Saturday, May 14, 2016

Care

You may tire of me as our December sun is setting
'Cause I'm not who I used to be
No longer easy on the eyes
But these wrinkles masterfully disguise
The youthful boy below
Who turned your way and saw
Something he was not looking for
Both a beginning and an end
But now he lives inside someone he does not recognize
When he catches his reflection on accident 

-Brothers on a Hotel Bed - Death Cab for Cutie


Of all the suffering ALS creates the most overlooked is the suffering it inflicts on primary caregivers. For every loss the patient endures, someone has to pick up the slack and that person is almost always the caregiver.  Think about that, you watch your loved one slowly die and you are expected to be their nurse /medical aid/social worker  and more. Your workload and stress ratchet up as your loved one declines. It is hard to imagine a scenario more likely to result in major depression. I do not know why we put so much burden on spouses or other family members but it is the standard practice in this country. Why Stephanie is expected to regularly perform tasks that Medicare considers to be "skilled nursing" with little or no training is beyond me, but that is our system at the moment.

No ALS caregiver, not the unpaid ones anyway, signed up for any of this nonsense. If you ask them most will put a brave face on it, but nobody actually wants the job. They have been thrown one of life's biggest curve balls and have only the inevitable loss of their person with ALS to look for release from their duties.

Of course all this radically changes the relationship between the now patient and now caregiver. More often than not they are a married couple as is the case with me and my wife Stephanie. How caregivers react to the new reality varies greatly. Many times a caregiver simply can't handle things and separations are not unheard of. I am very fortunate that Stephanie is as strong as she is because without her advocating for me I would be much worse off. Thanks to my situation her life is nothing like what she expected but she still fights for me. I have gone from a fit and active husband to one who is pretty much only good at making things wet and/or smelly. I can tell she hates having to be so involved in my personal care but she does what needs to be done. All this familarity with my every bodily function as well as the day to day stress has put a damper any real intimacy, just one more relationship challenge.

We are fortunate enough that we have been able to privately hire a couple of part time assistants to give Stephanie a few hours a week off. We are lucky to have found two outstanding aides, I look forward to my time with them and I know Stephanie really appreciates their efforts. People of low enough income who are on Medi-Cal get full time assistants as well as pay for family members who are providing care. It hardly seems fair that the surviving partner is expected to go essentially bankrupt before such care will be provided.

Caregiving in ALS is overlooked and under appreciated. The caregiver of a person with ALS has one of the most difficult jobs I can imagine, one which will only end unhappily. My caregiver may not  always feel like it, but she is the rock I depend on and words alone cannot express my gratitude or how sorry I am that her life has become so dominated by my disease. ALS is merciless. 



Wednesday, May 4, 2016

On Loss

Death,  dying and the like are the subject of much human study.  Generally what you'll talk about is the black line of no return. Dying of ALS is just like dying of anything, I imagine, except that you get to watch as the things that made you feel alive slip away one at a time in slow motion.The lesson ALS has to teach you is that you have a whole lot of dying to do before you get to the line.

At first the losses are small.. can't open a twist-off bottle cap anymore... can't wear contact lenses anymore... then they eat away at the things that make us alive.  Can't have a simple conversation... Can't eat solid food... Can't be the husband Stephanie deserves ... Can't ride a bike.  So many losses that you can't comprehend it all in real time. Only later do you discover that you can't get your bike gloves on anymore. You laugh and make the best of it, but some part of you is forever gone and you know it.It will happen a million more times.

Your personal life suffers a similar fate. Being a natural introvert, I never had very many people I was very close to.  I did have quite a few"bike friends", however.  I don't see much of them these days, appearing mostly like a ghost on a FaceBook comment.  When, however I run into someone in real life there is an understandable tension. While I have (mostly) had time to adjust to my changes, they are seeing maybe 6 months of decline all at once and you can see it in their faces.  Everyone says you look great, but you don't.  A rare few actively avoid me. Everyone deals according to the best of their ability to do so. 

As I get more and more locked in with my chair, I feel less and less part of the world. As I loose the ability to perform my own self care more and more of that duty falls on Stephanie  and the assistants we have hired. Between them  I am definitely not lacking for hands on human contact but strangely feel like I am. I think the problem is the chair and all the other equipment between me and everyone I interact with. My human contact these days no matter how kind my caregivers are is all fairly clinical. I don't really get to snuggle up to someone on the sofa or lie with my sweetie in bed. 

Really the hardest thing to deal with is what ALS has not taken from me.  I am still me. I still have a full set of human needs and desires but virtually no ability to do anything about them.  I still feel things just like I always have,  though my reactions aren't what they were.  I can see the people around me getting on with their lives, lives upon which I  can only add difficulties. I can imagine a life for Stephanie that does not involve me, and it both kills me and gives me strength.  I am almost a completely normal person, just one small problem.