Trish Vradenburg, TV writer who put spotlight on Alzheimer’s, 70


Trish Vradenburg. Photo courtesy of UsAgainstAlzheimer’s.

Trish Vradenburg. Photo courtesy of UsAgainstAlzheimer’s.

Trish Vradenburg, a television writer and advocate to end Alzheimer’s disease, died on April 17. She was 70.

A spokesperson for the family declined to disclose the cause of death, but in a phone interview, her husband, George, chairman and founding board member of UsAgainstAlzheimer’s, described his wife’s death as “sudden.”

Vradenburg and her husband co-founded UsAgainstAlzheimer’s, which aims to increase funding for Alzheimer’s research and discover a cure by 2020 for the progressive disease, a type of dementia, after her mother, Bea Lerner, died of Alzheimer’s in 1992. Vradenburg wrote a semi-autobiographical play about her mother, “Surviving Grace,” about a sitcom writer and her mom battling Alzheimer’s together.

Vradenburg was born Patricia Ann Lerner on May 9, 1946, in Newark, N.J. She began her career as a speechwriter in the U.S. Senate after graduating from Boston University, where she studied political science, in 1986. She was a television writer for “Designing Women,” “Family Ties” and “Kate & Allie”; published the novel “Liberated Lady”; and wrote for the New York Daily News, The Boston Globe, The Washington Post, Ladies’ Home Journal and Woman’s Day.

Judaism was important to Vradenburg, though she was a secular Jew. “She identified deeply with being Jewish and [I] converted to Judaism because she felt so deeply about her religion,” George, a former AOL executive, said. “I found this great depth in this community and purposefulness in the community.”

The couple resided in Washington, D.C., at the time of her death. They lived in Los Angeles and moved to Washington after George was offered a job with AOL. The two were married for 48 years at the time of Vradenburg’s death.

“A piece of light in the universe has gone out,” George said. “There is a brightness that will be dimmed.”

Her survivors include her husband, George; daughter Alissa Vradenburg and son-in-law Michael Sheresky; son Tyler Vradenburg and daughter-in-law Jeannine Cacioppe Vradenburg; brother Rabbi Michael Lerner and sister-in-law Cat Zavis; and four grandchildren.

A private funeral service was held April 20 in Los Angeles at Hillside Memorial Park and Mortuary. Lerner and Temple Israel of Hollywood Rabbi John Rosove led the service. A public memorial service in Washington is scheduled for May 9.

When Harry met Lilly…


Rabbi Harry Roth will read this article aloud to his wife, Lillian, after it’s published. They might be sitting in a community dining room or her bedroom, where she dorms with her assigned roommate — referred to as “the retired singer” — separated by a curtain. 

He’ll read this particular line out loud and she’ll listen as she either inspects her immaculately manicured, cherry-red nails or stares away in thought, trying to remember a name, a word, a memory, something stirring deep inside. Maybe she’ll be wearing that emerald green dress he bought her. 

Harry, 91, will be visiting his wife — whom he calls “my dear Lillian” — as he’s done every day for the past 18 months, ever since she was admitted into the Goldenberg-Ziman Family Special Care Center at the Los Angeles Jewish Home in Reseda after being diagnosed with Alzheimer’s disease.

Now in the advanced stages of the disease, Lillian remains in a wheelchair and is assisted by nurses. She first started showing signs after the couple moved to L.A. from Massachusetts nearly 20 years ago. At first, the symptoms were mild — she was forgetful and easily disoriented. But symptoms eventually worsened, and her confusion deepened. 

“She needed all kinds of help that I couldn’t give her,” Harry said in a defeated tone.

So, every single day, the aging rabbi travels from his apartment in Westwood to Lillian in Reseda; Harry takes Cityride on weekdays, and is driven by one of his two children on the weekends, or, on occasion, drives himself. 

“I need it more than she does,” Harry said about his daily visits. “I don’t know how I’d feel if I didn’t see her every day, and I don’t want to find out.” 

Since Lillian, his wife of 72 years, entered the Jewish Home, the only times Harry hasn’t visited her were after he underwent two minor operations and when he flew to New York for their grandson’s college graduation.

By the time Harry reads this out loud, his dear Lillian will be 92, or almost — her birthday is March 23. There are certain things you should know about her: She has pale green eyes, dainty hands and an identical twin named Vivian. When she was young, Lillian was zaftig, pretty, shy and practical. Growing up, her family took trips to Rockaway, N.Y., where she was known to dance the jitterbug. When she cooked, she baked a mean babka and an out-of-this-world chicken soup — the secret is to puree the vegetables, making the soup the color of carrots, Harry said. 

“It wasn’t hard to fall in love with her,” he said. 

They first met 85 years ago when Harry and his family moved to Corona, Queens, from their small-town shtetl in Romania, and Lillian and her family came to welcome the new arrivals. Harry was 6 then, and Lillian was 7.

On their wedding day, Oct. 14, 1942, Lillian was 21, but he was only 20 — Harry said he couldn’t legally drink alcohol or get married without parental consent. But he was old enough to serve in the military, and when he was on furlough — a five-day visit before returning overseas to serve in World War II — they tied the knot. 

The Orthodox ceremony took place on a Saturday evening, and the next morning they drove to the Catskills in New York for their honeymoon, a three-night stay at the Borscht Belt landmark Grossinger’s Catskill Resort Hotel. This was before the hotel built a swimming pool, so if they wanted to swim, they had to go to the lake. “Anyways, it was too cold to swim,” Harry still remembers. Four days later, he was stationed in France. 

Before retiring in 1990, Harry spent 28 years as a Reform rabbi in Massachusetts. Then he traded his stationary pulpit for a gig as chaplain on the Queen Elizabeth 2 cruise ship, where he and Lillian sailed the seas, traveling the world.

These days, Harry regularly attends Friday afternoon Shabbat services at the Goldenberg-Ziman Family Special Care Center with his wife. After, he eats a meal in the Jewish Home’s cafeteria, which includes chicken soup (“made with real chicken!”) and Manischewitz wine. Lillian stays at the Center, where she’s assisted by nurses.

The Goldenberg-Ziman Family Special Care Center is probably the most musical building at the Jewish Home. There’s always a blanket of sound, whether it’s a performance in the main room, a musical serenade in the back or the crooning coming from a stereo. Studies have shown that music is an effective therapy in the treatment of patients with Alzheimer’s and dementia. It soothes agitation, sparks memories, engages the mind and improves eating. 

“It’s the songs that she remembers,” said Harry about Lillian, who, depending on the day, might not recognize her husband. But even on what Harry calls “the bad days,” Lillian remembers the lyrics of her favorite melodies. 

When Harry asks Lillian,“Do you want to sing ‘Oyfn Pripetchik,’ ” at first she responds apathetically. But when he starts to sing, just the first few bars, she joins in and belts out the old Yiddish ballad, whose title translates as “On the Hearth.” 

It’s strange, Harry explained later, because Lillian wasn’t very musically oriented when she was younger. For some reason, though, the songs stuck with her. 

“I really don’t know where all this music came from,” he said. It’s through music that he’s able to still communicate with his wife.

Which is why Harry, as he nears reading this article’s end, likely will look up to gauge his wife’s response. And when he says the words, “Oyfn Pripetchik,” her eyes will focus, her head will turn, and he’ll read the first line of the song they know so well, “Oyfn pripetchik brent a fayerl — on the hearth, a fire burns.”

And together, they’ll sing. 

