Alzheimer's: A Crash Course for Friends and Relatives, pages 47–48
In The Seven Habits of Highly Effective People, Stephen Covey says to consider the give and take of friendships in terms of bookkeeping in an emotional account. We make investments by doing things that increase a friend’s trust; we make withdrawals in acts of thoughtlessness and betrayal. A strong positive balance keeps the relationship viable. This system is based on equivalence in the “currency” each person offers—the ability to initiate and plan enjoyable events, reciprocate, act on important discussions, make amends and forgive, each of which is contingent on memory.
In your relationship with a friend in early AD, imagine instead sailing on the open sea without a ledger of rights and wrongs. Sailors can’t plan far ahead; they must work with the wind and waves of the moment. They can’t march off the boat in a huff over a brewing storm. They enjoy the sun when it is shining and the sea when it is calm, understanding the inevitability of rapid change. With a loved one in the early stage of dementia, you are more a sailor than a banker. Forgotten plans, one-sided conversations, and turns of sudden anger or frustration are part of a journey, always worthwhile in its larger contexts of humanity and compassion, if challenging from the standpoints of ease and traditional reciprocity. In working out the changes in the relationship:
Remain in contact. You can help by continuing to include your friend in activities he would normally enjoy and in which he can safely participate.
Be flexible. You may have to cancel plans at the last minute. He cannot override his state of mind. You’d make the same concession for someone with an upset stomach or a migraine headache. Think in advance of an alternative for the time you’ve set aside: “It’s okay if you don’t feel like going, John. I can either stay for a visit, or I have errands I can run.” The concepts of date, day of the week, and hour of the day become hazy. Always call a short while ahead with a reminder of plans you’ve made and tell the caregiver, too. Build in extra time—hurrying is never a good idea.
Support strengths. Faith, humor, optimism, perseverance, and courage are among the character traits of many people with mild AD and caregivers alike. Acknowledge and encourage these strengths, without reproaching your friend when they aren’t in evidence on a given day. “Cheer up!” “Don’t let it get the best of you,” “Be brave,” and other such exhortations tend to raise hackles when coming from a person who doesn’t face the same set of trying circumstances. Along with the unwelcome changes, there can still be joy, and the depth of love and commitment often present in caregiving and other relationships is heartwarming. When your friend seems down, try saying your own version of the Bill Withers classic, “Lean on Me.”
• “I’ll be here for you; you’d do the same for me.”
• “You’re my friend. I’m here to stay.”
• “Thinking of the future is hard, but I’m with you now, and I will be then.”