Washington
DC
A few days ago, I was doing our laundry in the
basement of our small apartment building.
After washing one load, I put it in the dryer, filled the washer with a
second load, and went back to our apartment.
I came down an hour later, expecting to find both washer and dryer
cycles finished. Instead, I found them
still going. The LED on the washer
indicated that there were still forty-seven minutes remaining in its
cycle. I interrupted the dryer cycle and
found that the clothes were still very damp.
What was going on?
My first thought was that I’d forgotten to turn both
the dryer and the washer on after loading.
I
had previously done so occasionally on one machine or the other but never both
at the same time. Since both machines
were now running, of course, there was no logic to my thinking, but it took a
while for that to sink in.
It took me a bit to realize I should open the washer
to see what was in there. I was
surprised and a little confused to find clothes belonging to someone else. How did they get there? Then I noticed a basketful of our dry laundry
on top of the washer. Where did that
come from? Had I forgotten even to put
the clothes into the washer? Had I
forgotten to turn the washer on, which encouraged another person to empty our
dirty laundry from the machine and start washing his? The best way to figure that out, I thought,
was to check the dry clothes in the basket to see if they were clean or
dirty. It wasn’t obvious to me. These were the dark clothes and I couldn’t
remember whether I’d put the light clothes or the dark clothes into the washer
first, so that didn’t help me figure out whether they were clean or dirty. I then reasoned that the clothes in the
basket should be warm if they’d just come out of the dryer, but they were only
slightly warm in the middle of the basket, so what did that mean?
I see now that, as I tried to make sense of the
situation, I somehow couldn’t keep these few bits of information simultaneously
in my mind.
- I’d waited an hour, but both machines are on.
- The washing machine indicates forth-seven minutes left in the cycle.
- The clothes in the dryer are still damp.
- A basketful of our dry clothes sits on top of the washer.
I stood there going back and forth in my mind,
checking the dry clothes, trying to figure it out. Slowly, bit-by-bit, I realized: Someone else
had come down, taken my dry clothes from the dryer and put them into my empty
laundry basket, then put my wet clothes from the washer into the dryer and
finally started washing his clothes.
Even after I thought of that possibility, however, I wasn’t sure; it
seemed a little complicated. I left the
dryer going to finish its cycle and took the dry clothes to our apartment, but
the uncertainty cleared only slowly.
I had been confused, of course. In previous episodes of confusion, however,
I’d realized I was confused during
the confusion. This time I became aware
only gradually after it was clearing.
In reflecting on this, I notice how episodic my
confusion is. I’m lucid the overwhelming
majority of the time: Over the weekend, I gave a short talk without notes and
led a discussion for an hour and a half without trouble; I can usually figure out
computer complication or keep our finances in order. At our church yearly budget meeting on
Sunday, I was helpful in clarifying some complications. I haven't had much trouble writing this post
and explaining (in a hopefully unconfused way) the state of my confusion. As a general rule, I’m not confused at all,
and then suddenly something like this happens.
As usual, my laundry-room episode didn’t bother me
emotionally. Things like this are still
more fascinating than troubling. In
addition, episodes of obvious impairment resolve those fragments of uncertainty
that still bother me after all the tests
that were normal.
I’m having these episodes more often, though: putting
the cabinets together with my son Kai, confusion on
the train, and now this. It’s
nothing dramatic like getting lost and
it’s a very slow and uneven process, but the impairment does seem to be
worsening.
Even those not cognitively challenged have similar laundry moments, right along with disappearing socks. This was a lovely piece.
ReplyDeleteI found the sock.
DeleteWhat I notice about cognitive impairment is that although we all make mistakes, the person who is impaired has a hard time figuring out what went wrong and coming up with a solution, as David described in this post. That's an important distinction for the "worried well" who are noticing problems and worrying that it may be an early sign of dementia.
DeleteThere's a common saying about dementia, that it's normal to lose your keys, but not normal to forget what a key is used for. In my experience, dementia symptoms will be noticed long before you get to that point.
I am incredibly impressed that you were able to find the experience more fascinating than disturbing. I truly admire your ability to view this experience objectively. There is no better way to describe aging gracefully than that.