With electromagnetics and metal caps, Israeli companies aim to zap brain diseases


It looks like a futuristic salon hair dryer.

Connected to a computer by a bright orange strip, the half-cube with rounded corners sits comfortably atop the head, a coil of wires resting on the skull.

As a doctor stands at the computer, the patient gets comfortable. A few seconds later, a brief electromagnetic pulse hits the head.

Do this every weekday for six weeks, doctors tell Alzheimer’s patients, and you’ll feel your brain come back to life.

The technique, known as transcranial magnetic stimulation, or TMS, uses electromagnetic waves to penetrate the brain and activate underused neural connections.

Two Israeli companies are hoping it will change the way brain diseases are treated.

“This is the first time in neuroscience that we have a noninvasive tool to directly penetrate and influence deep structures of the brain in a targeted way,” said Ronen Segal, the chief technology officer of Brainsway, based in Jerusaslem. “No shocks, no hospitalization. You come into the clinic, you sit in the chair for 20 minutes, you get a series of electromagnetic zaps.”

Unlike electroshock therapy, now known as electroconvulsive therapy, or ECT — a risky and controversial procedure long used to counteract severe depression and other disorders — TMS targets specific regions of the brain rather than the whole organ and at a much lower intensity. Unlike ECT, Brainsway’s clinical trials show TMS carries almost no risk of seizure.

Brainsway is working on using TMS to combat a range of diseases. The company received approval this year from the U.S. Food and Drug Administration to treat depression with TMS, and has European Union permission to use the technique to treat 10 diseases or disorders, including Alzheimer’s, Parkinson’s and autism, even tobacco addiction. Other drug addictions and obesity are next on the company’s list.

Another Israeli company, Neuronix, focuses on Alzheimer’s, which affects 5 million Americans — a number sure to rise as the baby boomer generation ages.

“Every emotion, thought or action starts with electric activity in the brain,” Segal said. “The problem is if you have too much or too little activity, you get a brain disorder.”

In a person suffering from depression, for example, the section of the brain that regulates mood isn’t as active as it should be. Electromagnetic pulses targeting that section stimulate brain cells to fire, restoring them to a normal level of activity, Segal says, and teaching them to be more active in the long term.

For Alzheimer’s patients, treatment entails an additional step. Patients who receive Neuronix’s electromagnetic pulse have less than a minute of increased brain activity. During that window, a computer screen flashes a simple task meant to exercise the affected region of the brain — asking patients, in one example, whether two sentences mean the same thing.

Affirming that “The salad has tomatoes” equals “There are tomatoes in the salad” helps sustain the short-term benefit of TMS therapy.

“To understand [the sentences], to process them, to understand whether they have the same meaning, is a challenge,” said Orly Bar, Neuronix’s vice president for marketing. “We want to get to a point where the mechanism improves.”

While both companies emphasize that treatment should complement existing medication, not replace it, clinical trials show that TMS can be more effective in counteracting Alzheimer’s than current medications. And unlike pills that enter the bloodstream, the electromagnetic zaps have no side effects.

“We know there’s medicine that works on the same mechanism,” Bar said. “There’s no contradiction. They can work together great.”

Neuronix and Brainsway were both featured at Braintech Israel 2013, a conference in October highlighting Israel’s growing brain technology industry. Along with medical advancements, the conference showcased innovation in fields such as brain modeling and mind-control gaming.

“It’s widely accepted that we’ve made a lot of progress in heart disease and cancer,” said Miri Polachek, executive director of Israel Brain Technologies, the nonprofit that organized the conference. “The one area where we need to make a big push is the field of brain research.

“It’s no longer science fiction. You can see these things becoming real.”

USC seeks twins with Alzheimer’s for study


Researchers at the University of Southern California are seeking twins with Alzheimer’s for a study that seeks to help researchers understand risk factors for the disease. Participants will be interviewed about their life histories and their experience with Alzheimer’s. The interviews can take place by phone, in the homes of the participants or at the university campus.

The families of twins with Alzheimer’s can also contact the university about the study.

Alzheimer’s disease, a type of dementia, affects memory and behavior as neurons in the brain begin to malfunction. One in eight older Americans is affected by the disease, according to the Alzheimer’s Association.

Age is the strongest known risk factor influencing the development of Alzheimer’s. People with close relatives diagnosed with the disease are also at a greater risk. Although there is currently no cure for Alzheimer’s, there is evidence that many lifestyle choices, including mental, social and physical stimulation, can help decrease the risk of developing the disease or postpone its symptoms.

For more information about the USC study, call (213) 740-7555 or e-mail jsteuer@usc.edu.

Getting to know my dad, again


My 93-year-old father emerged as a different person when my mother was diagnosed with Alzheimer’s five years ago. He became independent, assertive, interested and engaging. When my mother died in October, he even became a bit spiritual. He’s certainly not the exhausted father with whom I grew up, who often didn’t know what to say to me. As a teenager and young adult, I never thought we would have much of a relationship. But now, as I approach 60 and he nears 94, the engagement between us has blossomed, as it has with my brother and all our children. The relationship he now has with my wife has become his most significant. She handles his money.

At 93, my father takes almost no medication. He doesn’t use a cane or a walker. And his mind rarely skips a beat. Until he was 88, my mother made just about every decision for them. All the family’s relationships with him were tracked through her. I realize now we had almost no idea who he really was.

Last year, when the Steven Spielberg/Tom Hanks miniseries about the World War II battles in the Pacific was being shown on TV, my father came forward with stories we had never heard. During the segment on Guadalcanal, he excitedly said to us, “That’s my regiment. Boy, they got that perfect. That’s exactly what it was like.” Then he recalled his fears hearing the Japanese soldiers talking above his head while he was hiding in a fox hole, seeing his friends’ body parts being blown off and suffering more than 10 bouts of malaria. When the segment aired about the regiment being taken on furlough to Australia, he told us about the women greeting the soldiers at the boat and their nights out on the town after unrelenting months in the jungle.

When I watched the young soldiers each week, I tried to see my father as one of them, and through it I saw a whole different person. It is painful to accept that his entire generation is almost gone, including my father’s four siblings, all his friends and his unit. He used to see his Army buddies at reunions, but that ended about seven years ago. He tells me often, “Everybody is dead.”

One of the most difficult realizations is that there is no one alive who was a witness to his life before my generation. He no longer has anyone to gibe with, sharing the particular Yiddish expressions that he, his brothers, sisters and cousins grew up with, contorting into their own vernacular, and mimicking specific uncles’ intonations that came from the Lithuanian shtetl. “Ahh, ich hawb a hejhek — I could give a sh__” and “Zhesh tu? —Take a look at that … you get it?”

True to his generation of Chicago soldiers, one of his favorite foods is still fried shrimp. I sometimes take him to Malibu Seafood, where I order salmon and he loads up on all the treif I stopped eating years ago. Once he said to me, “I’m going to take the leftovers back to the place, so they can heat them up in the microwave.” The place is the Jewish Home in Reseda. 

I said to him, “Dad, they’re not going to heat up shrimp in a microwave at the Jewish Home.” 

“Sure they will, if I ask them to.”

“No, Dad, they won’t.” And I threw the bag away.

Food has become one of his obsessions. He misses my mother’s cooking terribly. Recently, my son opened a restaurant on La Cienega Boulevard. The style is shared, small plates, where many dishes make up a night’s experience. After my father’s first visit, he called the next day: “Listen, don’t they serve a full meal at Micah’s restaurant? How’s he going to make any money?” And then he added, “I sure wish your mother had been alive to see this.” On his next visit, Micah had put on his contemporary Middle Eastern menu an appetizer of “challah and Gramma’s chopped liver.” My father lit up with a huge smile … and ate it all.

