When one is the sole caregiver for another person with a permanently disabling condition combined with dementia, there is a major--and permanent--paradigm shift.

The shift is from the previous paradign, usually one of partnership, the two partners in some loosely defined arrangement of equal partners or (more commonly) Master Partner-Junior Partner relationship.

Then one of them develops one of those life-altering conditions.

The shift is to a paradigm of Therapist/Servant. The need is for the caregiver to become many people: pharmacist, dietician, errand boy, chauffeur, maid, hairdresser, body servant, etc. But above all to become a therapist and provide a therapeutical environment for the patient 24/7.

It's a whole new world, requiring that the therapist/servant subsume all personal needs to the needs of the patient, convert all personal reactions to therapeutic and supportive expressions verbal and non-verbal, provide services wide and varying. Not to mention developing rigid self-control over emotions and reactions.

The transition time between the two paradigm stages is like Elizabeth Kubler-Ross's description of how someone mourns a death, with all the stages of denial, anger, bargaining, etc., until finally reaching the stage of acceptance. It is as it is, and the thoroughbred racehorse must be broken to the shafts of the cart at last.

Once the new paradigm is accepted, the therapist/servant can turn to learning the new skills required best to serve. Taking classes in practical nursing? Taking courses in psychology and counseling? Or just learn from trial and error, as with so many of life's skills.

In my next incarnation I want to be a cat.