I can unequivocally sum up the progression of my grandfather’s degenerative disease in terms of three different card games.

I’m 8 years old when I pull out the well-loved Uno cards, held together by an unappealing gray rubber band. My grandpa cackles in feigned agony when I gleefully slam down a “draw four” card. He makes me shake his hand when he wins to maintain my sportsmanship, but this rarely happens because he always lets me run out of cards first.

I’m 12 when my grandpa introduces me to gin rummy. The game’s sophisticated reputation makes me feel mature, and I still get a rush of pride whenever I end the round with more points. Complicated rules become difficult for my grandpa to follow, so our game nights last longer now. I don’t mind.

Hearts has been our game of choice for a few years now. I’m 17, he is 71. My grandma joins us now because you can’t play hearts with only two people. We wait patiently for my grandpa to process his next move, never pushing him to speed it up. We keep discarded piles on the table for an extra moment so he can organize his thoughts. Somehow, my grandpa still manages to win nearly every round.

My grandpa has primary progressive aphasia (PPA), a degenerative form of aphasia that impacts speech and language skills, and eventually short-term memory. Dissimilar to more well-known types of dementia or aphasia like Alzheimer’s, PPA generally doesn’t affect longstanding relationships due to memory loss. Instead, it strips away a person’s ability to communicate after years of difficulty recalling words, and comprehending speech and spelling.

Unlike Alzheimer’s, PPA is extremely rare. Google offers no graphic representation of the condition, as it does for nearly every other disease, and merely searching “PPA” leads to photography blogs or police association websites.

My family’s extensive research of PPA has yielded minimal results for just this reason. Up until a couple of months ago, my grandpa still had no formal diagnosis. Doctors had labeled him with varying levels of likelihood for several different forms of dementia, the two most likely types being PPA and Lewy Body Dementia (LBD).

Though not as rare as PPA, LBD is still scarcely researched. Being a certified form of dementia, LBD has a worse prognosis than PPA and is much more likely to result in long-term memory loss. However, it does offer many more expert doctors and potential treatments due to its relation to Parkinson’s disease and higher patient frequency.

For years, my family dreaded the day we would get a formal diagnosis. We would either be trapped in the unknown with PPA or the researched severity of LBD.

Receiving an official diagnosis of PPA was a terrifying relief. Being able to rule out LBD and its frightening statistics was reassuring, but realizing that I could no longer hide behind the unknown of my grandpa’s situation wasn’t something I had prepared myself for.

Getting a real diagnosis meant taking the little information we had seriously. When aphasia associations stated a typical prognosis of five to 10 years after diagnosis, I became cognizant of the fact that 10 years would never be enough. When numerous websites told me that the overwhelming majority of PPA patients would eventually become completely mute, I was forced to accept the fact that our routine activities may one day become unattainable.

After months of pleading with my mom in the fourth grade to pull me out of after school care, my grandparents agreed to watch me until 5 p.m. every weekday. My grandpa soon grew tired of me watching SpongeBob each afternoon and decided to intrigue me with a sort of weekly field trip.

Every Friday after school, instead of returning straight to my grandparents’ Beaverton home, my grandpa and I would drive to a new public or school park. Over several months we toured dozens of playgrounds in the West Hills, Southeast Portland and Hillsdale. I distinctly remember the deciding factors that would make a play structure impressive: an old, dangerously fast metal slide and a merry-go-round, which had become a rare treat in the parks I usually frequented.

At that point in my life, my relationship with my grandpa truly helped me handle the changing dynamics in my family. Having grown up an only child to working parents, I aged quickly in terms of my social and emotional abilities. My grandpa was always the only person in my family who treated me as mature as I felt. As I struggled with family issues entering into middle school, he was also the one who allowed me to lower my guard and act like the scared kid again. Having an unshakable bond with someone I knew would always support me was invaluable.

The last two weeks of December is when my grandpa comes entirely alive. His list of endless Christmas traditions electrifies him: chopping down a tree from a Douglas fir farm in Scholls, Oregon, shopping for my grandma’s gifts at the Washington Square Mall Nordstrom, cooking turkey and honey baked ham for Christmas Eve.

There’s one holiday tradition that especially connects my grandpa and me. Every Christmas morning growing up, he would pass out presents individually to each member of the family. He portrayed a sort of Santa character that I found both whimsical and admirable. As early symptoms of PPA started to inhabit my grandpa, he began to struggle to quickly read the names handwritten on the snowflake-shaped gift tags.

Once I turned 11 or 12, I took over the tradition of passing out presents. I felt a new sense of pride and maturity that can only come with others’ trust.

Nearly six years later, I still share the routine of Christmas morning with my grandpa. He sits in his decades-old leather chair, laughing jovially with my relatives, while I tactfully hand gifts to each member of my family. My grandpa never lets me decide what presents my grandma should open first; that’s still his job.

I can’t pinpoint when my grandpa’s symptoms first started. My mom tells me they have been there since before I can remember, but I refuse to believe that. I yearn to be able to say that I have known my grandpa before short-term memory loss and difficulty locating words took over his communicative life.

Doctors struggled with diagnosing my grandpa due to the gradualness of his symptoms. Typically, PPA patients are first diagnosed when they notice an early sign and end up severely impacted only three to 10 years later. However, my grandpa remains at relatively similar stages of his illness for months, even years, at a time. I can only notice the progression and severity of his symptoms after conversing with him for several hours. Only then do I realize the number of times he has lost his train of thought or I’ve helped him recall a simple word.

I find myself most affected by PPA not when a discussion takes longer than usual, but when my grandpa complains about my busy schedule. Or my excessive amounts of homework, or my frequent trips out of town. I am consumed not by disconnection or wishing for the past, but with overwhelming guilt and despondency.

I resent my challenging course load, a part-time job and standardized tests for robbing me of time I could be spending with my grandpa. I long for the weekends in middle school where I could spend days at my grandparents’ without missing work or important social events. Guilt wholly and overwhelmingly consumes me every time he alludes to how long it’s been since we’ve seen each other.

I do see my grandpa fairly regularly during family dinners, but we are never able to exchange more than 20 minutes of conversation. I detest the fact that I have to strain my relationship with my grandpa to maintain relationships with my other relatives. I feel contrite every weekend that passes that I’m not making the most of time, of life, with my grandpa by spending quality time in the comfort of his own home.

I haven’t played a game of hearts in months.

I am beginning to accept that I am a busy person, and that doesn’t make me a bad person. I can prioritize time with my grandpa to build a better relationship with him, but he will continue to recognize our bond even if we don’t see each other for months.

PPA will never define my grandpa. Knowing that his issues with communication can only progress and not improve is remarkably difficult for me to accept. I find myself leaving meaningful conversations ecstatically, forcing myself to forget the countless prognoses. Still, I am so incredibly grateful for the slow and gradual characteristics of his symptoms that allow me to continue to confide in and converse with him.

Neither doctors nor my grandma nor I know what the future will look like. I have no idea what I will be coming home to from college over Thanksgiving and Christmas break in just a couple years. All I know is that I will continue to enjoy my grandpa’s cooked turkey, laugh at his extraneous choice of Christmas tree and perform the paramount tradition that once belonged to him.