Laredo Med Center ER: which part of
"My father is an Alzheimer's patient"
did you not understand?

Let me set this up for you. Three hours into trying to contain our 80-year-old father in the ER cubicle where he will be seen for tests for pneumonia, a young security guard who has no doubt heard our litany of "Dad, you need to sit here" a couple of hundred times walks up to Melissa and me to say only one family member is allowed to be with my father.
My sister and I look at each other with measures of consternation and dismay. I say, "My father is an Alzheimer's patient. He doesn't understand why he is here. I can't leave my sister alone with him. We can barely keep him in this room."
Unfazed by anything I say, he reiterates hospital policy and tells us one of us has to leave, even as both of us struggle to keep our father from wheeling himself out of the tiny room and into the hallway. He tells us the charge nurse has told him only one of us can be here. I tell him to go get the charge nurse. He comes back with someone who is not the charge nurse, a woman who tells my father he can't leave and he needs to sit down. My father is pretty much obsessed at the moment with the foot rests on his wheelchair. He is oblivious to her instructions and continues doing all possible to leave the room. She also tells us what hospital policy is about one person in the room. I tell her a nurse who could see my sister needed help brought me into the ER, otherwise I could not have walked past locked doors. I tell her I am not leaving, though it occurs to me that Melissa and I should leave the two of them to try to figure out how to care for my father, how to contain him in a place that is not recognizable and does not compute into the narrow reality that anchors him to this life, a place that in fact is causing him a great deal of discomfort because it is unfamiliar. The idea of leaving my father with two such clueless individuals keeps us there.
I ask them, "Do you think you are talking to your own father who understands what you are saying and will take your instructions?"
When my father discounts in full the woman before him and makes up his mind to bolt past all of us, the security guard warns stridently, "Sir, get back in your room. Sir! Please get back in your room."
Melissa and I look at each other, comprehending the bizarreness of the moment, the oddity that hospital personnel at any level of skill or competency could be this oblivious to the needs of an Alzheimer's patient or that they might think that a man who has not listened to his children all night might listen to them. I am told once again I must leave, and I inform the security guard that I am not leaving. He will return soon with the charge nurse, a man named Jim who tells us he was pulled away from a really important life and death procedure on someone else to deal with us and that they were all really tired of our disrespect and our bad attitude.
I am floored. I have never seen this fellow before or directed any kind of an attitude toward him, but after he barks at us, we bark back about how long it is taking to get to the simple procedures my father still needs done. We tell him we are taking my father home as soon as the tests are completed, and he says with a measure of disdain that we can do whatever we want, but we need to sign releases.
After he leaves to tend to people in situations far more dire than ours, I ask Melissa why she chose this hospital. "It's worked out here before," she says. "Well, it's not going to again," I tell her.
The impolite exchange with Jim seems to speed things up. Two nurses run the EKG test after they wrestle my father to the gurney. If you didn't know they were dealing with an Alzheimer's patient, you might have thought there was an altercation going on behind the drawn curtains of the cubicle. After they leave, my father is a little more calm, nearly exhausted. Melissa and I each hold his hands, hands that in photographs have always looked elegant. We put his undershirt back on him and then his beautiful blue cotton shirt pinstriped with white, a shirt that is stitched at the button holes with green thread. He adjusts the shirt to his frame and buttons it efficiently.
Another nurse comes to collect fluids. We wait for the ER physician to return, a man who up to this point has been a little aloof, but who now rises to kindness and apprises us of my father's condition and what medicines he will prescribe. He brings us a cell phone so that we can discuss the discharge with my father's physician, Dr. Zuniga.
Jim, the charge nurse who had not been very nice a few minutes earlier returned with a realigned attitude, gave my father a shot in the hip, and told us we could leave and asked if there was anything else he could do for us.
The long night was anything but over. We still had to get my father into the car and back home. Confused and worn out, he kept braking the wheelchair's movement with his feet. Dad's caregiver Linda joined us in the ER lobby. When we got to the doorways out of the ER and the building, Dad held onto the jambs as though he believed wherever we were taking him was the wrong place to go. Melissa had the bright idea to turn the chair around and go through the doorways backwards, which worked like a charm. Getting him into the car was another matter. There were promises of ice cream and getting home to my mother. Linda knows all the right things to say.
In the parking lot of Laredo Medical Center near midnight, I process the day's events, feeling that which is ever present in my thoughts -- that the long, slow demise of this once vital man is a cruel end note on a life he would have told you a few years ago was something precious. I feel the anger, too, that is just under the surface and juxtaposed with the tender thoughts I have for my father, anger for so unjust an ending for the life of one so noble-hearted.
My mind races with the need to make sense of the evening at the hospital. What an affront it was to our tattered psyches to have a security guard and the charge nurse talk to us as they did and to hear in their cavalier voices how uninformed they were about what to do with my father and why two of us had to be there with him. I cannot imagine that Melissa or I, one without the other, could have gone through those hours trying to calm Dad in between procedures. I have no anger toward the guard or the charge nurse as much as I am aware that hospitalization sometimes has very little to do with care, that it often falls short, that the training for adherence to hospital procedure can at times obviate compassion.
I remembered the young nurse who had early in the long evening taken a blood sample and how kind he had been to my father. And finally my thoughts turn to love, that which I have for my parents and on this evening in particular for my sister Melissa, who under all pressures to make decisions for my parents remains clear-headed, responsible, and kind.
Maria Eugenia Guerra

