In October, as we recognize Breast Cancer Awareness Month, let us not forget women with dementia. The mammogram, and related cancer treatment, can be controversial for elderly dementia patients. A care team will help with decision making. In my case, with my mother, we chose to follow-up on a very late diagnosis of breast cancer, with no regrets.
When I brought my mother, Audrey, to live near me in Virginia in a loving nursing home where she would get the 24-hour care she needed, she asked me, before she lost language, or at least the sort of language we use when we make sense, “This is still South Carolina?” No, it was not, not really, and yet it was.
Sometimes I felt I was with my mother in Charleston before I was born, in a time when she was carefree. Other times over our last five years, I felt we were right there in the spotlight of a present moment, challenged by too many things you wish nobody would ever have to experience while living with dementia.
Unfortunately, Alzheimer’s disease, bad enough on its own, does not inoculate a person against other maladies. A full-grown woman does not regress to a sort of imaginary childhood and simultaneously abandon the body of a mature woman, even if the image she sees in a mirror is a little girl with a Buster Brown haircut. Women with dementia get breast cancer, too.
In her last year, approaching ninety, my mother was diagnosed with breast cancer for the second time. She was not the intelligent woman who at 71 convinced doctors to allow her to try chemotherapy or who counseled me regarding mammograms. She was not the logical woman who argued (and won) with her insurance company that an X-ray of the lungs was medically necessary. She was, in fact, a woman who had come to wonder where her left breast had gone.
Both old and young, both wise and confused, my mother held onto as much as she could. Some things still just got lost with or without my translation. The mammogram, which was routine in her former life, was one of those things. While mammograms and some cancer treatments for women with dementia are not always advised, what is best for one dementia patient may not be for another. In our case, we felt my mother needed to follow up.
My mother’s care team thought that removing a tumor would enhance quality of life if testing indicated such a need, and quality of life is key in dementia. I agreed, even if getting the lump checked out meant a visit to a clinic 12 miles from my mother’s comfort zone via ambulette, a long distance for somebody who had stopped going on Saturday morning excursions with me when a car became intimidating.
Audrey made it cheerfully to the clinic, though, and I was there to greet her, so it was OK, at least until we moved from the waiting room into the examination room, where we encountered a machine that was as alien to my mother as a spoon would become.
During mammography, a breast is tugged from the body and placed on a plate, after which another plate moves down to clamp the breast while an image is made. A technologist helps to adjust the body and the breast, and during mammography, you are not supposed to move. If the compression hurts, you grit your teeth and wait. You grit your teeth and wait, that is, if you understand what is going on.
I know, without a doubt, that there is a special place in heaven for the two technologists at the clinic who assisted my mother and me with her last mammogram. They were so patient, so kind, so courteous, so perfect for our needs, that after all was said and done I sent them a greeting card to thank them from the bottom of my caregiver’s heart and from Audrey’s.
My mother may have wondered where her other breast went, having forgotten her first episode with cancer. She may have fumbled through that last mammogram, and, a few weeks later, questioned an early morning trek to the hospital for surgery to remove her tumor. But by noon the day, her cancer was treated and she forgot surgery and was scooting around the halls of her nursing home in a wheelchair that gave her the ease of skates as she visited with her friends.
Getting even minimal treatment for breast cancer enhanced my mother’s quality of life in her last year as her aged body wound down. It allowed her to share time with friends, family and the nursing home community. Her love of life, whatever life gave her, was infectious. She passed that on. She passed on, and I took her home to her final resting place in South Carolina.