The Letter A is for Alzheimer’s

            Having just gotten my students’ grades in the mail to them in the time-honored fashion (on postcards stamped and addressed or, if they prefer privacy from their mail carrier, postcards enclosed in envelopes), I am back to share more of the letter that came after Mom’s assessment at UC Davis Neurology Center—the test that she had thought she’d aced.

Although I believe that the diagnosis of Alzheimer’s disease is accurate, problems such as syphilis or vitamin B 12 deficiency can also cause cognitive problems or make symptoms of dementia worse.  I recommend that you and Dr. Johnson discuss blood tests for RPR and vitamin B 12 levels.

Alzheimer’s disease progressively worsens, and there is presently no treatment to cure this illness.  In most cases the progression occurs over many years, but the rate of this change is quite variable from person to person and prediction of the rate of change is impossible in any given case.  However, it is important to plan that your mother will eventually need more assistance with day-to-day tasks.  This is one of the most important guiding principles underlying the management and decisions which you now face.

While Alzheimer’s disease is not curable, there are many adjustments which can be made to improve the quality of life for both you and your mother.  First and foremost is the importance of recognizing that this is an illness which affects the family, and especially the caregiver.  Therefore, it is important for you to make decisions based not only upon her welfare, but also based on your own physical and mental well-being. The ability to acknowledge your own needs, as well as those of your mother, is important in assuring that you will be able to continue to care for her in whatever way is best for both of you.

Although I do not think your mother requires continuous supervision, she may need this in the near future. 

In general, we discourage caregivers from attempting to accomplish all of the care of their own.  Some options to consider include:  1) Dividing the necessary supervision with other family members or friends.  2)  Hiring in-home help, such as a companion, homemaker or home health aide to assist with supervision and/or personal care.  3)  An adult day care program, to which your mother is taken for several hours a day.  It was our feeling that she might benefit from an adult day care program designed for people with memory loss.  The socialization, structured activity and light exercise provided by these programs often has a beneficial effect.  Although people may resist attending at first, most eventually enjoy these programs a great deal.  4)  Having your mother move to a residence where this kind of care could be provided.  Board and Care homes provide room and board, supervision, and, depending on the home, some reminders and help with dressing an bathing, medication monitoring, and activities.  The supervision and help that these homes provide varies greatly, so that each board and care facility which you may consider must be investigated carefully.

“

Not the Letter A, Mom's Assessment

            “I don’t want to brag,” Mom told us after she was assessed at the University of California, Davis, “but I think I got an A.”

            Here’s what we got.  A letter from John Olichney, M.D. Neurologist.  For some reason, it was addressed to me with a cc to Kathy Loss, who was her companion for 40+ years.  (I’m going to type up a portion every day until I get in (but not into) my students’ grades.

March 14, 2011

Dear Ms. Martin:

This letter is intended to provide you with a summary of my recent evaluation of her mother, Nadine Martin.  We think it will be most clear if we first review the medical diagnostic evaluation, and then discuss our recommendations.

As we explained in the conference, our diagnosis is Alzheimer’s disease.  Although there is no single diagnostic test that indicates the presence of the disease, when a comprehensive and appropriate diagnostic workup is done there is a high degree of accuracy.  Factors we considered include:  the history of the illness, the neurological and neuropsychological examinations, evaluation of laboratory tests and review of the brain scan.

All of the evidence we reviewed is consistent with Alzheimer’s disease and most importantly did not show evidence of a treatable condition that could cause the problems your mother is experiencing.

While the stages of dementia may be described in different ways, we generally separate the disease into three stages:  Early, middle and late.  The severity of the dementia describes the degree of cognitive impairments as mild, moderate or severe.  Our findings suggest your mother is the middle stage with moderate impairments.

As I explained at the appointment, you should follow-up with Ms. Rhoades in the near future regarding evaluation results and medication recommendations.  With your permission we are sending a summary of this evaluation to Steven Johnson, MD.

Making the Grade in a 12 Step Program

          This week, making out final grade reports, I thought about Mom’s telling us, the day she was tested for Alzheimer’s, “I don’t want to brag, but I think I got an A.”

          See how important grades are? 

          I was thinking this morning that I'd like to have a book club to discuss gradebooks.  It would really be a time to get together at midterm and at the end of the semester and read and discuss students' papers and discuss their skills and their needs.   

           Then I thought, "No, what we need is a support group, and I have to begin by saying, 'My name is Tina Martin, and I'm a grade Worry-holic.'"  The aim  of the 12-step program--one paper, one student, one grade at a time --would be to abstain from worry by focusing on more constructive things.  I would tell you about E.M.,  my wonderful Project Shine student from Downtown non-credit, who's taking only ESL 140 and a non-credit class, fewer than 12 units, and whose English skills are really just C but whose mind and character and efforts are definitely A.   

