Confabulation

Confabulation- that's the term for making up stories to explain things that aren't remembered.  Sometimes it takes on a paranoid twist.  Can't find the checkbook?  It's because someone came in the house and took it.  Money being taken out of the bank account you don't remember?  Someone is stealing from you.  Other times it is very plausible, but still fiction.  That is one of the most heard comments I get from family members.  The doctor doesn't see the memory problems because during the 15 minutes they spend with the loved one, they talk very rational and the stories seem plausible.

I should so know better, but I have to learn the hard way.  I have to verify everything  Mom tells me.  One week, she was telling me she is going back for more therapy for the stroke in January.  But when I talk with Dad about it, he tells me no, it is the psychological testing.  It is just as well that she doesn't remember.  Before the stroke, she was very upset about the upcoming testing.  She informed me she was going to cheat.  Because the psychologists who devised the tests would never expect someone to cheat and couldn't possibly anticipate that.  But it didn't do any good to rebut the statement, so let it go.  So at least now, she isn't worried about the testing because she thinks it is therapy.  Then last week, she was telling me "news" about my brother's plans that was not correct.  I didn't get to talk with Dad during the last conversation, so I wasn't able to confirm the information with him.  Good thing I keep in contact with my brothers and he gave me the correct information.  

While I dread medical confirmation of what I know to be the diagnosis, I am so hopeful about getting medication started.  I know it doesn't work for everyone and it won't change the diagnosis or outcome.  But if we could just slow the disease progression and keep even what is there now for a little longer...  Then comes planning once there is an official diagnosis.  But to keep my sanity, deal with one step at a time.

Stimulating the Senses

We took the assisted living residents to go see Christmas lights the other evening.  I was reminded again how important it is to stimulate the senses for those who have dementia and I was reminded how such universal symbols like Christmas lights can connect people to the here and now.  One of our residents has dementia which has been progressing.  It won't be long and she will need to move from our setting to something specialized for individuals with dementia.  But the night we went to see the lights, she was so on target.  Something about seeing the lights, listening to Christmas music as we drove.  She talked up a storm and was so on track with everything she was saying.  She was so animated talking about past Christmas experiences and traditions and what she loved about Christmas.  When you talk about living in the moment, this was the pinnacle of that kind of moment.  It reminded me of my first love, which is doing and creating activities for residents that give them joy, purpose and meaning in that moment.  And if I can create that kind of joy, for just one resident for just one moment, that is well worth the other annoyances that come up.

Self Determination

Well I was wrong.  My contact with the doctor has not been forgotten or forgiven.  In our conversation this weekend, we were talking about my brother and his diabetes.  My mother made a comment about how only the person with the disease should seek help for the problem because they are the only ones that can do anything about it.  Not a very subtly veiled comment about my intrusion into her affairs.

At the same time, I'm reading a book written by the guru of dementia care, Dr. William Thomas.  The book is called "Lessons from Hannah".  An excellent book by the way.  It is in story format, but speaks very well about how we as society need to be looking at elder care in a very different way.  I admit, I am guilty of thinking I know best about everything.  I totally understand what my mother is referring to and she should determine her own care.  Except that the symptoms of the illness we are dealing with in this case make it very difficult for the individual to make a very accurate self assessment.  Is my desire for the disease to be kept at bay as long as possible, more important than her right to make her own decisions, even if they can't be very well informed decisions?  So much gray area and so little black and white.  At the very least, this is experience is making me a much better care giver for the residents of the assisted living facility in my care.

Vascular Dementia

Well my plan to not talk to my parents last week because they were mad at me for contacting the doctor didn't work.  I got a call on Saturday from my dad.  My mom had a stroke on Thursday and she was discharged from the hospital on Saturday.  Turns out there was no lasting damage from the stroke.  While she was at the hospital, they did an MRI to check for any lack of blood flow to the brain.  From my dad's report, there was an area on the right hemisphere that showed damage.  Her stroke symptoms showed up on her left side, which makes sense.  When she left the hospital, she was able to move her legs, arms and her mouth wasn't drooping like it was when they went to the hospital.  So the first thing I think of is that her dementia symptoms are likely vascular related.

