“Henry hasn’t been that bad,” Mrs Van Winkle reported to Dr Miller. “The only big problem is he wakes up at night and thinks it’s morning. Then he wakes me up to fix breakfast, and I can’t get back to sleep. I can’t understand why he thinks it’s morning when it’s still dark.”

“I’ll prescribe a sleeping pill for him and see you both in a week to see how it works.”

Next visit she came in alone, in tears. “The sleeping pill worked fine,” she sobbed, “but now he wets the bed.”

“That only means the pill’s too strong. Incontinence occurs in the very late stages of the disease, but Henry is no where near that bad.”

She sobbed more intensely. “You mean that’s all I have to look forward to? He’s such a strong, proud man. He can never live through all this.”

“No, it’s not that bad. I’ll just prescribe a less potent sleeping pill, and if it’s still too strong, break it in half. As soon as we know the pill doesn’t cause problems, we can give him a memory stimulant. Of course, it can’t help once the brain cells are dead, but I think it’ll help Henry.”

“Dead?” she wailed even louder.

“Shhh,” said Dr Miller, “there are people in the waiting room.”

“You mean Henry’s brain cells are dead?” she whispered urgently.

“Well, yes, but in all of us brain cells die every day. We’re born with so many that we wouldn’t miss the ones that die at the normal rate for at least 120 years; and if they die a little faster it still doesn’t matter. If we exercise them, some grow back. Henry’s cells are getting sick or dying quite a bit faster than normal, but that’s the only difference between him and us. The important thing is how many he has left and whether we can help them work to their full potential. This medicine will do that. Take this prescription and start it in a few days when you’re sure he’s not having any more trouble from the sleeping pill. Bring him back in a month so I can see how much better he is doing.”

She dried her tears, took the prescriptions, and left without a word.

A month passed, then another. Then Mrs Van Winkle called again, “He’s sleeping OK, but his memory is worse.”

“Keep on giving him the medicine. Sometimes it takes a while. Bring him in for a refill, so I can see for myself.”

Again she came in tears, alone, “His memory was getting better, but when I gave him the keys to the car, he drove us into the lake at the golf course.”

“Why?”

“He thought it was the parking lot.”

“No, why did you give him the keys?”

“Because I was tired of doing everything myself. He used to do all those things for me—drive, mow the lawn, fix the dishwasher. Now I have to do it all myself, or hire someone. I’m tired of it. He was getting better. He should take some of his responsibilities again.”

“I’m afraid you don’t understand. We don’t expect Henry to get that much better. He may hold up his end of a simple conversation and follow your instructions to help with housework, if we get a good response, but that’s about all we expect. No matter how good he seems on any particular day, don’t give him the car keys.”

“But, then he’s not really Henry,” she sobbed. “Henry was so full of life, energy, and curiosity. He took the initiative and we did things. He made life interesting for me.”

“That’s true he’s not really the old Henry anymore. You can’t expect the help and companionship you used to have. He has Henry’s body and that reminds you of Henry, but he doesn’t have Henry’s mind or personality. He has fragments of them, but fewer all the time.”

“Well, if he’s not Henry, who is he?”

“I don’t know, but you must accept the idea that Henry is gone and you must deal with someone else. Someone you can’t depend on but have to care for. I know that’s difficult when it is somebody who looks just like Henry, and sometimes behaves with a trace of his personality. However, we should be prepared to lose him completely. When one of our organs, like our brain, wears out, another probably will soon, and it’s likely to be one that’s vital.”

“I guess I have to think about being on my own again.”

“Yes, but right now you have a special problem. I think you should get what help you can for it.”

She agreed. The next day she joined the Alzheimer’s support group and enrolled Henry in a daycare program. The program was operated by volunteer family members and so was affordable. It gave everyone enough rest to have a normal life some of the time.

All went well for a few months, then she called in a panic. Henry had an argument with another old man at daycare and she had to bring him home. She told him to sit down and he threw a book at her. She had to lock herself in the bedroom. That’s where she was calling from.

“Could he have gotten into his sleeping pills? That could make him suddenly confused and agitated.”

“No.”

“Then call an ambulance and have them take him to the hospital. The attendants will be able to manage him.”

Mrs Van Winkle called the ambulance and the next day called Dr Miller from home, “How’s he doing, Dr Miller?”

“He’s settled down. In fact, he’s pretty drowsy. We had to give him quite a bit of antipsychotic medicine to get him under control. We’ll lighten up over the next couple days and he’ll be as good as ever.”

“That’s not such good news, Doctor. You know, he’s been a lot worse the last few weeks. Sometimes he wets himself during the day, and I have to feed him like a baby. In fact, he’s just like a baby except he’s too big to carry around.”

“Well, let’s not jump to conclusions. Just a little of this new medicine may make him a lot better, but if not, it may be time to start thinking about a nursing home.”

“I know, but they’re so expensive. Isn’t there anything else we can do?”

“Well, let’s not cross bridges till we come to them. I’ll talk with you again in a couple of days.”

But, mercifully, the next day, the Angel of Death visited Henry Van Winkle.

 

***

 

Alzheimer’s and other physical brain diseases may appear to be only psychological problems in early stages. But talking therapy isn’t helpful even then, and we must rely on basic education, simple, repeated reassurance, and diplomatic guidance to manage problems. However, during Henry’s illness his wife suffered several episodes of actual psychological adjustment problems, and Dr Miller talked with her about them directly. She had relied on several erroneous assumptions including that, “Henry will always be there to help out,” and “I will never be alone after I get married,” and “Henry is a grown man and can take care of himself.”

Dr Miller’s psychotherapy was slow because of Mrs Van Winkle’s strong bond to Henry and strong desire to continue life as before. But when Henry’s death forced change, she was finally able to accept that he was gone. Her rational understanding was no longer confounded by Henry’s walking ghost. She was able to focus on her own needs and interests, and as she did, her bond to Henry faded more quickly. Of course, her memory of him would never be gone, but her fear of the problems he created left instantly and brought her an immediate sense of relief. After a few months she was surprised that she was usually happy and thought of Henry less often.

One day she ran into Dr Miller in the golf club lounge and exclaimed to him in frustration and guilt, “Maybe I never loved Henry after all. How can I feel so good when he’s lying in the ground?”

“You’ve simply resolved your grief, that’s all. I saw that you loved Henry as much as a woman could love any man, but normally, grief doesn’t go on forever. It continues only as long as it takes for you to accept and adjust to the change and for your bond to Henry to fade. You started all those tasks well before Henry actually died. We both knew it was coming.”

“Oh, that makes sense. Thank you, Dr Miller.”