He now often asks me about my work. I travel for business. Each time I tell him that I am leaving, he begins to rant and rave: “Again, you’re going? Jesus … how many times can you get on a plane? You need to stay home once in a while.” I realize he misses me. It’s a strange feeling. When I was growing up, I think I could have disappeared for months and he would have never noticed.

Recently I began a blog, called 60DaysTil60, about the 60 days leading up to my 60th birthday. One of the posts was about my mother. Somehow, someone with a computer at the Jewish Home must have been forwarded what I wrote, and they mentioned it to my father. He called and asked where it was published. I attempted to explain a blog to him. That opened up a whole conversation about technology, the Internet, Twitter and Facebook. In the end he said to me, “But if it’s not in a newspaper or a magazine, how can someone read it?” Try explaining that to a person turning 94.

The next time I saw him, he said something that really shook me. I told him I had a dream about my mother and that she was shuffling business cards when she said to me, “Gary, I just can’t seem to reach anybody.”

My father, always very rational, responded, “She’s not really gone.”

I took a deep breath. “Tell me.” 

“The other night, I was lying here on the bed. I heard her call out to me, ‘Herbie?’ It was just the way she always did. She was in this room.”

I believe him.

My father doesn’t ever like to be the center of attention. When I told him I was asked to write this article, he responded, “About me? What’s there to say about me?” Everyone at the Jewish Home reads The Jewish Journal. As he said to me, “No one in this place ever stops talking. There are no secrets.”

I hope he comes out of his room.

Happy Father’s Day, Dad. I know you’re reading this.

Gary Wexler is turning 60 and blogs about his impending irrelevancy at 60DaysTil60.com. He can be reached at Gary@GaryWexler.com.

Pingpong therapy brings net gains to Alzheimer’s patients


Usually, Fryda Dvorak needs a cane to move around. But put her behind a pingpong table and you wouldn’t know it.

Dvorak, 86 and living with early-stage Alzheimer’s disease, returns volley after volley with her confident lob, sometimes gritting her teeth in concentration as she reaches to hit the ball. She’s so focused on the game that she refuses to put the paddle down for a breather when her instructor, Irina, suggests they take a break.

Celia Hernandez, a friend who accompanies Dvorak to her twice-weekly pingpong sessions, knows something special is happening when her companion trains her eye on the small orange ball.

“She doesn’t remember what she had for breakfast or lunch, but she knows she hit the ball 64 times during her lesson, and that Irina lost three times,” Hernandez said.

Sound hard to believe? It’s one of many miracles that can be observed daily at the Gilbert Table Tennis Center, where the nonprofit Sport and Art Educational Foundation (SAEF) runs a pingpong therapy program for patients with Alzheimer’s. Long deemed a beneficial “brain sport” by medical professionals, pingpong could be a powerful tool to keep elderly brains spry and stave off the onset of dementia, SAEF organizers believe.

Under the program’s guidelines, elderly locals come once or twice a week to the Gilbert Center, a state-of-the-art training facility located in the Westside Jewish Community Center in Los Angeles. There, they take half-hour or hour-long “lessons” with one of the center’s coaches.

There’s none of the frenetic motion-blur of professional game play — although all of the coaches are staggeringly accomplished national and international champions who compete as well as coach. Instead, the instructors gently rally the ball back and forth with participants, giving them tips on how to hold the paddle, how to swing and how to approach the sport as a form of exercise more for the mind than the feet.

The result is a low-impact activity that stimulates concentration, improves hand-eye coordination and motor function, and leaves patients smiling as they find themselves learning an unexpected new skill.

SAEF currently serves about 30 clients at the Westside JCC, and also runs satellite tables at care facilities such as Silverado Senior Living and the Jewish Family Service’s Freda Mohr Multipurpose Center. The organization sends instructors to its outpost locations so people who aren’t as mobile can access them.

“We’re trying to reach as many people as we can,” said Yana Mouradian, SAEF’s vice president. “So far, everyone’s loving it and really benefiting from it.”

SAEF founded the Alzheimer’s program last May based on a 1997 clinical study conducted in Japan showing that brain-disease patients who played pingpong regularly experienced a boost in brain function and awareness, and decreased dementia and depression. That’s because the sport activates multiple regions of the brain and increases cerebral blood flow, improving players’ agility, alertness and overall mood.

In the study, through tests that measured their reasoning skills, communication and memory, a sample of 3,000 elderly table-tennis players were shown to have increased frontal lobe function after two minutes of play. An additional sample of 113 patients with brain diseases and dementia who were put on a pingpong-based rehabilitation program showed physical, mental and emotional improvement after a 10-month period. The number of patients dependent on a wheelchair dropped from 42 to 15, and those able to walk without any assistance rose from 41 to 66. The number of patients suffering from acute depression was halved. More than 70 patients had their dementia rating downgraded after the study period,  25 of them testing “normal” when their pingpong regimen was completed.

SAEF now wants to drum up funding for a similar study in the United States. They hope their program can be a model for pingpong therapy centers across the country. But can the SAEF program harness pingpong’s fountain-of-youth properties as effectively as the Japanese study? Step into the Gilbert Center’s ground-floor game room to find out.

On a recent afternoon, the center’s seven world-class, blue-top tables were in use as clients and coaches rallied the lightweight white and orange balls over the 6-inch-high net.

Betty Stein, 91, has been coming to the Gilbert Center for about seven months. Since starting lessons, she’s been eating more and remembering more of her activities, has better balance when she walks, and is more talkative, said her caregiver, Flor Narvaez.

“She’s more alive — she’s enjoying life more,” Narvaez said, as the neatly coiffed Stein rallied the ball with coach Bella Livshin at a table nearby. “When you live with her every day, you can see the difference — something’s going on.”

It’s much the same story with Dvorak, whose grin rarely faded during her pingpong session with coach Irina Jestkova.

Along with Alzheimer’s, Dvorak suffers from arthritis and muscular problems in her right arm and shoulder. She’s been playing for almost four months. “When she knows she’s going to play pingpong, she immediately cheers up,” said Hernandez, her companion. “She feels important here — like she can really do something — and that makes her happy.”

That translates physically for Dvorak. Although she usually depends on a cane to stand upright, here she stands unassisted in her black velour track suit, only occasionally leaning on the table as she plays. Signs of her arthritis are nonexistent as she easily swings the paddle to hit the ball.

SAEF created its table tennis therapy program for people like Dvorak, said SAEF president and founder Mikhail Zaretsky, who is himself a familiar presence on the pingpong circuit.

Born in Belarus (then the Soviet Union), where the sport is a national pastime, Zaretsky began playing at age 8 and won the prestigious Belarusian Junior Championship by 17. Now a full-time coach at the Gilbert Center, he has long seen the effects of table tennis on adults whose necks and backs were stiff from workdays spent in front of the computer.

“When they started playing pingpong, they felt better,” Zaretsky said. “People started sleeping better and had better concentration — they had more vitality.”

What happens in a person’s brain while playing ping pong? The player must anticipate where the ball will land, keep calm to position his or her hand, and use visual cues to hit the ball. It doesn’t require herculean strength, continual muscle toning or even the ability to stand up (some players enjoy the sport from their wheelchairs). All one needs is an interest in learning.

The SAEF program is currently free, and organizers would like to keep it that way—they just need to find enough funding.