Then I think the same thing I've heard so many families say, maybe if it's vascular dementia and her blood pressure is under control and blood thinning medication started, it won't continue to progress.  They have not been back to the primary care doctor yet, so I don't know yet what she is thinking.  The good news is that with this major event happening, my transgression of contacting the doctor about my concerns has been forgotten, at least for now.  It has worked out that I can continue my talking points of concern about a medical condition that can be treated.  In the light of the stroke, that approach has been easier to sell than an all out criticism of mom's memory which is how she took it originally.

So now begins the Google search on all things vascular dementia.  So far what I've found are mixed results.  Some information says the symptoms can slow when high blood pressure is treated and clots prevented.  Other information says the prognosis is not good.  I guess it is just one more step forward.

Strategic Withdrawl

It seems I am learning in person how difficult it is for families to address memory problems with their loved one.  As I said last post, I wrote a letter to my mother's doctor giving her my observations about mom's memory loss.  The doctor has recommended my mother get an MRI.  It is scheduled for next week.  In the meantime, I am now public enemy #1.  I still believe getting her medical help as soon as possible is the right decision.  I obviously didn't go about it the best way.

I should have known, for someone who has prided herself on her intellect all her life and whose self concept is so tied to her intelligence, my "accusations" are a direct assault on her person.  She told me she believes I have "thrown down the gauntlet" and she is going to prove me wrong.  How thankful I would be to be wrong.  I would gladly eat crow for the rest of my life to be wrong about this.  I am so thankful we should have some kind of answer in the next 2 weeks.

But for now, in order to save my own sanity, I have got to withdraw and just not talk with either my mom or dad.  I know this is my own bed I've made and I should have to lie in it.  This is one time I am so very thankful to be living far away.  It is possible for me to take the chicken way out and withdraw for a couple weeks.  But right now, there is just too much stress and since we do live far away, this is a stress I can eliminate, if temporarily.  At work, I have a couple empty beds at the assisted living facility.  Every business is in business to make money and in this economy, no-one's job is secure.  Then my husband's job is for the Department of Defense.  With the talk of federal budget cuts, his job is no more secure than anyone else's.

This solution  may be no better than how I started this process, but to save my own sanity, I have to withdraw and pray for the strength to deal with it and wisdom to know best to deal with it.  Probably should have done that to begin with.

To Know or Not to Know

Well now I've done it.  After returning home from seeing my parents,  I wrote to my Mom's doctor about my observations of her memory loss.  I haven't talked with my Mom yet, but my brother gave me a head's up that the doctor called her and talked with her about testing.  My purpose in writing to the doctor was to try to get her the standard dementia medication.  I know it doesn't cure and it is effective in about 50% of patients, but I would still like her to have the possibility.

I have watched one of my residents decline cognitively over the past year and a half.  Her family has been adamant about no medication.  And now she is getting close to the point I will have to discharge her to a skilled nursing facility.  Physically she is in great shape, but her cognition has really declined over a year and a half.  She came to assisted living in pretty good shape.  I contrast that with the husband of one of my support group members.  They have been dealing with something for 5 years and got the dementia diagnosis about 4 years ago.  He had several trials of different medication, but they did find a combination that didn't have too many side effects.  He has been at a plateau for about a year now and they seem to be having a pretty positive quality of life for the last several years.  I know not everyone responds to the medication, but if there is a chance it could work for my Mom and slow the progression, I would like to try.

Of course now the dilemma I should have had but blew right past is, is it fair to put my Mom in a position where she has confirmation of her fears with the actual diagnosis?  Is the benefit of the possibility of slowing the progression of the disease more important than the negative of knowing you have a non-curable, progressive disease?  Not such easy answers where you are facing it yourself as it is to watch other families and think you know what they should do.

I gave an in-service to my staff not long ago about dementia.  We talked about the small percentage of people who have a genetic predisposition.  There was discussion about whether you would want to know or not.  I'm looking at 2 generations ahead of me with the symptoms, if not clinical diagnosis.  My answer that day with my staff was, I was not sure I would want to know.  Now I've put my mother in a position where she may have to face the confirmation of a diagnosis.  Now we wait for the testing and results.  I think at this point my only solution is to pray; for strength for all of us, for peace with my decision, and for forgiveness from my parents for bringing this to a head.

