People absolutely assume I know exactly what to do because I'm a physician and a surgeon. The truth is, my medical degree didn't come with instructions on how to watch my mother slowly change before my eyes. I understand the science of dementia, but I still wrestle with the emotions, the uncertainty, and the countless day-to-day decisions that every caregiver faces. At the end of the day, I am her daughter first. Love doesn't make you an expert. It makes you vulnerable.

It did both. I recognized subtle cognitive changes much earlier than most people probably would have, but that awareness came at a cost. I knew what vascular dementia could mean. I knew there wasn't a cure. I understood the possible trajectory before I was emotionally ready to accept it. Sometimes knowledge is a gift, and sometimes it's a burden.

Sometimes they assume I don't need explanations because I'm a physician. Other times they speak only to the doctor in me and forget there's a daughter sitting in the room whose heart is breaking. The best clinicians recognize both. They respect my medical knowledge while making space for my humanity.

I need them to see both. My clinical background helps me understand complex decisions, but I still need empathy, reassurance, and compassion. In those moments I'm not presenting at grand rounds. I'm advocating for the woman who taught me how to be strong.

The relentless nature of it. Dementia never clocks out. Balancing surgeries, patients, teaching fellows, residents and students, administrative responsibilities, research, and then coming home to another full-time job as a caregiver can be overwhelming. There is no residency that prepares you for chronic anticipatory grief.

Many people think dementia is one disease with one predictable course. Vascular dementia often progresses differently. It can decline in steps, fluctuate dramatically from one day to the next, and many patients have mixed dementia with Alzheimer's disease as well. Families often become confused because one day their loved one seems almost like themselves, and the next day they don't. Those fluctuations are real.

It has changed everything. I don't just ask about symptoms anymore. I ask the caregiver how they're sleeping. When was the last time they ate a meal sitting down? When was the last time they laughed? Caregivers are often invisible in healthcare, yet they're carrying the entire system on their backs. I see them now because I am one.

I had to let go of the belief that I could fix everything. Physicians are trained to solve problems. Dementia teaches you that sometimes your greatest contribution isn't curing someone. It's loving them through something you cannot change. That lesson has humbled me more than any medical training ever could.

I wish every medical student, every resident and every fellow trainee had to spend several days living the life of a caregiver. Wake up multiple times a night. Help someone bathe. Manage medications. Navigate insurance. Miss work. Feel guilty for wanting an hour to yourself. We teach diseases beautifully. We don't teach what it feels like to live beside one.

Take off the white coat when you walk through your loved one's front door. Let yourself be a son, daughter, spouse, or sibling. Accept help before you think you need it. Don't confuse independence with strength. The strongest caregivers are often the ones who know when to lean on others.

I'm still learning that “No.” is a complete sentence. Exercise, meditation and prayer have become non-negotiable because they protect both my body and my mind. I've learned that saying yes to every request ultimately means saying no to my own health. Self-care isn't selfish. It's how I stay healthy enough to keep caring for the people who depend on me.

The turning point came when I realized I had shifted from trying to restore my mother's independence to preserving her dignity. That changed everything. Instead of asking, “How do I get things back to the way they were?” I started asking, “How do I make today meaningful?” That question transformed both of us. I also realized that your 'chosen family' is just as important — if not MORE important — than blood. Also: People will be people, so “LET IT GO!!”

People talk about memory loss, but they rarely talk about ambiguous loss. Your loved one is physically here, yet pieces of them slowly disappear. You grieve over and over while they're still alive. It's a unique kind of heartbreak. But here's what I've also learned: joy doesn't disappear. It simply changes its address. Sometimes it's found in a smile, a familiar song, a shared dance in the kitchen, or a hand squeeze that says everything words no longer can.