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.

This is getting to be a routine for me, a Saturday visit to see my dad, arriving at the Oahu Care Facility late in the morning, probably just after 11 a.m.

Meda dropped me off and drove down to check out the Goodwill thrift store, just a few blocks farther along Beretania. I waiting for the elevator, rode up to the third floor, signed in at the nurses’ station, and went to find him.

He was seated alone at the table normally occupied at mealtimes by the small group of men who live on the floor. When you reach anything near his age, women outnumber men by a large margin, it seems. He was dressed in a yellow t-shirt, with pocket (he insists on a pocket), and fleece pants, probably from Costco, and his old and now comfortable New Balance walking shoes.

He looked at me with surprise, and we began with what has now become the normal routine.

He asks: “How did you find me?”

It really is a mystery to him. But today he adds another layer. “How did you get past the security?”

“I’m a reporter,” I tell him. “We have our ways.”

He seems satisfied.

Then he points across the room.

“I’m looking at those two big ice machines over there,” he tells me, gazing into the distance. “But you’ve got to know the code,” he says, as he says four or five numbers, something sounding like a bank security code. Hence, I surmise, the question about security, although I have no idea what ice machines and security have to do with each other. Perhaps his mind is back on one of the kitchen projects he did for the military, some of which were in secure and little known locations on the island.

But I don’t see ice machines. Instead, across on the other side of the large room, perhaps two dozen women are sitting around several long tables while a male nursing assistant in his green outfit dances, microphone in hand, singing lackadaisically and more than slightly off-key while accompanied by a bland karaoke tune. Some are watching, others are off in their own parade. A television is on in the front of the room. Perhaps it’s showing lyrics, but somehow I think it’s also off on its own independent trajectory.

From where we’re sitting, it’s just loud and chaotic, music and unconnected images flying at us. Somehow my dad is is able to ignore the ruckus.

I expected him to ask about my absence, since I haven’t been here since we took off for a week in Portland, but it doesn’t come up. I don’t know that he processes time any more.

I ask how he’s feeling, and he complains about being tired. It fits with my sister’s report that he has slept through several of her recent visits.

Today I’ve brought along my iPad after figuring out how to load it up with several of the short videos I’ve made of our cats and the neighborhood dogs in Kaaawa. I also happen to have some pictures from our trip to Portland last week.

I play an older video of our cats going a little nuts over some fish that I’ve cooked. He looks at the screen. Not much reaction. I follow that with another video, this time of several large dogs, and I’m not sure if he’s connecting with it at all.

I stand up and walk back to the end of the room where his walker is standing against the wall. There’s a green fanny pack hanging on it. Luckily, when I unzip the main pocket, his glasses are there. I bring them back, set them carefully on his nose, tuck the frames over his ears. He takes over, one hand shakily adjusting their position.

Then I return to the iPad, switching to some of the Portland photos. There are several from a walking tour we went on, so the photos show our small group standing on street corners listening to our guide tell a story.

My dad reaches out, touches the iPad, and of course the photo responds. His finger touches the screen, and the photo moves, or gets bigger, or disappears. I try to keep up, keeping the flow of pictures going.

Then he stops, looks over at me, then at the current picture. He’s lost.

“Am I looking at fish?”

Now he’s got me flustered. How do you respond to a question like that?

“No, not fish. The fish was back in the movie with our cats. This is a group of us standing across the street from the main Portland library.”

Now I understand. His vision is about gone. He’s got cataracts growing in both eyes. Fish, people, cats, ice machines, piano, we all look pretty much the same when broken down into light and dark, shapes and motion. Memory going fast. Vision following. I can imagine this adds a lot to his normal state of confusion.

But then I discovered a batch of his old black and white photos that I forgot had been transferred to the iPad.

I chose this one at random.

He peered at the iPad, and I assumed he wouldn’t be able to make out anything. I was wrong.

After a pause of just a second or two, he said it had been taken at a meeting of the Geneva Club, a group of food service professionals. He pointed to himself, then identified each of the other men in turn. At least as far as this photo, he was not confused in the least.

Then lunch interrupted. A nursing assistant delivered his tray, then came around the table, opened up the paper bib, and stuck the two small adhesive spots to his shirt. Lunch was pretty basic. A glass of milk, a small can of high protein drink, a cup of pudding, and a bowl of what looked like a thick meat and rice soup.

My dad methodically removed each item from the tray, set them on the table in front of him, and then announced that he didn’t want any of it.

“I don’t usually eat anything at lunch,” he said, looking stubborn.

“You eat it,” he said, waving his hand at the table.

I’ve got a defense against the “you eat it” offer, and I throw it out quickly.