When she sits down at the end of her session, Dvorak is still glowing from the game. “When I play, my body is better. I can move,” she said, pumping her fists in the air like a marathon runner. “It makes me feel good. I feel like I’m still somebody, even at my age.”

For more information, call (323) 933-3703 or

Searching for the soul


On a recent Friday night, during one of her rare articulate moments, I asked my 88-year-old mother with Alzheimer’s if she could feel her soul.

“Yes, I certainly can,” she answered slowly, searching for her words, as she struggled to express the reflection of the feelings inside.

“How?” I probed.

“I believe in it. I always have,” she said.

I had come to Grancell Village at the Jewish Home for the Aging to pick up my 90-year-old father and bring him home for Shabbat dinner. My mother was so unusually alert that evening, so I brought her too.

At our house, with our adult children present, her ability to talk continued. I was so surprised that I brought out the volumes of hand-written recipe books that she began in 1947 and asked her if she knew what they were.

She picked them up and felt them. “Of course, I know what these are.”

“What are they?” I asked.

“These are a part of me,” she said slowly. “They are connected to who I am.”

I noticed that she had answered far deeper than saying, “These are my recipe books.”

I didn’t need any more evidence that she indeed felt her soul.

The next day, my father told me, she had reverted back and couldn’t string three words together.

At the age of 56, I have learned that we assume upon ourselves many labels and classifications during our lifetime. As much as we try to hold on, nothing stays static. In the last year, one of my most active identities has become being the son of an Alzheimer’s victim. As each week passes, the week before looks like a time when my mother was capable of miracles. A little more than two years ago she was still driving and cooking Rosh Hashannah dinners for 20 people. Now I don’t even have to worry about her reading this article. Always a voracious reader, she stopped reading a year ago.

My father, who doesn’t appear a day above 60, has stepped up in a big way, always at her side, completing her sentences and her movements, so that they can remain together in their apartment at the Jewish Home.

In my new capacity as the son of an Alzheimer’s victim, I have many questions. Some of them are Jewish questions. One kept me up for hours the other night, leading me to my bookshelf at 3 a.m., combing through volumes to see what insights I might glean. What happens to the soul during Alzheimer’s?

Right now, while my mother is still in physical form, where is her soul? The soul that was so deeply emotional, at times irrational, always larger than life, filled with equal amounts of love and anger, happiness and discontent that could burst forward with dancing, singing, crying, yelling and admonition—the soul that always reached out to those in despair, touching people with deep reservoirs of friendship and concern?

Does that soul still exist? Is it sick, too? Does it also have Alzheimer’s, while she is still alive? Maybe it is completely present, having pulled inside itself until it is released from this ailing body? There are comments my mother still makes as she did at my house that evening, when I can still see sparks of her soul.

When I put this question out to my friend, Larry Neinstein, a cantor and doctor who is head of student health at USC, he had much to say. Larry has multiple myeloma. In the last two years, he has survived through a successful blood transplant and refers to his ongoing chemo treatments as appetizer chemos, main course chemos, dessert chemos and triple high-dose atomic blasts. Larry thrives in remission, holding his breath of life from blood test to blood test. He is an inspiration to our entire circle of friends, who all stand in awe of his active life filled with family, work, hikes, music, trips abroad and his continuing to attend international conferences as a world-renowned keynote speaker on adolescent medicine.

Larry wrote me a few days later:

“The soul, I think, is only a flickering light when we are born,” he wrote. “It gains and grows in strength, meaning and depth throughout our life, through our families, our friends, our colleagues, through the profound moments, through music and through dance. At the same time, our soul is partially emptying itself to others, to our children as they are born, to friends and to the colleagues that we touch. It was like an ‘Ah ha!’ moment, when I was staring at my 1-month-old granddaughter’s eyes, and she was staring back with a combination of emptiness and fullness, of love and yearning, for her soul to have a chance of so much to come.

“I realized at that moment that my soul is in so many places and people, to one small degree or another,” he continued. “And the better life I have led, the deeper that soul that is in me, but the less that is left as I age. If I have led a full life, there will be none left on one side, and an immense amount left elsewhere.” 

Another friend of mine, a writer and editor, when I told him about these same questions, asked me in return, “Is this really about the questions?  Isn’t all this actually about the relationship with your mother?”

I gave his very penetrating question days of thought. While I might be psychologically in constant relationship with her understanding, and acting out the effect a parent has upon a child, I am no longer in an active give-and-take relationship with my mother.

As I told my brother, wife and kids recently, “The mother I knew is gone. This is not the same woman. This is a remnant of my mother. Shades of my mother have been removed, lifted to some other place. Without her full soul, I may recognize her physical appearance and even some of the things she says; her expressions and her scant memories. But while I give her all the respect and care she deserves—the attention and even interaction—there is no longer the exchange of dynamism and love between us that there once was.

She told me just three years ago, while we were driving on the 405, “You see this freeway?  If I ever get Alzheimer’s or any kind of dementia, you roll me out of this door right here and tell them I jumped out myself. I don’t ever want to be living like that in one of those places. Do you hear me?”

That was the mother with whom I was having a relationship. I often wonder what my responsibility is toward the mother I knew and her ebullient soul, as opposed to one at the Jewish Home?

Gary Wexler, a former advertising agency creative director, owns Passion Marketing, a consulting firm to nonprofit organizations worldwide, including major Jewish organizations in the United States, Canada and Israel.

The emotional landmines of family caregiving


Most families squabble. After a short cooling-off period, relatives tend to resolve spats and go on with their individual lives. But there are situations that make it difficult to restore harmony. For example, when an elderly loved one breaks a hip, suffers from dementia, a stroke or other disabling illness, spouses and adult children can become unglued. The frailty and dependence of a loved one often ignites emotional landmines, stirs up old family issues and uncovers personality traits best left buried.

Sibling Rivalry

A common situation goes like this: Sis worries that increasing forgetfulness threatens her mother’s safety. Her brother, on the other hand, argues that a few Post-It note reminders placed around mom’s home will remedy any “senior moments” she may have.

Sis replies, “You haven’t seen the burnt pots and pans left unattended on the stove.”

He comes back with “You are overreacting.”

Both want the best for their mother, but their competitiveness gets in the way of their ability to execute a plan. Each one is trying to prove that they are the smartest, most reasonable and the supreme problem-solver. Sibling rivalry never dies.

The siblings’ time would be better spent asking their mother what she prefers. Does mom want to remain in her home in the face of growing difficulties? Most seniors do. An assessment by a professional geriatric care manager (who is not a relative) would lay the groundwork for a plan to keep mom safe in her own home or, if that’s not wise, help the family find a more suitable living arrangement. For an explanation of what a geriatric care manager does and the location of one near you, visit www.caremanager.org.

The Golden-Haired Child

A painful situation for the primary caregiver occurs when another close relative does little or nothing to help, but they are adored and praised by the senior anyway. This frequently triggers resentment in the mentally and physically exhausted primary caregiver.

Keeping uninvolved relatives in the loop about medical conditions, treatments and finances increases the likelihood of their involvement. At the very least, it prevents later complaints that “nobody told me” or “I’d have never agreed to that had I’d known.”

It’s infuriating when others don’t do their share, but ultimately you can’t force people to do anything they don’t want to do. In the long run, you are better off not spending time stewing, a practice that results in more anger, bitterness and family feuds.

Before throwing in the towel, get together a family conference where the topic for discussion is “sharing the caring.” Generally, people are more willing to participate when they can contribute in a way that’s comfortable for them. Not everyone is willing or able to do hands-on care. Some relatives might have the know-how to help with figuring out and managing health benefits or home repairs or be willing to accompany the elder to doctor appointments.

