ALS

“Heigh-Ho, Heigh-Ho” A Caregiver’s March?

“Heigh-Ho” from Snow White and the Seven Dwarfs (1937), Walt Disney Productions

I was surprised to learn that the lyrics to this most popular Disney song from Snow White and the Seven Dwarfs are “It’s home from work we go,” rather than “off to work.”  Apparently, this is a very common error!  There is a point when the dwarfs do sing those lyrics, but not during this iconic scene.

I thought about “Heigh-Ho” and the seven dwarfs when I learned this week that as of the 2018 school year, my public middle school will be closed.  Amidst the challenges currently facing public schools, and having been through a school phase-out before, I am trying not to get too frazzled. I’m not exactly singing my way to and from school either.

The news about my school had me reflecting on my time spent there. Ben was diagnosed with ALS just before I entered this school. At the same time, my dad was fighting cancer. I was the caregiver for both. They were going through their journeys and I was going through one of my own, as a caregiver and as a daughter and a wife who was watching the decline of the people I loved while maintaining a full-time teaching job.

As a caregiver, leaving home and heading to work every day was not easy. Instead of “Heigh-Ho,” there was a cacophonous chorus of guilt, worry, anxiety and frustration. Managing caregiving and career is a delicate and stressful juggling act.

Emergencies requiring that I had to leave school began shortly after Ben’s ALS diagnosis. I have been very fortunate to have a principal that is understanding and supportive. My principal either covered my classes or arranged for coverages. He also allowed me to take days off to go to Walt Disney World with Ben for Halloween, something I promised Ben that I would do for as long as he was able to travel. There were many days that I missed school to accompany my dad to the Emergency Room, and there was a period of Family Medical Leave as well. There were days that I had to miss school because Ben had a difficult night or morning. In the middle of the night I might have had to rush to get Ben onto a commode or help him get comfortable because breathing was difficult. A good night’s sleep was a luxury. At times, I broke down in tears because I was overwhelmed and exhausted. I know Ben felt horrible and that made me feel horrible and guilty, because it certainly was not his fault.  While my dad and Ben were unquestionably my priority, I did worry about jeopardizing my job. Thinking about my future alone, and when Ben’s was so grim, made for a lot of sadness and guilt.

When Ben was able to walk independently, he would text me at school when he was awake and at his desk. If he stayed in bed late, because he felt safer there, I might not hear from him until around 2PM. One day, I had not heard from him by the end of the school day and he didn’t respond to my texts. I left school in a complete panic. I arrived home to find him completely fine and unharmed, but lying on the floor, where he had slid from the bed when he tried to stand up. He’d been there for almost five hours.  He was good humored about it, and was kept good company by our cat, Disney. After that, he sometimes preferred to stay in bed most of the day and stay awake most of the night, knowing that he could call me if there was a problem. He also wore a cell-phone around his neck because, early on, he refused to get a medic alert button.  I ran home when called me if he fell and could not stand up, or he could not get off the toilet. It is not easy to lift someone who cannot help you at all. Once, after a few hours of my not being able to get Ben off the ground, my principal even offered to come uptown to my apartment to help me lift him.

When Ben’s ALS had progressed to the point where he was afraid to walk by himself, I woke up earlier than usual and got him dressed and either walked him to his desk or transferred him to his chair and wheeled him to his desk and positioned his computer mouse under his hand. I made him coffee and oatmeal until he could no longer hold the cup by himself. Lastly, I positioned his medic alert button near him so he could access it if he needed to.  I kissed him good bye, took a deep breath and hoped for the best as I closed the door behind me.

In 2014, Ben finally agreed to get a home health aide for a few hours a day during the week, but she did not arrive until about an hour and half after I left for school, and she left about an hour before I got home. In the morning, I got him into his chair, strapped his medic alert button to his hand and left him to watch television in the bedroom until she arrived.  After she arrived and got him situated at his desk, he sent me a text that everything was okay. There were times when she contacted me that subways were not cooperative or she was running late, and I alerted Ben by calling our home phone and leaving a message that I hoped he would be able to hear, although he could not respond.