“If I eat it and wreck my appetite, Meda’s going to be upset.”

He nods. “You’re right,” he says. Nothing more needs to be said.

I had a small camera, so proceeded to take several photos, holding the camera at arms length and squeezing off pictures, one click at a time. Then I show several to him.

We both managed to get into the picture. He’s the one with the short, dark hair. I’m the one with the longer, graying hair and beard.

I ask him: “Who is that old guy with you in the picture?” He peers, but doesn’t get the joke.

Over the next 10 minutes or so, he didn’t even pick at the food. Finally, he took a sip of the protein drink. That was good. Usually once he breaks, he discovers that he is in fact hungry. But I don’t know if that happened on this day. I didn’t wait to find out.

I told him I was leaving. He nodded.

Then he looked out across the room.

“Have you noticed how many people are in wheelchairs these days?”

It’s clear that he doesn’t understand where he is and why he sees so many wheelchairs. That’s probably a good thing. Understanding the whole picture of where he is and why he’s there would be pretty depressing.

I put my hand on his shoulder and tell him that I’m taking off. He offers a goodbye, then turns back, probably to enjoy the view of those ice machines.

July 5th was a holiday, and we drove into Honolulu so that I could drop in for another late morning visit with my dad.

I usually get over to his nursing home in the late afternoon. He’s almost always in bed, and if awake he’ll ask me what time of day it is and, invariably, shake his head in amazement and disbelief when he hears that it’s late afternoon rather than early morning.

But on this Monday morning, his bed was empty. I returned to the large common room on the third floor, where group activities fill the period between breakfast and lunch. I didn’t see him in his usual spot at the table where the men gather for meals. I was starting to get worried when a couple of staffers pointed out where he was sitting, a spot which was hidden behind a column in the middle of the room and out of my view. He was seated in a chair about mid-way down this long table, one end facing a television set on a smaller table against the wall, a large American flag hanging from the ceiling behind it, a schedule of activities for the day hand-written on a small notice board. The other end of the table points towards the door into the hallway, where the nursing station overlooks the small lobby and elevators.

He was dressed in a light color t-shirt, long fleece pants, and his pair of dirty New Balance walking shoes with elastic runners laces that don’t need to be untied and retied.

He was surprised to see me, said hello, and asked after Meda. That was good. He knows who I am.

I asked how he had been.

“I’ve had a busy morning,” he said. Then, with a conspiratorial whisper, “but don’t ask me what I was doing!”

Then a look of confusion took over his face.

“Where am I? I don’t know where I am.”
He shifted in his chair to see a bit more of the room.
“I don’t recognize this place.”

Some months back, he sat in about the same spot and proudly told me it was the Commercial Club, a gathering spot for businessmen back in the period around WWII soon after he arrived in Honolulu to work in a downtown business. The Commercial Club was on the third floor of the McCandless Building on Bethel Street, while Dohrmann Hotel Supply Company of San Francisco, his employer, occupied the ground floor. This room is on the third floor of the Oahu Care Facility, a skilled nursing home on Beretania Street just past McCully. I don’t know if he realizes that he’s actually still on the third floor.

On that earlier day, he pointed to the piano in one corner of the room and told me about the great entertainment the Commercial Club presents, and he pointed out the window where, he recalled, one could look down Bethel Street towards the harbor.

On that day, he didn’t connect to present-day “reality”, but at least he was able to be present in some reality, whether by choice or by luck of the synapses.

But on the morning of July 5, 2010, he was simply lost and worried. This is far worse.

I reminded him that we were sitting just down the hall from the room where he’s “been bunking” (his description from another day) for a while.

That didn’t seem to click in his memory.

“Anyway, I’ve got to be going,” he abruptly announced, starting to fidget in his chair.

I asked where he was going.

“I think…,” he paused, eyes searching some unseen place. “It think it’s at the restaurant. I just got word.”

He thinks again, trying to fill me in on his situation.

“I think it has something to do with taxes.”

So I tried again to deflect his worries.

“Your taxes are all finished. They got turned in on time.”

He looked at me, the one eye clouded by a cataract looking a little cock-eyed.

“When?”

I count back to April 15, and tell him that the taxes were finished and turned in nearly three months ago.

It isn’t clear if that calmed him or whether the unexplained passage of time triggered more worries.

“And you can’t leave now because lunch is coming,” I said. Meals are one of the recurring events that give lives here on the third floor their daily structure, but repetition doesn’t help if you can’t remember it.

“I didn’t order lunch,” he fires back, still squirming in his chair in anticipation of getting up and heading out to “the restaurant”.

He’s very surprised when I tell him that they have his regular lunch on order.