The Scrooge

The Scrooge is the family member who skimps on or neglects care. I recall a daughter who petitioned the court and was granted the conservatorship of her severely demented mother. The siblings welcomed the newfound kindness of their previously self-centered sister. Then the daughter moved their mother to an unlicensed, below-standard “cheap” facility far away from other family members. Soon, she began to mishandle her mother’s finances.

Most Scrooges simply want to preserve their inheritance or “get it early.”

If the older woman (when she was still well) had executed a living will or designated an ethical person to be her durable power of attorney for health care and for financial decisions, the Scrooge may never have been able to take over her mother’s care for her own gain.

These documents can be downloaded and are explained online at www.caringinfo.org.

The Long-Distance Denier

Some relatives are well-meaning, but distance is an obstacle. In this group there are also a large number of deniers who insist that nothing is wrong with mom or pop. Almost as bad are the bossy long-distance relatives who issue inappropriate and unsolicited “advice.”

Two solutions come to mind. First, discover what the distant person is willing to do from their own home. For example, research medications, health conditions, locate resources online, or provide emotional support via telephone or even financial support. Second, invite a denier to eldersit so the caregiver can take a break. A few days of duty may open their eyes to the “true picture.”

The Sandwiched Caregiver

Some caregivers are squeezed between caring for an elderly parent and parenting a teenager. Every hour spent on eldercare represents an hour unavailable for children. The bane of the sandwiched caregiver is guilt. No matter how much they have done, they always feel they could have done more. Even worse is the guilt experienced when their frustration and exhaustion result in angry words directed at their spouse, teenager or even the older family member.

One solution is to include the entire family in eldercare. For instance, children usually love assisting with grandpa’s exercise. They can count the repetitions and cheer grandpa on. Teenage girls may get a kick out of doing grandma’s nails. Such activities lighten the caregiving load and help young people develop compassion.

Joining a support group is an ideal way to cope. To find a support group near you, start with the Alzheimer’s Association at (800) 272-3900 or www.alz.org.

The Overburdened

The overburdened are easily identified because the people they are caring for look better than they do. Overburdened caregivers are more inclined to have depressive illness, flare-ups of their own medical conditions and a higher mortality rate than those who are not caregivers.

The good news is that caregivers who choose their battles wisely, recognize that eldercare does not have to be perfect, and tend to their own health needs are able to provide better and longer care of their loved ones. While eldercare is often a thankless job, many caregivers report tremendous satisfaction when they reflect on the care they provided during the last years or months of their loved one’s life.

The Super Caregiver

The classic “Super Caregiver” is an adult child or spouse who refuses offers of help, saying, “No one can do it better than I can.”

Films: Dementia ordeal inspires comic tale of ‘The Savages’


Tamara Jenkins knows firsthand what an overwhelming task it is to care for a parent suffering from dementia. While she was in her mid-30s, she had to help care for both her father and grandmother during their final days in a nursing home.

She also knows that no matter how grave a situation might be, there are always sparks of humor surrounding it. So it’s no surprise that her new film, “The Savages,” addresses that very subject and does so with a healthy dose of comic perspective.

“I think it’s a natural sensibility of mine,” the writer-director said. “And I do think that on the underside of tragedy there is this human farce there at the same time. People are pushed to such extremes, and since they’re sort of doggy paddling through the situation, they often don’t know how to behave. I think that sometimes the behavior is unknowingly kinetic because they’re so frayed.”

“The Savages” tells the story of middle-aged siblings, Wendy and Jon Savage, who are suddenly forced to care for their estranged father, Lenny, who is left homeless after his girlfriend of 20 years dies. To compound matters, Lenny is sinking further into dementia and can no longer care for himself, leaving them in charge of finding a suitable rest home where he can be properly looked after. Once they do, Wendy handles the chore of taking her father cross-country from New York to Arizona.

Although the situation mirrors much of her own experiences, Jenkins points out this is not an autobiographical story.

“My experience was not exactly like what Jon and Wendy go through,” Jenkins said. “I had three other siblings — I’m not from Buffalo, and I never went to Sun City [the Arizona rest home]. I did fly my father across country, not unlike the movie, and that became a central theme because I didn’t realize the gravity of the task when I said, ‘OK, we’ll take dad across the country.’ And it wasn’t until I did it that it became clear to me that I really wasn’t equipped to handle the intensity of the task, that I was taking care of this person that needed help on such a level that I didn’t understand. So thematically that became a big part of the movie.”

The catalyst for Jenkins writing her script for “The Savages” was what she saw happening around her several years after her own ordeal.

“What helped bring it to the surface was suddenly my friends started going through this thing that for me happened in isolation, and it then became very relevant,” Jenkins revealed.

Theater: ‘Leipzig’ weaves heartfelt Alzheimer’s tale


Wendy Graf was at the women’s group at her synagogue when she discovered that a number of her colleagues were the children of Holocaust survivors. She became fascinated with the repercussions of the tragedy on their lives, but put aside the subject as she wrote “Lessons,” a play about a widower who decides to have a bar mitzvah. More recently, a person close to her developed Alzheimer’s disease. The synchronicity of memory loss with so-called “second-generation” syndrome provided the raw material for Graf’s new play, “Leipzig,” the latest offering of the West Coast Jewish Theater, now playing at the Marilyn Monroe Theatre at the Lee Strasberg Theatre and Film Institute.

The veteran actress Salome Jens so deeply embodies Eva, the Alzheimer-ridden Holocaust survivor, that one could swear she herself had the disease. Her performance is one of great subtlety — the slightest head movement, the slightest flick of her hand, and, above all, the blankness of her stare conveying the hopelessness of the illness.

She wears an ethereal nightgown, appropriate for a woman who seems to shimmer, flicker and fade in the air, like the distant circus sounds that come to her as she recalls her childhood in Germany.
Unfortunately, as compelling as this performance is, as well as that of Eva’s husband, George, played by Mitchell Ryan, the part of the daughter, Helen, played by Mimi Kennedy, does not always work. There is no question that Graf’s storyline ably demonstrates the generational clash between the parents and the baby boomer daughter, but Helen’s frequent on-the-nose psychobabble and her quips with Jesus present a tonal and thematic disconnect.

Eva and George belong in a Tennessee Williams or Arthur Miller play, while Helen does not. Eva reminds one of a nuanced Blanche Dubois, delusional though without the flamboyance, and George could be the missing father in Miller’s “The Price.” Indeed, the set’s toppled lamps, empty shelves and hanging bicycle, which create what Graf calls “an attic of your mind,” seem right out of “The Price,” just as the Kristallnacht theme echoes Miller’s “Broken Glass.”

Perhaps the disconnect arises because Graf is influenced by Tony Kushner. One can see this echo in her ruminations on mortality spiced with angelology. It’s just that the make-believe Jesus in “Leipzig,” wearing long locks and dressed in white robe like a yogi or martial arts guru, offers a comic relief that serves less to entertain and more to detract from the seriousness of the play.

Which is not to suggest that Graf does not know her material. She studied the Holocaust carefully, and her naming of Helen after the character’s deceased grandmother is a nice touch that rings true. There is no denying the poignancy of the subject, and this play represents a heartfelt attempt at capturing it.

“Leipzig” runs through Dec. 10 at the Marilyn Monroe Theatre, Lee Strasberg Theatre and Film Institute, 7936 Santa Monica Blvd., West Hollywood.

