Category Archives: Aging & dementia

Still too strong for his own good

My dad’s life story may be nearing an end.

He is resting reasonably comfortably, although an occasional moan will emerge as if, somewhere, he’s feeling pain or discomfort. But he really hasn’t been coherent the last couple of days, at least not during the time I’ve spent at his bedside. There are periods where he is unresponsive, his eyes, only partially open, don’t seem to be looking at this world. Then there are moments when he opens his eyes, looks up, and says, “hello, Ian,” before drifting off into space again.

Yesterday I arrived late in the afternoon and stopped to sign in the visitor log. There I ran into one of the staff whose job keeps her in contact with all the residents. She was looking at my dad’s medical charts.

He’s been refusing food the last two times I’ve been here at meal time, and I asked if that had changed.

She shook her head. “It happens,” she said, referring to the loss of appetite and refusal to eat. The hospice folks had left a sheet of paper alongside his bed containing a discussion of food and eating, or not eating. It’s one of those things that is very disturbing to family members, but is fairly common. Kate knew she didn’t have to repeat all of this.

“He’s strong, your father. Probably all those years being athletic,” she said. Repeating herself: “He’s still strong.”

“And now it works against him,” I answered.

She got my unstated message. He’s unfortunately still too strong to go quickly or easily.

Kate shook her head. “Because he was so athletic, he wouldn’t want to be left like this.” She’s right again.

I always thought that one day he would go out in his boat several miles offshore, jump into the ocean, scrub the bottom of the boat, and then just let himself drift off. But by the time he might have seen what was ahead, he was no longer able to operate the boat on his own and instead had to rely on younger crew members. His window of opportunity had passed.

Then there was the day I found his old police department pistols in a bag on a shelf in his closet, along with a stash of old bullets. He was already showing symptoms of dementia, and I don’t even know if he remembered the guns. But paranoia got the best of me, and I lifted the bag and its contents off the shelf, took them out to the car, and turned them in at the police station. Probably unnecessary, but best not to have to worry.

But now he’s beyond all that. He can barely muster the energy to lift his hand to his face, or lift a napkin the six inches or so from his chest to the rolling table where a glass of milk and a can of high protein drink have been left.

He was asleep when I got to his bed. The other three beds in the room were empty, their occupants out in the common room where dinner was being served.

I rubbed his shoulder, his arm, his hand, signaling my presence while saying hello. His eyelids quivered, then lifted slightly, barely opening a slit for his eye to peer out at the world. We didn’t connect.

I told him that one of his oldest friends had been there to see him earlier in the day. He and Wally must have met very soon after my dad arrived in Honolulu in 1939, and they went on to found the Waikiki Surf Club soon after the end of WWII.

“Wally came to see you today,” I said in a voice louder than necessary, I’m sure. He looked up at me, his eyes blank. “He’s your oldest friend, and it was very nice of him to visit.”

I don’t know if any of this was getting through.

Then he tried to say something, but even leaning over his bed to get me ear close to his mouth, I couldn’t make out the word or words. His voice is hoarse because the oxygen tends to dry out his throat. It’s an effort to get the words out, and I feel bad that I can’t understand what he’s trying to say. It’s hard for both of us, I think.

I tell him that it’s okay, that I’m here, that he can just relax, although he’s more collapsed than relaxed, even with the medication he’s getting for pain and anxiety.

I stayed around for a while, just in case he could sense my presence. I don’t know if he did or not.

Then I slipped away, leaving him to his somewhat restless drifting.

Failure to Thrive

No, that’s not a description of what’s ailing the economy.

“Failure to thrive” is my father’s latest official diagnosis, sort of a catch-all when no single medical issue–and he has a bunch–immediately jumps out as the cause of his current decline. He’s dealing with recurring pneumonia, has lost weight, and has started declining meals, eating only sporadically, although still drinking.

I heard the term for the first time yesterday during a meeting with Sandra, a hospice nurse from St. Francis Hospice. We met in a conference room at the nursing home, along with my mother and sister.

Sandra had just come from introducing herself to my father and checking his medical records. She had already conclude he is eligible for hospice care because his weight loss crossed a specific threshold and his condition was no longer “stable”.

She their brief interaction up in his room on the third floor, she asked if he had heard of hospice and what hospice care tries to do during this end of life stage.

