My Mother’s Clocks: On Losing Time with Dementia

It is 2019 when a doctor first asks my mother to draw a clock, and to set the time to ten minutes past eleven. She hands my mother a piece of unlined white paper and a pencil, and she waits to see what my mother will produce. We all already know the outcome—at least my father, the doctor, and I do. But my mother has retained the dignified hope that sheer effort is what’s lacking. She furrows her brow, and slowly gets to work. She draws a perfect circle, and meticulously places numbers inside of it.

My mother is the child of the black middle class. Her father, a professor at Brooklyn College, and her mother, a middle school math teacher, lived in a black world of dentists and educators, doctors and bankers. Their world was governed by the idea—the fiction, really—that while effort would not save you from the intensity of anti-blackness, it could shield you.

My mother had one refrain when I was a child: take pride in the way you look. Never leave the house with rumpled clothes or hair askew, with bad breath or mismatched socks. Never offer anyone a reason to deny you anything. My mother brings this belief in determination and pride to her clock drawing, as if the slow care she brings to her circle will be sufficient to pass this final exam, one that comes far too late, administered in the harsh florescent light of a neurologist’s office.

By the time we sit for this clock drawing exercise, we are out of time. My mother has already had an MRI and a cat scan; she has already spent four hours failing a diagnostic testing because she no longer knows what year it is, or how to draw a triangle inside of a circle. She has already abruptly left her job, one that brought her to tears each night even though she could never quite explain why.  She has already announced that the daily commute to New York City is too much, that she needs something simpler.

She has cut our regular phone conversations to two minutes of formalities that always begin with her panicked question: is everything okay, Jen? By the time my mother sits down to slowly draw a clock, her face has become her mother’s: her skin is a pale gray, and her gaze is always fixed on something in the distance, as if she has noticed something far away that no one else can see.

The clock test is celebrated for its clarity. It can screen for dementia in minutes. Some say that a British doctor—Henry Head—used it first in the early decades of the twentieth century, and while it cannot screen for particular forms of cognitive impairment, it sounds a clinical alarm. It remains celebrated for its simplicity: it does not require literacy skills and it is thought to be, as one medical journal describes, “less sensitive to differences among individuals of varying educational and racial backgrounds.”

If you can draw the clock without trouble, if you understand what a circle with numbers inside of it means, you can feel a sense of relief. In the years since that first doctor presented my mother with a blank square of paper, other doctors have asked her some version of the same questions: What is today? Who is the president? How old are you? All of these questions are really the same question: Do you know what time it is?

I measure the last few years by watching my mother’s clocks deteriorate. I know nothing about what the pace of their deterioration means—but I know enough to understand that even on days when she could draw a clock, we are well past the stage of hope. As her doctor coldly told us, there is no cure for Alzheimer’s, only the slow—and sometimes fast—pace of deterioration which will cruelly accelerate with time.

I know these clocks feel like a merciless metaphor for how little time it feels like we have left, and about how frightening the future seems—a future that seems filled with disorientation, repeated questions, confusing stares, and for things that seem so unbearable that I can’t even write them.

I have spent much of my life watching clocks. I watched my funding clock in graduate school, my tenure clock as an assistant professor, and I still measure time by the clock of the school year: life is divided into two semesters and a summer. I watch my daughter grow, I watch my parents age, I see my own face change, I watch my mother recede: her voice quieter, her sentences shorter, her presence shrinking. I wait, but I’m not entirely sure what I’m waiting for.

There are the logistics, of course, of memory care and home health aides, trying to decide which frightening actions will trigger us to hire help. But there is also the waiting for things to get worse, even as I realize they always are, sometimes so subtly that I don’t notice until my mother asks my daughter to pass her a plow: this time last year, my mother knew the word fork. Waiting is the clock-watching that marks my life now.

In 2020, my father wrote a note. He had clearly prepared it for a doctor’s visit and had listed in his tiny scrawl his observations of my mother:

· Uneasy with company

· Always looking at phone—even with family present

· Loss of confidence

And then a long space, and a final phrase:

· Everyone recognizes changes

He amassed this list to offer it as proof to a doctor who will later provide only the truth of the situation we find ourselves in: everything my father has observed will worsen. My father is measuring time in the distance my mother has traveled from the person he knew best to the person with whom he now lives.

