Families, support, privacy, caregiving and chaos and misunderstandings in unprepared families

I am an only child who grew up in a nuclear family and spent most of my childhood in cities far away from relatives, I always had this “grass is greener when you have siblings and a large family” conviction which was further boosted by all the talk I heard about how families were always there for you, they were the people you could depend on, the safety net, and so on. I even remember how, when I was around eight or nine years old, someone asked me what I wanted, and I said I wanted a brother or sister, “kisee bhee size ka ho”, something everyone around me found very amusing (except my parents, perhaps).

Cut forward several years, I started having doubts about this “normal family” warm, fuzzy envelop of love, of “your family is always there for you, with you” sort of business. My experience net had widened. I saw families that remained rock-solid together regardless of tsunamis of setbacks. I also saw families where siblings retained a relaxed amiability across distances that let them connect emotionally even if months has passed by between conversations. But then there were families where sibling fights were bitter and beyond reconciliation. And there were the other families where, whilst there were no outright yelling-slanging match, the gaps were unbridgeable and smiles stiff and reserved for when outsiders were watching, and the normal distance of cities and busy schedules were a matter of relief. There was no universal standard of “family”.

And I wondered whether the implied concept of “normal, happy family” and lasting sibling affection was more a matter of wishful thinking. Perhaps people kept talking of it as a norm when it was actually more of an “ideal”. I wondered whether repeated statements of “this is our culture” and “normalcy” around “family-oriented society” made people feel defensive, guilty, or inadequate about their differences and conflicts with siblings.

As children, siblings are forced to live in the same house, and even if their personalities and stuff are vastly different, they manage to survive together. But as adults, living in separate homes with their own families, perhaps the differences between siblings are easier to act on, because a distance can be maintained? Or is it distance over the years that creates the rift? Maybe one needs to work on maintaining the connection with siblings the way one needs to work at maintaining anything worthwhile; perhaps it cannot be taken for granted…Frequent interactions, exchanging thoughts, sharing responsibilities, comings and goings, on an ongoing basis, not just when there is a crisis. Hey, I’m an only child, I’m clueless. What I do know is that things are not always as hunky-dory as they are supposed to be, even amongst siblings who seemed close enough as kids.

Nowadays, as someone who talks to many caregivers, and also sometimes gathers their stories as interviews, I have repeatedly heard stories of severe sibling conflicts over caregiving, far more serious than “he took my geometry box” childhood squabbles everyone treats as “cute.”

When I talk to caregivers, I find that they open up about the more “gory” details of their cracks in happy families only after rapport is established, and even then, they are defensive, and more likely to open up to fellow caregivers than to others. Even in situations seething with bitterness, people tend to hide the problems from outsiders (ghar kee baat baahar nahin kehnee chaahiye) either out of privacy or shame, fearing that they would be called complaining or would face comments like, “but surely you love your brother” or “brothers and sisters must support each other”, sentences they are not really happy to hear given their situation.

(My idea is not to say conflict is inevitable, but to say, hey, let us understand situations where it may occur and see if we can prevent/ diffuse it. None of us need more trouble in life)

I have managed to get a few caregivers share their family-conflict experiences through interviews. A few months ago, a woman facing severe mismatches with a sibling (over sharing caregiving work and taking decisions) wrote in to thank me for an interview I had put up on family conflicts, saying she was relieved to know that she was not the only one facing that sort of problem. She felt that she could make some small changes that would reduce the chance of misunderstandings because she now understood something of the opposite perspective better.

And more recently, I met a caregiver, Ritika (not her real name).

Ritika’s initial chat and queries were on simple, small problems; she would narrate some issue, we would chat. But I could sense her tension. Over long, continued interactions, she then began unfolding the more overwhelming and personal aspects of her situation. A month ago, she agreed to share her story with others through an interview on my site, because talking to me she realized that more people needed to know that stories like hers happen, too.

Ritika could be a woman in the apartment next door to you for all you know. She lives in an upper middle class locality, looks after her father alone, has family in other cities. I assume that to neighbors who may pass her in the corridor, she seems energetic on some days, tired on others, is active in some types of interactions that living in an apartment complex necessitates, and is not active in others. She does not mix much. In short, she is one of us except that she has been plunged into a situation most of us assume we will never be plunged into.

When volunteers encounter people of such a profile, they often give advice on how the caregiver needs to do more for the patient; they give advice on how the children should be willing to make more time for the father with dementia, they talk of love and tenderness and about patience.