Planning ahead with Legal matters

The last couple weeks have been very intense.  I went back to Missouri for a working vacation.  I recently had an elder law attorney speak at the Caregiver Support Group.  He talked about the legal paperwork you should be sure to have in place.  So I scanned copies of my parents Advanced Directive, Power of Attorneys, Wills, all forms of insurance, and something with the account numbers on all their other assets and bills.  We went to the bank and put my name on the checking account, only on the signature card, not as a joint owner.  That was one of the pieces of advice the Elder Law attorney gave and the staff member at the bank agreed.  I also made sure a friend of the family and a neighbor have my contact information.  It seems to be the most I can do living 1000 miles away.  I was researching the topic for my last Caregiver Support Group and the phrase that "most caregiving begins with an emergency call in the night", really stuck with me.  There is so much you can't anticipate.  This way, at least I will have somewhat of a head start.

My boss has had a rough couple weeks too.  She had to move her mother from assisted living to a skilled nursing facility because she has declined to where she needs more care.  Doesn't really put you in the mood for the holidays.  We make quite a pair, my boss and I.  We both have loved caring for seniors with dementia during our long term care careers.  Now we both find ourselves dealing with it on a personal basis. As with the job, she is several steps ahead of me in the process. I still love my job and would not change.  Maybe this will give me another perspective so I can do a better job in my job and my job help me to do a better job with family caregiving.  One more box checked off, on to the next.

Where you focus is what you will find

Why is it I try to assess what Mom remembers and what she has forgotten every time I talk with her?  Is it because like every other family I've ever talked with, I'm hoping to find evidence that I'm wrong?  That all that is going on is normal aging?  This week, our family pets have seemed to be compiled into one.  Lest you think we were a family of animal hoarders and there were too many to remember, in my 50 years, there were 5 cats including the 2 current ones and 2 inherited from me, and 4 dogs, 2 of which lived for 20 years.  My brother noticed the same thing several weeks ago.  One of the cats they inherited from me when I had my first child became our childhood pet during the conversation with my brother.  Or it is that she is not able to remember their names?  She is having trouble with words, the aphasia they talk about with dementia.  She will use descriptions instead of the noun, I think because she can't find the word.  But why do I obsess about what is lost?  No matter if I figure out why, I will still not be able to change what is happening.

I find myself as the daughter, reminding myself to follow the advice of myself the professional.  If I focus on the negative, what she has lost, it won't change the disease.  I know deep down it is dementia.  And like every other family, I desperately hope I'm  wrong.  But if I focus on the negative, I will lose the positive.  And there is the whole reason for this blog in the first place.  No matter what I know after 30 years of professional experience in long term care and working with people with dementia, when it hits home and becomes personal, I am the same as every other family dealing with this illness.  Now I just need to remind myself to focus on the positive.  Focus on what is still there.  Write down what I want to remember for the future, for my kids future.  What you focus on it what you will find.  Let me focus on the positive.

Frustration with "Professional" resources

This fall I decided to change the meeting time of the support group to the evening so that people like me, working children, could attend.  Then I set out to find speakers to talk about local resources.  How disappointing to find that the Area Agency on Aging, local home health providers, pretty much any of the "professional" resources are unwilling to come speak at an evening meeting that is held after business hours.  How inconvenient that there may be people like me out there who work during the day and can't attend a meeting during business hours.  I find it hard to believe that in this day of the service economy, businesses that provide a service are unwilling to go outside the box.

I guess what that means for me and the Caregiver Support group is that it is all the more important for me to know about resources to pass on to others.  On the other hand, it reminds me in my role as an assisted living administrator that I need to be sure families have access to me and any other resources in caring for their loved ones during "off" hours as well as business hours.  As I tell other people, sometimes you learn from examples of what not to do as much as those that you want to emulate.

Long Distance Caregiving

I read a sobering statistic in the new book I'm reading, "Learning to Speak Alzheimer's".  It said that 30% of caregivers die before the loved one they are caring for dies.  I read that the day after I had a conversation with my Dad about how he was having trouble with his blood pressure.  All I could think of was, "If something happens, will Mom be able to get help?  Can she call 911 or at least go to the neighbors to get help".  One of the topics I want to do with the Caregiver Support Group is long distance caregiving.  I might as well share what I learn as I try to come up with contingency plans for my own family.  It would be so much easier if my parents would just let me take over.  And so I join the same dilemma I see over and over again with families in assisted living.  Not so easy when you are in the middle of it as it is looking in from the outside.  Who knows, maybe I can come up with a resource that I can share to be of benefit to others long distance caregiving.  Stay tuned as I work out a process.

