I don't know what depression has in mind for my future

I worked in a personal care home for over a decade.  In Manitoba, 80-85% of all residents have a diagnosis of dementia or alzheimer type dementia.  Most of these residents are lovely and are joys to take care of.  They make us smile, they make us laugh, they make us appreciate our health.  When a family member was diagnosed with dementia, the family would ask, "what can we expect?"  I would give them literature and I would tell them what typically happens, then, I would caution them, that everyone walks their own path.  There are not two people who experience the disease in the exact same way.  That is the frustrating aspect of dementia.  You don't really know for certainty what to expect.  The other thing with alzheimer dementia, as with all dementia, it is a progressive chronic disease and there is no cure.  The best we can expect is a long plateau.  It is best managed by a team of health care professionals but we still don't know definitively what path dementia will take in that person's life. 

I often think of the time I spent working in a personal care home.  I remember one lady that had been on dialysis for over a decade.  She was just tired of it.  She used to fight it so much that she had to be strapped down for the transport to dialysis.  She did everything in her power to show us that she didn't want to continue.  However, she also had dementia and she spoke a language other than English so competency was an issue and was she competent to understand the consequences of refusing dialysis.  Many minds worked very hard on this case trying to understand his wishes and respect her dignity.  We also were told that she would be dead within a week if she didn't continue with dialysis.  In the end, the people who knew her the best, her family, made the painful decision to discontinue the dialysis.  She lived another three months where she was allowed to rest.  Medical professionals couldn't explain how she was able to live, but obviously she was walking her own path.

A similar case was a man in his 90s.  The low hemoglobin in his blood required him to have frequent blood transfusions.  First, monthly.  That was easy.  Then, weekly.  That was a little more difficult.  It required more frequent analysis of his blood.  That meant more pokes with needles on his already thin and fragile skin.  And, transitions are difficult.  Even though, by that time, he was very familiar with the transition from personal care home to hospital and back, it was difficult on him.  Every time he returned, he seemed a little more tired and disorientated.  He missed regular meals and wasn't interested in having them outside of meal time.  Then, he had to have blood transfusions every second day.  That was really difficult on him.  He said he didn't like spending half of his life on a stretcher.  Then, it was determined that he needed a blood transfusion every day.  So, there was a conversation.  It was becoming too costly to transport him everyday and perhaps he would be better off moving to the hospital full-time.  He and his family didn't want that.  They wanted to stay in the personal care home that had become home to him.  The family raised the issue that no one else wanted to raise.  Blood was in short supply.  Did it make sense to give him one unit of blood every day?  The patient made the decision and even though he was in his 90s, he was competent.  No more blood transfusions.  He was told that in making that decision, death would occur within a day.  He understood and his family gathered around.  After a few days, they went on with their lives at his request.  They were there 8 months later when he left this earth.  During that 8 months, he kept defying medical science by surviving.  He didn't care about that.  He just wanted to have his meals with the rest of his mates and not be poked every day.  The medical field is pretty good at depicting outcomes but not with absolute certainty.  Everyone has a different path. 

Depression is no different.  I have read many books trying to get answers.  I have attended many groups and many classes.  My health care team is continually experimenting with my medication trying to find what works for me.  Depression is a disease but it is not universal.  Sometimes I am very good at hiding it, sometimes I can not.  Sometimes things seem to pull me out of my depression for a day or two but it never lasts.  And, just because that works once or twice doesn't mean it will work ever again.  I don't know the path depression will take in my life.  Sometimes, it doesn't seem like an issue and the next day, it dominates me.  It is hard to make sense of it.  It is a disease so I can't talk to it, but I still try.  I try to say that whatever happens, please allow me to be kind to others.  I can't ask my depression to allow me to be kind to myself because it is the source of my biggest self-judgments.  My depression also gives me hope.  It lets me know that, while I will always live with depression, there is hope that I may not suffer with depression.  That is the path I want to walk down.  The path named Hope.