G'ma's slow decline into demntia was fodder for many posts here in The Burrow. I wrote about our adventures, I wrote about her slippage, I wrote about my emotions. What I didn't write about was what it was like before we decided that she was losing her mind.
That's what it was like - her mind was being lost, one detail, one competence, one ability at a time. Often, the whole thing didn't disappear at once. Take the last game of Clue we played. The Cuters, G'ma, and I were sitting at the game table in our big house in Marin. Little Cuter was trying to explain the rules to her grandmother, trying not to giggle as her grandmother's pinky dipped between her lips, as her head sank further and further to the right, as her eyebrows and forehead wriggled and wrinkled, as her shoulders shrugged.
We laughed and laughed and laughed that night, teasing G'ma about her inability to remember the rules, or which token was hers, or if it were her turn or not. This isn't that hard, G'ma the kids kept telling her. She just laughed and said Sure, if I weren't old!
But it wasn't that she was old. It was her dementia showing.
We'd go to a restaurant, and I was doing the ordering for all of us. My mom couldn't remember what she'd chosen, even if she tried keeping her finger on the menu. My sister would call from the grocery store, wondering what she needed, and she always said sandwich bags. I just opened the last of those boxes; she stopped buying them in 2008. Her floors were dusty where they'd always been spotless. Her refrigerator was filled with delivered foodstuffs; she never thought to open the door and see what could be heated up.
Those were the subtle signs, I guess. The more obvious ones - leaving the gas burners on the stove flaming through the night - we never heard about, if they happened. And some of those obvious ones I chose to ignore.
For example, G'ma was in charge of Daddooooo's medication regimen. She gave him the pills and he took them. Often, she'd call and complain that he was throwing up in the morning, an action she was sure was hostility on his part directed toward her. Since their relationship had always been contentious, I assumed that this was just more of the same ... bad mouthing him, even when it was absurd. But then, he vomited before my nephew's bar mitzvah. I took him upstairs to change his clothes and, while washing the stains out of his shirt, looked at the medication on the shelf above the sink.
Do Not Take Within 2 Hours of Eating.
No wonder he was throwing up; she was giving him the pills with his breakfast. This wasn't nastiness on her part; it was the dementia. Did I do anything about it?
I wrote NOT WITH FOOD in bold black marker on that pill bottle. I got her daily pill dispensers and walked her through putting her own meds in them in the proper sequence. We labeled them AM and LUNCH and PM and BED; I'm still using one of them for my pills.
But that was a temporary fix. When I'd visit, every 6 weeks or so, I'd find several vials of the same medication in the cupboard. I'd find disorganization in the containers. I bought more of them and filled them all and left them stacked so they'd be available for the future.... but that just made it worse. What are all these things doing in the bathroom? I don't need them! I'm fine.
It was the I'm fine that stopped me every time. If she thought she was okay, who was I to disagree. If she wanted to live alone, with supervision from afar, then that was the dispositive answer. She wasn't falling. She wasn't locking herself out. When she walked and got lost she asked a police officer for directions and was able to give him the business card Brother made for her and the friendly officer drove her right home.
Sister was hysterical - what if! what if! what if! - but Brother and I were more sanguine.
She was walking - that's a good thing. She recognized the problem - that's a good thing. She found a solution - that's a good thing. No harm, no foul.
Except, Sister was right and we were wrong. These were all the indications of pieces of her brain that were slipping away. It was more than why am I in the kitchen? It was where am I and how did I get here?
And yet, we let her be. She lived alone on Long Island until she drove around her town for 2 hours, trying to find her house. She knew she'd gone to the grocery store, because there were bags in the back seat. She recognized neighborhoods as she drove through them, wondering about the kids who lived there when were young. She just couldn't figure out how to get home. Finally, she found the library. She parked, went inside to say hello to the librarians, then got back in the car and drove home.
Of course I can find my way home from the library, but maybe I shouldn't be driving any more.
Brother went up the next weekend and took her car..... a fact which registered in her brain a few days after he left when she called me and asked if her car was now with him in Maryland.... because it certainly wasn't in her garage.
She moved to an apartment in New Jersey, where Sister looked after her, and then she realized that snow and cold and ice did not have to be part of her life and she moved here. She fell the first night, in my garage, before she ever got into my house, and it was downhill from there on.
Anesthesia is not good for an aged brain, and she required a lot of it as she continued to fall and break ankles and wrists and back and leg. She was too functional for the Assisted Living Center when she moved in, but she wasn't functional enough for the Independent Living Center she started out in. She was lucky enough to have the funds to pay for excellent care, but it didn't make any difference to her mental decline.
We were losing her by inches. It took us much too long to acknowledge it.... not that it would have made any difference at all.
So, Liz, when you ask me When did you know? the answer is simple: long before I admitted it to myself.