For more information, call (323) 650-7777.

Who Will Care for the Caregivers?


About five years ago, Nina Dayan noticed that her husband’s moods began alternating between anger and depression. Then her husband started doing strange things: He would hide her keys, steal money from her purse and share his social security number with strangers on the phone.

Eventually, his Alzheimer’s disease was confirmed. The diagnosis explained her husband’s strange behavior, but it didn’t make things any easier for Dayan. She remained on constant guard to ensure he didn’t answer the phone, open the mail or touch the checkbook.

“I had to sleep with one eye open,” said Dayan, 77. “It was making me a nervous wreck.”

Although she was suffering from her own ailments, including back and knee problems, Dayan’s caregiving prevented her from seeking medical attention for her own ailments. Dayan’s actions illustrate the approach taken by most caregivers: Ironically, those who devote themselves to caring for others tend to neglect their own well-being.

“Caregivers take themselves out of the circle of care in order to focus on their loved one,” said Gary Barg, founder and editor-in-chief of Today’s Caregiver magazine. “We want to make sure our loved ones are getting the rest they need, but we never sleep. We want to make sure our loved ones get the care they need, but when’s the last time a caregiver ever went to a doctor?”

This topic and others will be explored at The Los Angeles Fearless Family Caregiver Conference in Carson on June 28, sponsored by Today’s Caregiver magazine along with the City of L.A. Department of Aging and the L.A. County Area Agency on Aging. Keynote speaker Barg said the conference will not only provide practical information for attendees, but help them overcome the sense of isolation so typical of caregivers.

Given the sheer number of caregivers in the United States, the issue of caregiver well-being presents a serious challenge. According to AARP, more than 44 million Americans provide unpaid care to friends and family. That number will continue to rise as the population ages. Currently, family caregivers provide about 80 percent of the assistance required by those who need help with daily activities such as bathing and dressing, taking medications and paying bills.

Caregivers span all ages, although statistically the average caregiver is a 46-year-old woman who is married and employed outside the home. Caregivers may tend to someone older, like a parent; close in age, such as a spouse; or younger, like a child. Sometimes, as in the case of the sandwich generation, they provide care to multiple generations simultaneously.

Whatever their particular situation, caregivers face a host of common challenges, including financial and legal issues, need for respite and lack of information about existing community resources such as counseling services, adult day care centers and home-health care agencies. In addition, they experience depression at twice the rate of the general population. (The rate jumps to six times for caregivers of individuals with Alzheimer’s and other brain-related impairments.)

Barg said the gathering shows caregivers that “there are other people in the community going through what you’re going through. It’s important to be around others.”

Barg also urges caregivers to see their role as a job, even if it is a labor of love. This entails learning as much as possible, attending conferences and support groups and communicating with members of the patient’s health care team.

“The more you treat yourself as a professional and the more you care for yourself, the better job you can do for your loved one,” he said.

As for Nina Dayan, she found help at the Eichenbaum Health Center at the Freda Mohr Senior Service Center on Fairfax Boulevard. In addition to exercising there three times a week, Dayan attends lectures and programs and participates in a support group for people whose spouses have Alzheimer’s.

Eight months ago, Dayan placed her 85-year-old husband in an assisted living facility in Santa Monica.

“I took care of him until I couldn’t anymore, and had to take care of myself,” she said. She has since undergone cataract surgery on both eyes, and will have knee replacement surgery this month.

Dayan said her husband has adjusted to his new living arrangement and has made many friends. Now, he spends his day socializing instead of bickering with her. She still worries about his health and her own, as well as how long her finances will hold out. But her relief at finding an interim solution is apparent. As Dayan puts it, “I’m breathing again.”

The L.A. Fearless Family Caregiver Conference will take place on Tuesday, June 28, 9:30 a.m. to 3:30 p.m. at The Carson Center. 801 East Carson St., Carson. For more information or to register, call (800) 829-2734 or visit www.caregiver.com.

Caregiver Resources:

California Caregiver Resource Centers: www.cacrc.org/californiacrc

AARP: www.aarp.org

Family Caregiver Alliance: www.caregiver.org

Jewish Family Service: www.jfsla.org

 

Total Recall


Twice in the past couple of days, I’ve been in conversation and found myself grasping for a word. On both occasions, my 4-year-old supplied the word before I could come up with it. And, of course, there are the times that I walk into a room only to realize that I have no idea what I wanted to do once I got there. Are these natural lapses or early signs of something more sinister?

"We are all one day closer to Alzheimer’s disease," Dr. Gary Small says forebodingly in his book "The Memory Bible: An Innovative Strategy for Keeping Your Brain Young" (Hyperion, 2003). "Alzheimer’s and dementia begin forming in our brains much earlier than anyone previously imagined, even in our 20s."

Fortunately, we can thwart — or at least postpone — this progression.

"It is never too late or too early to protect our brain cells and delay memory decline," writes Small, who is the director of the UCLA Center on Aging. "By using games, puzzles and some new approaches to daily activities, we can improve our short- and long-term memory abilities and possibly prevent future memory loss and Alzheimer’s disease."

The good news about Small’s "anti-brain aging" program is that all of the recommendations are pretty basic. They do not require exotic terminology or elaborate equipment. The bad news is that change isn’t instantaneous. Beyond the memory tricks and techniques, the plan calls for making fundamental changes to diet, amount of physical activity and stress levels — easier said than done.

Launching into the book, I started with the memory self-assessment, which identified my degree of "memory challenge" as "moderate." (It took me four tries to correctly tally my score, so I guess my mathematical abilities would rate as "pathetic.") In another test, I was able to recall six out of 10 unrelated words 20 minutes after reviewing the list.

Small’s principal memory technique is called Look-Snap-Connect. "Look" means to truly pay attention. For example, most of us are so busy thinking of other things when we’re introduced to a new person, that we understandably can’t recall their name just minutes later. This step involves actively focusing on what you want to remember, taking time to absorb details and meaning. "Snap" refers to creating a mental picture of the information, such as visualizing a frankfurter to remember the name Frank. "Connect" involves combining mental pictures in a meaningful way, creating a story of sorts that will help you retain and access what you want to remember.

Another strategy is called chunking — dividing a large group of items into smaller groups or groupings with common characteristics. The "Roman Room" technique involves visualizing a familiar room and mentally placing items to be remembered — for example items on a grocery list or the topics of a lecture — in specific locations within the room. Small also presents the Peg Method as a way of "forever removing uncertainty about remembering numbers." I thought I’d try it to learn my husband’s Social Security number, but the method requires creating and memorizing visual images for each of the 10 digits, then linking the images in a story. That seemed like much more effort than simply memorizing the number the old-fashioned way.

When it comes to brain power, Small believes in the "use it or lose it" philosophy. He recommends "a daily regimen of mental aerobics," which can involve such activities as crossword puzzles, brain teasers and other endeavors that keep us mentally stimulated. He cites research that found that the risk of developing Alzheimer’s disease was three times lower in people who had been intellectually active during their 40s and 50s compared to those who hadn’t.

Beyond the techniques and the brain teasers, Small’s recommendations are the same ones we’ve all heard repeatedly for maintaining wellness and staving off disease: following a low-fat diet, reducing stress, staying physically active, getting sufficient sleep, balancing work and leisure, avoiding tobacco and other drugs, and engaging in meaningful activities and relationships. He does offer some specific dietary recommendations, including taking 400-800 units of vitamin E and 500-1,000 milligrams of vitamin C daily, as well as eating foods — such as avocado, salmon and walnuts — that are rich in omega-3 essential fatty acids.