“They know what you want,” I explain. “And it’s all taken care of. It comes with the room.”

He looks at me again, surprise spreading across his face. Although its the same meal routine that he’s had daily since moving into this facility 18 months ago, it’s all news to him.

“What a deal,” I add, hoping that the thought of getting a room-plus-meal bargain will make this son of Scot immigrants more receptive to staying put mentally as well as physically.

He shakes his head, still surprised by the idea that they already have his lunch order. “Well, I guess you learn something every day,” he says with a hint of amazement.

The actual conversation went a lot slower, with long pauses in between sentences. Meanwhile, staff were getting other people ready for lunch, moving some in wheel chairs over to the table. We’re the only males at this particular table. It doesn’t seem to matter. No one notices.

Then the tray arrives. Plastic covers are removed to reveal the lunch. A bowl of clear broth. A cup of pear halves. A dinner plate with green peas, a scoop of rice, and something that looks like creamed chicken. A glass of milk. A small can of a high protein drink. Straws are dropped into place.

He looks up at the nursing assistant who delivered the tray.

“Is this taken care of?”

He looks around, then back at her.

“I never seem to have any money in my pocket any more,” he explains.

“Oh, Mr. Lind,” she responds brightly, “everything is free!”

The last word thrown out with a lilt as if freeing it from the rest of the sentence.

My father gets a sly tone to his voice, then quips, with a smile embedded in his voice: “Be careful how you say that!”

I sat with him as he started to taste the food, very slowly. He picks up a few peas on his fork, his hand shaking a bit but manages to reach his mouth. He chews, pauses. A few more peas. Then the tiniest taste of rice. Pause. More peas.

I can see that, at this pace, lunch will take quite a while.

Across the table, two women are being spoon fed by staff. I don’t know if my dad notices. I get the sense that much of the time, his world extends out about as far as he can reach. Anything beyond that doesn’t get processed.

I tell him that Meda and I have to go shopping now in order to get back to Kaaawa in time for an afternoon nap.

“Then you’d better get done soon,” he says with a chuckle. I think he’s looking forward to finding his room and taking his own nap. When he wakes up, he’ll assume it’s morning, although in our reality it will be late afternoon.

There’s a moment of mental whiplash every time he awakes. Luckily, after it passes, he doesn’t remember.

I finally got to connect with my father yesterday, a little more than three weeks after my last visit.

First there was our absence, a brief trip to the east coast, then the nursing home implemented a quarantine on his floor because of an outbreak of an intestinal flu that lasted over a week, and just as they were authorizing visits again I caught a cold and stayed away to avoid sharing those germs with him.

I was feeling more than a little guilty, especially with Fathers Day around the corner and no special plans. I’m still coughing a little, but it’s been several days since I’ve felt any active cold symptoms, so I stopped in yesterday afternoon.

He was awake and laying in bed, dressed in a bright t-shirt, hands behind his head, and relatively alert. He greeted me warmly. As I started to apologize for my lengthy absence, I could see that he wasn’t aware of how much time had passed. So I switched gears from an apology to a report on what’s been happening in which our trip, the quarantine, and my cold were parts of my own saga, and he could follow them as part of my narrative.

I’ve noticed that he has different modes. There are days when he seems very tired, his voice thin, reactions slow, and he’s confused about where he is. There are days when he is quite alert, recognizes family and staff, carries his end of a limited conversation, and the question of location, mental or physical, doesn’t come up. Then there are days like yesterday, where he seemed alert, his voice strong, he recognized me when I arrived and made the mental connection to asking about Meda, but some synapses were just misfiring and our conversation became disjointed and, well, humorous.

But first he had something to say. His voice low, just above a whisper.

“Somebody was injured,” he said, his eyes signaling to the right, beyond the curtain that separates his bed from the other three in the room. “I think they wrote it all down, take a look.” His face said, “what happened?”

Now my dad, who often complained about the television or other sounds from the other side of the curtain being too loud, now is worried about the silence.

I did look. The next bed was freshly made up, its former occupant gone, along with his television set, the stack of DVDs that his family supplied, the little tray of snacks from recent visitors. No notes, no indication of what happened.

I said I would check. Later.

I tried to tell him about my purchase of a new laptop computer, a factory reconditioned 15″ MacBook Pro to replace my aging and, by today’s standards, much slower model. I tried to describe the anxiety produced by the process of transferring all the programs and files from the old computer to the new one. I described it as being like moving to a new desk, and having to move all your files, books, papers, pens, pencils, typewriter, supplies, and everything else from one to the other. I could tell that he was a little vague on the computer images, but the idea of moving things in the office and tidying up a new desk seemed to get through. He nodded as I tried to embellish my telling side of the story. I wrapped up by telling him that I thought I had succeeded in moving everything over to the new computer and was already enjoying working on it.

