Year-End Reflections

Today is my birthday. I was really looking forward to posting on the blog again. I had planned a whole week of "Year-End Recaps" covering my interests and hobbies. Most people do this around New Year's, but I've always preferred to do it on my birthday since that is a pretty self-reflective time. However, this year is different. My father passed away ten days ago.

This isn't intended be a maudlin post that plays upon your sympathies. I don't know how anyone can summarize a 78-year life in a eulogy, let alone something as trivial as a blog post. But since I've often spent my birthday in reflection, it's appropriate that I spend some time reflecting on my dad. These are just some general thoughts, and I'm not organizing, structuring, or editing (Hah! Like I ever do!).

The last two years had been very difficult for him and my mother. Early on, I posted about a lot of the health problems he went through. I fell out of that habit after the initial catharsis of getting it all out. He had his ups and downs, including a very frightening heart attack during dialysis this past November. All of us thought that was the end right there. He recovered phenomenally well, and in hindsight I believe he did it just to spend one last Christmas with us before letting go.

He was a shell of the man he used to be. I know he was miserable. I don't think he was in pain, but the indignity of having a catheter, the irritation of dialysis, and the exhaustion of being sick and weak for so long had taken their toll. He couldn't do any of the things he used to enjoy, and each day it seemed like he had even less energy.

But despite all of that, he did keep his spirits up. He was a fighter; unfortunately he seemed to fight the doctors and nurses more than the illnesses. His mind was sharp to the end. Sure, he had trouble remembering what day it was, but he certainly knew what channel Fox News was on and he could tell you to the second when it was time for his dialysis to end (and he would!). The Alzheimer's was the diagnosis I feared the most. I dreaded the thought of losing him gradually over the years while his body remained. As terrible as it may sound, in many ways I'm grateful that he went the way he did-- peacefully taking a nap on his couch at home.

The funeral service was very nice. He was buried in the Houston National Cemetery, with the three-man flag ceremony. It's amazing how quickly that lone bugle playing Taps can bring a tear to your eye. We had a lot of friends and family come to the service, which was very nice. My brother spoke, but I did not. I knew that I wouldn't be able to get through any words I wanted to say. Instead, I stood with my brother, ready to finish for him if necessary.

My dad was very fortunate to have a lifelong friend give his eulogy. My dad and Kent Akord had remained friends for 75 years. How astounding is that!? They met in the neighborhood, went to elementary school, high school, and even college together. The stories he told were fantastic. I'd known my dad all my life, but that's just over half as long as they knew each other.

When pulling pictures for the wonderful video my brother made, I loved seeing all the different aspects of my dad. He's always been my dad, and in my adult years he's also been my friend. At occasions like this, you get to see how others experienced him. What he was like as a brother, an uncle, a husband, a friend, a co-worker, a neighbor. What kind of person was he at 10, 17, 25, 35, or 45http://www.blogger.com/img/blank.gif? My experience of him was only a fraction of who he was.

When talking with the pastor in preparation for the service, he told us to celebrate his life. He asked us questions to remind us (and inform him) about what our dad was like. Memory is a funny thing. I could remember a lot from the last couple of years, and a lot from when I was a kid, but I had trouble remembering things from even five or ten years ago. I'd love to list all of those memories, but if I go down that rabbit hole I'll never return.

I'll end this with just two things, two recommendations for those who have read this far. Last year, I saw the movie Tree of Life. It was transcendent. It was a poem in movie form. It required you to pause, slow down, contemplate. It was about a child and his relationship with his father; it was also about man and his relationship with God. It was about life. Not everybody liked it, and that's okay. The father played by Brad Pitt was really nothing like my father, but in the metaphorical sense he is just like everyone's father. It is very moving. See this film.

The other thing I would say is to just take some time to appreciate the people around you. That's so cliche, I know, but I don't just mean it in the sense of telling them that you love them. Just appreciate that you have friends, that you have family. Acknowledge the good times while they're happening. Cherish the memories. Tell some of the stories that you haven't told in years.

Thank you, Dad, for all the obvious things and the trivial ones. Thanks for the peanut-butter-and-crackers, the water-skiing, the lectures, the Christmas lights, the home-made slime, caring for the cat you hated, and sending me to the college you loved. Thanks for everything, Dad.

My Father's Health, Part 5: Neurology

Well, I've been putting off posting about my Dad again for over a month. I still haven't completely collected my thoughts or decided exactly what I want to say, but the longer I put it off, the more difficult it will be. A couple of months ago my father was diagnosed with Alzheimer's Disease.

