Monday, August 22, 2011

Threatened by shadows at night, and exposed in the light

So, you may recall that a relatively short time ago, I said something about letting my then-kinda-crazy 85-year-old dad make his own choices in life, like to live alone even under circumstances that would constitute elder abuse if they were imposed upon him by others. I swore I wouldn't override his will even if he was acting against his best interest. I also used a qualifier that amounted to something like: "as long as he is competent to make that call."

How quickly things can change.

I was away two weekends ago on a king-hell fantastic hiking weekend with one of my sons in New Hampshire. I even blogged about it here. I also gave my dad a call just to check in on him, and things weren't right. I mean they *really* weren't right.

He was telling stories about having fallen (not terribly novel for him) but the explanation was different than the usual routine of just having misstepped. Instead, a phantom "he," later identified as his handyman, Rich, had boobytrapped the house and even stood over my dad laughing as he struggled to get off the floor. The same "he" was a frequent visitor. "You hear him in the early morning hours. Tap tap tap on the walls. Trying to drive me crazy." Oh boy. Then he said Rich had stolen his shoes, his keys, a pair of sneakers and his wallet. I had a feeling I might find them pretty easily.

So when I got back to the Philly area, I took a day off from work and headed over there to see just how far gone he was. I don't think was quite prepared for what I found. First, when I walked in, he said, "Rich, is that you?" When I told him Rich had quit days earlier (true story), he said, "Oh, he will be back. He always comes back at night." And then I started surveying the place. Furniture overturned in the living room. A broken fluorescent bulb in another room on the floor. Then, I started looking for a few of the missing items. Within minutes, I found them all. (OK, in the interest of accuracy, I should admit that there's still one shoe strangely unaccounted-for). So I said, "Hey, dad, you feel like there's anything wrong?" and his answer made me jump -- a wild, crazy cackling laugh followed by a denial that anything was amiss. My father doesn't cackle. Jesus.

And then I went into the kitchen. A wash of heat hit me from the stove. It was like a textbook on dementia come to life. There was a kettle, empty of water, blackened on the bottom, resting atop a red-hot burner on the (thankfully) electric stovetop. Double Jesus.

From that moment on, I went into what a friend calls "TCB" mode. Taking care of business. It was the melting kettle that did it, for sure. I went upstairs and called 911, and I was initially a hair apologetic: "Um, I am calling with what I *think* constitutes an emergency, but you tell me...." I told the operator what I had found, and she said, "Oh sir, I am calling you an ambulance."

I met the cops and EMTs outside and we put together a story to tell my dad, about how they were under orders to take him into hospital for an evaluation, etc. He balked, but ultimately gave in.

He isn't ever going to go home.

The battery of tests showed a prior stroke that we knew about, in theory, but, apparently, its effects may be spreading. Plus, they suspect another more recent one that couldn't be confirmed because he moved during the MRI.

The old guy fought *everything* in the hospital. He didn't eat for the first day or more. Despite the fact that he couldn't stand up, even with his walker, he physically attacked staff both of the first two nights and they started him on anti-psychotic meds to control his behavior. Later they added anti-dementia meds to the stew, after a diagnosis of "progressive dementia." He tried to lie his way out the door multiple times. But his ability to deceive others effectively had passed him by. My favorite attempted piece of misinformation involved a claim that "Dr. Doolittle" had authorized his discharge and could we please get going? How the nurse didn't laugh, I have no idea. Instead, she just calmly said, "Oh, you know, there really isn't a Doolittle on our staff of doctors. I know them all and none of them is named Doolittle." Katie, you are Nurse of the Year, if not the whole damn decade.

Ultimately, after a few days, a zillion tests, multiple meetings between me and various docs, nurses and social workers -- all of whom were several degrees greater than merely awesome -- my father was moved, against his will under a power of attorney that has me in control of his affairs, to a local nursing home in a locked dementia unit.

And, somewhat amazingly, when I visited him yesterday -- my first time seeing him at this place -- he was calmly sitting in a room full of similarly situated patients, enjoying a sandwich and watching the Phillies game with great interest. Mind you, when he gave me an update on the game, he had every single detail wrong, except for the inning, but trust me....reality isn't what we are looking for here. Safety and contentedness are all we can hope for and he seemed to be almost basking in both. Yeah, he still thinks he is going home. He even dictated a grocery-shopping list to me to fill in anticipation of his return home. But, again, I am not interested in attempting to correct him into understanding his plight at this point. I pretended to make the shopping list, and he seemed satisfied. I am also not stupid enough to think that every visit will go so smoothly. It's a work in progress, but at least now the artist's canvas sits in a safe place instead of dangling off a cliff as the work goes on.

So what can you learn from all this? Hell, in general, I don't know. I guess mostly hope your parents aren't as stubborn as my dad. But there are a few things that made this easier than it might have been. First of all, have a plan. Don't go into this stuff like a deer in the headlights or an ostrich hiding in the sand. When I first got to the hospital this time, I knew he was not going home again and I made sure docs, nurses and social workers were all on board for that approach. It required acting massively Type A and taking the bull by the horns and all that, but it paid off in spades. In fact, that was a multi-day project, but it was worth every second of effort. Secondly, have a power of attorney ready to go. If you have elderly parents and they haven't signed a document to give you control of their affairs if they falter mentally, you need to get that shit done. Now. Better yet, when you get the thing, read it and make sure it is detailed and gives you power over everything if necessary. The less you have to go into court (hope that isn't at all), the easier/smoother things will be. Finally, think about long-term-care insurance. My dad has it and it means that he will have fewer financial issues over this nursing home.

I was driving home from work today, and I *know* I was driving fast, and I *know* it was a sunny day, and I *know* the first Squirrel Bait album was soothing my cerebral cortex like only its Huskers/Mats hybrid roar can do, but there was something else along for the ride today that made me feel just a little better than all that wind and sun and beautiful volume could on their own -- the realization that maybe, just maybe, a very stressful chapter of my life was coming to a less-stressful close.

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