Sandra said he surprised her by calmly saying: “I think the Big Guy will be calling me soon.” She reported that he didn’t seem anxious as he said this.

Perhaps that’s the trip “over the mountain” that he mentioned during my visit over the weekend. I don’t know.

My sister points out that my dad’s mother died in 1982, one day before her 97th birthday. My dad’s 97th birthday will be on December 7, if he makes it.

Something’s happening

The telephone rang at home Saturday morning. It was my sister, Bonnie.

“Something’s happening.”

When Bonnie’s phone call came, I was still on my last cup of morning coffee. I had posted more scans of my dad’s old pictures earlier in the morning, including some of him in Aloha Week events that took place 60 years ago. After that, we had gone out on our regular daily walk down to the beach, paid our respects to dawn, and visited with the daily dogs along the way, then made the walk home where we had a spread of grapes, cottage cheese, a bowl of cereal, and coffee waiting.

Then came the phone call.

“Something’s happening.”

Actually, it turns out, two things were happening. Bonnie reported that when she stopped at the nursing home the day before, our father was confused and disoriented. He’s had several periods like this over the past several years, even when he was still at home. They might last an hour, or more than a day. Each “episode” leaves him with fewer faculties, although in the past he has slowly recovered from each one, just not back to the same level of the last plateau, so he’s on a gradual series of steps down the memory hole.

His doctors have previously said these are probably the visible results of one or more micro-strokes, more active short-circuits in an already diminished brain.

And, she said, he complained of nose bleed, and the nursing staff reported he coughed up spots of blood several times. They scheduled him for a chest x-ray to be done on Sunday.

Bonnie tried to fill me in quickly.

“It’s not a ‘put everything down and come right now’ situation,” Bonnie said, “but you might want to get into town today and visit,” her tone of voice undercutting the first part of the sentence.

I got the message, and soon found myself walking into my dad’s room, towards the back corner, past the three other beds, whose occupants were out having lunch in the common room down the hall.

The bed was adjusted to put him in a half-sitting position. Small plastic tubes ran over her ears and were delivering oxygen into his nostrils from a small machine that sat humming away on the floor beside the bed. His eyes were closed, mouth sagging open slightly.

The sun was shining through the window next to his bed. Through much of his nearly two-year stay in this nursing home, he has been lucky to have the spot under the window, at the end of the room on the third floor. But on this Saturday, he wasn’t in any condition to enjoy the bright, sunny Hawaiian day.

It was quiet in the room, except for the hum of the oxygen machine and occasional sounds as buses pulled up to the stop just below the window and picked up or discharged passengers. He was almost totally still, except for the twitch of a toe or hand every once in a while.

After a few minutes, one of the nursing assistants came to check on him before bringing lunch. She gently woke him up.

“Wake up, Mr. Lind,” she said, squeezing his right hand. “You have company.”

His right eye slowly opened, then his head moved an inch or two in my direction until I was in his field of vision.

Today I couldn’t see any sign of recognition. He didn’t say anything, but moved his almost blank gaze back in her direction. He tried to say something, but the words didn’t fall into place. The next sound was a low chuckle, as if he found humor in his inability to wrap his tongue around the desired words. She retreated towards the hall, leaving us alone.

I had to lean forward, closing the space between us, to hear what he said next. His voice low, raspy. The sound of a brain short-circuiting.

“What was it like on the other side of the mountain?”

“What’s the sky like?”

He could have been talking about our home in Kaaawa, but I got the feeling his mountain was somewhere else.

“I’m a day ahead of you,” he said, apparently by way of explanation.

Pause.

“But Ian can help you. He was there.”

I nod. Nothing else to do.

Seconds pass, ever so slowly.

“The hurricane, did she tell you?”

The words emerge only through effort and will power.

I tell him I haven’t heard about the hurricane.

“They went out and found a hurricane,” he repeats.

Then another mental leap.

“Any sign of Sears Roebuck?”

Followed by, after several seconds of silence: “Were the soldiers with you?”

He paused. His open eye looking straight ahead.

“How did you bump into them?”

I’m starting to feel myself spinning while trying to follow the almost random words, but the nursing assistant returns carrying a tray with his regular lunch, breaking up the moment.