This was the result I most feared, and yet somewhat expected. He's taking medication (Aricept, I believe) which is supposed to slow down the onset of symptoms. They think they found it early enough to make a difference, but there still isn't a cure.

I've been very reluctant to do the necessary research about the disease and treatment and what to expect in the coming years. I don't think of it as denial, but maybe it is. I accept that he has it, but I just don't feel like learning about it yet. When he was in the hospital back in December/January (See Part 4), he suffered from dementia brought on by "sundowning" and accentuated by a drug he was taking for his bladder. He was very cantankerous, often extremely confused and forgetful. On a number of occasions he didn't even recognize me. That was hard to deal with, but at the time I coped with it very well. I was the one telling the rest of my family that we might have to accept the idea that he might never recover from that. I was very glad to be proven wrong.

But now, it looms on the horizon, which is even worse. Being struck with it suddenly, I had no choice but to deal with it. Now that I have an indeterminate amount of time to prepare, I find myself not wanting to prepare at all. But enough about me.

I'm concerned about my Dad. He's been in and out of the hospital numerous times this past year, and he absolutely hates it. It seems like at least once a month something occurs that requires a hospital visit, and inevitably that extends to a stay of at least a couple nights. He puts on a good face around the doctors and nurses, but he absolutely despises being there, and I don't blame him. The problem, however, is that now he is reluctant to say when something is wrong or to see a doctor for fear that it will put him back in the hospital.

Just this week his home nurse made her visit, and was shocked by how difficult his breathing was. She insisted my Mom take him to the ER, and they found early stage pneumonia. It's been treated and he's been released, but I have no doubt he would never have said anything about having trouble breathing.

But even that isn't really what concerns me. My Dad's depressed. He doesn't like to talk about it with the rest of the family, but he confides in me. I think it's a combination of his poor health, the frequent hospital visits, and the Alzheimer's diagnosis. Which makes me wonder if that was really necessary. I wasn't there when my parents went to the neurologist for the verdict. I can only imagine what the scene was like. My mother is practically deaf, and my father hears only what he wants and often forgets or misses details.

My question is, should the doctor have told him he has Alzheimer's? Wouldn't it have been better for just the rest of us to know and deal with it? Why put that burden on him? My Dad used to volunteer at a local home for Alzheimer's patients, ironically. He knows exactly what to expect (I sometimes wonder if he had a secret suspicion about himself that made him choose that kind of volunteerism). Like most men and most fathers, my Dad likes to be in control. He doesn't believe there are things he can't handle by himself. To be hit with the knowledge that your mind is slowly leaving you must be devastating.

I said my Dad was depressed, but it's more complicated than that. I know he wants to live. I know he wants to get better. But I think he finds it hard to motivate himself when he knows what's coming. He doesn't want to be a burden on his family. All the things he was hoping for the future may never come to pass. He still talks about fixing our old motorboat to take the kids water-skiing. He talks about the chores he needs to do around the house. He talks about getting his strength back in order to drive. Yet at the same time, I think he knows none of those things are ever going to happen. Do I discourage him by reminding him of limitations? Do I feed his delusions and encourage those plans? Currently, I sort of humor him and then try to change the subject.

I don't know how to end this post, which is appropriate since I'm sure there will be many more to come on this subject. I just needed to write something to get some of these thoughts out of my head. Don't worry, I have several more up-beat and strange posts coming, I just wanted to get this one out of the way first.

My Father's Health, Part 1: Chronology

When I started these posts/essays about my father's health, it was absolutely not my intention to just run in reverse order. I thought I would post new things as they occurred (like a Part 5), then jump back to old things when I could. The order could have easily been 4, 5, 3, 6, 1, 2, depending on what I felt like talking about.

Instead, it seemed easier to incorporate current issues with their past precedents, and that's worked out pretty well. Now, however, I have several new things to write about, and I just don't feel like it. Also, this one should be pretty quick, so I can finish up this backwards look and continue going forward.

I mentioned in one of my earlier posts that I believe we teach history wrong. Usually, it's a dry memorization of facts, historical timelines, and biographies. It wasn't until I was long out of school that I discovered I actually really like history. The way the subject had always been presented, though, had been a barrier to my enjoyment of it.

I could easily write a whole post on this subject, and hopefully someday I will. But for now, let me just break my idea down to the basics. History should be taught in reverse.

