Saturday, May 16, 2009

Constants, Changes and Boundaries

I have been doing a lot of thinking about how Beth’s life is now. Of course this is all based on my perceptions and Beth most likely has a somewhat different view. Well, I can’t speak for Beth or Linda so my perceptions are what you get.

At this time there seems to be two definite constants for Beth – fear and change. I hope there is a third constant of love from Linda, me and the extended family Beth has built through her blog but I think the fear often overrides the feeling of being loved.

Fear is Beth’s constant companion. With her memory problems increasing and her regressions, much of what we take for granted is lost to her. She often doesn’t recognize this apartment. She doesn’t know who the careworkers are, doesn’t understand why she is sick and has to use a wheelchair, doesn’t understand why strangers keep telling her what to do. Imagine being a toddler lost in a gigantic crowded shopping mall and you might get an idea of what the fear is like. When Beth is not regressed the fear is still there. It is the fear of what happens next with her condition: fear of overheating, losing more function, losing cognitive abilities even more, never being treated, never being taken seriously by the medicos. There is fear of being abandoned by everyone or of being institutionalized.

Adding to the fear and often fueling it is change. Beth’s condition fluctuates, often quite dramatically. During good periods she can do 10K’s, visit the park, play badminton write or talk on many complex topics and conduct in depth research. During bad periods she becomes very weak and loses cognitive abilities. These are the times when she is too sick to muster the energy to leave the apartment, go to the doctor or finish simple tasks.

Beth can go from the good periods to the bad periods in the course of a few days, a few hours or even a few minutes. I have been conversing with her and over the course of 30 minutes she loses energy, cognitive ability and regresses. I started out talking to adult Beth and now I am talking with the 5 year old who doesn’t understand what I am saying. It is these periods of rapid regression which cause the most anxiety and fear. I (or Linda) am dealing with Beth as I would with any adult. By the time I realize that I need to switch to dealing with a 5 year old I have made Beth upset and frightened. I am trying to learn to pick up on the cues to Beth regressing to avoid causing the fear.

As part of learning to interact in ways that don’t increase Beth’s anxiety I have become very aware of boundaries. We all have a series of boundaries that are part of how we interact with others. There are people in my life who I am more comfortable with. I have different boundaries for them compared to casual acquaintances or co-workers. I trust people who respect my boundaries and am suspicious of people who ignore them.

For Beth boundaries are important. With the medical stuff she has lost many choices and people touch her often, regardless of if she is comfortable with it. When she goes to bed she is hovered over as we watch for seizures or to be sure she keeps breathing. She has no privacy in showering or being in the bathroom. A lot of the boundaries have fallen victim to her illness. This is why it is so very important to respect other boundaries Beth has.

There is just one area where Beth seems to be unable to set boundaries – when she perceives that someone needs help. Beth is the most giving person I have ever known who always places herself last. This means there are times when Beth will stay up all night emailing people who are having a tough time even though it costs her so much energy her body can’t manage to breathe without prompting.

If I am having a bad time, need support and I keep it from Beth that hurts her. She wants to be there for me (as well as other friends who need help). I just have to balance it so that Beth doesn’t make herself weaker/sicker in the course of being there for me. I have to remember that while Beth can help me I also need to help myself. Just as it is important to Beth that I know she cares, it is important to me that her caring for me not push her closer to hospital.

Hmmm… it would seem I have some tasks.
Help Beth feel that being loved is also a constant in her life.
Understand the cognitive and physical changes Beth goes through and react in ways that reassure her and make her feel safe.
Be aware of boundaries and honor them. Place boundaries to help Beth put her health first more.

Well this blog post seems to have gotten quite rambling. Thank you for letting me sort out my thoughts. If they have helped you as well then that is even better.


rachelcreative said...

I like hearing what you have to say, your perceptions.

You're a good friend. You're an exceptional friend.

Neil said...

Hi Cheryl:
Thanks for sharing your viewpoint. I can certainly understand her fear. And I'm grateful that you are there for her. Rather, for both Cheryl and Linda.

I try to remind Beth that I love her, even though I haven't met her; I hope that helps sometimes.

I emailed Beth privately, with a photo of myself from a medieval event last weekend. If you're interested, ask her to show it to you. There's a very visible, decidedly non-medieval Gotta Fly wristband on my belt in that photo; I sent the photo to her to let her know that I think of her every day.

I also wore the wheels 'n wings t-shirt (when we were finished being medieval) on Sunday; I know people were looking at it, but nobody said anything, I was so tired that I didn't mention the origin.