Family Dynamics

I have a family at the assisted living right now who are having a time.  Two children with very different personalities, different views on what needs to be done and no-one has been designated Power of Attorney. I try to help both of them and remain neutral in this situation, but I can't help but project myself and my brothers in the same future situation.  You have very capable and responsible adults with different views about what is important for quality of life, what the goals are for medical care, trying to take into consideration what would be their father's wishes and you can't help but filter those through your own personal beliefs.

I hadn't planned on taking a trip to Missouri this year.  But since I will still have 1 more week of vacation to use before the end of the year, I have decided I want to take that trip.  I have seen so many things in the last few months, that I want to try to be proactive as much as possible.  I'd better get my name on the bank accounts so bill paying could continue in the event of a crisis.  I am already named the Power of Attorney.  I'm having an elder law attorney speak at the Caregiver Support Group in September and I hope to find out what other practical things I need to do in advance to minimize problems later.

But what can you do in advance to prepare the relationship piece.  All 3 of us children are intelligent people.  Of course I believe I should have the last word since I am the Power of Attorney and I am a health care professional.  But my brothers are also very strong personalities with strong views and rightly so who may not agree that I would know best.   I also see my cousin who has lost both parents in the last two years.  Her only sibling is giving her a hard time as the executor of the estate.  So not only has she lost her parents, but her relationship with her brother is not good because of these differences of opinion about what should be done.  Is there a way to be sure our parents have the best quality of life and maintain relationships when there may be very different views on what quality of life means?  How do I help the assisted living family members when I don't have all the answers myself?  Why is it there are more questions as you get older instead of more answers?

It's different when it's personal

During my weekly phone call to my parents, I let myself become annoyed.  We were talking about my job, which is unusual in itself because I usually spend an hour saying, "yes, uh-huh".  And my Mom made a comment about how terrible it was.  Here is the person who has championed my career for years and in fact raised me to believe your career was the most important part of your life, now criticizing my helping profession.  I let my emotions get the better of me and I flipped off, "no it would be much better to let someone stay at home who was not safe and let them start the house on fire and die unnecessarily like someone did here locally a few weeks ago, than to have them move to assisted living".  Then as usual, looking back on the conversation, (and after reading a chapter in a new book I got called Speaking Alzheimer's) I realize that the same job she once praised me for and was so pleased about when we were both younger, is completely different now that it may apply to her.  When she said, it is terrible to think about giving up everything you have and living in one room, she was realizing that is an option she may soon be facing.  My problem is that I have to figure out how to have these insights before it is too late instead of realizing after it is over.

I think my only hope is to rely on the wisdom of God and pray for insight before I call.  No matter how many years of experience I have in the field, I need the wisdom and leading of God to handle this the right way when it comes to my own family.  God grant me the wisdom before the conversation, rather than after.

Guilt, guilt and more guilt

I think guilt must be the one constant when you are a caregiver.  Are you doing enough, are you doing the "right things", should you be doing something different?  My guilt this week involves how different it is as a family member compared to being a professional.  I can listen to assisted living residents tell the same stories over and over and have patience unlimited.  But when my mom starts to launch into the same stories I've heard over and over, my patience wears thin.  Then I feel guilty.  I've told family members a hundred times that things are different when it is your family that has dementia, even if you have lots of experience with others.  And I see first hand how true that is.

My mom is a talker.  She has a tremendous need to talk a lot, the typical extrovert.  This was true before her memory started to slip.  Now that she doesn't remember she has already told you the story, a lot means for hours at a time.  I am not a talker and I need quiet to recharge.  So every week when I call, I hear the same stories over and over for an hour or so. I get annoyed and then I feel guilty.  I know in my mind I should be thankful.  We are in the early stages, she is still able to carry on a conversation, she still knows who I am.  So how do I fix this?  In my devotion time this morning I'm reading how sometimes God allows us experiences, some would call trials, that enable us to comfort others as He comforts us in our trials.  I can tell you that I certainly understand better how the most intelligent, health care professionals can function just the same as the average man on the street when it is their family member that develops dementia.  Maybe that is the lesson to be learned?