I don't understand why this isn't obvious. That's the way history is written; that's the philosophy behind how it is studied; why isn't it taught that way too? History is a series of connected events with causal relationships. When looking back at the past, we are always asking, "What was the cause of this effect? Why did this happen?" If we started students with right now, we could show them how things came to be the way they are. And yes, there can be multiple causes, and different opinions, and all of that stuff. But by following these causal threads in reverse, it actually breeds more questions and encourages thought and curiosity. History should be thought of in terms of "Why", not just in terms of "What." Barack Obama was elected President. In the old way, this was the end of the lesson. In my version, it would be the beginning. Why was he elected President? Why was it considered significant? What led to it happening? James Burke did a similar thing with his fantastic show Connections. Looked at this way, history can be fascinating.

So, another question: What does any of this have to do with my father's health?

Because my Dad's diagnosis was a similar, backwards-looking investigation.

Now that we have all the facts, we can put it in the proper order. While it was happening, all the doctors were grasping at small pieces of the whole. It was like that old saying about five blind men describing different parts of an elephant.

Here's how it breaks down:

• Many years ago, my Dad had prostate cancer. The prostate was surgically removed, but they followed up with some radiation treatment to make sure.
• The radiation treatment damaged his bladder, though we weren't aware of it.
• Slowly but surely, his bladder started to fill up with blood clots. As this happened, it lost effectiveness and started building up excess fluid.
• As the excess fluid built up, it caused a back up in the kidneys. Slowly but surely, the kidneys fell further behind cleaning out his system, and started to fail. The fluid continued to build up.
• My father was getting weaker and weaker, but he just attributed it to getting older.
• As the fluid continued to build up, it started to spill over into his lungs. His lungs had to work harder, so the passageways grew to accommodate more air.
• With the larger passageways, he started aspirating (which is when you drink something and it goes into your lungs instead of your stomach), which of course made the problem worse.
• My Dad starts to experience shortness of breath, and that is what sends him to the doctor. He went to his cardiologist to talk about his difficulty breathing. It was only after many tests and many specialists that this whole timeline was revealed.

Was there a way that this chain of events could have been detected and intercepted before things got to this stage? Surely. I don't know if we should look to blame the doctors at his regular check ups, or my father for not paying enough attention to his own body. Somebody, somewhere, wasn't reading the signs properly.

But that's just the thing about history, too. When you're in the moment, how can you know if an event is significant or not? Will this pain lessen or increase? Should I go now, or wait a couple of days? Obviously, you can't know. The lesson I will try to take from this is just to be more aware.

My Father's Health, Part 2: Nephrology

Nephrology is the branch of medicine that deals with the kidneys. It is not the study of dead people, which is what I always think of when I hear it. That's necrology. Anyway, the kidneys are responsible for a lot of things that generally all relate to cleaning out your system. This means urine, blood, electrolytes, etc. Wikipedia has a pretty good page about it if you're interested.

My Dad suffers from kidney failure. The term "failure" had always given me the impression that it was an all-or-nothing proposition, but instead it is more a matter of degree. We have two kidneys, which is generally more than we need. This is what allows kidney donations and transplants. Also, when kidneys stop working, sometimes they just need a break to recover, after which they start right up again. In the mean time, patients with kidney failure get to endure dialysis.

In the simplest terms, dialysis is just hooking up to an artificial kidney three times a week and letting it do the kidneys' work for it. In some cases, this gives the kidneys the break they need to regain functionality. In most cases, this is a procedure that will continue the rest of your life. The process varies in length based on the individual, but for my dad it lasts about three and a half hours.

When he first began the treatment, he was still in the hospital and still suffering from dementia. Most of the time he was able to sleep through it, but on occasion he would become quite ornery and insist on leaving. Later, after he came home, we went to a local dialysis clinic (more on that in a minute). He needed constant supervision for the first month or so, but now he's able to handle it by himself. I spent many sessions with him trying to keep him distracted, and failing. His favorite pastimes seemed to be eavesdropping and staring at the clock, neither one of which is very conducive to passing the time.

He never believed anyone when they told him how long he'd been there, or how much time he had left to go. One time, I thought I would be clever and help him. I started a countdown clock with him at the beginning (while he was still lucid) for 3 hours, 30 minutes. An hour later, he's sure we've been there too long already. I showed him my watch, and without hesitation he said, "Yeah, see? It says we've been here 2 1/2 hours already." Of course he didn't realize the clock was counting backwards.

But all of that is behind him now. He still dreads dialysis more than anything about his current situation, but he's finally learned to accept it. It does help, after all, and cleaning out his systems had certainly helped his mental state.

