BY: BRIAN P. SMITH, MS, MA, MDiv
Looking back, the signs were there for several years. Grandma Blanche started misplacing her keys and wallet in her early 50s. Having lived through the Great Depression, my grandma would hide money around the house rather than have it all deposited in a bank. The problem was she would forget where she hid it. I can remember my mother going through every inch of Grandma's house one day and collecting over $5,000. She convinced Grandma it would be safer to put her money into a certificate of deposit. Grandma was more thrilled over the free toaster she received from the credit union than the fact she had found thousands of dollars hidden around her house.
Grandma began having trouble retrieving words to finish sentences: "Oh, you know … the whatchamacallit." She called people she had known for years by the wrong name.
"Grandma Blanche is just getting a little forgetful," my mother would tell us. "It's normal."
Grandma then moved in with her younger sister, Dorothy, who lived a few blocks away. That seemed to help — for a little while.
One week, the bottom seemed to drop out from under her. She got lost walking in the neighborhood where she had lived for 50 years. She started to forget to dress herself before she left the house. She would leave the gas stove on, and my aunt would have to turn it off. One evening when my aunt came home from work, Grandma did not recognize her own sister and asked her to leave or she would call the police. We knew this was no longer normal forgetfulness.
My mother brought Grandma to a neurologist and while there was no way of diagnosing Alzheimer's in the early 1980s, we were told she had all of the classic symptoms and that she was already in the moderately severe stage. The doctor told my mother, "Blanche has masked this disease for over 10 years. For her own safety, someone should be with her 24/7."
My Aunt Dorothy, who had her own health issues, could not take care of her. My mother, an only child, owned a business and could not afford to close the shop for an indefinite period of time. All of my siblings lived out of town, and I was in the seminary at the time. We had no choice but to place Grandma in Mary, Queen and Mother Center, a Catholic long-term care facility in St. Louis.
Blanche's health was otherwise excellent — strong heart, good blood pressure — and her Alzheimer's progressed for the next three years. While it was difficult for my family to watch our vibrant grandmother slowly diminish, there were countless blessings along the way. I want to share some of those blessings and how they have affected me personally and professionally over the last 30 years.
One of the earliest blessings came during the first month Grandma was in long-term care. My mother was visiting her mom one evening, and she ran into the priest-chaplain, Fr. Homer Noser.
"Oh Mrs. Smith," he said, "Your mother loves attending Mass every day and receiving Holy Communion."
My mother was startled by his statement because although Blanche had been baptized Catholic as an infant, her family had left the church a few years later. Her father had died suddenly when she was a young child, and when the funeral procession arrived at the gates of Calvary Cemetery, the family was turned away because he had not been a "practicing Catholic." The rest of the family, though practicing Catholics, were so hurt by the lack of compassion that they left the Catholic Church and became Presbyterian. My grandmother and my mother were raised Presbyterian.
Mom converted to Catholicism at age 18 without her mother's knowledge. She finally told Grandma a couple weeks after her confirmation and first communion. My mother prayed for over 40 years that somehow her mother would come back to the Catholic Church, receive the sacraments and be buried from the church. When Grandma was diagnosed with probable Alzheimer's disease, we all gave up hope that she would return to the Catholic Church. How would she ever be able to manage the RCIA classes? How could she even comprehend?
Mom shared all of this with Fr. Noser, and he just smiled.
"Well, I just assumed your mother was Catholic because I know you are," he said. "So I anointed her the first day she arrived. She is a baptized Catholic, her sins have been forgiven and now she is going to daily Communion. Mrs. Smith, your mother is in full communion with the church and there is no reason she cannot be buried from the church."
What we thought was no longer humanly possible for Grandma, God made possible through healing moments called "absolution, anointing and Holy Communion." This is an important lesson for all of us in health care to remember: We tend to limit what we think is possible and forget that God's grace is infinite. God's grace is simple, direct and not bound by our human constructs, nor can it be thwarted by any disease. Sharing in God's healing ministry means we acknowledge that God's grace is more powerful than our medicine, technology and what we think we know.
A second blessing came about six months later. I had the opportunity to travel to Italy for a month while I was in my first year of the seminary. I was afraid Grandma might die while I was gone.
My mother encouraged me to go, telling me, "Blanche's doctor thinks she is healthy and will probably live a few more years."