My days at school revolved around texts and phone calls to my dad and Ben to make sure they were alright, and also to their medical professionals for follow-up.  Though I did walk around with my cell phone, in case I was needed, teaching was a good distraction. When you’re teaching you have to be “on” for your students. I was dedicated to my students and to my family. The students knew that my dad was ill and they knew when he died, and I taught by example life lessons on compassion and responsibility. Until quite recently, I never shared anything about Ben because I could not emotionally handle a lot of questions or reactions.

After a day of school, there was no cheerful marching to “Heigh-Ho, Heigh-Ho, it’s home from work we go.” OK, so Grumpy was never cheerful. I was not exactly Grumpy, but I would have been the eighth dwarf, Anxious.

ALS,Grief,Disney,Snow White,Caregiving, 7 Dwarfs

Ben (pre-ALS) and Grumpy, Walt Disney World, 2001

I texted Ben when I left school to see if he was okay and if he needed me to run any errands. There was rarely dawdling, strolling or window shopping. On the occasion that Ben was feeling secure, if I had the energy, I ran to the nearby Sephora to try nail polishes. It was my whimsical escape. It’s important to have those.

There were times that I would receive a text from Ben on my way home that he spilled something or he needed to use the commode, but I could get home only as fast as a subway train would allow. This is just one demoralizing aspect of ALS, and other diseases, of course, and the only way to get through is with understanding and love. Humor helps a lot, too.

There was an instance after school, when I was visiting my aunt who has Alzheimer’s Disease, and I got a call from the medic alert company that the alarm had been activated. They said that they spoke to Ben from the intercom and it seemed he pressed the button by accident, but they wanted to notify me. I tried calling and texting Ben, but he did not answer. I grabbed a taxi and ran home in a frenzy to find him calmly sitting at his desk, wondering why I got so upset, since he had spoken to the medic alert company. Ben’s dexterity was compromised and the mouse got away from him, so he could not reply to my text messages. I simply hugged him, not knowing if I should laugh or cry. I did both.

As soon as I opened the door to my apartment, my hands-on caregiver responsibilities commenced, even though the reality was that I was also caregiving from school. After a day of teaching, interspersed with texts and phone calls, I needed some down time and it was not going to happen. Ben preferred me to be his caregiver, so, rather than ask his home health aide to do some tasks, he often waited for me to come home.  It was sweet, but it was difficult. He wanted me to stop working, but that was not possible. I was exhausted and probably depressed, and sometimes became aloof, doing what needed to be done but keeping to myself. To this day, I feel bad about that, but I’ve also begun to come to terms with the fact that our situation was happening to both of us in different ways and that although Ben’s needs were my immediate priority, my feelings also mattered.

ALS,Grief,Disney,Snow White,Caregiving, 7 Dwarfs

Not sure who the real Dopey is!

In the evenings, I prepared Ben’s dinner, which was always a culinary adventure with the Vitamix. As his ALS progressed, chewing and swallowing became increasingly difficult, but Ben wanted to postpone getting a feeding tube. His foods had to be pureed and almost bisque-like in consistency. I experimented with all sorts of sauces, and incorporating mashed potatoes that he loved, and we made it as fun as it could be. I admired how hard he pushed himself, but when he could no longer hold utensils or a soup cup, I fed him.  He began to lose energy for and interest in eating, so he was losing too much weight. I made and fed him a daily ice cream shake and a nutritional supplement drink for extra calories. For the rest of the evening, we watched television and used our computers. I helped him wash up and dress for bed, transferred him to the bed and got him comfortable. With a bad back of my own, by the end of the day, I was exhausted, sometimes in physical pain, and not always in the best mood because of it. On days when Ben was feeling down, uncomfortable, or scared, he was critical and harsh. At these times, it was hard to feel loving and we just followed our routines. Sometimes we cried, out of sadness, anger or frustration. The bad feelings happen, and it has taken me a long while to accept that we are all human and just like in Inside Out, you can’t just push sadness into a corner. But love was there, and it kept us going.

