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Tripping on the Road: August 20, 2014

It’s been a long day. Sometimes, we celebrate even though there’s a darker shadow just below the surface. Birthdays come and go, in their endless parade – until suddenly, we wonder if there will be a next one in that lineup. At least I do. Mortality casts a lengthening shadow, and at this time of year, as the sunset looms ever earlier in the evening, we start to think of the way things wane and wind down. The blades spin slower. Their shadows fall in dark bands across our skin.

But the sky is indelibly blue and the close of the light casts glory across the waters. The Pubnico windmills turn, turn, turn … the gulls on Yarmouth Harbour rise and scatter over its salt mirror. I stitch the path between these two actions with smaller things: opening a pat of butter at a restaurant; helping to put on a pair of shoes (no laces – only velcro now); assisting my husband with getting out of our car and being able to stand. When he falls, I can’t manage to restore him to his feet. Chatting with friends, I am keenly aware that on the other side of the table sits a man who, not so long ago, would have introduced himself, added his own remarks, enjoyed the conversation – but can only smile now, as well as his facial muscles will allow. It’s almost like looking at one of the Greek masks: comedy or tragedy.  I’m relieved when comedy wins.

His voice inevitably falters. He tries not to talk much any more, in case someone might misinterpret or, worse, assume he’s “not all there” – drunk, on drugs, senile. Explaining about his disease takes too many words and he doesn’t have enough breath to deliver them without his voice amplifier. A couple months earlier, he could manage three syllables per breath. The amplifier has pushed that number to ten. But he doesn’t always wear it when he’s just out wandering around. So the words drown him.

Still, he gamely tackles his parmesan haddock with mashed potatoes (no more french fries), sips a Diet Coke (his throat seems to respond to the carbonation and he doesn’t choke as much), samples some bread pudding. His feeding tube lurks beneath his shirt. He knows it’s there, of course, but he refuses to relinquish his solid meals just yet. That will come soon enough. On the drive home, he speaks of pain – cramps in his arms, legs, chest. At night, he fumbles with a BiPap breathing mask so a machine can force his lungs to take in air. And he wonders where to buy suspenders to hold his pants up! Weight loss and diminished muscle tone make it tough to keep them in place. Gravity is merciless.

While we’re on this day trip, unknown to us, compassionate folks in Yarmouth are participating in the Ice Bucket Challenge. They shiver and grin through their discomfort, which is duly recorded for posterity. Two thumbs up to them all! ALS gets much-needed attention and those who wish to donate are inspired to do so.

I briefly wonder if any of the PALS (People with ALS) from our area were able to attend this wet and icy event. There aren’t very many – only two or three. It would have been fun to watch the local challenge in person, since we “ALS families” are affected more than anybody else. But this, I think, highlights the ultimate isolation that this disease can bring. When there’s a community fundraiser for, say, breast cancer research, chances are there will be breast cancer survivors or patients applauding or even saying a few words of appreciation, or possibly tossing a ball at a hapless dunk-tank volunteer. Same goes for MS, diabetes, kidney disease or almost any other health-related cause one can name. You’ll usually see a few patients and their families represented among the spectators. With ALS, in a smaller community it might be hard to find anyone who actually has the disease, let alone is able to be there. Thank goodness for videos! They’ve allowed so many of us to share in the experience without struggling to make a physical appearance.

Still, it’s very cool – literally as well as figuratively – that David’s birthday was also the date chosen for the ALS Ice Bucket Challenge in his own town! Perfect timing. Thanks, Mayor Mood.

So ALS is finally “out there”. People are learning what it is, why this battle is so important, how they can help. ALS isn’t just a bunch of letters that need to be explained. And it no longer wears only Lou Gehrig’s face. It wears David’s, and Pete Frates’, and all the others who take this same road trip. These are beautiful, brave faces even when they can’t smile any more.

This, my friends, is the reality behind the ice water and the donations and the long-overdue hype. These are people who have been going about their lives, working, learning, sharing, contributing, hoping and planning. Suddenly it all crashes. At any age, under any circumstances, that terrible diagnosis changes everything. Yet hope remains as a constant, in these bleakest hours. There’s reason to celebrate even on these long days when the sun fades in mid-evening. Maybe not a wild, street-dancing kind of party but at least a whoop of excitement. A “YES”! An awareness that we aren’t in this fight on our own.

