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“Mom,it’sPeggy.”“Hello,Peggy,it’sgoodtoseeyou.”Myfrail,90-year-oldmotherdoesnotrisefromherpositiononthecouch.Shelooksatmewithclearblueeyesandsmiles.Sheisweak,andrisingfromasittingpositionisanordeal,sosheremainsinplace,sittingonaspecialpadtoprotectherthinbodyfromthepressureofsitting.Ikissheronthecheek,sosoftandpapery.Shewouldnotliketoknowwhatshelookslikenow,withmissingteeth,scragglyhairandwearingadiaper.Herappearancehadbeensoimportant.Becauseshecouldn’taffordtheclothessheloved,shelearnedtosewatayoungage,andtailoredbeautifuloutfits.Nowshewearscomfortablesoftpantsandtopsthatwehavepickedoutforher.Webuycolorfulfleecejackets;shealwayslovedcolorandknewexactlywhichonesshecouldweartobestadvantage.Nowsheisnotawareofwhatsheiswearing,andhercolorsaremainlyforus,herkids,andthepeoplewhocareforherinthefacilityforpeoplewithadvanceddementia.Sheisafavoriteofthestaff,sosweetandsharing,carefulofthefeelingsofothers.Itisaclear,crispdayinearlySeptember,adaytypicalforMinnesota:lowhumidity,brilliantbluesky.Italkaboutthelovelinessofthedayandencouragehertositoutsidewithme.Sheagrees,asshedoestoanyofmysuggestions.Sheisadifferentkindofmothertomenow:nolongertheboss,butthechild.Weslowlywalkacrossthecentralmeetingroominthisbuildingwhereshehaslivedforthepastthreeyears.It’sdividedintofour“homes.”Likeher,thesevenotherdementiapatientswhoshareherlivingareahavelovedoneswhocannolongercareforthem.Fromthetimewewerelittle,Momwarnedusthatshewouldneverimposeonuswhenshewasold.InthedepthsoftheDepression,shehadbeendisplacedfromherbedroombyanelderlyrelativewholivedwithherfamilyoffoursisters,motherandfather,andsheneverforgotit.Dadwasforcedtocommitherhere;hewashersameageandinfailinghealth,andhecouldnolongercopewithhercare.Whilehewasalive,theysaweachotherallthetime.Hewouldwalkoverfromhisassisted-livingbuildingnextdoor.Heisnowgonefortwoyears.Herrealhome,herhusbandof65years,herchildren,herprofession,herhobbiesandskills,evenhergreenthumb—thesehaveallfadedfromherlife.Shecan’trememberthatshewasahomeecteacher,amotherofeight,withanadoringhusband;thatshecouldgrowanything,couldsewbeautifully,alwaysdressedimpeccablyanddidn’tcareforentertaining.IliveathousandmilesawayinBaltimore,andIvisithereverythreemonths.SpacingthevisitslikethismeansthatIseedefinitechangesinhermemorywitheachvisit.IamaphysicianandIcan’thelpnoticingthatsheisslippingeachtimeIseeher.Icannotletherknowinadvanceofmyvisitsbecauseshecannotuseatelephone,andshehasvirtuallynomemoryofrecentevents.Eveniftoldofmyvisitbyhercaregivers,shewouldnotretaintheinformation.SoIjustshowup.Sheisneversurprisedtoseeme.Theabilitytobesurprisedseemsnottohavesurvivedtheravagesofherdementia.Sheacceptswhatcomestoher.Despitethis,shehasneveryetfailedtorecognizeme,althoughrecognitionhasbeenalittleslowlately.FirstIseeapuzzledexpressiononherface,asshesearcheshermoth-eatenmemoryformyname,myidentity.Thenshesmilesandgreetsmebyname,introducesmeallaroundwithallthreenames,first,middleandnickname.Namesshegaveme.Relieffloodsovermeeachtime.Ileadthewayasweslowlystepfromthemeetingroomandwalkthroughtheglassdoorstotheoutside.Shehaltinglypushesherwalkerinfrontofherasshenegotiatesthedoorway.Brilliantsunshineassaultsusaswestepintotheenclosedcourtyard.Thereisacupolainthecenter,withbenchesinside,andsmooth,pavedpathsaroundtheouteredge.Flowershavebeenplantedallaroundtheperimeterandinwaist-highplantersscatteredhereandthere.Wewalktogethertoagroupingofthreerockingchairsintheshadeofabirchtree,reallyalovelyspot.Wehavesatherebefore,manytimes.Igrabarocker,andshegingerlytransfersfromherwalkerintoachair.Iaskafewquestions,focusingontheweatherandourimmediatesurroundings.Shehaslostnearlyeverything,exceptwhatisintheimmediatehereandnow.ShecanbecometemporarilysadandconfusedifshecannotremembersomeoneItalkabout,soIdon’tmentionmyfamily.Itiseasierifwejusttalkaboutthebeautifulday.Thenanotherpatient,awomaninher70swhoisinexcellentphysicalcondition,thinandtrim,speed-walksby,onhertwice-dailyconstitutional.Shedropsdownintheremainingrockerontheothersideofmymother,asksherhowsheisandwhysheisnotwalking.Iknowherwell;weseeeachotherateachvisit.Butdespiteherphysicalwell-being,shehasseveredementia,too.Asshesits,Igetuptowalkabitinthesun,andasIleave,IoverhearthefellowpatientaskwhoIam.IalmostcrywhenIheartheanswer.“Someladyfromchurch,”mymothersays.BrenneckeisaradiologistandmedicaldirectorofradiologyatJohnsHopkinsatGreenSpringStation.