On weekends, I was the sole caregiver, and leaving school on Fridays came with a mix of excitement and dread of what might happen. There was no TGIF.  Before my dad passed away, my weekends were split between traveling to see him and taking care of Ben. Fortunately, at that point, Ben was more comfortable being alone for several hours. When it was just the two of us, Ben was happy that I would be home all weekend, and that touched my heart, and I did treasure our time together, but at the same time, I wanted and needed to have some time for rest and relaxation after a 24-hour work week. Ben was torn, too, because he did want me to do things that I enjoyed, like going to the theater, but he resented not being able to go out, and there were times that he said, “If I don’t have a life, why should you?” To be honest, it still upsets me when I think about it, but I truly do understand it. It is hard to BE a caregiver, but it is hard to NEED a caregiver. In this situation, no one is really at their best. We were not great at talking about it, but communication really is essential.

After nearly a year of having a home health aide, Ben had decided, without discussing it with me, to let her go at the end of my school year, telling me that I should and would be his caregiver over the summer. This was something that had me quite concerned because of the physical and emotional demands, and logistics of doing things like grocery shopping and other errands. Frankly, I also resented that he felt entitled to it and took it for granted rather than talking to me about it, and he resented that I felt that way. In reality, he knew me and I knew myself well enough to know that I would have accepted the responsibility. Again, better communication skills might have helped us to better address this issue.

I began to describe my state of mind as “an inch away from a nervous breakdown.” Although well-intended and heartfelt, it was not helpful to be told to take care of myself. Sometimes that’s just not possible. Ben was dying. His needs were immediate and they were not negotiable. Telling me what Ben or I “should” or “should not” do became frustrating.  However, all of this did teach me an important lesson: you cannot presume to know what is going on in someone else’s life or head, or within their own family dynamics, so it’s kind to ask how you can offer support and to be a shoulder to lean on, but you must tread carefully when offering advice, especially if it is unsolicited.

Timing was the sole good thing about when Ben ended up in the hospital with a respiratory crisis just a few days after the school year ended. If you’re thinking “Heigh-Ho-Heigh-Ho, it’s off to/home from the hospital we go,” that was not happening either. But, I was free to spend every day and many nights at his side in the hospital, still overseeing his care, and being the person he relied on for love, support and advocacy. With a BiPAP mask and then a tracheostomy, communication became more complicated, but since I was with him so much, I often had an easier time figuring out what he was saying. I kept my role as a caregiver even though he was surrounded by medical staff. It was an emotional summer. Neither of us was prepared or expecting to say good bye at this point because his progression had been fairly slow. He chose his path and I supported him.

In grief, people told me it would be helpful to return to my routine at school. What they did not realize was that caregiving WAS my routine. I was not returning to my routine at all. There were still no cheerful choruses of “Heigh-Ho.” Work was a painful reminder of losing loved ones and myself.  But, I have in recent months begun to redefine myself, and caregiving is something that has become a part of me, whether through work with caregivers or volunteering with my local ALS chapter.

If you remember, the seven dwarfs worked in the mines. On our first visit to Walt Disney World after his ALS diagnosis, when we approached Mickey for our photos, it was clear that everything was not okay with us. On our way out, one of the cast members quietly handed me “a ruby from the mines” and said that he hoped it brought us good luck. I still have that ruby. It has served as a reminder to dig for the rubies- the positive aspects or loving care in caregiving- even when it is hard work.

Some of our rubies: There were days when we sent each other funny and silly texts, even when his dexterity became too compromised to use his phone. He found an app, Mighty Text, that allowed him to send texts from his phone through computer, and he used a virtual keyboard.  There was also that absolutely incredible and romantic time that he surprised me by spending the day getting dressed and ready to take me to see “Beauty and the Beast-3D.” There were the mornings that he woke up to discover that I had decorated his desk or the apartment for a holiday. He looked forward to those surprises. Watching Ben struggle with ALS with such bravery and persistence, and a zest for life, showed me new sides of him to admire, love and nurture.