 

Uncovering Lou Gehrig’s Mirror

I never knew how someone dying could say he was the luckiest man in the world.
But now I understand. – Mickey Mantle

You should have scrabbled for it sooner,
hung it before the images first appeared –
maybe to reflect yourself, maybe this room
when snow sifted against a windowscreen.

But summer’s here now, with diamond afternoons,
and star-showers over the hills. Time to look.
The glaze wavers you. Your masked smile inverts.
Not tragedy yet, but the corners loosen.

You hold out a hand, touch the slicksilver,
fingertip to fingertip. “Make a fist,” your doctor
asked yesterday. But you can’t anymore. Arms
ripple their own nerves, and the child they held

has been gone for years. You used to laugh
and swing her up, that game you played best –
just a small girl’s arc through air. “Higher,
Daddy, higher.” First base: front step,

lunch pail beside you, crickets rubbing wind.
Old weathervane spinning on the barn. Radio
scores from the kitchen: no errors. You will
make one. Somebody else can be champion.

The glass tarnishes everything. Your shadow
drops its razor and rolls away. Supper flows
from a bag, libation for a man without hunger.
Bottom of the ninth: Steee-rrrriiike threeee!

In your head, you flip that chair and run crazy
down the lawn, gut trailing a tube. Those damn
wheels slowly turn and stop. You churn for the plate,
dust on your legs, no breath, nothing but crickets.

A long slide home.

 

(c) 2014 Brenda Levy Tate

 

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“Emotional Predators” of the Elderly

Advancing years – coupled with illness – often make us vulnerable to many challenges. If we have loved ones to help us cope and to offer protection against personal harm, this can be immensely reassuring. Sadly, some seniors – especially if they’re confronting major disabilities and gradually losing their sense of self-control or independence – often fall victim to others who insinuate themselves between the concerned family and the struggling father, mother or grandparent.

Because women tend to outlive men in Westernized nations, this particular situation can entail a gender imbalance. However, both males and females do become targets for the unscrupulous. Sadly, these unethical individuals usually gain the confidence of the victim through an appearance of friendship and good intentions. By the time family members become aware that something is awry, the relationship between predator and prey might be firmly established. It’s then very difficult to convince the elderly person that he or she is being conned.

This is frequently not a matter of mental incompetence but of misplaced trust. As we age, or face various hardships at any stage in our lives, we do need to feel that we’re the focus of someone else’s attention. We need to believe we’re highly valued and that we’ll receive assistance from those who know us best. Usually, in fact, we are important to our loved ones and we do get help as needed. Unfortunately, our adult children might well have jobs and families that take up much of their time. Spouses, too, might be feeling overwhelmed by the demands of caregiving and coping with their own ageing processes. They might not be aware that others are showing excessive and inappropriate interest in their partners.

Granted, elder abuse – and the kinds of scams that often accompany it – can also happen within families. This is a whole different topic. And there are many wonderful souls who visit seniors in nursing homes or at their own residences, assist them with everyday needs and genuinely want to make a positive difference. Heaven knows, we need these merciful angels! But my own concern is with total-to-near-strangers who materialize almost out of nowhere and gain the trust of their victims. Whether their intent is to acquire property, exploit financially or merely to interfere with the individual’s social and personal interactions, the results can be disastrous.

Con artists have no shame and will practise their deception without any qualms. But then there are those other folks who don’t understand the circumstances and honestly think they’re being kind and compassionate. They never stop to consider the impact their attention might be having on others who have been part of that senior’s life for many, many years. These people are, perhaps, more naive than malicious, but in the end they can do dreadful damage. If the person is undergoing medical treatment, usually the next-of-kin are the ones who understand each procedure and help to manage appointments, medications and so on. Most medical authorities want to deal with next-of-kin, such as spouses and/or grown children, or professionals such as nurses and Homecare providers. They’re not going to accept someone with no legal connections as an appropriate source of patient support.