          How much do we grade on skills, and how much do we grade on needs--theirs and ours?  At the beginning of the semester, we tell them how their grades will be calculated, but do we follow that?  The 72.9 and 75.2 are the grades that came of the calculations.  What now?  E.M.'s average is 86.9.  I can make that an 87, but can I make an 87 and A when his departmental exams show C on reading and C on grammar?  Some of the 86.9 grade is already inflated because it's the result, not of his English skill but of extra credit reports he wrote and re-wrote.  I told the students that I couldn't give them higher grades just because they did extra work because their grades had to reflect their skills.  So I would read their extra-credit reports and give them a grade.  If it wasn't an A or a B, I'd give them the chance to re-write it so that their extra effort would really help their grade.  Was that fudging a bit?  Another student's grade wouldn't be as high as 72.9 (73) if I hadn't made her extra-credit reports part of the grade.  Doesn't the English Department beg us to send students with good English language skills?  

       I had a  Vietnamese friend who was so outstanding in every way that I could perceive but couldn't get beyond an entry-level job, which mystified me--until I saw something she'd written.  Her writing was so awful that I wouldn't have let her out of my ESL 140 class, and yet she'd been passed on through all the ESL writing classes at CCSF and at SFSU--probably by teachers who were impressed by her delightful personality and valiant efforts if not her skills.   I think they did her an injustice.  But I fear that I will do that too.  Will do.  Have done.  Am doing. 

            I really do think a support group for grade worry-holics would be wonderful.

Thoughts on Mom’s Death and Dying in General

                David Hathwell, who retired a few years after teaching literature to the gifted students at Lowell, shared his beautifully written poem about death, “Slipping Off the Raft,” with a group of people including Jonathan and me.  After I shared Jonathan’s very thoughtful reflections on it and a few of my own thoughts, David let us read how he went about writing it, inspired—or perhaps provoked—by what David called “Julia Child’s awful saying” about friends slipping off the raft.

                But it doesn’t seem so awful to me.  I WILL go gentle into that good night, if I have the choice.  I’d have wished that for Mom too, that she could have slipped off the raft instead of suffering so much mental and emotional anguish. 

                David also pondered “in what odd circumstances would somebody slip away and nobody do anything to help or be particularly distressed?”  But in the poem it’s clear that when they hear the sound, they think it is just troubled sleep.  Even the person dying thinks it’s just troubled sleep.  When Mother was suffering so much, we were particularly distressed, but we weren’t particularly distressed by her death. 

                But I wondered whether David felt that people really hadn’t cared much, that they didn’t notice, weren’t distressed.

                So today at the Y, I realized that I hadn’t missed a couple of people that I really like.  I asked Ken, “When are you going to Turkey?” and he said, “I just got back,” and I commented on what a short trip that must have been.  “Two weeks,” he said.  I had “felt” him there at the Y every day.  I had also “felt” Annie, the receptionist, who I heard had been out sick.

                I’ve recently changed my days, which used to be every other day, meaning that some weeks I’d be there on a Monday, Wednesday, Friday, Sunday, and other weeks I’d be there Tuesday, Thursday, Saturday.  So I started asking people I hadn’t remembered seeing, “Were you gone for a while?” and one man, Tom, said, “No, you were.”

                So I was the one who’d slipped off the raft but only in a temporary sense. 

                Was it better to be missed or for people to continue to feel my presence the way I felt Ken’s and Annie’s.  The way I still feel Mom’s.

Mom on Grammar: "You'd Better Tell Them"

Mom and Grammar Continued

            When Mom was still at home, and I was visiting her every Friday, I would occasionally take my students’ compositions along to read one or two to her.  As I said earlier, she thought I was among the luckiest of so-called professionals because, as she told people when she was no longer at home, “My daughter Tina teaches people from all over the world!”  I never told her that I was failing at it. 

But maybe she could tell because she would make those comments--“That’s not very good grammar”-- and sometimes she’d add, “You’d better tell them.”  I took them to mean the students, not the immigration authorities.

            That’s what I’m going to have to do now, as the semester comes to a close—tell them, the students. 

As I was telling a colleague who’s much more self-confident (and probably more competent) than I am,  after more than 30 years of teaching writing, I still wonder at the processing of the student writer...psycholinguistics...learning readiness...and my own attempts at being a solution to the problem instead of a contributing factor.  

            One of my hardest-working students (who got a B in her previous course but whose writing prompted me to send her to Early Alert at the beginning of the semester) accomplished some feats that are admirable, correctly using three gerunds in a row and even putting our much-practice “In spite of the fact that + Subject + Verb” lesson to use.  But I never convinced her of the logic of direct address:

            If you ask “me what do I think about using public transportation,” I would tell you I have two ideas in my mind.

            If Mother saw that, she might say, “Couldn’t she have at least left the ‘me’ out of the incorrectly punctuated indirect speech?”

            I told the students to look for changes in punctuation, word order, tense, and pronouns when they changed direct speech to reported speech.  I wonder where she was looking—in her mind?  I wouldn’t advise that if her mind is anything like mine!

            I always try to remember how I would be writing if I had the same time and exposure to Chinese that my student has had to English, and I know that she’s way ahead of where I would be, but I can still hear Mother agonizing, as I am doing now.

            I wish my student were here to clarify the sentence “The other thing is the theise all always labor during the people wait the bus.”

            Mother would say, “That’s not very good grammar.  You’d better tell her.”