as it travels to the little world that is 4th floor. Slow enough so that people in wheelchairs don’t have the doors slammed on them and slow enough to provide a moment of transition from everything below to everything above.

On the 1st floor are the offices and corporate things. Most everything is beautifully arranged with a view of the gardens and grounds.  A post card serenity is there with a background of light Christian music. You imagine your grandmother there. Indeed, you can imagine yourself there some day, a suburban place of rest and relaxation where, after years of work and challenge, you can literally sit on a park bench and watch the lake change with the seasons. It’s that good.

As the elevator proceeds up each floor harder things become more apparent. People who are ill. People for whom the picture postcard of retirement turned into a scrum of illness, deterioration, and a single room with a few possessions and, if you are fortunate, no roommate. 4th floor, at the top, is where this truth of growing old and changing is where that other reality is most real.

Alzheimer’s disease is an illness of the brain. No one is quite sure how you get it and no one knows how to stop it. It kills you, eventually, but not before the person you thought you were gets slowly erased one brain cell at a time until your brain simply tells the rest of you to stop living. Even a cancer has a slim chance but right now there is no chance for the person with Alzheimer’s.

There are times when the very word is fraught with peril. Imagine the mixed emotions to be descendants of Dr. Alzheimer, the person who gave his name to this terrible thing because he began the process of figuring out what it was but also a name that can strike abject terror into the person sitting across from the doctor.  If you hear that word, and the diagnosis is true, you will die but not before you change into something you wouldn’t recognize even if you could and the thought of it is a pain worse than any other illness.

The only respite is that eventually you won’t know what’s happening to you. The earliest stages are the toughest because you remain, for a while, aware of the changes, aware there is something terribly wrong happening, and you enter a world where nothing is the same even minute by minute. You can be lost within three feet of where you once stood and the people and places you knew slowly fade out of your comprehension, becoming thoughts you struggle to grasp and words that evade your tongue.  As things progress you will lose control of your bowel and bladder and your speech, if it exists, will become gibberish. You may be able to smile but the rest of the world will become a blur where you are moved from place to place and tended to like an infant because, well, you are becoming one. The one good thing, perhaps, is that your death will be quite peaceful, gentle even, as the ravages of the disease give way to a simple falling asleep.

As you ride the elevator from 1st to 4th floor you prepare for this, the people who work as helpers and the families and friends of those who bear this terrible burden. What will I see today? How will this person, or people, I care for be when the door opens and I see them in this place? At best you hope they are at a certain place of comfort and peace. At worst you prepare for what you might need to do when the ravages of this disease turn ugly inside of them. Mostly it’s a little of each.

Some can’t take it at all. Family members who can’t bear the sight slip quietly off the floor never to be seen again until the very end. There’s too much trauma, too much loss, too much heartbreak to bear to look again. That’s understandable. Others are in for the long haul, women, mostly, who come sometimes every day and keep watch as their loved one slips away. Occasionally there is a husband and wife who have taken their vows to this end, a love that refuses to die even in the face of this monstrous thing.

And when you work on this floor, this place where the sometimes forgotten and forgetting have found shelter, you make up your mind to get through this day as best you can. Things will be messy, they always are. Yet, there will also be moments when love breaks through even the horrible reality of Alzheimer’s Disease. There is a quiet confidence that even though the people you care for will forget you and the world will as well (Who, in our cult of youth, wants to remember the suffering and broken?) that God remembers and good, even when it’s never noticed, still has an eternal quality to it.

So the elevator is slow, it has to be, but you press the button for 4th floor and stay the course.