When called to account for their actions, these so-called “friends” will typically protest. “But I was only trying to help.” “He loves going for drives.” “I’m just being a good neighbour.” Or – worst of all – “I don’t see any of YOU looking after her!”

At times, either party may misrepresent his/her marital status or familial ties. He or she might even play the “pity card” rather effectively. “Poor me – my wife is more like my sister now.” “Don’t worry; we’re separated.” “Our marriage has been dead for years.” “It’s OK, she (he) won’t mind as long as we’re just friends.” “He totally ignores me most of the time.” “My children never do anything for me.” And so on. Without actually having known this individual beforehand, the sympathetic listener might well be inclined to believe everything at face value. This can also occur in online relationships where the “details” can be slanted to fit the intention. Indeed, the devil is in those details when that’s the case.

It’s usually not hard to determine the truth. Separated or divorced? Ask to see proof – the papers themselves, or a document scan sent as an email attachment. Neglectful family? Check the Facebook page, if there is one, and see whether or not family members show up on it. Or make discreet inquiries around the community. She (or he) won’t mind? Then why not talk to him or her, make email contact or call and ask? If you’re reluctant to do that, perhaps you ought to question your own motives and then back away. And if there is no documentation of a marriage breakdown, it’s best to run. Fast!

Otherwise, such a “friendship” can quickly alienate a family from a loved one if that person is still living independently and has, in fact, not been estranged from those who care most. This is simply not fair. 

Some opportunists will even claim to be affiliated with a particular religion that sincerely cares for the senior’s soul, even when it doesn’t. They’ll pray with him, visit him regularly, invite him to their church. Flattered, and unaware he’s being used for profit, he will respond with eagerness. Needless to say, there will be some tradeoff: salvation for donations. The relatives often have no idea this is going on. Countless elderly folks have been bilked out of their life savings by charlatans operating in the name of God. A valid and caring church will offer support to its adherents. A fake one will siphon away their money.

For partners and others responsible for the welfare of a vulnerable individual, here are a few warning signs that might indicate a problem:

– the appearance of a new “friend” or “companion” whom the family members don’t know very well, if at all
– the exclusion of family, by the above individual, from activities involving their loved one
– unusual generosity on the part of the senior when it comes to either money or time given to a stranger
– secretiveness and refusal to respond to questions about new or recent relationships
– unavailability for family events, or unexpected refusal to attend them
– increasing suspicion directed at loved ones over their concern for the situation
– hostility and resentment that appear to have little or no cause
– lack of communication through the usual channels (phone, email, texting, Facebook messages or whatever)
– loss of empathy with others who might also be facing hard times; self-absorption
– indifference to consequences, or inability to think ahead
– sudden and inexplicable interest in activities that have never before been important

I am the wife of a seriously ill senior. His disease has no cure and it will ultimately take him from us. Yes, my daughter and I occasionally find ourselves dealing with disruptions by those who don’t have his (or our family’s) best interests at heart. Sometimes there have been innocent approaches and other times, not so much. The trick is to know the difference! I’ve also had connections with other families that were torn apart by the machinations of a predator.

I hope that anyone in similar circumstances will find my reflections relevant. Some readers might even recognize their own stories here. They key is to remain vigilant. We have to speak up! If we don’t, who will?

Stand firm. We’re our loved one’s last and most reliable line of defence.  He or she might not realize this, but we do.

Sonnet for a Not-So-Well-Meaning Stranger

You call yourself his “friend”; he names you thus
as well – and yet, my dear, you have not been
with him these thirty years or more; not seen
his weeping wounds, nor braved the night, to rush
down rainy back roads while he cries in pain.
Have never heard his doctor say “Cancer”;
his specialist sigh “ALS” – his answer:
“Thank you. I’ve lived my span. I can’t complain.”

You, madam, think a casual embrace
is somehow your entitlement to share
one more adventure with this man? His wife,
his daughter, and her little son must face
your interference? You were never there!
Just go away – wreck someone else’s life.