As he tells me a few days ago, my mother has become someone who is irritated by everything—noise, cold, heat, surprising sounds. She finds it increasingly hard to find comfort in any part of daily life, feels as if everything is an inconvenience, a discomfort, or worse, a threat.

I find that same piece of paper a few weeks ago, and find that my father has and annotated it, circling the symptoms that have worsened, underlining and starring words. He has marked the last three years with a grammar of symbols that communicates only that everything is getting worse.

Where does the story begin? If this is a story of slow deterioration over time, where does it begin?

It is two days after my daughter is born, in an unusually cold spell in January in Washington DC. It is our second night back in our apartment, and time has collapsed into a haze of bottle assembly and diaper changes. My mother offers to stay up and hold the baby while I sleep. I offer her a piece of paper with simple feeding instructions, and wake up a few hours later to find my mother’s hands quivering.

Later I find a series of notes written in shaky handwriting that I can only guess she meant to deliver to me later: Fed baby. Crying. Fed again. Won’t stop crying. The baby is fine—her appetite governs everything and she wails until she is fed—but my mother is not. A screaming baby is a ticking time bomb, and in the quietest hours of the night, a baby’s wail is like a bleeping alarm clock that one wants to mute. In the haze of exhaustion and hormones, her inability to help felt like a betrayal, but now I understand it—I think—as the beginning of the moment we find ourselves in.

But if I think back, three years earlier, during my semester long sabbatical in Spain, I remember the week when my parents flew to visit us. My father rented a small stick shift car that, it turned out, he could not drive well. But we made it to the pueblos blancos where we ate Thanksgiving dinner in Arcos de la Frontera in a small restaurant on the side of a mountain and visited the bull ring in Ronda.

We wandered quiet winding roads in empty towns, we saw people hang orange sheets from the windows of their white buildings. Toward the end of the trip, my husband asks my mother: you know where you are, right? She smiles broadly. I have no idea.

The doctor tells us that her MRI shows white spots on her brain, that these are mysterious, and that if we want to know the full truth of what’s happening in her body, we can have the doctor perform a spinal tap and look for signs of stroke or something else.

Does it seem to you she had a stroke? I ask. The doctor shakes her head. But if we have a spinal tap, we have something the doctor amorphously calls information. It is information that will do nothing to alleviate the moment we are in. It will only confirm that a clock inside of my mother started its own rhythmical ticking before we even noticed, and by the time we did, it was too late.

In 2022, my mother is asked to draw a clock and to set it to ten past eleven. She draws the number ten. She draws the number eleven. She draws a line connecting them. That is the same year my mother refuses to buy anything at Target because the prices offend her. $10 for a bra?! She scoffs. That’s insanity. She emits a low snort which has become her trademark, a sign of disgust and indignation. She is chronically irritable, perennially upset.

But nothing upsets her more than prices. For her, the year is 1978—or so she reveals to her doctor when she is asked what time it is–and the prices of everything are far too high. The only flicker of recognition of the times we are in is when the doctor asks her who the president is. Donald Trump, she says, and lets out her snort. He isn’t the president anymore, but she’s not that far off.  And his name and her disgust have shot through her cognitive haze. She remembers to be offended, and that is something.

My parents eat dinner at our house every Sunday, but now as soon as the meal ends, my mother squeezes my father’s arm. It’s time to go, she pleads. Once the evening turns dark, she senses it is late—even when it isn’t—and she insists they need to return home to feed the cat, to get to bed, to prepare for another day.

Two nights ago, as she leaves my house, she looks at me and says I’ve known you a long time. I say, Yes, you have. She squints. She studies my face. I can see her slowly telling time. She responds I think I knew you when you were young. Yes, I reply, we have known each other forty-three years. She pauses. She stares at my face. She puts her hand on my shoulder. That’s a very long time.

She laughs. It’s the laugh that comes to her now when she can’t discern if someone is joking, the one that emerges when she wants to assure me—and maybe herself—that she knows exactly what is going on.