My Father's Health, Part 4: Mentally

No, you haven't missed the first three parts; don't bother looking for them. I decided to start with part four for a number of reasons:

• The newest stuff is freshest in my mind
• I'll be able to add new things without waiting until I've caught up with the old
• I'm kind of tired of talking about the old stuff
• I think we teach history wrong (the subject of another blog post someday)

The short recap is that my 76-year-old Dad (77 in two weeks) went into the hospital on December 5th, and didn't come out until January 20th. After multiple surgeries, most everything is on the mend. His kidneys are not likely to regain functionality, so he will probably be on dialysis for the rest of his life. He's also very weak and is barely able to get around on his own.

But what I want to talk about now is his mental state. It's a fairly weird and difficult subject for any son to describe the decline of his father's mind. I'm not sure if this post is intended as sharing, therapy, ranting, or what.

For a month before he went into the hospital, my Dad was showing some small signs of dementia. It was sporadic, but he would forget the date, people's names, that sort of thing. We took him to see a neurologist, but their scans showed nothing out of the ordinary for a man of his age. They just wanted to keep an eye on things.

Fast-forward a few weeks to when he's in the hospital, and it's a different situation. Everything combines to really mess with his head. The drugs he takes for his bladder, the anesthesia he has for the surgeries, the disorientation of being in a strange bed with a constant parade of strangers checking on you, they all interact and cause his dementia to really manifest. There's a common ailment among the elderly called "Sundowning," in which the patient can be perfectly normal during the day, but as soon as night comes, everything turns upside-down. This was my Dad to a tee. One nurse told me that he had a completely different personality at night, and I believe it. I spent several nights sleeping in his room, and I experienced him at his worst to be sure.

As he was in the hospital longer, it just got worse. Towards the end of his stay, he was almost completely incoherent or "confused" all day long. I say confused because that seems to be the preferred term used in the hospital. I don't know if it's a medical diagnosis or just PC. But the interesting thing was, he wasn't a raving loon. He spoke very rationally. The problem was that the reality he was in had no bearing on the reality the rest of us were in. There was one time he was convinced he was in Kennedy, Texas at a chemical plant he used to go to more than 20 years ago. He kept asking about specific people, could tell you all sorts of things about the plant, but he had no idea how old he was or what year it was.

Fortunately, neurologists took a look at him in the hospital and realized that there was something more going on than usual. They took him off of a bladder medication, and there was improvement almost immediately. The doctors were aware of the possible psychological side effects from the drugs, but they claimed it was a "necessary evil" in order to first cure his bladder. Unfortunately, they can't assure us that the damaged caused to his brain is reversible.

Ok, wow. That took a lot longer to get to the point than I thought. Oh, well.

Yesterday, I sat with my Dad through out his dialysis, which is about four hours. Normally, we can drop him off and pick him up when it's done, but that is no longer an option. The dialysis facility now requires someone to be there with him because he's started acting up towards the end of the session. It's just like the sundowning he was doing before.

My Dad's present condition is greatly improved. He knows what's going on, he remembers people, he can function pretty well. His long-term memory is great. However, he seems to have no short term memory. He has real difficulty remembering what day it is, and what he has done in the past few hours.

So, during dialysis, the first two hours go great. He's friendly and polite. He sits in the recliner, watches some TV, and often dozes off. But the last two hours, look out! Suddenly he believes that he's already been there for six hours. He insists he has to go. I have to talk to him constantly to tell him it isn't time yet. He doesn't believe me. He looks at the clock, but can't read it. I think he just makes up numbers, sometimes. He gets very angry at me, and complains that everyone is conspiring against him.

I thought I would be clever and use the timer on my watch to count down the four hours he was in dialysis. That way, he would have a constant clock showing how much time was left. Well, that backfired. When he looked at it, he forgot that it was counting down and read it as the time of day. "See!? It says 2:00! I've been here too long already!" It is very exhausting.

Later, once he's home, he calms down a bit. He gets very antsy and irritable about leaving, but once he's gone he's fine. He sleeps for a while, and forgets everything. He has no memory of complaining, arguing, or trying to get out of the chair. So the cycle starts all over again for the next time.

We are hopeful, however. The doctors tell us it can take three to six weeks for all the medication and anesthesia to leave his system. They'll do more tests on him in the future once they're sure he's clear, and then they can prescribe medicine to help his memory.

The hard part is facing the fact that he could be like this forever, or continue to decline. I have several friends who have lost their parents. My wife lost her Dad to cancer just seven years ago, and she's still not really over it. I have support when I need it. But the difference is, my father isn't actually dying. In some ways, I think that would be easier to deal with. Death is tragic and heart-wrenching, but it is also natural and inevitable. If my Dad just slowly lost his mind, his personality, his ability to function, but kept living for another 10 years, how would I deal with that? How would my Mom deal with it? These are questions that are easy to ignore when hypothetical, but very challenging when they hit close to home.