And while some caregivers listen, others sidle away from such advisors, because these caregivers cannot open up about the actual, serious problems they are facing.

Some problems, you see, are difficult to share. Like a zero bank balance and not having money to buy food. Like having to skip meals so that the father can eat, like having to sell off silver and gold because there is just no money…the sort of problems Ritika has faced…

Yet Ritika does have family, well-to-do family…a sibling, a husband. And they were not part of her support or safety net through those extreme times, and are not emotionally there for her even now.

Ritika’s story is complex. Events piled on to events, there were misunderstandings caused by things her father did (probably in part because of his dementia), and these actions caused pain and distances, and Ritika is bearing the brunt of the bitterness. And there is loneliness. Rifts are created easily, but not mended that way. (The interview is here: Dementia caregiving can create chaos: a solo caregiver describes challenges faced on multiple fronts)

As Ritika talked to me of how the caregiving has created chaos in her life, leaving her stranded alone in multiple ways, I was convinced that this story needs to be told. Not to get Ritika sympathy or praise, nor, indeed, to get her blame or speeches. And not to make readers criticize the others around her, because every story has multiple perspectives, and there are always reasons why things happen. Blame games never help.

I feel Ritika’s story needs to be told because people need to know and understand what happens in some cases. What can cause rifts, misunderstandings, how poor communication and planning end up overwhelming and stressing an unsupported caregiver, even if that is not what the rest of the family intended to do. Readers need to draw lessons for themselves, be prepared.

This interview focuses on the impact of caregiving on all aspects of the caregiver’s life and identity. The caregiving that Ritika does is exhausting in itself, because she does all the caregiving alone for a father who is dependent, uncommunicative, on catheter and diaper and unable to clean himself. But Ritika’s exhaustion does not come solely from the caregiving work, nor from the fact that she has to earn money alongside; her exhaustion comes from these and a multitude of other factors, all combined into a mass that presses on her.

Yet, as Ritika says: it need not have been like this To quote her further:

If there are elders in a family, the chances are that such situations will occur. Families can be ready for them. They can plan for them. When situations occur, solutions don’t automatically evolve out of sheer love and affection for each other. Solutions evolve out of trust and sitting together and planning for all eventualities. All ties get tested at times like this if there is no plan.

It is a long interview, and frankly, I was amazed to find how balanced Ritika is about everything going on in her life. If the interview seems depressing at places, it is solely because the situation is overwhelming; Ritika herself is energetic and balanced and active in spite of it all.

Let me hope sharing this story will provide readers another data point in the spectrum of caregiver lives. That they will “listen”, that it will help them understand. That they will glimpse the underlying complexity care situations may have, and next time they meet a caregiver, they will not be hasty in judging, in acting preachy and simplistic. Or when a caregiver falls silent in face of what may sound like criticism, that they will pause and wonder whether this person, too, could be facing some of the sort of problems Ritika faces, but is too diffident to say anything. Even a fraction of such problems could overwhelm.

Do read the interview: Dementia caregiving can create chaos: a solo caregiver describes challenges faced on multiple fronts

Even using a pseudonym, the story was difficult for Ritika to tell, and it took her effort and courage. So let us at least see if we can, for some minutes, sink into that situation and feel with her, and then return back to our own skins to see whether this understanding nudges us along to consider some changes we may want to make in our own lives…

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Reducing caregiver isolation, working from home, using coworking

Recently, I shared my own experience of isolation and loss of social skills as I became more and more home-bound, and then I suggested that caregivers be alert about this possibility and guard against it. A few days later, I happened to talk to a caregiver and she described what she planned to remain connected to people even when she worked from home. I asked her whether I can share her idea, and she not only agreed, she even said that such sharing helps people and she also may pick up ideas if others share their ideas (hint, hint, to any of you who has ideas)

Anyway, so this caregiver looks after a dependent parent who has dementia and is immobile, but can be safely left alone for a few hours. The caregiver works from home, executing freelance assignments that she does on her computer and emails. She was once very active socially and her enforced seclusion dampens her spirit, so here is what she is considering:

This caregiver has an “office room” to work from. Now she will add some tables and chairs to this room to make it suitable for multiple users. She will then invite friends who work from home to use her office room as their offices. Each person will work on her own assignments while sharing the same office space and in the companionable presence of others, so that they all feel like working more and don’t succumb to distractions or feel lonely. The caregiver plans to put out flasks of tea or coffee (for which she may ask her friends to pool money, or maybe not, she hasn’t decided).