Will it make a difference? I tried to memorize another list of 10 words — and, this time, I could remember nine of them. But having just finished the book, it’s too early for me to tell how much of a change it will make in the long run. And much of that depends on how thoroughly I follow through on the book’s recommendations. So I made a list of the steps I plan to take as part of my new memory regimen. But just in case the list gets lost, I’m also telling my 4-year-old.

The UCLA Center on Aging holds classes in improving memory. For more information, call 310 794-0676.

A Knight’s Tale


Philanthropist and art benefactor Sir Arthur Gilbert died at his Beverly Hills home Sunday of a heart attack. He was 88 and had struggled with cancer and diabetes. The Journal had slated the following profile of Gilbert, a leading philanthropist, art collector and businessman, to run in this issue. Anita Chabria met with him last week.

Sir Arthur Gilbert was one of Los Angeles’ few resident knights, having been honored by the Queen of England two years ago, but he was best-known here as a philanthropist and real estate entrepreneur who helped shape his adopted city.

Born Arthur Bernstein in 1913, Gilbert came to the United States from London in 1949. Early in life, he and his first wife, Rosalinde, who passed away in 1995 from Alzheimer’s disease, ran an exclusive evening wear manufacturing company that catered to London’s post-war wealthy. But Gilbert felt that taxes were too high in his homeland, and longed for better weather. He found it in Los Angeles.

Most of Gilbert’s fortune came from real estate. He had dabbled in commercial real estate with his older brother while living in London, but it wasn’t until his immigration to the States that land deals became a focus.

In 1955, he purchased 100 acres in the then-barren City of Commerce. Since then, he had been involved in scores of projects, including the coup of bringing Barney’s New York to Beverly Hills in a long-term lease at his building in a prime strip of Wilshire Boulevard. Other projects include the Union Bank building at the corner of Beverly and Wilshire and Gibraltar Square in Beverly Hills. When buying real estate, Gilbert always felt that location was the most important feature. His motto was “always buy the best you can,” says longtime friend Richard Ziman.

Despite the numerous projects he created, Gilbert once told a newspaper reporter that the only one of his buildings he ever liked was the modern home he built for himself on a bluff in Coldwater Canyon.

Gilbert was also a philanthropist with a list of pet projects that spanned the globe. He was a founder of the Music Center, and a major supporter of Technion-Israel Institute of Technology, from which he received the Albert Einstein Award in 1978.

In 1999 he received an Honorary Doctorate of Philosophy by the Hebrew University of Jerusalem for his long-term support, including a $25 million donation to the Hebrew University’s Rothberg International School. He had attended the university’s opening in 1925, when he was 12 years old.

Gilbert’s father, one of England’s most prominent furriers, was very religious and lived six months of each year in Israel. Although Gilbert remained in boarding school in London during most of those family excursions, the deep commitment he had toward Israel and Jewish causes can be seen in his long legacy of giving.

Aside from philanthropy and real estate, Gilbert was known for two personal passions: playing tennis and collecting art.

Gilbert was more often found in workout clothes than business suits, according to friends, and made it a point to play tennis every day when in good health. He even refused to work on Wednesdays, instead dubbing it his “holy day” and spending it at his tennis club, says wife Marjorie Gilbert.

“Arthur never wore long pants before 6 o’clock,” said Ziman, who added that Gilbert was most often found in trademark yellow shorts.

But it was Gilbert’s second passion — art collecting — that created a legacy worthy of a knighthood.

He began collecting silver and gold pieces solely to furnish his Coldwater Canyon home in 1960. Within 15 years, he had amassed a collection significant enough to warrant an exhibit in the Victoria and Albert Museum in London.

“He bought everything he saw,” says Jeanette Hanisee Gabriel, private curator of Gilbert’s collections.

He originally intended to give his silver and mosaic collections to LACMA, but had increasingly tense relations with the museum over where and how the collections would be displayed. By 1996, Gilbert was on poor terms with the L.A. museum, and instead gave the pieces to the Somerset House in England. The recently redone museum on the Thames River will use the silver collection as its centerpiece, giving his contributions 25,000 square feet of exhibition space. The decorative arts collection on display contains more than 800 pieces of gold and silver. He also amassed one of the most significant collections of Italian mosaics in the world, matched only by the Hermitage Museum in St. Petersburg, Russia.

For donating those collections, valued at more than $125 million, Queen Elizabeth II gave Gilbert a knighthood in 1999.

“He wanted the public to enjoy his art,” says Marjorie Gilbert. “From Day One, Arthur never built the collection for himself.”

Services for Gilbert will be held Fri., September 7 at 12 noon at Hillside Mortuary.

Gilbert is survived by Lady Marjorie Gilbert, her daughter Susan and granddaughter Ashley; by his son Colin, granddaughter Windy (Terry) Gallagher; great-grandsons Patrick, Keelan, Colin and his sister Mathilda Barnett.

Donations may be sent to the American Diabetes Association, 6300 Wilshire Blvd., Los Angeles, 90048.

The Editor’s Corner


My mother is87. Or is it 90? As long as I can remember, I thought that she hadbeen born in 1910, was named Miriam Euffa, and brought here from Kievas a 5-year-old by parents who were educated, and who had been partof what must have been a turn-of-the-century minority: theRussian-Ukrainian Jewish professional class. Now Medicare tells methat her Social Security card lists her year of birth as 1907.

At this point, I ask myself, what difference canit make? My mother has Alzheimer’s. The disease has ushered her intoa realm where days, weeks, years hardly seem to matter. Until just afew days ago, she resided in Cedars-Sinai Medical Center, where shewas recovering from pneumonia (which she apparently contracted aftershe broke her hip and underwent surgery at Midway Hospital inJanuary, followed by three weeks of physical therapy at the BeverlyHills Rehabilitation Center in February).

Thanks to her two-month period of extended stay inthese three separate medical facilities, I have become knowledgeable(and dismayed) about hospital life for the elderly. I have watched mymother move rapidly from living as a woman who was mobile,semi-independent and trapped in the early stages of Alzheimer’s tosomeone who is now a patient, stripped bare, functioning in a stateof helplessness, or what a doctor described as delusionalpsychosis.

Is this a natural decline, one in which the bodymalfunctions and the Alzheimer’s mind quickly follows suit? Or is it,in some large measure, a fallout from our cutting-edge,multimillion-dollar corporate hospital system? I have come to believethat this health-care system, with the best intentions in the world,failed me and the aging parent I turned over to their highlyspecialized care.

I know, this could just be my way of release, anexpression of despair, depression and, yes, an underlying ragebursting through after months of frustration. My mother enteredCedars because she had been overmedicated and had become highlyagitated. Once she was admitted, Cedars’ proficient medical expertisecame into play: Tests were given; X-rays taken; new medicationprescribed. It became evident that several weeks earlier, either atMidway or at the Beverly Hills Rehab Center, water had settled in herlungs. She had contracted pneumonia, but it had not shown up before,or else no one had noticed.

Treatment for pneumonia moved into high gear, but,in the process, her mind became more disoriented. Medication for herdementia became a hit-and-miss affair as doctors struggled valiantlyto find a combination of drugs and a proper dosage that would serveher (and the nurses) well. And I rediscovered what had begun to dawnon me earlier– namely, that the operating procedures at all threemedical facilities ran counter to my mother’s particular needs. Toput it bluntly, while the pneumonia was checked, her mental stateslipped radically. She needed individual care, and that apparentlywas outside the hospitals’, and the rehabilitation center’s, range ofcaregiving — in part for budgetary (read financial) concerns, inpart for organizational reasons. Had I known then the limitations andconsequences of her hospital care, I would have limited her stay ineach medical institution to a bare minimum.

