Sleepless and aggressive

The phone rang just after breakfast this morning. It was the senior nurse from Dorothy’s care home, to advise me that Dorothy had been aggressive with staff yesterday: “…nothing serious, no one hurt, but just to let you know…..”. It wasn’t the first time, but such a call has been rare in the last eight months.

Yesterday, I had picked her up about 10am and we visited some dear friends, a house-bound couple who live nearby, and we shared a lovely hour or so over a ‘cuppa and cake’ morning tea. It was nearly lunchtime when we returned to Dorothy’s care home, so I stayed whilst she had lunch – I just sat with her and had another cup of tea – my lunch could wait. After lunch, while I was still there, the visiting Podiatrist treated her feet and cut her toenails and she seemed relaxed and content. Then we walked and talked, well, one-way talked, and I finally left her dozing in an armchair; we kissed, and I explained “I had to go now”. At the time I wondered why she was a bit sleepy, but the phone call just now explained that she had been very restless the night before, and was up and prowling most of the night, and again last night, apparently. In all our married life, she has always been a good sleeper; never restless and always drops off to sleep easily; whereas I have often been an erratic-pattern sleeper, frequently having to resort to pills or nocturnal meandering until I finally succumb to solid sleep.

Dorothy is basically having four types of medical tablets, two small-dose drugs to keep her relaxed and another two mood-enhancing and sleeping types, and it has not been varied for several weeks. I will try to discover and understand if this medication was a factor in her two-night, one-day, different behaviour pattern when the visiting doctor is back from his holiday in a couple of weeks, but I suspect that this apparently isolated incident of insomnia will remain inexplicable – just part of the Alzheimer’s puzzle.

I’ve just come home after spending most of today with Dorothy and I’m mentally exhausted! It is just not possible to converse or even hold her attention for very long, no matter what I try. We spend most of the time walking, and today it had to be indoors because the weather is so inclement with icy cold wind and frequent showers. Meanwhile, I am confident that the nursing staff are vigilant and caring and, really, that should be comforting to me, but I still feel on edge and guilty and helpless. That’s probably how Dorothy feels, too, with the added emotion of not really being aware of where she is, or why. Every few hours, perhaps especially when I am with her, she sobs for a while, and mumbles words I can’t understand. She can stop crying just as quickly, and I thank God for that, as it tears me apart, too. This afternoon she was very content, happy to carry and cuddle a baby doll, stroking and kissing it when we sat. We watched and listened to Andre Rieu on the big screen TV for a while, but her span of attention is very short and neither the music nor the screen held any appeal for long; but she was happy to ‘sort of’ briefly dance with me to the ‘waltzy’ music!

When I left, late this afternoon, Dorothy was quite relaxed, even a bit sleepy, and not at all aggressive. But she can be very insistent, or should I say obstinate, when asked to do something, like get changed into her nightgown, or if she is rebuffed when she wants to start a ‘conversation’ with someone.

The other residents in her unit are a mixed lot, as you would expect, with only one ambulatory male and another ten ladies. The behaviour of other residents with Dorothy is mostly benign and they are all, mostly, solitary in their relationships except for two who are almost inseparable. There is a general aura of peaceful coexistence with not much interaction, certainly little cogent conversation, but there is sometimes a little simmering belligerence evident, especially from a few who are a bit ‘prickly’ and, no doubt, there may be times when this applies to Dorothy. There are a couple of residents who can become agitated, but this is usually frustration when they want to open the door (to freedom?) and it is electronically locked; repeated, random pressing on the numeric keypad just doesn’t work!

It seems to me that with Alzheimer’s there is always the potential for low-level conflict and unpredictable interaction in a group like this, so I must learn to accept and cope with these sorts of phone calls, just as the wonderful staff have been trained to accept and deal with these interpersonal  reactions. Maybe I have this same behaviour, latent, in my own headspace!