But let me take a minute to describe the dialysis clinic. You might think that a facility designed to have out-patient medical procedures would be fairly nice. Sadly, that is not the case. First, it is located in strip shopping center where the corner anchor is a sports bar. When you enter the dialysis room, it looks like a blood clinic from the '50s, or, for those of you who fell on hard times in college, like a plasma donation center. There are several rows of green vinyl reclining chairs that would look more at home in a dentist office. TO compliment that look, on the right side of each of these chairs is a large metal crane arm, such as a dentist would use for x-rays. However in this case, the arm contains a small television instead of a camera. On the left side of every chair is the dialysis machine itself. This is an interesting contraption of contradictions. It is about the shape of a small refrigerator. It has two rotating dials on the front that circulate the blood in and out, and look almost like a reel to reel tape deck. Above that is a very high tech touch screen computer monitor. But in sharp contrast to the monitor, the very top of the machine there is a tri-colored lamp that beeps and flashes either red, yellow, or green depending on your status. I cannot describe this light well enough. It looks like something you'd be more likely to see on an end-cap advertising a special at Wal-Mart than on a medical device.

The television comes with headphones, and (if it's working) you can watch any of several broadcast shows. My Dad usually starts dialysis at 11:30. Do you have any idea what kind of quality television is on in the middle of the day? Even he can't stand watching it. My sister brought him a portable DVD player, and that has worked very well. He watches a movie for a couple of hours, and that really takes his mind away from the time.

There are other, closer dialysis places, and we're currently on the waiting list for one. However, I haven't toured it myself, so I have no idea if it is any nicer. At least this other one is next to a grocery store instead of a saloon.

Today I have been on the phone with a cardiovascular surgeon in order to set a date for my Dad to have yet another operation. This one is not as serious or invasive, and hopefully can be done quickly. I have forgotten the term, but they will insert a device in my Dad's vein to facilitate dialysis. Currently, he uses a catheter in his upper chest that was inserted at the hospital. Supposedly, with the intravenous method, it can shave an hour off of the dialysis time. So of course, my Dad was all for that, and I don't blame him.

One thing that has pointed out how different we are during his adjustment to dialysis is his preference for passing time. He loves to do yardwork, he likes to be active and productive. Even though he could (and did) sit on the couch and watch Fox News all afternoon, he can't stand just sitting and watching TV during dialysis. He doesn't care to read, either. I'm nearly the complete opposite. For me, this would be like a dream situation. I could sit in that chair three times a week and do nothing but watch movies and read? For three hours? Sign me up!

Of course, it's easy for me to say that from the outside. I know that the process is tedious and unpleasant, and it wipes him out for the rest of the day. Basically, the four days a week when he doesn't have dialysis are about the only times he feels as though he's really living. He has become stronger every day, walking frequently without even a cane, and yet every other day he has to be chained to this chair for hours to make him "better." It's interesting to me how our modern medical wonders still haven't made obsolete the phrase "the cure is worse than the disease."

My Father's Health, Part 3: Urology

So, my Dad's health has improved steadily since he was released from the hospital. He is slowly getting his strength back, and is able to walk (short distances) with the aid of a cane. His mental facilities are gradually improving as well, although he still has trouble remembering what day it is.

Last week I accompanied him and my Mom to the urologist's office for a check up. A great deal of the work he had done over his extended stay in December and January was due to his bladder.

For a quick lay-person's explanation, think of the bladder like a balloon. As it fills with urine, it expands. After a while, the muscled walls of the bladder contract to expel the excess fluid. Unfortunately for my Dad, his wasn't quite working right.

Many years ago, he had his prostate removed due to cancer. It's very common for men of a certain age to get prostate cancer. Some say that all men get it, it's just that something else kills them first. Anyway, after having it removed, they later went back and did some radiation treatment to make sure the cancer was gone. This is something I've recently learned that they no longer do. Good thing, since that procedure seems to be what caused all of my father's problems.

His bladder had stop expelling fluid. After an exploratory surgery (December), they discovered a large amount of blood clots in the bladder. It seams that the radiation had residual effects which caused the scarring and clotting in his bladder. As this built up, his bladder continued to stretch out, but had trouble restricting again. So, a surgeon went in, literally scooped out the blood clots, and sewed his bladder back shut.

Sadly, he didn't do a very good job. A week or so later, my Dad is in a different (better) hospital repeating the surgery. There were other errors as well, but I won't digress into them now. The point is, my Dad's bladder was finally cleaned out, urine was flowing as expected, but the "balloon" had been stretched out so much, it would likely never function properly again.