The day before I left for Rome, I went to tell Grandma good-bye. It was not a good day for her. She was agitated, seemed afraid and did not know who I was. I told her I loved her, that I was going to Italy for a month and would be back in a month — but she did not comprehend any of it. I left for Rome, saddened and not sure what I would find when I returned.
The day after I returned to St. Louis, I went to see Grandma. My mother warned me, "She is not recognizing any of us anymore."
When I went to her room at Mary, Queen and Mother Center, I first knocked on the door and then entered. Grandma was in bed, wide awake. She looked at me, gave me a big smile, reached up for a hug and said, "Brian."
I almost fell over because it had been almost a year since she had spoken my name; and it would be the last time she would ever speak my name in this life. But that moment of lucidity carried me through the next two years, every time I visited her. When she gave no visible signs of recognizing me and when her words no longer made any sense, I remembered that glimmer of light in her eyes when she was able to communicate through the web of tangles in her brain to her grandson.
In spite of what this disease was doing to Grandma's brain, she was still a person capable of loving and certainly capable of receiving love. From that moment forward, it no longer mattered to me whether she could communicate or even if she recognized me. What mattered is that I could be present to her, and let her know I was there for her and loved her.
Her doctor once told me, "We will never know what an Alzheimer's patient comprehends. I think it is best to communicate with your Grandma as if she understands every word you say, and every gesture you make. I think we will all be surprised when we get to heaven and our loved ones tell us everything we did for them and everything we said to them while they were in this state."
The final blessing I will share — though I could include so many more — happened during Grandma's last six months on this earth. The disease was in its final stages. Grandma could no longer feed herself or use the toilet. Her words were garbled, and she usually was in an agitated state.
One day I went to visit her, and she was in a wheelchair near the nurses' station, with other residents nearby. One of the other women on the unit who had Alzheimer's was agitated and crying. I thought this might upset Blanche, so I started to wheel her in the opposite direction. She put her foot on the floor so I could no longer move the wheelchair. Slowly, she started to wheel herself in the direction of the crying woman.
Grandma slowly got out of her chair, gave the woman a big hug and began to lovingly stroke her hair. Though her words were indistinguishable, her tone conveyed a loving and soothing reassurance. The woman immediately calmed down. Grandma came back to her wheelchair and stared at me with a look I will never forget. Though she could not say the words, her eyes were scolding me: "Don't you ever pass by a person in need."
Grandma was still the same kind-hearted, loving woman who never knew a stranger and always helped the poor and suffering. Even with Alzheimer's, she was teaching and modeling for me what it means to be a Christian.
A nurse later told me, "Your grandma does that every day. She goes to all the other patients who are having a bad day and comforts them."
In her own way, Blanche was the Good Samaritan at this long-term care facility in St. Louis. In spite of her disease, she was showing her family and the staff of Mary, Queen and Mother how simple it is to convey to another person they are not alone and someone is there in their moment of fear and loneliness. In spite of what we all thought we knew about the final stages of Alzheimer's — the inability to recognize and communicate — Grandma proved us all wrong. Her ability to recognize human pain and suffering and to communicate love and compassion was stronger than the plaque taking over her brain. She may not have been able to communicate that she knew who we were, but up until her last few days, she was able to communicate love to people in pain.
As a mission leader, I often think back to these glimpses of grace. I learned so much from Grandma during her three-year journey with Alzheimer's. I learned that God's grace is the ultimate healing power and cannot be limited by what we think is possible. Medicine and technology serve a purpose, but the ultimate healer is God.
Second, God's grace works through all of us, even when we are sick, limited and "diminished." God's grace and healing can flow through us in a simple smile, a pat on the hand or a hug.
Finally, human dignity must be given to every person at every stage of their life. We treat our brothers and sisters with dignity and respect because God lives in them. It does not matter how they appear, even if they appear to be "out of it." Because they are human, they are God's children, and God's life resides within them even when our feeble eyes cannot recognize it.
And sometimes — in fact most of the time — the ones who appear to be "out of it" are the ones who see and are themselves glimpses of God's grace.
BRIAN P. SMITH, MS, MA, MDiv, is senior director, mission integration and leadership formation, the Catholic Health Association, St. Louis.