Month: December 2023

This tree is a small live spruce tree that uprooted and put in a planter. It’s doing duty as our Christmas tree, for a second year. It’s not clear to me how the tree feels about this.

Art and I had a 90-minute telephone appointment with some of the doctors at the neuropsychology department at the Portland VA. This was follow-up on the tests that were run during our visit down south, in November.

There was a lot of detail, not least starting out with about half an hour’s worth of CYA gobbledy-gook (“cover-your-ass” medical discussion of the validity of the tests, baseline, etc) which, with its abstraction, immediately left Arthur uncomprehending, which wasn’t a very good start.

I won’t go into details – they confirmed my intuition that his dementia (since that’s what we’re officially calling it now) has progressed substantially since a similar evaluation in 2020, and my gut feeling is that he was actually much more functional directly after his accident in 2018 than he is now.

There were three salient moments.

First was when the doctors raised, off-handedly and as if it was a previously discussed thing, Arthur’s “depression.” I use quote marks because Arthur actually became visibly agitated when it was mentioned, and angrily said, “I don’t have that problem.” My personal addendum, which I was probably unable to convey to the doctors clearly with Arthur sitting right there, is that Arthur has always struggled with some degree of undiagnosed depression, but it’s something he has never been open to discussing. The mere mention of it left him much more closed off and uninterested in the rest of the talk – he spent a lot of time looking for specks of dirt to pick out of the carpet at his feet, as he does now when he’s had “enough” of whatever telephone or skype conversation we’re having.

Second was when we got into some summary of etiology (medical cause of the dementia). The verbiage was thick in the air, but what I finally gathered is that they’re most comfortable assuming multiple causes, broken into three categories. 1) He’s had repeated TBI (traumatic brain injury), due to the main fall that broke his neck in 2018, but likely other “head bonkings” (Art’s words) such as when he fell off the ladder in our first year up here, down in the road last year, or even when he modified the sheetrock in the bedroom last month; Art seems to prefer encountering hard objects with his skull rather than using his hands to catch himself, because of the severe arthritis pain in his shoulders. 2) They mentioned vascular problems in the brain, a kind of medical shorthand for stroke and stroke-like events, such as the scarring noted in CT scans at the basal ganglia; these stroke-like events are not singular, but something that seem to occur occasionally, and perhaps back in time to well before the fall/stroke in 2018. 3) They used the word Alzheimers repeatedly (and for the first time), and while observing that if it’s Alzheimers, it’s a “non-typical type” but it’s still within an Alzheimers type dementia; I could tell that Arthur recognized the word and found it alarming, by watching his reactions as we talked.

Third was that despite his extremely slow processing speed and quite limited ability to recall recently mentioned facts, stories, words, sequences, etc, his comprehension vocabulary is still amazingly high – which is to say, once you penetrate past the extremely slow processing speed, entailing multiple repetitions and a lot of patience while you see the “loading” icon spinning in his eyes, he’ll know what you’re talking about. His underlying well-educated mind is still there, but just weirdly shrouded by these processing and memory issues.

During all the interview, I did most of the talking. Arthur sometimes seemed to follow, though he did his schtick of pretending not to understand when he didn’t like what he was hearing. It’s quite difficult, with him, as he’s always done this thing of pretending not to understand, as a jokey way of getting out of certain sorts of discussion, and of course, now, he often really actually doesn’t understand. So his pretending to not understand (and not care) is a facade to conceal his actual non-understanding.

In the wake of the call, Arthur was grumpy. I went to work. At dinner, when I got home, I gave him a summary of the talk – which he asked for. I skipped over the depression part, but spent a lot of time talking about etiology, and focused on the final part – the doctors’ recommendations. Most of these are quite self-evident: exercise, develop strategies for dealing with forgetfulness, adapt social interactions for dealing with very slow processing speed. But these efforts of course run up against Arthur’s return to comments like: “Wait, I don’t process things slowly” or “I don’t need routines, I do things when they need to be done”. Then other moments, he’d say “I have no brain” or “I forget everything.” It’s all provided together, a word-salad of mutually incoherent cliches that are what’s left of his self. And they all require a proactive interest in self-care, which is Arthur’s single hugest weakness, to be frank. And I can only nag so much – it’s very much a “pick your battles” thing at this point, and so I can’t always focus on these types of things.

Life goes on.

[daily log: walking, 5km; retailing, 8hr]