Role of Support Groups

I have been hosting a support group for Caregivers of people with dementia for about 4 years now.  Attendance is declining and I'm wondering if it is even a useful format any more.  the Alzheimer's Association has a website with so much information.  Maybe in this day online information is what people are looking for?  Then I have the one spouse who attends every month and tells me he doesn't get anything out of it.  Do I need to keep using my time and resources to keep something going that is not helping anyone?  I always felt like there was something important in the connecting of people who are having similar experiences.  I spoke with the one faithful attendee and we talked about changing the time.  I originally scheduled it for afternoon thinking that spouses who are caring for someone would be less likely to drive at night.  We'll try evening and see if that helps attendance.  Maybe I'm just in a funk and need to refresh.  I guess time will tell.

The risk of not making someone angry

So last week a woman died in a house fire.  They stated on the news that she was known to have dementia.  The fire smoldered for hours before it was discovered and the fire department called.  She had been dead for some time by the time the fire was discovered.  In my experience with families, I have to wonder if there had been a discussion about needing some kind of assistance, a sitter, family staying with her, going somewhere else, anything?  It is just a news story and the characters are not known to me personally.  But the situation is one I see over and over and over again.  As the memory gets worse, the person is not making good decisions.  Yet no-one wants to rock the boat and make mama mad by suggesting help.  So instead, she continues on in an unsafe situation.  In many situations, there are not dramatic outcomes such as this.  But I have to wonder and I'm not trying to be a smart alec;  Is it preferable that mama was able to stay in her house on her own, even though she died in a tragic fire, rather than making her angry?

I know it's easy to look in from the outside and make judgments or second guess others decisions.  But why, when we know someone is not making good decisions and we don't let them drive, we manage their finances for them, etc, do we go along with their decision about care?  So the question becomes, which would you rather deal with, making a decision for safety even if it makes someone mad, or knowing something that happened could have been prevented?  It's not an easy choice, but it is real.

Professional versus personal

It is so much easier to deal with individuals professionally rather than personally.  I got called back to work last night with a resident who got in the car and was not going to get out, wanting to "go home".  It doesn't matter that the family are medical professionals.  I hope I was able to convey to the family that's normal and okay.  No matter how much training or experience, when it is your family, the family role takes priority.  I've watched it with my boss, I've seen it with family members of my residents, I know I will be in the same situation in the future.  It is so much easier to come into a situation fresh, having had a full night's sleep, not knowing the person that used to be-only what you see before you at this minute, knowing you will be able to hand off to another staff member that is also fresh and rested and can return to your own home when it is over.

I was also amazed by looking at my past and seeing how everything has come together to make this possible.  I prayed before getting to work, asking for the right words to say.  And when I left last night after calming things down, I realized how right Joyce Meyer is when she says it is so good when you know you are in the middle of God's will for your life.  Oh how tough were those years working with juvenile delinquents and how I felt that was "paying my dues".  But without that training I wouldn't have the skills I now have that made last night's success possible.  Thank you God for knowing what you are doing.  Help me to fulfill your will for my life.

There is no one right decision

I knew it had been a while since I posted, but had no idea how long.  One reason is that I wonder what on earth I might have useful to share.  I attended a workshop session by a neurologist on the latest findings on Alzheimer's Disease.  Now he had a lot of valuable information to share.  But, I feel like this is something God has called me to do.  Who am I to second guess God.   The second reason is that there has been a lot going on at the assisted living, and it has brought up a lot of my own questions.  One of the residents was diagnosed with a terminal illness.  The plan was for her to go back to where she has lots of family.  But the illness progressed faster than expected and now she can't make the trip.

It has brought back my struggle with my parents being in another state and no other family close to them.  Do I try to talk them into moving to our town?  One the one hand, they would be close and we could spend time together while they are still in fairly good health.  And then when it gets bad, they won't be by themselves.  On the other hand, should they give up their friends and activities so we can see them maybe once a week?  I still have to work full time and am lucky enough to have a full time job.  That doesn't seem quite fair either.  There isn't just one right answer.  And even for every family, there are several good possibilities.  I get so frustrated when there are well meaning friends who tell people that the choice they made is what everyone should do.  Too bad it isn't that easy.  There would be a lot fewer stressed out parents and children if that were so.

At the same time, I know what the future will bring.  I've watched other families deal with it for almost 30 years now.  I don't want to wait until Mom can't remember who I am to make the move.  It would be really nice to make some memories that at least I will have before then.  What to do, what to do.