Down memory lane, one year of gathering caregiver perspectives, caregiver voices

I’m an asocial and risk-averse person, but I can be bloody-minded if convinced that something needs to be done, and so I sometimes start projects that defy sanity. That’s how I plunged into a rather hefty project around a year ago, self-directed, without any pressure from anyone but my own stubborn nature. It happened when I got sick of rummaging for dementia care stuff directly applicable in India, because though the Internet abounds with information on dementia, and also on its care, and there are plenty of books, too, most of these are designed for a different cultural context.

I wanted more tips that could be used here, in India, with terminology I could relate to, more examples, more situations. Stuff that took into account the abysmal awareness about dementia in India, and the lack of institutional support. Stuff that suggested resources available in India, or in Indian languages. Most of all, I missed the voices of fellow caregivers–their stories, their struggles, their successes. The community that remains hidden in shadows.

And so I created the Dementia Care Notes site.

Of course, there was no way I could say that anyone would bother to visit my new site. How would people know it existed? Why would they bother to read it? But hey, even if I lost some time and effort and money, at least I wouldn’t get this dirty helpless feeling that I hadn’t tried…

It was in September last year that I started planning an entire site dedicated to family caregivers looking after dementia patients in India. Not just a section on a website, not merely a few pages or a pamphlet, but a full-fledged site. I drafted out the core set of pages, and then, in late October, I bought the domain and made the site live. The website now has over 90 pages, all full of information about dementia and its care, resources in India, books, DVDs, presentations, and…plenty of interviews.

As of today, the Dementia Care Notes site has twenty-three detailed interviews, eighteen of them being interviews of caregivers. (see the list and click the links to individual interviews here)

Listening to caregivers, respecting them, supporting them

Years ago, when I was still a newbie caregiver and hadn’t realized (let alone accepted) that I’d be paying a heavy price in terms of my career, a friend/ colleague made the mistake of calling me up and asking me how things were. He vaguely knew of my mother’s issues and my problems of coping, and I therefore (I’ve always been naïve) took his question to be a genuine one, and proceeded with the answer. If a squirm can be seen over a phone line, well, that explains what I perceived, but I was overwhelmed, desperate, and here was a listener…

Or was he?

A few minutes into it, he said, (I paraphrase and abbreviate, but you’ll get the drift) “Yes, well, sorry, hmm, ya, okay, so, must be bad, huh, hmmm, yaa, so, what else is going on? Let’s talk of something hmmm, ya, well, like, well positive…so how’re things…what else…”

Utter fool that I was, I answered, “There is nothing else.” Then it registered on my slow brain that he hadn’t wanted any of this rant. He’d probably expected me to be “positive.” He’d probably just wanted a couple of good, positive sentences from me before he went on to whatever else he had called for.

A full-speed train takes a few minutes to stop after the brakes are applied; I would probably have tapered off in about five sentences but by that time he had managed to sign off the conversation anyway.

I felt bewildered and also let down. I may not have minded had he not asked at all, but asking me and then not listening…

He never called again. I don’t know whether he took a conscious decision about it; it was probably just a discomfort he felt when he thought of me, something that made him choose to make other calls instead. He probably forgot the incident.

This incident happened almost nine years ago. As far as I was concerned, I was not asking him for solutions, or even sympathy. All I did was narrate my situation in response to a question. I may have come around to the point of uttering “positive” statements that society expects, but he shut me out before that.

Overall, this was just one of the early incidents that made me start understanding how isolating caregiving could be. It is through stuff like this that I began to realize that if I talked about the realities of my life, people switched off or decided to avoid me. If I wanted company, I had to pretend my life was very different.

A difficult story to write: A caregiver’s tale

This post is about two women I read about in the newspapers, Sangeetha and Baby. The first time I read about them was in December 2010, while scanning newspapers for caregiver stories (I do this regularly to share India-based dementia caregiving stories on my website. I read about them again the same way, in February 2011. For the last few weeks, I’ve been trying to make myself write this post about them. My way of honoring them. Because writing is my way of doing things.

Here is what I read in December, the first installment of the story.

The story starts in a simple way: Baby, a poor, widowed woman wanted her daughter Sangeetha to get educated, and slogging for years as a laborer to earn money, often ignoring her pains and other health problems.  Daughter Sangeetha studied hard, completed a bachelor’s degree, and then did her post-graduate diploma in computer applications.

