate and I to the ER…from suctioning food out of mom’s throat after a really bad choking incident to learning how to humbly with grace help my mom to use the toilet…watching someone die of this horrendously cruel illness has been the single most hardest thing that we have ever done.” In all of this suffering, it can be hard to find time to breath let alone hope or optimism for the future.

Crisis

As I reflected further on the past several years of crisis, I found myself writing, “Every step of this journey, has been one thing after another and those things have been huge, time-consuming, painful, and have resulted in all of us having memories which we would prefer not to. But, in all of this suffering, there is joy. After almost losing Mom last weekend, I saw her on Wednesday and she spoke seven words in a row to me- something I did not think that I would ever hear from her again. That was a good day. This entire process has taught me valuable life lessons- for example, to be there for Mom I have given up a significant portion of my income. I would rather be living paycheck to paycheck and be there for Mom than have all the wealth in the world. But, anyway when that notice came as a family we were trying to figure out how to continue providing care for Mom with my illness getting worse, Dad’s financial situation which we all knew was not good, my brother’s grief related poor choices which were leading him down the wrong life path, plus our usual life stuff- Kate being the mom of a toddler, Emily living in NYC and dealing with guilt of not being closer, etc. That notice changed everything for me- I stopped surviving and starting focusing on other things.” From this low point in the journey, I made a conscious choice to prioritize. I found myself with two mantras which have served me well: 1. Not my monkey and 2. This is a marathon, not a sprint.

Not my Monkey

Managing mom dying has taken considerable resources. We are lucky. There are five of us. For the first year, I wanted to be an active participant with all of it. From applying for benefits to funeral planning every part of it, I wanted to be involved in and helping with. But, we didn’t need five people on all of the tasks. Since my existential crisis and loss of faith, I have separate my monkeys from everyone else’s monkeys. For example, we recently had a situation that needed copious amounts of emails and phone calls. In this situation, there was not much I could offer to it. Rather than calling into conference calls and being an active part, I allowed my sisters to take the lead and had them merely CC me on the emails. In this way, I knew what was going on, but I freed up the time that I would otherwise have had to spend on the phone or participating actively. While they managed that, I spent time with Mom at the nursing home and helped with developing a new plan for eating. In another example, I am the weekday nursing home person. I am available during the week, so I visit on weekdays. On the weekend, I stay home and manage my own life. Sometimes I miss out on seeing extended family or visiting with my brother, but, I am able to have time at home to rest, work, grocery shop, etc. when I otherwise would not.

This is a Marathon Not a Sprint

We have limited time with Mom. In knowing that she is dying, it is tempting to spend every resource and every ounce of energy being with her. But, if I give ALL of my resources right now, I won’t have any for next month or next week. So, I have to prioritize and allow myself the ability to say “no.” Back when Mom was at home, I didn’t have many choices. The times and days I said I would be there she and Dad were counting on me. If I didn’t go then, Dad had to call out of work, or we would have had to deal with the agency and beg them to find someone to step in. Mom’s days were always harder with the agency, and there was enormous pressure to make sure that no matter what I was there. Now, even though Mom has skilled nursing care at the nursing home, I still feel these pressures. When I tell Mom I am going to be there; I show up. No matter what. But, it is on me to manage when I am going to show up and what I tell her. It is also on me to recognize and forgive myself when I can’t. It is a constant readjustment of boundaries, schedules, and knowing that if I have nothing left over, then I am no good to anyone.

Finding Myself

I can’t describe it accurately, but after losing my faith over the summer, I regained it. From that low point, I found a calm core inside of myself which I had thought I had lost- the “everything happens for a reason, and it will all work out” core. I like you try my best to find optimism in these dark places, and I must believe that 1.) everything happens for a reason, and 2.) suffering has meaning (a great life lesson from Viktor Frankl and “Man’s Search for Meaning

I do believe we get a happy ever after- we just have to redefine it. Happy every after in a new chapter without this most recent crisis lingering over our heads. Happy every after to enjoy those seven words in a row. Happy every after to make meaning from all of this. I don’t know yet- my higher power did not consult me and ask me for my permission for any of this, and the universe often provides these lessons in retrospect, so the jury is still out on the exact ending. But, I do think we get a happy ever after just not the one we would choose if we were asked.

For today, Dad can spend time with Mom after work, and they can enjoy each other’s company. For today, I can sit on mom’s bed with her, Red Sox playing in the background, and help her to remove her toenail polish and trim her toenails- lost in the comfort of being with my Mom. Ultimately, all we have is today.

In the words of the Beatles, “and in the end, the love you take is equal to the love you make.” We are blessed, as, despite everything, the one thing I know without a doubt is that love remains.

An Introduction to Anticipatory Grief

“He’d lived long enough to know that everyone handled grief in different ways, and little by little, they all seemed to accept their new lives.” -Nicholas Sparks

After Mom was officially diagnosed with PSP, I set about doing what I do- reading and learning everything I could about the topic. While this method works for me, I do not recommend this path to all loved ones who are in the PSP journey. Watching videos of people with late-stage PSP was incredibly hard, I curled up in a ball in my comfy chair, a box of tissues beside me, computer on my lap and tried to wrap my head around what was coming- and it seemed almost impossible. But, those videos haunted me and began to prepare me for the future. They also triggered my anticipatory grief.

What is anticipatory grief?

Anticipatory grief is grieving that begins before someone dies. In my case, the grieving began with the label of PSP and understanding that it is terminal, progressive, and non-curable. The symptoms of anticipatory grief vary from person to person, but, these symptoms are generally the same as those experienced after death. In my case, the feelings of anticipatory grief are complex and interwoven into the grief I feel watching my mom lose various abilities.

What do I need to know about coping with anticipatory grief?

  1. No two people will have the same experiences!  While I have experienced profound anticipatory grief, Medicine Net  points out that not all people have symptoms of anticipatory grief. In other cases, anticipatory grief might have the same symptoms of depression whereas for others the senses of loss might manifest as anger.
  2. Use your support system! I have a diverse and expansive support network of people which have helped me to process Mom’s death. In addition to my friends and family, I found a PSP support group online which has been critical to helping me to both process and learn about PSP. The Cure PSP organization has on online find support tool and Grief.com offers a searchable list of support groups throughout the United States. Finding support can be critical to processing and coping with anticipatory grief.
  3. Be gentle with yourself! When caring for someone with a terminal illness there can be days when it simply does not feel like enough. Between normal life responsibilities, care taking, and grieving it can be easy to slip into destructive behaviors or harmful patterns of negative self-talk. In these moments, learning to recognize the behavior and reminding yourself to stop and breath is critical.
  4. Give yourself the time! It is okay to feel exactly how you are feeling. Take a minute (or longer) and allow yourself to feel. Instead of choking back the tears give yourself the gift of allowing them. If you are feeling angry allow yourself to be angry. Stomp your feet, yell, tell God to “fuck off” if you have to. Then after feeding the feeling for a brief time, get up and get moving! Do something, anything!
  5. Seek professional help if you need to! Anticipatory grief can be overwhelming and can become increasingly complex. Some people find that a professional can best assist them through this time. If you find your grief becoming overwhelming or impairing your ability to function, then it might be helpful for you to see a therapist or join a professional support group.