On ALS and The Little Mermaid- When Ariel Lost Her Voice and Herself

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November is National Caregivers Month and on this date, November 17, in 1989, The Little Mermaid was released. Today seems a perfect opportunity to honor both. In my Disney way, I want to describe the progression of ALS as Ben expressed his experience and as I witnessed it. This also brings into view emotional impacts on caregivers that transcend meeting physical needs of those we love and care for.

ALS/Lou Gehrig’s disease, is defined as a disease which causes the death of neurons that control voluntary muscles. My friends and family became aware of the physical effects of the disease primarily through Ben’s experience. Ben’s first symptoms were a lack of balance and falling. His legs also became tired very quickly. As the disease progressed, he lost the ability to use his legs at all, and then his arms and hands, then chewing and swallowing became difficult, and his speech became increasingly impaired as he experienced those muscle losses. His cognitive skills were not affected, so he was completely aware of what was happening to his body.  The progression of ALS varies from person to person, so, for example, some people may never lose their ability to walk, others lose their ability to speak first, while Ben lost it last. Eventually, the ability to breathe is lost and a ventilator is required, and that is often the cause of death from the disease.

This scene from Disney’s The Little Mermaid was poignant to me within the context of ALS. Ariel wanted so much to be a human and to be with Prince Eric that she was willing to relinquish her voice to the sea witch, Ursula. Ariel knew that her voice was integral to who she was, but she was in love, and you know how that goes, especially in a Disney film. Once she gives her voice to Ursula, she quickly realizes that she has lost the ability to express herself, and her ability to sing, which was so important to her. She also did not realize that without her voice, she was no longer recognizable to Prince Eric. Of course, she made a choice. Someone with ALS does not get a choice, and I would venture to guess that they would advise her to keep her precious voice.

The loss of easy communication was very frustrating to Ben. First, phone use became difficult because handling the phone was hard and it was difficult to understand him. We then began frequent texting. Ben used a virtual/on-screen keyboard and an app that connected his phone to the computer screen. However, if his hand slid off the mouse, communication was cut off and that led to some very tense moments.

Living with Ben, I was more likely to understand what he said and I could facilitate conversations with others. There were times, however, that even I could not understand him. He would shake his head and tell me to “forget it,” which upset both of us. When communication was an obstacle and he was homebound, Ben did notice and lament that he had less contact with people. Friends and relatives with whom he thought he was close stopped reaching out, or, they made promises to visit that they did not keep. At the same time, he did not really want people to see him only as he appeared. He did not want them to see him looking gaunt and struggling to talk, eat and move. It left him feeling isolated and hurt.

When strangers did not understand Ben, they sometimes assumed that he was mentally challenged and spoke to him like a child or addressed only me. Often, Ben laughed about it, but on some occasions he felt invisible and very misunderstood. So, I involved Ben in the discussions to show people that Ben was fully capable of understanding and had lots of opinions and many people did follow my lead. As caregivers and loved ones, I see it as our responsibility to educate people through example, because some people are willing but not quite sure how to engage with people with a variety of disabilities. Unfortunately, not being able to say what he wanted and be truly seen and heard sometimes caused Ben to withdraw. I cannot begin to imagine how Ben felt to be seen for the ALS symptoms rather than for himself.

After a respiratory crisis landed Ben in the hospital, he had a Bipap mask before he had the tracheostomy. This was the first time that Ben really had absolutely no voice. He could not call me, or call for help, or just have a conversation. On an emotional note, he could not kiss me or tell me he loved me. When I recently re-watched The Little Mermaid and I saw Ariel panic the first time she tried to speak and remembered that she could no longer do so, I remembered Ben’s panic at the thought that he could not easily get someone’s attention with is voice, but he also could not use a hospital call button. Ben was afraid to be alone in the hospital room and I was afraid when he was alone. The mask obscured his mouth, so reading his lips was also very difficult. We spelled out words by my reciting the alphabet and his nodding when I reached the correct letter. However, the length and tediousness of that process frustrated him, and he began to weigh what he really needed to say. There were many incidents when hospital staff ignored Ben and asked me questions that he could answer. I immediately addressed those questions to him so that he could participate in the discussion. Yes, it took longer, and it was not easy, but he mattered, and staff had to accept that. Most really were wonderful, and they got a glimpse of who Ben really was beneath the ALS. But, just as Ariel felt devastated that Prince Eric did not recognize her, Ben, too, felt that he was becoming unrecognizable, even to himself. It also made him look at how he saw himself moving forward, which was something he had tried to avoid since his diagnosis nearly six years earlier.