Let us pause for a moment to imagine this: Baby, lifting heavy loads of stone, working long hours, and her daughter, struggling to study. I think it would be reasonable to assume that Sangeetha would be a first learner in the family, and every achievement of hers becomes more significant given her circumstances. She must have shown courage and intelligence. Presumably she did not fritter away her energies in the sort of fun and games that most of her peers would be doing; her mother worked hard, and so did she. They shared a dream, that of Sangeetha being educated.

To go on with the facts of the story, as reported: Baby’s severe pains reached a state when they could not be neglected. MRIs were done. Investigations conducted. Baby had developed Parkinson’s. Her mix of problems soon included dementia. Sangeetha, her education complete, had been trying to earn money on the side while attending coaching classes so that she could get a government job. But with Baby now having fits and falling, Sangeetha had to shift her role and become a fulltime caregiver.

I remember thinking, as I read this, that O’Henry would be proud of how life imitates fiction; this was a real-life Gift of the Magi story. Instead of working to get the job and complete her mother’s dream, Sangeetha gave up the possibility of a job because she could not leave her mother alone for even ten minutes. As the round-the-clock caregiver, Sangeetha lived in a small thatched hut and cleaned and fed her mother and watched her worsen. There was no money, no food, no medicine, except the small amounts that came thanks to the charity of some people and organizations. There was no time to go out and earn anything. There was no energy.  There were only bucketfuls of soiled clothes and caregiving work that never ended, and Sangeetha did it without grumbling. Day after day, month after month, year after year.

“A gem,” is how a neighbour described Sangeetha.

Paring down to essentials

The process of adjusting life to cope with my mother’s situation began when her confusion and memory loss started becoming visible in longer interactions, well over a decade ago. She had not been diagnosed at this time (though we had been visiting neurologists) and we made these adjustments in response to her strange behavior and our failure to reach her through reason and negotiation.

My main focus of adjustment at this point was to create an environment that minimized her rage or frustration cycles. This was, I confess,  not as part of some well-thought out, compassionate and caring strategy, but a form of self-preservation. There was an air of helplessness and frustration. We had no idea she was suffering from a medical condition. Her “unreasonable” and “dictatorial” methods seemed parental meanness, of the sort movies depict, and I was trying to stay safe and sane.

For example, if she wanted her food served hot and got agitated otherwise, I tried my best to be around to make it and serve it hot.

A common loneliness…

For the last few days, I’ve been recalling some of the challenges posed in caregiving because of my mother’s condition. These were places where her memory loss and confusion resulted in her saying and doing things that hurt her and people around her. They caused me repeated embarrassment and anger and frustration, they made me withdraw from people around me and effectively isolated me, and they made her fall ill and hurt herself. Most of the time, though I had begun to register that she was acting out of confusion (and not because she wanted to be mean), I had no effective way to reach out to her or to explain to others or generally make things better. There was an overall sense of helplessness and inevitability that I experienced.

I’d like to wrap up this part of my recollections by sharing her obvious sense of insecurity and isolation.

There were many incidents in those difficult years that showed how insecure my mother had started feeling. In addition to making me promise again and again that I would take care of her, she made it a point to complain to everyone about me, and when they talked tough to me, she’d tell me, “See, did you see what he said? You must do your duty properly.” Essentially, she was using these complaints to make sure I didn’t forget or neglect my duty. Earlier, I’d seen it as manipulation done out of dislike for me, but over time I realized this to be a twisted thinking of hers to get what she wanted.

She felt that if others were always telling me what my duty was, she would be safer.

Ramblings on love, hate, and a life worth living

February has been a mixed month for my mother, the most painful part being when she went down with fever but could not tell us where the pain was. Being a dementia patient in an advanced stage, she cannot communicate her problems to us, which means we have to be detectives. Much investigation and deduction was attempted, without success, medication given to control the fever. Two days into the problem, she broke and swallowed a tooth–ouch! She broke another tooth again, the next day. Ergo, a tooth infection. Fever’s under control, and a dentist was requested to make a home visit to assess her dental status A major project is now to be planned–a trip to the dentist to remove another tooth that is tethering on a breakdown, and to clean up the stuff left behind by the two not-so-neatly broken teeth. That she is fully bedridden makes the challenge more, well, challenging. Ah, well.

But what’s prompted me to write this blog is something quite unrelated, actually, a few unrelated things, that happened these last two weeks.