Brenda Levy Tate

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On the Road Again

How ’bout them Habs? That final game should be somethin’ else! I have a happy husband this morning. We are Canadian, so we tend to root for the only Canadian team in the Stanley Cup race. However, Boston has Canadian players too. Brad Marchand is from our part of the country. And of course, there’s also Sidney Crosby; the Penguins face their own seventh game, do or die. We are hoping for “do”.

For those unfamiliar with Nova Scotia, this is a small province. The odds of producing NHL players are probably against us, owing to population. Yet produce them we do, and not just your average puck-chasers, either. According to one list, there have been 68 NHLers from NS. However, Yarmouth’s own Jody Shelley was omitted from that roster because he wasn’t born here, but his formative years were all spent in NS. He was a local favourite during the many seasons of his on-ice career.

So most Nova Scotians know and love their hockey, even when we don’t always watch every game on TV or at the local arena. My late father, Bert Levy, coached and/or managed teams in the Annapolis Valley back in the day. As a child, I often went to the old Acadia University rink to watch Valley Hockey League contests with him. I vividly remember the excitement, the smell of the place, the hot dogs slathered in mustard! I’ll write about my father in another blog entry at some point.

We have a visit to the ALS clinic tomorrow at the NS rehab centre. We’ll soon know every curve in the road to and from Halifax. I need a good cushion for my butt … which in itself IS a cushion, but not nearly enough! I take along my camera(s) and manage to make the most of the drive whenever I can – but I will never again leave a camera in a hospital! I made that mistake when we were at the Infirmary for the second neurological consult. I had thought of walking through the Public Gardens during David’s tests, to shoot a few images of whatever was in bloom, but misplaced my Canon T4i in the examining room instead. A month later, it came back to me after someone found it and the neurologist’s office tracked down the owner. Meanwhile, thinking it lost, I’d already replaced the missing camera with a Canon 7D, so now the T4i has become a nice backup for the newer and fancier model. Both cameras will last me twice as long. And the lesson has been completely absorbed. They stay locked in my car!

Still, these drives are daunting after awhile. They take seven hours, round-trip, not counting any stops. Our daughter works at an elementary school in Yarmouth; she’s a guidance counselor at Meadowfields. The staff raised money to buy us gift certificates that are certainly making these trips easier to bear. This will be our fifth one and we continue to be grateful for their support. The ALS clinic is held twice a month but I don’t think we need to attend all of them, although there will undoubtedly be a referral or two to other specialists in the future. This week’s consult will involve an anesthesiologist, whose field is pain management, and a GI surgeon. The topic of placing a PEG tube is very much in everyone’s mind right now. ALS patients (PALS) risk choking and aspiration of food as their swallowing function diminishes. Yet they require nutrition, of course, so a feeding tube permits them to receive it with greater safety and comfort. Bulbar-onset ALS, which David has, first affects the throat, voice and associated areas. In fact, he first knew something was drastically wrong when he began choking on his food and swallowing with great difficulty, accompanied by slurred and indistinct speech. Fine-motor control in his hands has greatly diminished. Yet he can still use his legs and get around, albeit more slowly. Limb-onset ALS – which is the more common type – attacks the legs and the other issues develop later. It is, however, normally slower to progress. David’s bulbar symptoms began only in October, 2013.

So he can take walks if he doesn’t overdo it and wears proper shoes. Still, one should never assume. To the casual observer, such a patient appears to be able-bodied. But with a bulbar patient’s loss of strength to eat well also comes weakness in other locations – fingers, hands, arms – and inevitably it spreads to the legs, often striking one side harder than the other for a short time. We are there now. The falls at unexpected moments have started to occur. For a man who not so long ago climbed Gros Morne mountain in Newfoundland, this is a frightening and devastating consequence of his condition.