I’ve said before that being a caregiver was the most challenging, frustrating, and sad experience, and yet it was also the most loving, important and rewarding experience of my life. It is a heartbreaking but precious gift to bring comfort to someone you love, particularly when that person is facing death. I will always treasure the profound closeness we shared throughout that time, and, despite the challenges, I know in my heart, without a doubt, that I would be their caregiver all over again. That’s the biggest, most invaluable ruby of all!

To My Mickey, With Love From His Minnie

 

Today, February 21, is Ben’s birthday. As I often do, I have been reminiscing by looking at old photos. While looking at our most recent birthday pictures, I was reminded about his table that broke over the holidays and, in so doing, broke my heart. That ugly, shaky table held many birthday cakes and other celebrations. I’m glad to have those pictures. I’ve put together a video of photos from some of these occasions, and, of course, some Walt Disney World photos. Some were taken when he had ALS and some in the pre-ALS days. The love was always there, so I embrace all of the memories.

In the background, you will hear The Beatles’, “Happy Birthday.” Ben woke me up with that song every year on my birthday. Now, I am playing it for him.

While it’s emotional to make these videos (click here for the one I made for my dad), I also find it comforting to revisit beautiful memories. It is a good way to focus my attention when I’m feeling down and a positive way to deal with grief. It doesn’t mean that it doesn’t come with tears, but tears are okay.  So are smiles.

No candle on a cake now, but always wishes that he is comfortable, and running, singing and eating to his heart’s delight. And, wishes for a cure for ALS, because wishes do come true, even if, as Cinderella’s Fairy Godmother says, “even miracles take a little time.”

When Ben proposed to me, he asked me to be His Minnie. So, I now say

Happy Birthday to My Mickey!

With much love and pixie dust from His Minnie

Walt Disney World, Halloween

Ben and I at Walt Disney World, Halloween 2011

So This is Love… The World According to Cinderella

Cinderella, Disney, ALS, Grief, Caregiving

Walt Disney World
July, 2014

 

“Cinderella” is celebrating a birthday today. The film was released on this date in 1950. She was my favorite princess when I was a child. She remains dear to my heart because there is more to Cinderella than what meets the eye. She had feistiness and determination, and also a loyalty to her father’s memory that let her tolerate the poor treatment by her stepmother and stepsisters and maintain her dignity. Cinderella knew the power of dreams, and in the end, all of those qualities got her the love of the prince of her dreams and a position of respect and power!

Cinderella knew at her core that, despite treating her horribly, “They can’t order me to stop dreaming.” There’s a good life lesson. I know that people sometimes think I’m unrealistic because of my Disney love and its connection to wishing and dreaming. On the contrary, as the caregiver for my dad and for Ben, I was hit with harsh realities on a daily basis. Dreaming and wishing were my escape. They encouraged me to find creative ways to solve problems. And, they allowed me to envision a future where my dad and Ben had peace and comfort. Now, as I work through grief, dreams help me to redefine myself and reshape my life. No one can tell me that dreams are not valuable and important.

It’s pretty cool to make dreams come true, too. Ben wanted so much to go to Walt Disney World as often as possible. That last trip we took, in July 2014, was a dream come true for him. It was a challenge, and I wished a lot for things to go smoothly. They went fantastically! We even had a Walt Disney World Halloween in July! Now THAT’s pixie dust and Disney magic at their finest!

Ben and I with Cinderella
Walt Disney World
July 2014

Maybe you didn’t literally talk to your Fairy Godmother, but I imagine that a lot of readers have had a similar conversation with someone, or with themselves, and questioned their faith that they could handle things or that things would be ok.