Firs, I’d like to share a memory dating around seven years ago. Seven years ago, I was still naive about dementia and how it affects people, still thinking increased memory loss was like losing ten keys a day instead of one. My mother was in her own denial mode, unwilling to admit to any memory loss. The world around her (as I can see in retrospect) bewildered her, and she was not going to tell anyone that. She was a fighter, she was. Often I saw her writing with a fierce concentration in a diary, and snap it close when I entered her room. ONe day, she left it open near her breakfast tray, and there it was, written with a red pen, written so angrily that the pen had torn through the paper. There were many broken sentences on the page, and I stopped short when I saw my name. She had written that she hated me, written it again and again and again, and written about others she hated, and at the end, there was: I hate hate hate the world.

to talk or not to talk and whether one has a choice

On to the social interaction business, and my apparent ambivalence.

The life and choices I have are quite different from people who have been ‘peers’ of mine, and as I accept my new realities, I find myself grappling with trying to decide whom to interact with, how much, and for what aspects.

I have mentioned caregiver isolation before, and to me, this means that there is an entire range of topics I want to share but cannot share because the communication gap is too severe. I do not want to put off people and lose the bit of sharing I do have, so I have to choose carefully.

catching up is easier than fretting about it

So, today, I have started actually catching up. I had a deadline I met yesterday, and with that, I have got myself a surge of energy to begin catching up.

And guess what? That consolidation of my to-do lists that I have spent quite a bit of time and a lot of energy fretting over, took all of ten minutes The closing of last year’s diary and starting a new diary for this year took another fifteen minutes…

One funny thing about being busy is that I am never too busy to read stuff I want to read. Or to take a long walk, or listen to a talk that interests me. The ‘busy-ness’ of my life manifests in stuff more to do with socializing or other stuff that takes more ‘focus’ from me, and which I suspect will yield less pleasure. Actually, quite a few of the stuff I always manage to procrastinate about turn out reasonably satisfying, and even fun, when I get down to them. What diminishes the potentiality of enjoyment is the tension I’ve keyed myself into by imagining how horribly tiring and boring and overwhelming it may be.

a solo dance is not good enough

Sometimes, some health news alarms me, like this one which suggests we party to keep away dementia.

Because, I cannot party. Not because I don’t want to, but because partying means you have a social circle that accepts you into its fun-making, and a support system that allows a measure of spontaneity, and a personal nature that can set aside all bothersome thoughts and responsibilities to wear dancing shoes and a beaming smile.

For me, there have been days, well weeks at a stretch, when I haven’t got to talk to any adult other than one having dementia. “A calm and outgoing personality” needs a possibility of venues to implement that outgoingness Social contact may be a way to stave off dementia, but it cannot be my way. Most of my interactions with fellow humans is by reading what they write (I gobble books) or through online groups, or through a sense of sharing (however limited) that blogging gives me. I enjoy a sprinkling of phone conversations with friends who stay in touch even though we never can meet. That, according to another article I read, does not count as being socially active. You have to go out and meet them, period.

caregivers and their new planet

My focus in this post is the social isolation caregivers experience, a theme I have explored in previous posts, and a common problem caregivers face.

All of us shed old friends and acquaintances as time passes. School friends are forgotten, people who shared the same hobbies fall away as their hobbies or ours change. We leave a job, and our contact with old colleagues withers away. We move to another city. Children and siblings move away and marry. Many of these just happen, as a type of growing apart, when things that bind us are not relevant any more. Most of the time, we may not even notice them.

Some partings, though, do bring sorrow–those not initiated by us, or those with a lot of bitterness/ acrimony. Breakups. Divorces. Deaths. Fights. Misunderstandings. Each of these takes a toll, diminishing us in some way.

But then, there are new connections, too. A new lover, a new set of colleagues, a new community joined. A child born, a marriage that connects you to a new family. Some of these changes enrich us, some are unpleasant (a horrible boss, a tyrannical in-law).

caregiver isolation

Yesterday, I shared a story of Friend A, alone, sad, feeling let down. The tragedy is, such isolation is not, well, isolated.

Again and again, if they open their hearts to you, caregivers will tell you how their caregiving becomes even more burdensome because people they knew earlier, friends, relatives, start cutting away. Often, this happens gradually, and often it happens without grace. That is, if asked, people give reasons that sort of blame the caregiver for it.

I know this from my own experience, and I know it from the experience of many other caregivers.  These are the sort of sentences we hear: