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Dementia: A Tragic Fate for My Father

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My father, Harry Mendelson, was no big shot. He certainly never made much money. I recall, as a young Jewish boy growing up in goyishe Prairie Village, Kansas, occasionally hearing people talk about "the Jews", and how they had all the money. It confused me. I remember wondering if they were talking about some different sort of Jews.

Though he never got rich, my father was a good man. He went to trade school and became a draftsman. He worked at the Colgate-Palmolive plant drawing blueprints for construction of assembly line machinery. He worked there for nearly 40 years. The job didn't pay enough to meet the expenses of raising three boys, at least not in the fashion that my mother expected, so he took extra work when he could. Things were often worse than I knew, but we never went hungry and we never did without. That is, not without too much.

His pleasures were the simple ones. He had a wonderful sense of humor, he loved a hearty meal on the table, and he possessed the uncanny ability to sniff out the perfect fishing hole. On television, he preferred the Ernie Kovaks Show to Playhouse 90. He was the kind of guy that perfect strangers would strike up conversations with in a ticket line or at a bus stop. He was honest and dependable. When he said he would do something, you knew that he would do it.

On warm summer nights, the Kansas City A's ball game would be on the radio as he grilled some chicken or hamburgers for our supper in the backyard. The lilting, yet emphatic radio voice of Merle Harmon would float through the twilight, mingling with the chirping of the crickets, and the hissing and popping of the meat on the hot grill. At those times he seemed most at ease. Not Madeline cakes and lime blossom tea, but rather the peppery aroma of grilled meat blended with the scent of newly mowed, summer grass evoke Proustian memories of my father and my childhood.

My father was athletic. As a young man he boxed and practiced judo. I remember him doing push-ups every morning. But all his life he suffered high blood pressure and high cholesterol. It led to heart disease, and at age 65 he underwent coronary artery bypass surgery. The surgery saved his heart, but he was never the same. It is not unusual for this surgery to loose showers of tiny fragments of arterial plaque into the blood coursing to the brain, and I suspect that some lodged in areas of his frontal cortex. It is not clear whether the surgery did the damage, or if it accelerated a more subtle pathological process already in motion. I suspect it was both. In any case, he began to change.

I recall one telling incident that occurred a few years after the surgery at a large family reunion. After our meal, cousins, uncles, and aunts stepped up to the microphone at the front of the banquet hall to say a few words. One of our cousins rose from his seat and lumbered over to the microphone. This cousin could kindly be described as "odd". However, as a member of the family, his eccentricity, obesity and ill-fitting clothes were always given some allowance. As he stood before us and fumbled with the paper upon which he had written his speech, my father let loose a loud, prolonged, and heartfelt, "Oh, my God!" Although most of us were thinking the same thing, my father's outburst broke the rules of social engagement and gave embarrassing testimony to the early stage of his illness.

Over the next few years my father had increasing difficulty expressing himself. His word choices sometimes made no sense. A sad, but undeniably humorous example arose when a couple my parents knew invited them to tour the Nelson Gallery of Art in Kansas City. The old gallery is built of stone, with high ceilings and long hallways. In unrestrained fashion my father passed gas loudly and forcefully in one of the exhibition rooms. The report echoed down the spacious corridors.

That lapse in social grace was another byproduct of his dementia. However, for days afterward he perseverated in reporting his troubling perception that their friends were very angry with him "because I fluctuated at the art gallery." Even when challenged about his choice of the word, "fluctuate", he simply looked puzzled then continued on using the word to express his annoyance with himself and his friends.

As is often the case in dementia, some of his living skills seemed to remain intact, but only deceptively so. Like many with the illness, he continued to drive his car far longer than he should have. That ended the afternoon he took a right turn into what he thought was a driveway, but was actually a wide walking path in a neighborhood park. He drove its entire length, looking for the parking lot he had expected to find at its end. The strollers were irate and the police were not sympathetic.

My mother kept and cared for him as long as she could at home, but episodes of confusion, incontinence, and falls finally forced her to place him in a care facility. There, his social disinhibitions and indelicacies gradually faded into long silences and social withdrawal. Finally, he drifted into apathy and a complete inability to speak at all. Not too many months after he lost his speech, he suffered the loss of his ability to swallow. That unfortunate man, who so dearly loved to eat, was thus deprived of his last pleasure. Eventually a tube was inserted through his abdomen and into his stomach to provide him with nourishment.

The last time I saw my father, he was propped up in a chair staring impassively, neither moving nor speaking. I remember a painful sense of disbelief at how old and diminished that once bright and physically powerful man looked. He turned his eyes toward my face and let them linger for the briefest of moments, which served as the only evidence of any recognition of who I was. Not many months later he died in his sleep.

The progression of my father's illness was frightening to watch. The look of bewilderment that would fall across his face from time to time leads me to suspect that it was frightening for him as well. A mind in pieces does not easily harbor peace of mind. As we have aged, my brothers and I have grown justifiably more concerned about our own potential for developing dementia. Though it was certainly nothing he would have planned, in journeying down the dreadful path of dementia right before our eyes, my father shouldered yet another burden for his sons.

He revealed to us our vulnerability, and he prepared us for what might happen if we did not care for ourselves. We understand our lives and our selves differently from him having been ill. As a psychiatrist, I have been able to learn from this experience and help other individuals and their families through the heartache of being diagnosed with dementia. I have learned and written about how to avoid the illness, which, of course, is the best of all possibilities. In many respects, I owe my book, Beyond Alzheimer's, to my father. I dedicated it to him.

It is now 10 years since my father died. It saddens me that he was never able to enjoy the little bit of money he had set aside for his retirement. It saddens me most that he was never able to be a grandfather for my children. My 9-year-old twin girls, who never knew him, only giggle when they hear his name, which they interpret as, "Hairy Mendelson". He would have enjoyed that. My father was a decent, hardworking family man, and he did not deserve the fate of dementia that he suffered. But, in all honesty, not the worst of us does.

Dr. Mendelson is the author of the new book, Beyond Alzheimer's.