There’s been a bit of a scare as we transferred from the dementia train to the medical express.

It started with a cough.

It was the middle of last week, and when I pulled into the parking lot of the nursing home for an afternoon visit with my father, I spotted my sister in her car getting ready to leave. She had been upstairs, and he had briefly opened his eyes, greeted her, and promptly fell back asleep.

It might not be worth the trip upstairs, she said, since he didn’t seem likely to wake up any time soon.

But I went through the routine anyway. In to the small lobby, squirt some antibacterial hand lotion from the dispenser on the wall across from the elevator, next to the machine that dispenses candies and other goodies, then up to the third floor. Today I didn’t have to check the big common area, since I knew he was in bed.

I found him there, as described. I stood next to the bed for a minute or two, then touched his shoulder. No response. Then I gave his shoulder a slight shake. His eyelids fluttered, then opened slightly, still droopy from sleep. Or from whatever.

“Ian.” He said my name as his eyes closed again, his voice very soft, just a whisper, really.

He lay in bed on his back, sheet pulled up to his chest, feet straight out, arms resting on his torso, looking as if he had been placed in bed and arranged for viewing. It wasn’t a good image but it stuck in my brain.

Then he started to speak, again in a whisper, as if the words had to power past the weight of sleep. I had to watch his lips as they tried to put form to words.

“Your sister was just here,” he said, his voice slow, soft, and warm. “She gave me two pecks,” he said, pausing for a long second to gather the energy to finish his sentence. “…right on the pecker.” Did I imagine the edge of a naughty giggle as he lay, eyes closed, after pushing the words out? It could have been in my mind, but it seemed to me that he was aware of, and pleased by, his double entendre, just among us guys.

Then he coughed. At first, sort of a brief, throat clearing cough. Then a deep, body wracking, face-reddening cough that left him spent. Not good.

I asked him about the cough. He couldn’t speak yet, but he raised his right hand from under the sheet to tap his chest. Then he coughed again, long and hard, before settling back on the pillow, spent. I hit the button to raise the head of the bed, not quite into a sitting position, thinking that it can be easier to breath while sitting up if you’ve got chest congestion.

Then I thought back to my last visit, when he had refused to eat lunch, and wondering whether he had the strength to fight this.

As the coughing passed, he remained still, eyes closed. I couldn’t tell if he was awake or not behind the eyes, and I slipped out, heading directly towards the nursing station to report the cough.

It turned out Bonnie had already flagged it and he was on the list for a doctor’s visit.

Not a moment too soon, it turned out.

By the end of the week, a chest x-ray had confirmed some degree of fluid in his lungs. I didn’t get specifics, but I got the just of it. Pneumonia. I don’t know much about being this old, but I certainly know that pneumonia is a common cause of death in this kind of setting. The doctors office said they were proceeding to administer antibiotics and a diuretic to try to reduce the fluid.

I admit that I was slow in becoming alarmed. I’m not used to making the connection. Cough. Possible death.

It didn’t hit me until yesterday morning when my iPhone meowed while we were on the road heading in to deliver our car for servicing by the folks at Wrenchwerks. I checked the message after dropping off the car. It was a nurse practitioner from the gerontologist’s office with an update. She said my dad had a bad reaction to the strong antibiotic he was given, which caused nausea, vomiting, and more. So he had been taken off the drug. Now they’re concerned about dehydration, another killer of the aged (my editorial thought, not hers). The message went on about breathing assistance and hydration, and images of tubes and needles and drips and things medical came to mind.

Then it hit me. He completed a medical directive, which we have periodically reviewed with the staff at the nursing home. It’s basically a “no heroic measures”, “do not resuscitate” order. If he keels over from a heart attack, or simply decides to stop eating and fade away, we’re supposed to step back and let nature take its course. He didn’t want to be a human veg kept alive by machine.

But where’s the line between routine care, keeping him comfortable, and the artificial support his directive seeks to avoid? Are we supposed to let a bout of pneumonia quickly take him down without intervening, or take reasonable steps to deal with it?

As I recall, earlier discussions ended up with the “no heroics, but let the doctor make the call on immediate care,” or something along those lines.

From a cough to thoughts of terminal conditions in just a few days. Something I didn’t expect, although I don’t know what I really expect at all. I haven’t been this close to this late stage of the process of dying before.

Bonnie and I were there again yesterday afternoon. She had gotten another medical update, which wasn’t as scary, although in his weakened condition, it’s all relatively high concern. Breathing assistance is apparently a mask dispensing medication that you might get in an inhaler. They were waiting for delivery of the medication. He’s able to drink on his own, they say, and are trying to encourage that, but during our afternoon visit he managed only a single sip of water. Bonnie also offered him a small chunk of ice, which he gratefully accepted and sucked on as it melted. Small steps in the right direction.

He was awake, but still able to speak only in a whisper. He tapped his chest. “Tuberculosis,” he said.

“Not quite,” Bonnie responded gently.

He repeated the gesture. “Pneumonia.”

Pause. “Where do you think I got it?”

Bonnie again fielded the question, responding that this is all too common when you spend a lot of time lying in bed.

He was tired, eye’s open just a very narrow slit. I signaled that we should let him rest.

Bonnie tells him. “You need to rest, and get well. The alternative is not an option.”

Another pause. “Unless you want it to be.”

I don’t know if he understood what she was saying, the permissive thought behind the words. If you’re ready, we’ll understand. I doubt it, but he’s surprised me lots of other times.

Bonnie gathered up the bag of soiled clothes, all shirts this time, and we made our exit.

I’m still catching up with the transition from our concern over the course of his dementia to the immediate and separate medical crisis. How fragile it all is! I suppose that’s another valuable lesson to take away from the day.