Cinderella,Disney,ALS,Grief,Caregiving

Cinderella, 1950
Walt Disney Productions

During caregiving days, when my dad and/or Ben was struggling, knowing that in the end I was going to lose them, it was easy to lose hope and optimism. In those times, I had to thank goodness for the insight and “Bibbidi-bobbidi-boo” of Cinderella’s Fairy Godmother. For me, the dreams and the wishes got me through very difficult and sad days of terminal illness and caregiving and feeling that nothing I did really mattered. There were no cures, no one was going to get better, and things were becoming more difficult. But, I could dream, and those dreams helped me keep the faith.

There is a song in the film, “So This is Love.” The song is sweet and romantic, and love is beautiful. In the rough times, it is easy to lose sight of those feelings. The thing is, when we are watching someone struggle with illness or we are struggling with caregiving responsibilities, we accept these challenges, and embrace them, because this is love. It’s that simple. And, that complicated.

At the heart of the film is the song “A Dream is a Wish Your Heart Makes.”

A dream is a wish your heart makes
When you’re fast asleep.
In dreams you will lose your heartaches.
Whatever you wish for, you keep.
Have faith in your dreams, and someday
Your rainbow will come smiling through.
No matter how your heart is grieving,
If you keep on believing,
The dreams that you wish will come true.

I’ve always been a dreamer. I believe that my wish came true that my dad and Ben are both at peace, even though grief is hard for me. I’ve written before that I will wish for and dream about cures for ALS, and also for cancer and the many other horrible diseases. Sometimes it seems futile, but I remember that Fairy Godmother said, “Even miracles take a little time.”

 

Always Let Your Conscience Be Your Guide

Caregiving, Walt Disney World, Disney, Pinocchio

Pinocchio and Jiminy Cricket
Walt Disney World

Pinocchio was released on February 7, 1940. I do love this story of the mischievous little puppet who just wants to be a real boy. For me, so much of the film is about the song lyrics. They took on a special meaning when I was a caregiver.

When times are hard during caregiving, whether it is in the role of caregiving itself or in watching your caree struggle, it is easy to wish, as Pinocchio did:

I’ve got no strings
So I have fun
I’m not tied up to anyone
They’ve got strings
But you can see
There are no strings on me

There were times when I just wanted to stroll home instead of rushing to tend to Ben, or go to dinner with a friend, or watch tv without an interruption. For me, much stress came when Ben was feeling frustrated and took it out on me by being critical and difficult. Ben did not want to accept that he needed more care than I alone could provide. He did not want to admit that he was afraid to stay alone. I did not know how to approach him about the fact that he needed more care. I didn’t want to disappoint him and yet I was upset because his expectations were unrealistic. I was upset with myself for rarely standing up for myself. Frustration was perfectly understandable on both of our parts.

The truth was that I was attached not by actual strings, but by my heart. When I did have some time to myself, Ben was pretty much the only thing on my mind. If I went out, I constantly texted him to see if everything was ok, even when someone was with him. I knew he was most comfortable with me and I was most comfortable when I was there.

When he did finally agree to get a home health aide, we had our routines for when they would update me. I had my phone with me at all times waiting for his text telling me that he was awake and seated at his computer. Even when he was in the hospital, and I knew he had constant medical attention, I felt the need to be there. After all, he could not even move his hand to use a call button. The strings that attached us were heartstrings, and there was no breaking them.

I had a lot of support from friends, his medical care team and some family. Of course, they were concerned about Ben, but they were also concerned about me and that I was running myself ragged. I know the philosophy that if you don’t take care of yourself, you can’t take care of anyone else. But, it was impossible for me to prioritize myself knowing that Ben had ALS and it was progressing, and knowing that he could not help needing assistance. In the back of my mind, he was dying, so while he was here I had to do anything to help, advocate for and entertain him.

There are also certain realities that affected caregiving. Insurance does not cover home health aides. Since ALS is a disease that does not have a predictable progression, even when he admitted to needing help, he was afraid that he would completely deplete his savings. These are such stressful situations to deal with in the midst of dealing with the physical and emotional impact of the disease. It is tragic that better care and attention is not given to circumstances such as these and to supporting caregivers and carees. I could devote many blogs to that subject!

I had so many people tell me that I simply had to tell Ben that I could not care for him anymore, or he could not stay in the apartment anymore, or he had to begin to pay for care. People are very good at giving advice. And, in my experience, they really do mean well. Interestingly, they don’t always follow the advice they give. Some people who told me to take a hard line with Ben have been in caregiving situations where they were also towing the line without support and with unrealistic expectations from others. In grief, people have also told me what I “should do.” Again, they mean well. Some people think that blogging and pursuing opportunities to support other caregivers keeps me in the past. I disagree. I feel it is important, and even responsible, and it is also rewarding. It allows me to take my experiences that have shaped me and use them positively as I live. But, no one should really have to defend themselves. I say this here because, as caregivers, we all have to redefine our lives, and maybe my own experience will give other caregivers food for thought.  The bottom line is that we all know in our hearts what we have to do because our consciences are our guides. We can request and get advice, but only we know ourselves and our circumstances. And, until you walk in someone else’s shoes, you cannot clearly judge them. I mean this about caregivers and carees.

Jiminy Cricket was so right when he said, “Always let your conscience be your guide.” I had to do what I felt was right for Ben. I hope that I’ve come out of the experience with a stronger ability to communicate my feelings, but I still would not have changed my actions. Although I always worried that I was not a good enough caregiver, particularly when Ben was in bad spirits and critical of me, I let my conscience be my guide. I look back and am grateful that, in the end, Ben was able to stay at home with me until he went into the hospital, and I was at his side until he left this world.

As I wrote in a previous post, I still believe in making wishes, and I love the song “When You Wish Upon a Star.” I wished that Ben would find peace and I do believe that wish has come true and that he is in a place where he can walk and talk and eat and play his musical instruments. I wish for a cure for ALS. I will continue to wish until it comes true because, as the song goes

When you wish upon a star
Makes no difference who you are
Anything your heart desires
Will come to you

If your heart is in your dream
No request is too extreme
When you wish upon a star
As dreamers do

Like a bolt out of the blue
Fate steps in and sees you through
When you wish upon a star
Your dreams come true

All music and lyrics by Leigh Harline and Ned Washington

Caregiving, a Six-Act, 24-Minute Performance

It was an honor to participate in Caregiving.com’s live broadcast, “Caregiving: A 6-act, 24-minute Performance.”

In case you missed the presentation, you can view it right here!

To summarize, six caregivers presented their experience in different stages of caregiving, from anticipating becoming a caregiver to after caregiving is over.

The Performers:
Andrew Koch, The Expectant Caregiver
Tami Neumann, The Freshman Caregiver
Carolyn Grant, The Entrenched Caregiver
Lisa Riggi, The Pragmatic Caregiver
Abby Kass, The Transitioning Caregiver
Colleen Kavanaugh, The Godspeed Caregiver

Please click here for more information about everyone. Listening to the other presenters was enlightening and inspiring. The performance goes beyond textbook explanations of caregiving and takes you into our lives and through the difficult and the heartwarming aspects of being a family caregiver.

My own presentation as a Transitioning Caregiver focused on when I knew the end was near for Ben. It’s a journey my close friends and family know about and it was a difficult one. I continue to be in awe of Ben’s bravery.

Deciding what to share in the presentation was actually a valuable and interesting process. When I first talked to Denise Brown, the Director, and narrator, of the performance, I recounted the details of what transpired from the time Ben went into the Emergency Room until he left this world. Denise pointed out that I was telling Ben’s story and not my own. Until that point, I never really thought about that. I had thought of the journey as Ben’s, although I was his caregiver. However, this process prompted me to think about my own journey as Ben’s caregiver and as the person closest to him as I watched him succumb to ALS.

I’ve said before that being a caregiver changed me. It is who I am. I embrace all of the emotions associated with it- good and bad- and continue to sort through some of my feelings and memories. My blog’s Disney-sprinkled reflections on these experiences help me in this process and will hopefully inform, inspire and/or validate other current and former caregivers.

I welcome your comments on this presentation.  And, please visit www.caregiving.com to learn more about its many services.