Ursula tells Ariel that even without her voice, she has her looks, and to “never underestimate the importance of body language.” Unfortunately, with ALS, Ben could not rely on body language. He certainly did not underestimate its importance. ALS slowly strips away a person’s ability to move their limbs and even make facial expressions. Although Ben’s experience with ALS never progressed to the point where he was completely immobilized, some people are left only with the ability to blink, if that. Without a voice or facial and body expressions, a person would understandably feel isolated and even irrelevant. Although visits from loved ones are appreciated, they are not easy, so, unfortunately, as in Ben’s case, visits become less frequent.

Ben could certainly have related to Ariel’s wish to have legs like a human. As he lost his ability to walk, he often told me that in his dreams he always saw himself walking and running. As Ben lost his abilities to walk and move his arms and hands, he saw himself as weak and self-conscious. He missed going outside and playing handball. He did enjoy using his scooter, but daily life skills were becoming impossible and that carries an emotional toll. He walked until he accepted that his legs could not handle a single step without his sinking to the ground. That took away his freedom to move around the apartment. It chipped away at his dignity to have to be transferred to and from the bed, his chair and the commode, and to have to be fed his meals. He often denied that he needed as much assistance as he did, which was stressful for me as his caregiver, but that was what he needed to tell himself to deny that ALS was progressing.

Ben was also aggravated that he could no longer do things that he loved to do, like play music on his keyboard and fix computers. He could still talk me through what needed to be done with the computer hardware, but it was not the same. He also continued to research and discover adaptive electronic and computer devices, though they rarely worked for long, as new symptoms of ALS constantly appeared that rendered them ineffective. Music always remained an essential part of Ben’s life and our relationship, and although he couldn’t play his instruments, and we could no longer dance, he never stopped listening to music and making little videos with music clips for me to celebrate different occasions. I also brought his iPad to the hospital, so he could always listen to his favorite tunes.

Body language encompasses body image. ALS seriously impacted on Ben’s body image. He said that he did not like to look at himself in mirrors. As eating became more challenging, Ben lost a lot of weight. His feet got terribly swollen and even the widest shoes did not fit, so he wore adjustable slippers. He could no longer shave himself and although he said I did a pretty good job, I did not do as perfect a job as he did. We could make it fun and funny, but the underlying issue- the deterioration of his muscles- was frightening and tragic. At one point, his aide shaved his beard and left only his mustache. He was a bit insulted that it took me a while to notice exactly what was different.  I think that I somewhat tuned out the physical because there were simply so many changes, and they were too sad to dwell upon. Ben, on the other hand, regularly studied the photos from our visits to Walt Disney World and compared his physical changes from visit to visit. In fact, when I showed pictures of those visits to friends, they always commented on how thin Ben had become, shocked by his physical transformation. When I looked at the photos, I saw only the joy on his face. I guess that’s the Pollyanna in me.

Fortunately for Ariel, she was surrounded by people (well, mer-people and some very adorable sea friends) who loved and looked out for her. Sebastian was an astute and compassionate, if high-strung, caregiver. Nutty but devoted Scuttle revealed Ursula’s evil magical trick to get Eric and Ariel’s voice was restored, she was able to keep her legs and marry the Prince. There was the Disney happy ending.

ALS is not a fictional magical trick, rather, it is a cruel disease to which Ben ultimately succumbed. Still, despite the obvious devastation of his struggle and of losing him, I have to look at the end of Ben’s ALS story with some positive thoughts. Ben’s personality shone as he left this world, according to the very wishes that he expressed, even without his voice, embraced by people he loved and requested to be present, and with music that filled his heart. He was heard and he knew that he mattered and was loved, as his hero Buzz Lightyear said, “to infinity and beyond.”

