Some guys want to be cowboys. This guy was a cowboy. A real-life, cattle-raising, horse-riding, lover-of-the-land kind of cowboy. He dressed like a cowboy, and it was clear he had worked hard all of his life. But it took just a few moments to witness the twinkle in his eye, the good humor, and the happy man that added a playful, gentle side to the cowboy.
I met his lovely wife a few years ago, in Sterling, Colorado. I had been teaching the DAWN Method Dementia Coach Classes in rural Colorado. The DAWN Method was designed to help people learn how to care for their loved ones with dementia at home. And these rural communities, like many rural communities, have fewer services such as home care. So going there to teach families how to care for their loved ones at home felt like good economics, relevant, and like a good help.
I met the cowboy’s wife following class 1. She was attentive throughout the class and asked insightful questions. After the class, she approached me, and we chatted. She shared a bit of their story, and I shared a bit of what I had been learning through the years of using the tools of the DAWN Method. She said that what I was sharing gave her something she never expected to have in the dementia journey with her husband: hope.
This wife and I formed a warm and important relationship. Following the eight weeks of DAWN classes, we began meeting by Zoom every week. Each week, she would share the current situation in their home, and we would apply the tools of the DAWN Method to help make the situation clearer and more positive in the future.
We talked through her husband’s permanent move to the passenger seat, and how anosognosia made it necessary for us to create a story he could feel comfortable with, which made the situation easier for his wife.
We talked through how to help him continue to be socially successful at church, even while his humor and friendliness, with diminishing filters, nearly made church too stressful for them. Going to church was important to both of them, and they continued attending until the final few months of his life.
We talked through issues related to visits with long-time friends and how to help those visits bring gifts versus stress for her husband AND her.
We processed how to encourage him to get adequate nutrition and hydration, and when it became okay to let his diminishing appetite not be a struggle, but instead let it be.
I advocated for him to have adequate pain relief. He was a cowboy, after all, and a hard-working guy all of his life. His body bore the symptoms of this life. People experiencing dementia need us to be their advocates related to pain, as they often struggle to correctly interpret pain and advocate for pain relief. This conversation led his wife and me to shift our focus from “fixing” situations to making decisions on his behalf through the lens of quality of life.
A few months ago, when his speech was changing, and his mobility was changing, and his appetite was changing, and his confusion was increasing, I spoke about palliative care. But palliative care was not available in their rural area, so we continued to process through how to care for him at home.
In May, I encouraged her to reach out for a hospice evaluation. “Hospice folks are the experts at end of life,” I said, and “If he is truly at end of life, they will see that, and he will qualify for hospice, and you will have extra help.” He did qualify. And she did receive some extra support. It was just enough, along with the excellent help of her private caregiver team and some agency caregivers, for the cowboy to remain at home, and draw his last breath right there at home just a few weeks after going on hospice.
None of this journey was easy for him, or for his wife. But it was an important journey, and his wife regularly made comments about how her life was getting better, how she was learning so much, how she wouldn’t trade one second, how she saw even more clearly what a good man her husband was…even as the symptoms of dementia changed his abilities.
She loved her husband dearly. And he clearly loved her. She gave him the very best of herself in these final years, and the honor was mine to walk alongside them and be a helper and a friend.