The catalog of breakdowns over the two months hasbeen extensive, but I will cite only a few. At Cedars, for example,someone had been inattentive and let my mother struggle out of bedalone. She has no short-term memory and, so, is unaware that shecannot yet walk. The result: She fell on her head. A quick trip toX-ray revealed that this 90-pound 90-year-old sustained only a bump,soreness and some swelling. No concussion, no broken neck or hip, nosevere damage. And no immediate or direct communication withme.

In part, because of this fear for her safety, thenursing staff began tying her down in a quite effective way: arestraining band across her chest and, at times, her feet strapped tothe ends of the bed frame. I walked in once at Cedars to find herscreaming frantically for help, unclear where she was (she thoughtprison) or why these people had tied her down and locked the door.She was agitated and terrified. And convinced that the nurses wereplotting against her. Why else would they treat her this way?

The nurses were clearsighted about the answers.First, she was “restrained” to protect her from falling and breakingher hip again. Second, the door was closed because she made too muchnoise, calling for assistance or simply asking for attention. Inshort, she was a nuisance, and there was neither time nor staff tofill these needs of hers. She was being protected for her own good,to be sure, but there was a strong likelihood, as her doctorsverified to me, that she also was being driven mad.

“The reality is,” explained one of the nurses, “weare not equipped to give patients one-on-one care. Someone like yourmother needs an available nurse around the clock. We don’t providethat.” Hire private nurses, one of her doctors advised me. Eitherthat or send the family to care for her.

The difficulty appears to be that the system inplace is designed for maintaining order and organizationalefficiency, for diagnosing and treating illness, for deliveringbabies and removing someone’s appendix, for heart surgery andrespiratory ailments, but not necessarily for the individual care ofthose elderly who require personal attention. “Get your mother out ofhere as soon as possible,” a staff member at the rehab centerconfided to me when I complained that my mother’s needs were oftenignored and that her bed often reeked of urine. “This place hasexcellent facilities and people for physical therapy,” I was told,”but is totally unprepared to deal with Alzheimer patients.”

The problem largely has to do with money. Theresimply are not enough funds available to cover one-on-one nursingcare. Or at least it is not given high enough priority. Hospitals arestruggling to raise dollars in order to provide decent medical care.Medicare payments barely scratch the surface of costs andexpenses.

Fault also lies with the nursing system that hasbeen put in place. Nurses rotate on 12-hour shifts and are assignedeight or nine different rooms and patients each shift. What they arenot given is a set of individual men and women whom they follow fromadmission to release. The process works against the possibility thatnurses will become familiar with the rhythm of a patient’s life, orthat they will empathize or bond with anyone in their care. It makesfor impersonality when precisely the opposite is often desperatelyneeded for many seniors.

It also leads to a reporting system that isparticularistic but rarely complete. Nurses can only report todoctors what they have observed during their shift: percentage offood eaten, medication taken, a rasping cough, agitation. But thereis little intimate linking of these facts to the rise and fall of apatient’s mood, spirits or progress. When I made these observationsto a doctor, he exclaimed, wearily, that he had been fighting thatbattle (in vain, he implied) for more than 10 years.

One evening, when I slept in my mother’s room, Iheard a woman crying for help. She was half awake, half asleep nextdoor. I looked to see if a nurse was available. Yes. Someone was atthe nursing station, another nurse in the corridor. I went back tobed. But the cries — a constant moan now from a wan, elderly,delirious woman — continued. It had become half plea, half chant. Islipped into her room, touched her forehead and held her hand. Shequieted. What she seemed to want was assurance that she was notalone, abandoned in some strange, twilight world.

In fairness, I should add that not all the nursesare inured to the plight of patients or exhibitthis form ofdistance. Two, in particular, who pulled a shift with my mother –Marlene Williams and Daisy da Silva — responded to her in verycaring ways. But then I discovered they were LVNs (licensedvocational nurses), subordinate to the RNs. They had not had time, Ithought, to be subsumed by the system.

Then there are the physicians. They are the Lordsof the Manor, but, alas, mostly visiting Lords. The doctors I came toknow at Cedars, those responsible for my mother’s well-being — JayJordan, a cardiologist and her main physician; Ronald J. Davidson, apsychiatrist and her geriatric doctor; and Martin Gordon, a pulmonaryspecialist (along with Isaac Schmidt, her surgeon from MidwayHospital) — were all splendid, top-of-the-line, well-trained, caringand straightforward. No sentimentalizing, no euphemisms. Concernedfor their patient and concerned for me.

The gap between them and the daily life of thehospital — where, for the most part, they diagnose and prescribe forpatients and seem to function somewhat like specialized consultants– is enormous. They speak to the relevant nurses, who implement thecare, but who manage patients according to rotational shifts.

What gets passed along then are literal messages,often by telephone: Do this; stop that; change the medication. Allwritten down and passed along from one nurse to another. The rest,the details, the context, the exceptions, the parenthetical asides,the possibility that something may be amiss outside the illness thatis being treated, these all fall between the cracks. There are fewlengthy exchanges — little in the way of discussion.

It will probably come as no surprise to you thatabove and beyond the hospital bills, which Medicare and my mother’ssecondary insurance mainly covered, I hired two private caregiverswho agreed to look after my mother in the hospital, each taking a12-hour shift six days a week. They were not registered nurses,though they had considerable experience caring for seniors,particularly those with Alzheimer’s. The doctors listened attentively(and with gratitude) to their comments on my mother’s health andstate of being, for these caregivers became the best and mostconsistent guide to her moods, her behavior and her health — eventhough they were outside the hospital’s regimen and were notofficially accountable or responsible for her medicaltreatment.

I realize after the fact that what I had set upwas a process of caring for the sick and dying outside the legalentity we call a hospital. Actually, it is a practice I firstobserved more than 30 years ago, when I was a young journalist inWest Africa. There, I witnessed a handful of overworked well-traineddoctors ministering to more people than seemed humanly manageable.Alongside them, an overwhelmed cadre of nurses, not trained well byour standards, tried their best to render patient care underconditions that would never pass muster in the United States.

But every family shared the burden of caring fortheir sisters, brothers, parents, nieces and nephews by moving intothe hospital room. They remained there until it was possible to bringtheir relative home — or until death silenced everyone. It is ironicto me that in the midst of high-powered multimillion-dollar medicalinstitutions, great and wonderful and humane complexes, complete withsuperbly trained doctors, that is where I now find myself.

Early last week, I spoke to my mother’s doctors.Was there any point in keeping her in the hospital? I asked. Couldshe not just as easily be ill at home? Perhaps with more dignity? Andperhaps with more personal attention, since the two women who tendedher in the hospital will take turns living and caring for her. And ifshe is dying, is it not more humane to let her live her last monthsin her apartment, surrounded by familiar objects and personal voices,than in a hospital room? A place where we can all eat and laughtogether, touching her and letting her eavesdrop on us as we play outthe cycle of our lives?

Their answers were rational, direct, filled withcommon sense. Last Saturday, I removed my mother from the hospital.We carted home an oxygen connector and a backup tank. — GeneLichtenstein, Editor

For a story with a happier ending, see WendyMadnik’s description of The Jewish Home for the Aging.


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