2025

Many people are afraid of developing dementia, which is increasingly common as we live ever longer. I have a compelling reason to harbor that fear.

My paternal grandmother developed dementia in her early sixties. The diagnosis was made without any of today’s imaging and biomarker techniques, but the course of her decline, it’s clear in retrospect, was typical for Alzheimer’s. Luckily, she never lost her sweetness or her Southern-ness: she remained hospitable and cheerful to the end, politely hiding her pills under her linen napkin.  One afternoon during a drive through the rural South, she kept promising us that the White Cliffs of Dover were just over the next hill!

One of the first house calls I made during my internal medicine residency many years ago was to visit Mr. R: a 70-year-old veteran, retired electrician, devoted grandfather, and church volunteer who’d shown signs of memory loss for six years. His forgetfulness was initially dismissed as “senior moments.” Then he forgot his wife’s birthday—something he’d never done in 40 years.

The turning point came when he got lost after picking up his grandson from school. They were finally found two hours away, where a flustered Mr. R had been driving in circles. Taking away his car keys was traumatic, and subsequent memory testing confirmed a probable diagnosis of Alzheimer’s disease.

(This story arose from a prompt to write a brief memoir inspired by an excerpt from a poem. The excerpt I chose, from Hafizah Augustus Geter’s poem “Paula,” was “a storm suddenly opens its jaw.”)

The luncheon started innocently enough. My friends and I were talking about indisposed spouses, some temporarily, others more seriously—like milk that had started to spoil but was still potable. Mine was heading closer toward curdled each day, but in small increments. Even so, thoughts of the future were harder to entertain.

Grandma was famous in our family for her cinnamon buns. Born in 1900, she was of the age of never following a recipe. My sister and I would ask her how to make cinnamon buns, and all we got was “watch me.” We wish we had watched more closely and taken notes.

When Grandma announced she was moving to assisted living, we were surprised, as she appeared to still have good health other than somewhat weak legs and poor hearing. Her cognition seemed fine, and we never worried about her living alone. But now in her eighties, her older siblings had passed,  and her youngest sister lived four hours away. So when she chose a group home owned by a great-niece, we thought all would be well.

“I don’t want to live with this,” read a note we found afterward. “Just let me die.”

At the time he wrote the note, Dad had recently been diagnosed with cognitive impairment, often a precursor to Alzheimer’s; years earlier, his uncle had suffered from what was then called “senile dementia.”

New York radio station WBAI has Gershwin classics on all day. Ella Fitzgerald and Louis Armstrong are singing the one that always made her laugh. I hope she’s still able to hear it; I turn up the volume:

You say potato, I say po-tah-to,
You say tomato, I say to-mah-to, . . .

She sits mute, a breathing statue whose life has been slowly erased from within.

Our days are gray, bleak, silent. Her silence can last days, sometimes weeks. I hear only half-words, gentle grunts, mumbles, and sighs. I wonder if she is able to think.

Dad and I visited Ma every day in the nursing home. Sometimes she greeted me with a smile and a welcoming, “Well, look who’s here!” Other times she dismissed me with a menacing look and hurtful words: “You’re a piece of shit.” Dad would remind me that it was her dementia speaking, but that didn’t erase my heartache or dry my tears.

Despite lacking higher education, due to her immigrant parents’ belief that daughters did not deserve a college degree, Ma was a smart woman. She read constantly, both novels and newspapers, and she could mentally add up her grocery bill, always coming within a few pennies of the actual cost. Ma had a sharp mind, one that did not allow for false flattery or foolishness; instead, she would set a goal and achieve it, allowing nothing—and no one—to stand in her way.