Conversations with my 86-year-old grandmother dissolve into an eerie déjà vu. Last week, we talked at length about my sister-in-law's pregnancy. I answered the same questions she posed the last time we spoke: how the pregnancy was going, when the baby was due, possible names. How could you not remember this? I thought. She told me that objects are missing from her home. She believes someone is stealing her things.
It wasn't until I read Sybil Lockhart's compelling memoir, Mother in the Middle: A Biologist's Story of Caring for Mother and Child, that I realized why my grandmother seemed so confused. This is dementia, I thought. My grandmother has dementia. On the heels of those thoughts came another, guilt-inducing one: This complicates things.
The neural connections in my grandmother's brain are breaking down, her thought processes degenerating. Some connections have been severed altogether, like those that help her realize no one is breaking into her house and taking her things. At the same time that my grandmother's mind is losing its hold, my sister-in-law's baby is growing more neurons than it needs, developing profound and necessary connections and intersections before it even comes into the world.
This contrast, between developing and degenerating minds, between caring for growing children and for a declining mother, frames Lockhart's book. A former columnist for Literary Mama, Lockhart has gathered her stories of caregiving into an intriguing memoir about her experience of raising small children while coping with her mother's early-onset Alzheimer's disease. We follow Lockhart as she meets and marries her husband, moves across the country, and decides to start a family, all in one year. While Lockhart's life is filled with new beginnings, her mother shows nagging, inconclusive signs of mental decline. As Lockhart's story progresses, she is caught between two distinct roles: new mother and de facto detective, charged with the task of penetrating the mysteries of her mother's encroaching dementia.
As I read Lockhart's account of her mother's unraveling mind, I understood more clearly the decline in my grandmother's. The woman who is my grandmother now is not the woman I knew as a child. That woman was an artist, a painter. She took long car trips on a whim, lived for shopping, and dressed impeccably in bold colors. That woman has been replaced with a frightened person who no longer leaves the house much and hasn't picked up a paintbrush in years.
Lockhart eloquently describes similar changes in her mother -- from a free-spirited, vibrant woman to one who is diminished and afraid. This woman, who supported her family after Lockhart's father lost his sight, who agitated for peace and inspired children with her teaching, gradually loses her glimmer as Lockhart watches, helpless to stop it. Lockhart and I, as daughter and as granddaughter, both cope with this loss, a loss Lockhart elegantly captures and translates for the reader.
The pain of this loss is that it comes in small incremental stages, and not all at once. Lockhart's mother's decline -- as in so many cases of dementia -- is subtle, inconclusive, and nearly subject to debate. After Lockhart's daughter, Zoë, is born, her mother arrives to help with the new baby. Lockhart finds herself in the strange position of helping her mother through simple tasks, such as demonstrating how to use a coffeepot and reminding her how to cook a simple dinner. Meanwhile, Zoë demands the attention of a newborn. The baby cries inconsolably, and Lockhart looks to her mother for help she clearly doesn't know how to give:
"I wanted to be a model mom, sweet and nurturing, the way Ma had been, and here I was totally unable to console my baby. Another part of me wanted to be saved, to be taught by Ma, the teacher, how to do this, but she just sat nearby, mute, looking worried."
Eventually, even this slow decline is recognized for what it is. Lockhart's mother is diagnosed with Alzheimer's in the same month that Lockhart herself discovers she is pregnant with a long-wanted second child. While Lockhart juggles a full-time job, a second pregnancy and a growing toddler, the changes in her mother's brain trigger more erratic and problematic behavior in her mother. A hallmark of dementia is a lowering of inhibitions. In a poignant exchange, Lockhart's three-year-old daughter asks her grandma to read her a Winnie-the-Pooh book. Like Tigger, Zoë springs around the living room while her grandma attempts to read. Patient at first, her grandma becomes increasingly agitated:
Suddenly Ma pulled her arm back and threw the book on to the floor, hard. "You're RUINING the STORY!"
Zoë stopped bouncing, surprised, eyes wide and indignant. "I am not!" ...
"You are TOO!" Ma was insisting.
"God DAMN it, I'm not reading to you ANYMORE."
"I don't care, and no throwing books!"
As Zoë stomped angrily away, my heart was racing -- but just as quickly, it was sinking. In the wake of her swearing and her anger, my vision of Ma as the patient, wise old grandma for my Zoë was fading fast. Zoë had just learned that Ma could not be the grown-up with her. She was quoting Ma the rules.
Lockhart stands between her mother and her daughter, torn between disciplining her own mother and worrying about her child. An earlier scene in the book hearkens to this same dilemma, one in which Lockhart's mother needs to be "put to bed" with her usual routine, while Lockhart's children themselves need bath, bed and tucking in. In both scenes, Lockhart remembers that children are resilient and that even if she knows the difference between the person her mother once was and the one she is now, her kids don't know their grandmother as anyone else. Both of these moments highlight the experience Lockhart captures so well: the tangled roles of mother and daughter, and the clear stresses involved.
Lockhart's professional background brings a unique and significant perspective to this story. A neurobiologist, she brilliantly unveils the science behind dementia and Alzheimer's. Her knowledge of the brain and its inner workings allows for scientific explanations of brain chemistry and its connection to dementia: how excess calcium in a cell excites neurons to death; how plaques deposit and cause the brain's proteins to tangle; why some brains are more disposed toward these biochemical processes than others. As she teases out these scientific truths and their workings in her own mother's brain, Lockhart intertwines science writing into the tapestry of her day-to-day caretaking roles and reveals for the lay audience the brain's complex beauty, its development and its potential atrophy.
In the setting of Lockhart's lab, the reader and the author together bask in the wonder of the filaments of neurons, at the electrical buzz of intercellular communication. Looking at neurons under a microscope, Lockhart brilliantly describes for the reader what she is seeing: the thrill of watching a live neuron fire in a petri dish and cause heart tissue to beat. A true scientist and observer, Lockhart turns her disciplined eye to those gradual, unfolding truths in her mother's behavior. In this way, the structure of Lockhart's narrative mirrors beautifully not only the experience of science and scientific inquiry -- careful observation, trial, experiment and conclusion -- but also the mysteries in her own mother's brain. The initial changes in her mother's behavior unfold in bits and pieces, but finally Lockhart, and the reader, are faced with undeniable realities about her mother's mental state -- memory loss, confusion, erratic behavior -- that add up unmistakably to dementia. The connections between Lockhart's roles as scientist, daughter and mother, are stunning in their construction, and profoundly effective as a storytelling device.
As the baby boom generation ages, more of us are "mothers in the middle," caring for parents with increasing health needs along with caring for our children. Lockhart guides us through her experience as daughter, as mother, as caretaker and provides insight into not just the biological processes at work, but the social and interpersonal ones as well. Since reading this book, I've talked to my own family members about the changes in my grandmother's behavior, and how the changes mirror those in Lockhart's mother. I've passed the book along for them to read. I'm saddened by my grandmother's decline, but I find Lockhart's narrative of dementia in day-to-day life comforting. This is an important book on what it means to be a mother, a daughter, a scientist, and a caregiver.