Now, I use my voice to spread awareness and support caregivers and people with ALS. And, in my Disney way, I will keep wishing on stars for a cure that will ensure a genuinely happy ending for those with ALS.

On a Significant Date, “Love Is A Song That Never Ends”

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For me, today, July 6, will always be the day everything changed. It’s not a typical milestone date. No diagnosis, no birthday, no death date, but the day that Ben went into the hospital. Dates are important to me, for better or for worse. One of the many reasons this date is so significant is because it became the day when we could no longer deny or postpone Ben’s fate with ALS. So much happened leading up to this day. I’ve documented it often, and you can click here to see the details of that date. When choosing a quote for this post, the unwavering feeling is the song from Bambi, “Love is a Song That Never Ends.”

As a teacher, the end of June and beginning of July is a happy time. This year was particularly challenging, so I was more exhilarated than usual to leave the school building. I am trying to focus on the future, because I have put in place exciting prospects. Still, the memories of that summer nine years ago are like Eeyore’s gray clouds. I don’t relive each and every detail anymoreI allow myself to feel the sadness, grateful that it is no longer as paralyzing as it once was. I also continue to reflect on that time—where I was, where I am, how far I have come (or not).

Today, I happen to be home with a bad cold and laryngitis, so writing, remembering, and reflecting are perfect activities. Tears have fallen, and that’s fine. I will watch my “One Dance” video and listen to the lyrics, remembering how that song was the one that allowed me to acknowledge to myself that Ben was never coming home from the hospital, that we would never dance again, and that he was going to die. Yes, that may have been obvious to everyone else, and it is not that it was not obvious to me, but being alone and facing that in our apartment was a terrible heartache. An important message for me in the original Inside Out is that we can aim for joy, but it is not that simple, because our experiences are comprised of so many emotions and moments of significance, and sometimes joy arises from or coincides with anguish in unexpected ways.

Making summer plans had become a conflict of grief and wanting, or knowing that I should want, to move forward with my life. I made my plans with a clear conscience. I have no rules about my grief anymore, and I embrace it when it appears in good and bad memories. I will visit friends, human ones and my animal buddies at the Georgia Aquarium. I have again become accustomed to traveling by myself and I appreciate my good friends. I am also comfortable with wishing that one day, I will have a new love for company. I still don’t act on those wishes, leaving it to the fairies to deliver to me. But, I am living. Ben is always with me, and that’s okay, too. In fact, I wouldn’t want it any other way. After all, “Love is a Song That Never Ends.”

Caregivers Have Stories To Tell

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There are some Disney film quotes that linger in my mind. In the live action Cinderella, the narrator, who is Fairy Godmother, explained that after Cinderella’s mother passed away, “Time passed, and pain turned to memory.” I struggled with this for a long time because the pain was palpable and hardly fading into memory. In my mind, referring to it as a memory meant I had to dig a bit to conjure it. Now, it has been ten years since I lost my dad, and this summer will mark nine years without Ben. Although I still cannot say that pain turned to memory, I realize that I do not live in the pain any longer. Today, I realized that living at more of a distance from that pain makes harsh memories of those days extremely difficult. Setbacks throw off the balance I have achieved in my coexistence with grief and I’m back in the memories.

If you regularly read my blog, you know that theater is my favorite activity and my treasured escape. Today, I attended a play called Mary Jane, by Amy Herzog, and starring Rachel McAdams. It is the story of a single mother who is the caregiver for her baby son, Alex, who has Cerebral Palsy. We never meet Alex, who is on a ventilator, has seizures and seems to be nonverbal. The play revolves around Mary Jane’s conversations with various people, including nurses, doctors, strangers in the hospital, and a chaplain. It is a beautifully done play and it is very emotional. I knew it would be difficult for me to watch. But, I needed to see it and I wanted to support it. It was not an escape. It was a step back into my own experience. I made a point of going by myself so I could be alone with my thoughts, my tears, my recollections.

I could instantly relate to watching Mary Jane go from one challenge to the next, often with a smile, and always as an advocate. Hearing people tell her to take care of herself and watching her take it in and not even reply brought me back to my own reactions to advice I knew was heartfelt but that I also knew I was not going to follow. I had to force myself to focus on the play because my mind jumped to my own still vivid interactions. I was very fortunate to have a majority of wonderful people tending to my dad and Ben. Still, I learned to use my voice to ensure their good care, something that did not come naturally to me at the time.

Grief remains enigmatic to me. I never know exactly what will spur a setback. I knew that this show would bring tears. Indeed, it was a tragic story and I empathized on a deep level as Mary Jane dealt with her son’s episodes and emergencies. It was a scene with music therapist that hit me the hardest. Mary Jane is at a breaking point when a music therapist came by after the baby had a medical procedure, so he was sleeping. The music therapist explained that she wouldn’t be able to come back later that day and wouldn’t be at the hospital for another few days, when she couldn’t promise that she could return to see Alex. This was the one thing that Mary Jane simply couldn’t accept because she said that Alex was looking forward to this. In speaking with Mary Jane, the music therapist said that it was possible that Alex was conscious enough to hear the music, and she played a song. It soothed Mary Jane as much as we want to believe it soothed Alex.

Of all that happened in this play, this interaction, and the mention of music, affected me intensely. At one point, Ben had a crisis and he had to be intubated. It was terrifying, and in order to cope, as I stood outside the room, I tried to shift my focus to how fascinating it was that they converted his room into a kind of operating room, with people and equipment quickly moving in and out. Afterwards, I sat with him as he slept. When a nurse came in to check on him, she told me that although his eyes were closed and he wasn’t entirely awake, he could probably hear me. I remember being overwhelmed with a feeling of helplessness and I burst into tears. The nurse hugged me, and I asked if she thought he would hear music. I had brought his iPad to the hospital so he could listen to music. The nurse encouraged me to play the music, which I did. I remember asking Ben if he heard me and he nodded slightly. I asked him if he wanted to listen to the music and he nodded again. Music was always a driving force in Ben’s life, and it proved to be an important part of his hospital experience, too.  

When Ben was first admitted to the hospital, the palliative team asked about his interests and I told them music and computers. At the time that this crisis occurred, we had not received a visit from a music therapist. However, when he was transferred to the ICU after an emergency intubation, a music therapist visited the ICU- which was unusual- and cheered Ben with guitar music. He even played some Beatles music, which Ben loved. Ben enjoyed several visits from music therapists, and the guitarist even played for him at his bedside on the day he separated from the vent and left this world.

After the play, I walked home with my thoughts. I listened to my “Ben Playlist” of songs that were important to us, some of which were played on the day he died. I gave myself permission to feel the grief. I was grateful to be by myself. I did not want to hear any other opinions, or comfort, or suggestions of what I “should” do or think.

As stressful as it is to revisit those days, I always come back to that as awful as it was, there was so much love and caring. As Iago said in Aladdin: The Return of Jafar, You’ll be surprised the things you can live through.”  The pain of those days is now tempered with perspective. The pain may be a memory, but it is easily summoned and, on days like today, it lingers. I do not avoid the memories, or even the tears. That experience has impacted my life and taught me a lot about myself. Feeling the grief also lets me know that I have grown and moved forward. I’m grateful to be able to articulate my feelings here, and also grateful when I hear from people who relate and then want to share their own experiences. We have the experience of caregiving – and sometimes grief- in common, and it is okay to feel, internalize, and grieve differently.

I could not have seen this play when I was entrenched in caregiving. In fact, I avoided anything that was at all sad for a few years after I lost my dad and Ben. Now, I’m ready. I felt compelled to see this play to honor my experience but also to support art that puts the spotlight on caregivers and the caregiving experience.  Not long ago, I wrote about another play that I saw about caregiving, called Cost of Living, by Martyna Majok. (click here to read that post) This play also left a lasting impression on me. There are more than 53 million caregivers in the United States. They have stories that need to be told. I am so grateful for the artists who bring these issues to life.

Thank you for reading my stories. Caregivers, tell your stories. You matter.