ReplyDeleteI've been following your blog for two months and have found it very helpful. For several years, I've suspected that my husband has something going on. He's 56 years of age. The episodes are intermittent, but are increasing in number and intensity. Sometimes it's a matter of him being unable to remember something he was told a few minutes previously, or having to repeat it several times in a few minutes. At times, he seems unable to think out several steps ahead. He definitely prefers to do things automatically, and not have to plan them. He has always misplaced keys and wallet, but now if they're on separate tables within feet of each other, he doesn't see the items or have the awareness to look for them. He has taken a few steps to investigate the cause, but he's basically in denial about the changes. It helps to read your blog, because it shows me that there is an intermittency about the process. Sadly, it also leads me to believe he's experiencing MCI, and it's difficult to know how to respond to him when he wants to be treated like a rational man when he's not acting like one.
ReplyDeleteMy father has Alzheimer's and has been in a care facility for two years. My mother visits him often, and shares her experiences with him. We live in another state, so I'm not around on a regular basis. But some of what she's experiencing with Dad sounds really familiar to me.
Thank you for sharing your insights as you travel this road.
It's a very difficult situation you've been put into. On the one hand, the important advantage of getting a thorough medical evaluation is that there are medical causes of MCI and dementia that are reversible or for which steps can be taken to minimize progression. It's true that Alzheimer's (70-80%) and Lewy-Body disease (10-20%) are both untreatable at the present time. The progression of the next most common cause, vascular dementia (from small strokes), can be slowed down by diet and exercise. But then there are a range of uncommon causes that can be treated. And those are worth finding out about.
DeleteOn the other hand, if your husband isn't interested in finding out at this point, then you're probably not going to change thatl
I agree with David that you are in a very difficult situation. Seeing what your husband doesn't (or can't) puts you on a rough tightrope.
DeleteI'm responding to the word "denial" and would ask you to consider anosognosia, i.e., lack of psychological insight. I don't know if it applies in your husband's case, but it applies in my partner's case. She has MS that acts like traumatic brain injury, with significant damage to her prefrontal cortex. Much of her behavior looks like denial, but I believe there are instances where her brain simply does not make the necessary connections for her to perceive that something is wrong. For years she had insisted she was fine, when I could see clearly that she was not. Her surgery for an unrelated condition allowed me to assemble a healthcare team. These days she says she's thankful that I had dragged her "kicking and screaming" (her words) into getting help.
The difference between denial and anosognosia has helped me in my approach to her condition. Denial is a defense mechanism, which to me implies a kind of deliberateness even if not consciously realized. Whereas anosognosia to me implies a more organic damage that truly alters one's perception of reality. What helped me, especially in the beginning, was keeping a log of incidents that I could share with healthcare professionals.
David, I am very thankful not only for your candid exploration of your own condition and the way in which you educate us through your writing, but also for your tremendous sense of grace in light of all that is happening. Even when dealing with confusion, you do so with great clarity and compassion. Thank you.
Thank you very much for the above comment. I didn't consider anosognosia, but I think you're correct that it could very well be the issue. I first learned about anosognosia way back in medical school: Stroke victims who might have lost the use of, say, the entire left side of their body could not recognize the loss and would insist that their left side was just fine, clearly not a psychological condition but a physical injury to part of the brain, in this case due to Alzheimer's. If you're interested in further information, I wrote an entire post on this on Aug 21 "It's Not Denial." While it's quite uncommon in stroke victims, I suspect it's much more common in Alzheimer's. The response to that post was that when caregivers realized that their loved one had no control whatsoever over their "denial," the caregiver found it much easier to relate to the affected person.
DeleteAgain, to Anonymous (2), thanks for writing. It's important to be continually reminded about the condition.
Hi David, I have been following your blog for months and know that you have had extensive testing, but I am going to go out on a limb here and ask if it is possible that you are experiencing TIAs.
ReplyDeleteIn the area of cognitive impairment, ANYthing is possible. In my case, low risk factors for cardiovascular disease, a negative physical, a normal MRI, and the pattern of symptoms make it unlikely. But anything is possible.
DeleteI appreciate your words. My much loved mom is slipping away from me, more each week. You give me a lot to think about, as this seems to run in our family. Thanks for your efforts here.
ReplyDelete