So, if you don't have a functioning bladder, how do you get rid of the fluid? I'm glad you asked! Boys and girls, let me introduce you to a word: catheter. Doesn't sound so bad-- like kitty cat, but with a soft ending. Basically, a catheter is a very benign object. It's simply a tube inserted through an orifice to drain or insert fluids. My Dad has a catheter in his torso to facilitate dialysis. But there are types of catheters. For example, be on the look out for the "Foley" catheter. That doesn't sound too bad. Dave Foley, the guy from Kids in the Hall, right? Sadly, no. A Foley catheter is inserted up one's urethra directly to the bladder to allow it to drain. Except the urethra is in a man's penis. I apologize if this is too graphic, but I assume we're all adults here.

My Dad has had to endure several Foley catheters. For that alone he deserves respect. This time, however, they were going to do something different: a supra-pubic catheter. This one is a minor surgery that makes an incision in your lower abdomen and sticks a tube straight into the bladder. No muss, no fuss, just a tube going down your pants leg leading to a bag of pee.

And finally, we're caught up to the present day. Since leaving the hospital, my Dad has had this tube and bag contraption attached to his abdomen. He was scheduled for a follow up to see if they could remove it, but it so happens that the night before his appointment, he accidentally pulled it out during the night.

Now, to me, this is inconceivable. How could anyone with a tube sticking directly in an organ through a hole in your flesh, pull it out? And not be bleeding, crying, screaming, killing your way to the hospital? But, I guess I just don't understand.

Anyway, we go to the urology doctor to talk about it. We were expecting it to be removed about now anyway, so maybe this is normal. Doc says, "Sure, no problem. The hole seems to have closed properly, let's just go back to a Foley." I'm sure all men reading this can imagine the look produced on both my and my Dad's face at the sound of that.

So the doctor tries to put in a Foley. Right there. In the office. Dad is very, very uncomfortable, but far too polite to use the sailor language I was formulating. The doctor stops. "Hmm," he says, "that's odd. Let's take a look." This is always fun, because doctors have so many ways to "look" at things.

First, they do a sonogram. Don't try the "Is it a boy or a girl" routine here, guys. They've heard it and don't appreciate it. So, using radar to look at the bladder, they see that it is full, but not too full; meaning-- no emergency.

Next, they decide to do a scope (I don't remember the technical term), where they'll insert a camera and take a look at his urethra. A camera! In his pee pee! I ask the nurse if I should wait outside, and she says, and I quote: "No, it's really cool. It's just like a big balloon. You should stay and watch."

As a quick aside, I have to say that I've been blessed with not being squeamish about blood, guts, the human body, or any of that sort of stuff. This is basically the complete opposite of my older brother, who passes out at the mere thought of blood.

So, of course, I'm in.

The doctor and nurse do the necessary preparatory work. My Mom was kind of hoping to leave, but since I was staying she did too. My Dad was just beside himself, wishing it were all over, and regretting his decision to return to the doctor.

So, there it is. Live on a closed-circuit TV in crisp color, my Dad's urethra. Now, understand, I haven't seen the inside of my Dad's penis in almost 43 years, so my memory of it is pretty hazy. But basically, it's just a tube. As we try to reach the bladder, we hit a road block. Literally. It seems that since my Dad's surgery (and other issues), the scar tissue in his urethra has completely closed it off. That is why the Foley wasn't working.

This means that he has to get another supra-pubic. This means that he has to go to the hospital. Because of delays and wanting to keep him under observation, this means another overnight stay. This leads to more sundowning craziness, during which he pulls the catheters out (again) and requires another surgery, and another night in the hospital. So, what we thought was going to be a routine check up ended up being a three-day weekend stay at the hospital. I suppose it could have been worse, but that was bad enough.

He's home now, and better for it. He still has the tube running down his leg leading to a bag of urine, which isn't exactly "sporty." But we're hoping to get a different type of bag that is like a long tube that hides in the pants leg. Part of the problem is that my Dad's organs just won't commit to either working or quitting. Usually, when you experience kidney failure, you produce little to no urine and that is taken care of by dialysis. My Dad is producing some urine, but not a lot. On the positive side, that means there is still a chance his kidneys may regain functionality. On the bad side, he has to carry around a bag full of his own pee.

It is times like these that make you ponder what medical treatments will be available in 20 years. Will I have to have tubes and a bag of pee? Or will they just take a tissue sample and grow me a new bladder? Let's hope I live long enough to find out.

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.