Personality Changes

I was reminded this week how many people understand about the symptom of memory problems with Alzheimer's disease, but don't understand that personality changes can also be a symptom.  I spoke with a couple that were clearly overwhelmed with trying to make care arrangements for his father.  They understood that he was not making good decisions because of the disease.  Yet the son was so hurt by some of the words and actions of his father.  We have developed such keen abilities to make judgments about what people are feeling based on their words and actions.  We do it without thinking.  We continue to use those same skills when someone we love has Alzheimer's disease.  We forget that behaviors and words are the result of thoughts and the thought process is disrupted in Alzheimer's disease.  I've seen so many people who continue to judge the status of their relationship based on current behaviors and words which then causes them so much pain.  Instead, we need to insert a new way of processing words and actions when someone we love has Alzheimer's.  We need to actively remind ourselves that the disease is influencing what our loved one says and does.  And then comes the detective work to try and figure out what they are trying to communicate, which is a topic all by itself.  I guess that is one of the most difficult things about the disease, the individual is no longer the person we knew.

The family ended up needing to find a secure facility and so the man did not come to stay at my assisted living.  The experience was a reminder to me to be sure to inform families about likely personality changes.  I hope I was a help to them and I sure wish them the best as they continue this journey.

Preparing for the marathon

The monthly Caregiver Support Group was this past Thursday.  I was reminded as the participants talked of their experiences, that dealing with dementia is a marathon for families and friends.  Interestingly, my husband is a runner preparing for his first marathon.  His training has a lot to teach me about how to deal with this illness.  One of my worst habits is worrying.  Mostly I think about all the "what ifs".  I tell myself it is so I can plan ahead.  But mostly it is a bad habit that steals my ability to enjoy the here and now by focusing on things that may never even happen.  My husband tells me about how his training for the marathon is just as much about what goes on in your head as it is training your muscles.

One of the women in the support group is such an inspiration.  They have been dealing with Alzheimer's disease for about 5 years now.  Her outlook is absolutely inspiring.  She takes one day at a time and deals with what ever is going on right now.  She finds joy in the every day as she can.  She knows things will get worse, but she doesn't focus on that.  Such a lesson for me, the professional, to learn.  We are early in the illness and things are off kilter, but manageable.  I need to enjoy my life now and not waste the time worrying about what will come in the future.  I need to remember that God has a plan.  Through experience, I know He will provide at the right time.  I need to print out the Bible verse Mathew 6:34 and carry it with me.  "Therefore do not worry about tomorrow, for tomorrow will worry about itself.  Each day has enough trouble of its own."  I know that for myself, my faith will be an important part of dealing with this illness.  So here's to enjoying today!

Importance of early diagnosis

Mom has not had an official diagnosis yet.  I was talking with one of my assisted living  family members the other day about how frustrating it is when the doctor spends 5 to 10 minutes, doesn't see anything and assumes you are over reacting. Seriously, is this something anyone really thinks I want to be right about?  Of course my dad doesn't want to see it.  He watched my grandmother decline to where she didn't recognize my mother and how hard that was for my mother.  I have one brother that agrees with me, one that does not.  My husband sees it, my good friend said she saw warning signs two years ago at my youngest son's graduation.  But when we are playing dominoes, a game you played with my 20 something children every night during the 8 summers they spent with you and we have to explain where the dime line is every time it is your turn-there is a problem.  You know how many turns there are in a game of double 9's?

Every day I am confronted with people who waited too long to admit there was a problem.  There's the long distance truck driver trying to find care arrangements in a hurry so he can return to his job.  The sister trying to figure out how to pay for care because her brother made some poor financial decisions because of the disease.  The family that now has to go through the court process of guardianship so they can prevent poor decisions.  And every day I have someone call me who knows their loved one needs care but assumed someone else would pay for it.  My favorite was the person who came out and said to me "he doesn't want to use his money to pay for care".  Oh how I wanted to say "Well who's money would he like to use?"  Medicaid is getting very strict on individuals needing to have skilled nursing needs in order to qualify.  So many people out there stuck in very bad situations because they were in denial, didn't want to offend their loved one, on and on.  So no, I don't want to be right about the diagnosis, but I don't want to end up making decisions in a crisis like so many people I talk to every day.