Friday, May 09, 2008

Friday miscellanea

No special topic today -- on Fridays, I'll just post whatever happens to be on my mind.

What's on my mind today is my 91-year old father-in-law, Al.

For a lot of years, Al seemed to defy gravity, if you think of old age as a natural force dragging us down to earth.  Till  a year ago or so he seemed at least a decade younger than his chronological age -- his hair was salt-and-pepper, he was fit and healthy, kept up with current events, had an active social life, and aside from a touch of high blood pressure and a genetic predisposition to high cholesterol, he had no major, or even minor, medical problems.  Hell, the man still had all his own teeth.  (Which as of two years ago is more than I can say.)  All in all, he was in good shape for someone in his late eighties, and though of course intellectually we knew better, Karen and I both imagined he'd probably stay in perfect health till the day he finally keeled over, or died in his sleep, or got kidnapped by aliens.

Sadly, though, gravity caught up with Al and dragged him down to earth sometime last year, around the time he finally gave in to family pressure and moved out of his condo into an independent living facility.  He didn't want to do it; Al wanted to keep living on his own, but we'd begun to notice he was slowing down -- he wasn't as active as he used to be, he had trouble remembering things, he got lost driving to the store.  None of this was unexpected, of course; he was ninety, and the fact he'd been able to live on his own for so long was pretty amazing.  We saw what was happening before Al did, and he resisted making a change for quite a while, but eventually he gave in.  He sold his condo, moved to an independent-living complex, and almost before he fully settled in, the gradual decline we'd noticed became a steep slide into frailty and dementia.

Late last November, we got a call from one of his friends.  Al had been taken to a psychiatric facility, suffering from a full-scale panic attack.  From what his friend told us, and what his doctor said later, it became apparent Al had developed, almost overnight, a severe case of Alzheimer's.  Realizing that under the circumstances Al could no longer live so far from his family, we made arrangements to move him into assisted care near our home. 

I flew out to Arizona to pack up Al's belongings and hire a mover, and that's when the truth of how far he'd declined hit me --

His apartment looked like the motel room in "Memento."

Everywhere, on almost every surface, Al had left post-it notes to himself -- reminding himself to check the mail, to take his medicine, to pick up laundry, to pay bills, to make phone calls, to wash dishes.  At first glance, except for the quantity of reminders, nothing that unusual -- most of the notes were the kind anyone might make for himself.  But there were other notes, overlaying many of these -- notes of phone conversations; notes of questions he meant to ask Karen or his doctor or his lawyer, and notes of the answers he'd been given; and notes to ask the same question again, and notes of the same answers.  Notes reminding him to make notes.  Notes about notes. 

Al was externalizing his memory.  As his capacity to retain new memories deteriorated, he developed a strategy to maintain the illusion that his mind remained unimpaired.  And for months, the strategy worked, till the stress of maintaining the illusion finally overwhelmed him, and he collapsed with anxiety.  Because we lived in a different state, we hadn't seen how he'd been living, and his conversation on the phone -- while sometimes a little repetitive -- hadn't seemed all that different from the conversations we had before.  But standing in his living room, and looking at the evidence all around me of his deterioration, I realized that what had appeared like a sudden, overnight collapse in fact had been on its way for quite some time.

In a way, I admire Al's ability to fool us into believing things were all right when, in retrospect, obviously they weren't.  It's a tribute to his intelligence (and yes, his guile) that he pulled off the deception for so long.  It reminds me of Donald Pleasance's character in "The Great Escape" -- the forger losing his eyesight, who works out a series of tricks to conceal his blindness from his superiors, till one of them (literally) trips him up.

We moved Al to an assisted living facility here in Los Angeles in early December of last year.  He hasn't lost his long term memory, but his short term memory is almost non-existent now.  During the course of a brief conversation, he 'll repeat the same question and receive the same answer half a dozen times, unless he can be distracted to a different topic.  As I said to Karen, he hasn't lost his curiosity -- only his ability to retain the information that might satisfy it.  It's sad to see, and I can only hope that among the memories he can't retain, is the knowledge of what he's lost.

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