He thought about it. Then he asked: “Are you going to throw all your papers away?”

I thought fleetingly about trying to explain, these were computer files and not paper files, but then thought better of it. “No,” I said, “I hope not.”

Then I mentioned what I paid for the computer. As I mentioned, it’s factory reconditioned and comes with a full Apple warranty, and sells for several hundred dollars off, even well below the “education” discount that Meda qualifies for. But it was quite obvious that the price tag, which sounded so reasonable to me, broke the bank from his 96 year old perspective. During most of his life, prices were obviously a lot lower than today.

He looked at me, a sense of wonder or surprise reflected in his expression, and let a comment about the price slip out.

“Does your mother know that?”

I laughed, mostly because I couldn’t tell if, in his mind, “mother” referred to my mother, his mother, or my wife, and I didn’t want to spoil the little joke by trying to clarify.

At some point I mentioned my sister, Bonnie. She is there to see him every couple of days, but my mention of her name started him going.

“Bonnie…Bonnie…there’s a name of someone….” He paused, rubbed his eyes, then looked long and hard at his fingers, their age showing. “Bonnie. That’s someone who can’t visit me.” At least I think that’s what he said. He might have said, “can’t see me”. Either way, I wasn’t sure what he meant. I’m guessing his mind was going back to the recent quarantine when she was able to make a quick stop to deliver clean clothes but wasn’t allowed to really visit. I told him that, according to the log at the desk, she had been to see him just a day or two before, and recalled that she mentioned he had been asleep and didn’t wake up during one or two of her recent visits. Maybe she also explained that he had slept through a visit or two. But he didn’t seem to connect to any of my explanations, so I just let it go.

Then my phone rang. It was someone wanting to get together to talk about a new web site “coming soon”. When the call was finished, I commented that these fancy computer phones mean that work follows you everywhere.

He put his hands back behind his head, relaxing.

“What time is it? What time of day?”

I tell him that it’s around 4 p.m., and dinner will be coming in about an hour. “Still time for a short nap before you eat,” I tell him.

He just settles into his pillow.

“Wouldn’t you like to have my schedule?”

He looked pleased with himself, and totally comfortable. Usually I’m never quite clear on what his schedule looks like in his own mind. He has often imagined that he had been out doing business, traveling the islands to visit customers or make sales calls. Now, though, it was different. He looked like someone on vacation. At ease.

Now he knows that he sleeps, he gets up late, gets to eat three meals a day, and there’s always someone nearby if he needs assistance. He used to be anxious much of the time. Now he seems to be accepting it as it comes.

But it wasn’t too long before he had started to fidget. “I don’t want to take too much of your time,” he said, as if he had dropped in on me unexpectedly. He fiddled with his shirt, pulled on the bed sheets, reached under to feel whether he had shorts on.

I thought he seemed to be preparing to use the plastic bottle, usually somewhere within reach, that he can use to relieve himself without all the struggle of getting out of bed and across to the bathroom. I spotted it hanging on the railing at one side of the bed and set it on the rolling table within easy reach.

He looked up at me, surprised but smiling. “Oh, you want to use the bottle?” He reached out to hand it to me.

I think he was aware and was making a joke, which, it seems to me, requires a degree of self-awareness that he doesn’t always seem to possess. So I took it as a good sign.

In any case, it became my exit line. On my way out, I told him that I would see if I could find out what had happened in his room.

I asked one of the nursing assistants out in the hall, pointing to the small series of photos just outside the door which contain pictures of the men assigned to each bed in the room. There was no photo in the place reserved for the man in the next bed.

“Did we lose one?” I ask, my question unintentionally ambiguous.

“Oh, he went home,” she replied, then moved on with a meal tray in hand, heading into a room across the hall.

I don’t know if that was the sanitized answer authorized for the families of other paying guests, or whether it was the factual answer. I can imagine it either way. But I’ll take it at face value and tell my dad that the other man went home. On second thought, I worry that this line of thought will get him back fixating on finding where he parked his car, locating his keys, which he knows have been “missing”, and driving himself home. So maybe mentions of “going home” are not a good idea.

Perhaps it’s best to just kick the can down the road, as they say, like Gov. Lingle with the state budget. “I’m haven’t gotten a good answer yet,” I’ll say if he asks. That’s one of the tricks. Defer, delay, stall, and in a few minutes he usually won’t remember what he had been worrying about. And it will be a couple of days before I get back to see him. A lot depends on his schedule.