So the paperwork increases. A form for a handicapped parking permit is waiting to be completed. The definition of a disability includes more than confinement to a wheelchair. Those who suffer from conditions such as ALS, and are still able to walk, fit the definition if they are physically limited to short walking distances. In a small community, mall parking lots tend not to be too daunting but in larger centres, they can be vast. I’ve gained insight into those who park in a handicapped spot and then walk away from their vehicles. Some folks assume they’re abusing the system – and this is not so. They are simply trying to remain mobile, within the limitations of their strength, but can’t push things too far (literally). For cardiac patients, these limitations can arise from severe shortness of breath. With neuro-muscular conditions, such as ALS, there can be other difficulties. When those motor neurons quit, they quit forever. This can happen faster with over-exertion. And in the end, inevitably, the wheelchair and other obvious support devices will come. The series will, in essence, be tied at that point. Nobody should wish this to happen to a stranger in a marked parking space. So if you spot someone parking in a handicapped space, then walking to the mall, please keep an open mind. Please be compassionate. The reality is often not what the appearance might suggest.

We learn as we go. Looking back to May of last year, who could have imagined how life would take such a radical shift? But it does, for many people, all the time. We’re not unusual. Each of us confronts his or her own destiny, for good or ill. There are no fixed strategies to reach that destiny, no set rules of play. We just find the best approach and trust it will get us there. And that the team will bring  its A game, every minute of regulation play, right through to a hard-fought overtime. That’s the goal, after all. This disease will win in the end but it’s not much of a victory when the winner plays dirty.  And ALS plays very dirty indeed.

At Life’s Summit

From this point, a person can look down and back. All the braided paths – so far below – are worn like ribbons in the stone and clay. The man or woman stands at a peak, buffeted by colder winds than either has ever known. Eyelashes blink themselves free of ice, then blink again. No matter that it is spring – or summer – or whenever else they find themselves up here. This chill is no respecter of time or season.

ALS – At Life’s Summit.

If anybody were to think ahead and idly imagine the worst among physical afflictions that burden humanity, surely this one would top the mountain. It is pitiless; its grip is implacable. It holds its chosen men and women firm on the pinnacle, with nowhere left to go but down.

Yet the view remains remarkable. The air is clean and the noises of earth diminish, with their currents of anger, despair, grief and hatred. Up here, it’s between the individual and his or her own will. The body fails but the mind endures. Hands that no longer possess the strength to write a single syllable are replaced by a power of another kind – the power that moves even this mountain; even this weight. Muscles have nothing to do with such a force. If it comes from any identifiable source, that source is the soul itself.

And it doesn’t make any difference whether he once threw the fastest pitch in the league or told a thousand pilots they were cleared for takeoff; whether she sketched a whirling sky or played a Bach partita that wakened God Himself. Whether they stood in front of elementary-school classes or stitched the seams in baseballs. It’s all irrelevant to the man or woman poised on the apex, confronting a destiny that will avalanche every former thing down the slopes and into the past.

The first to go might be the legs with their capacity to walk upright, toe-tap to a fiddler, wander along a beach as the foam fills in each footprint. Or it could be the formation of words, the easy flow of language like a waterfall, clear and coherent. The brain knows what it wants to speak; the throat or tongue or lips refuse to acknowledge its wishes. A man’s roar of laughter is muted; a woman’s cheerful giggle falls silent. A glass of wine turns to an instrument of strangulation. A satisfying meal becomes merely the memory of that meal, distilled into something the body will accept. A steak morsel, a lobster fragment, a strawberry slice, are held in the mouth like promises that can no longer be kept – tasted, then taken away. They are but ghosts from a feast remembered.

Yes, the world shrinks and constricts. It allows small room for resistance. This disease shows few mercies to those whom it seeks to partner. There are no bargains. The odds tilt sideways until every card is in the hands of the enemy, and its opponent’s hands can hold nothing at all. Not even empty air.

Yet the man remains; the woman holds on. They discover new ways to communicate, plan, and dream. They don’t abandon themselves, nor do they expect the rest of us to give up on them. We can’t always control what changes us, or deflect its momentum, not even a little. They already know this. We stand before them in awe, wondering whether we could face their fate and remain unbroken by it – brilliant and brave and somehow ageless. Printed immortal on the firmament, like the tracery of a comet that has passed but not entirely vanished.

For they are resolute, even when there are no voices left. As we watch, they quietly rise and shake the stars.

David Tate with Cash

My husband, David, diagnosed with ALS in 2014 …