There’s a bowl of what I think was stew and rice, a cup of pudding, a glass of milk, a small can of a high protein drink. She carefully opened two small packets of crackers and stacked them up.

He didn’t make any move to eat. We waited.

She broke first. “Here, I give you some,” she said, picking up a spoon, dipping up some of the meat and rice mixture, and aiming it towards his mouth, which dutifully opened on command. “You have to eat, Papa,” she said encouragingly. He chewed, slowly, chewed some more, swallowed, or tried to. The process was repeated, but on the third spoonful he exclaimed in pain. The source of the pain wasn’t clear, but it seemed to hurt when he swallowed. He refused further food. When offered the straw, he did take a few long pulls on the protein drink, then lay back.

We were left alone again.

“The hurricane,” he said. “They couldn’t get any drapery materials.”

I have no idea whether he is worried about the draperies or the hurricane.

He stared ahead. Then slowly looked at his tray, lifted his hand to point vaguely at the cup.

“It’s pudding,” I said. “You’ll like it.”

With great effort, his right hand lifted off the bed, stiff fingers slowly grasped ahold of the fork, dipped the end into the pudding, and maneuvered it to his mouth. It was just enough to taste, not really enough to eat.

His hand, still holding the fork, dropped down to the tray. He closed his eye. I thought he had dropped asleep, but then it reopened, to stare ahead at…what? I can’t honestly say.

Meanwhile, it was as if he forgot that right hand. It was still holding the fork, balanced in space and time. I don’t know how it managed to achieve such a steady state. It seemed like it belonged to someone else. After several minutes, I finally reached over and took the fork out of his fingers, telling him that he could rest.

I noticed then that the fingertips on his right hand were a pink blush, the color visible beneath his nails. The left hand, no similar color. I have no idea what that meant. It’s too late to worry, perhaps.

Then he spoke again.

“Has your mother been around? I haven’t seen her much lately,” he said.

I tell him that I haven’t seen her yet today. He makes eye contact, then slowly fades into a deep sleep.

Not too long after I left, my sister arrived and caught another interaction.

She later wrote:

He dozed again, but when a little old lady from down the hall “came visiting”, he thought she was my mother and greeted her warmly.

“Why, Mrs. Lind, I don’t see nearly enough of you these days. Won’t you sit down? Bonnie, help your mother with a chair.”

I did not correct him, and he was disappointed when a nurse came to take the lady back to her own room.

Bottom line: The x-ray confirmed that he does have recurring pneumonia. This is not good. He’s getting an antibiotic, small doses of morphine for the pain, along with oxygen. His physician has now put in a referral to hospice care, which will be handled by St. Francis, if he’s approved. We meet tomorrow with the hospice nurse to learn more.

Bonnie writes: “I wish him a fearless mind and a peaceful heart.”

Well said.

[text]Was it a coincidence that I just found this small, somewhat blurry photograph at the end of last week? On close inspection, it’s my dad at the finish of a mile race while running track in high school. The year had to be 1932 or 1933.

In the photo, he’s caught mid-stride, both feet just off the ground,
his eyes fixed on the finish line ahead, his closest competitors visible far behind, spectators watching him pass, one even stepping onto the track for a better view.

Click on the photo for a larger version.

An accompanying undated news story identifies the event as the Eighth Annual Coast League track and field meet held at Fullerton.

Johnny Lind of Wilson furnished the biggest upset of the day when he won the mile by six yards from Mallery of San Diego. Lind’s victory fell like a bomb among the Coast League Schools.

He was, they say, a great high-school miler.

From another clipping: “That beautiful stride of Lind’s is greatly feared by many of the best milers in Southern California.”

Now I wish I had seen him run, but this is as close as I’ll get.

No wife, he said.

It’s been over a month since my dad’s brush with pneumonia. We were all lucky, I suppose. He survived, despite the bad reaction to antibiotics, and has been been on a long, slow recovery trajectory.

For several weeks, he was just exhausted. Slept a lot. I admit to visiting less.

In the past couple of weeks, his physical health and mental condition have been on separate tracks. Sometimes they are running parallel, sometimes there’s a big divergence. And things seem to change quickly. I think of that image of the wobbling track of a hurricane, like a bottle in a current. It’s on a general track in one direction, but it wobbles along that track in a way that can create significant differences.

When I stopped to see him early last week, he was in bed, but agitated and very upset. He wanted to know if I had heard anything about “what’s happening.”

“No,” I replied cautiously, not knowing what he was talking about.

Then it came right out.

“When I got home last night,” he said, serious, making eye contact with me. “I didn’t have a wife. She was gone. She moved out on me. I think she moved in with Bonnie.”

“Home” is in Kahala, the house where my parents lived since somewhere around the beginning of WWII. He hasn’t been home, at least not physically, since a couple of days before Thanksgiving in 2008. Bonnie is my sister. She’s been living with my mom in Kahala to assist since before my dad ended up in this nursing home.

He was very worried about the situation and my mother’s absence.

“I don’t understand why she didn’t call,” he said.

Okay, I can understand that, at some level, he’s worried she hasn’t been here to visit very often. She’s at home dealing with her own mobility and health issues, and getting to his bed on the third floor of the nursing home becomes a major expedition.

Then it got worse.

“There was a Japanese guy in the kitchen, and he looked like he had been invited.”

All this took me by surprise, and I really didn’t know how to respond. I think I told him that one of her club meetings probably just ran a little long, but that I would check it out.

He closed his eyes again for a minute or so, then looked up at me.

“I pulled out a couple of chafing dishes, just in case,” he said, then launched into an explanation of how these can be used for warming, or for steaming, like a double boiler.

This is something he would have done back when he ran his own restaurant supply company. He would pull stuff out of their inventory for various needs. Last minute Christmas gifts? Head for the stockroom. Birthday? Pull out a frying pan. Today he spoke as if he really had just opened a few boxes and dug out their contents. Just in case.

Meanwhile, I was trying to guess the source of the brain short-circuit leading to the sighting of a Japanese man “in the kitchen.”

Did he catch sight of the man in the next bed, which he continually forgets is there? Did a new nursing assistant deliver his meal? I never did quite figure that one out.

Despite floating in the fantasy zone, he surprised me with a couple of other mental jumps that showed his brain can make connections. When I mentioned that one of Meda’s sisters is moving to a home in Menlo Park, California, he quickly pointed out his cousin, Bill Fairley, had lived in Menlo Park. And then he remembered the name of one of the people in an old photo I showed him on my previous visit. In the picture with my dad were Duke Kahanamoku, Dad Center, and several other unidentified men.

“Ward Brewster.” I didn’t know what he was talking about. “Ward Brewster, I think he was the short guy in the picture. He was around the beach a lot.”

He remembered the photo, and added another name to it.

Then Bob, the 3rd floor nursing supervisor, stopped in.

My dad called out cheerfully, “Hello, Paul!”

He thinks that he’s talking to Paul, who apparently welcomed people to the old Commercial Club in downtown Honolulu. The business club was upstairs from the Dohrmann Hotel Supply Company, where my dad worked from the time he arrived in Honolulu in 1939.

Bob knows the story, and doesn’t mind at all being “Paul”.

Another day, another visit. On this afternoon, I found him in bed, but his voice was clear and strong. His mind, though, was someplace else.

He greeted me by name, but that was the high point.

He closed his eyes.

Opened them.

Asked me if my friend was still visiting.

I didn’t know what he was talking about, but didn’t want to argue.

So I said, no, they’re gone.

He asked: “Did she leave yesterday?”

She? Again, I was winging it.

“No, earlier in the week,” I sputtered.

He asks: “When does your wife get back?”

Oh, oh. I tell the truth.

“She wasn’t gone. She’s been here.”

He looked at me.

Closed his eyes.

Opened his eyes.

“Who’s the guy having all that fun?”

I ask, puzzled, “which guy?”

“The one on the golf course,” pointing across the room towards the hall.

I had to just say that I didn’t know.

Then, trying to say something more, he managed only a few slurred words. I couldn’t tell whether this was the sleep, vague state of mind, or another micro stroke, of which he apparently has had many.

He had lunch in front of him and, when he next opened his eyes, was surprised to see it.

He asked: “How long has that been here?”

Then: “Was I here when it came in?”

It took several seconds, then he understood that he must have been there, since he was in the bed and apparently hadn’t been anywhere in a while.

He looked at the food, but didn’t eat anything.

Then he closed his eyes again and was asleep.

And so we continue on this winding path.