Attention deficit

I remember that when I was growing up my father preferred engrossing himself in a book to watching TV. There was always a book in progress on his nightstand or on the coffee table. In between books he would watch westerns, old WWII movies, or movies starring his favorite movie star and war hero Jimmy Stewart. Sundays he and I spent watching football games.
Today my father is easily entertained by someone walking in from another room. He talks about getting a job or needing help with something he hasn't done in a long time. On bad days he sits there with very little recognition of the surroundings or the people around him. On good days he can communicate the importance of a picture or the headlines in the newspaper. When we were at war with Iraq -- the one we declared, not the one we fight now -- he would point to a headline and ask how the trouble was going. He talks about one item or another quickly, and if you don't keep up you lose track of where he is. Sometimes you can change the subject with just a word or by introducing an object into his line of vision. Other times he will completely ignore you and continue on whatever path he was on. Sometimes changing the tone in your voice will get the reaction you were waiting for.
It is very difficult to keep him fastened to one subject. Just recently when he did not look well, Meg thought he might have pneumonia. Dad's doctor suggested a visit to the emergency room for some tests. It was not hard getting my father into the car. The mere suggestion of going for a ride was enough for him. I got him checked in quickly but we had to wait for a while before he was called. My father does not understand having to wait your turn, so Linda, my father's caregiver, and I took turns wheeling him down the hall as though we were going somewhere. If I came around the corner and he saw Linda, he would react like hadn't seen her in years. If Linda came around the corner he would tell me it was about time I got there.
We were finally called in and taken into a room deep in the emergency room, down a hallway of rooms I have never seen or knew existed. The hospital staff would not let Linda in with me. I was hoping we would not take long so I didn't worry about being by myself with my father, because up to this point he was calm and controllable. Five minutes in the ER cubicle and things went south quickly. At one point I was trying to hold my father in the cubicle with my body blocking the door. Before I knew it, he had pushed me out and we were in the hallway moving away from the room. My phone was ringing and a nurse was trying to tell me I had a phone call on another phone. I knew it as Meg calling me, but I only got to push the button to talk but had to stuff the phone in my pocket because we were still moving away from the room. I tried to explain to the nurse that I couldn't do this alone and he needed to go get Meg, whom I thought was calling me from the door. He did as I asked and she appeared out of nowhere. Since she was a new face, my father reacted as soon as she suggested we go back to the room. At one point I went to the desk and asked politely what the status was of tests, etc. I explained that my father has Alzheimer's and he was trying to leave and we were having trouble controlling him. I was told they were waiting for a technician and it would be a few minutes. Someone came by for us and we went to x-ray. It took the technician and I about 20 minutes to convince my father that it wouldn't hurt. The technician was patient and understood. He worked hard for the x-ray and finally got it on the second try. We got back to the room and Meg told me the lab guy just left and would be back. This nurse also worked hard but was able to get the lab work done. After about hour three of this ordeal a security officer came by and wanted one of us to leave. We explained my father's condition and that it usually takes two people to keep him calm. He said this was unacceptable and one of us would have to leave. He wanted a description of the nurse who let both of us in. While he went to look for this nurse another technician came in for one more test. He remembered my father from a prior visit and understood the situation. He said he was going to get help and would be back. The security guard came back with an administrative type who also ordered one of us to leave. We once again explained the situation and she tried to tell my father that he would have to sit down and wait. He said "OK" and made his way to the door. She repeated her command and he moved closer to the door. We asked her about the last test and the technician who went to find some help over 20 minutes before. Both she and the security guard left and came back with the charge nurse. We were told we were being rude and disrespectful. He repeated the command of one of us having to leave. Meg and I stood aside as the three of them tried to make my father understand that they were busy and he had to wait. We debated about leaving him alone with them and seeing how long it would take them to ask both of us to come back in, but we knew better and leaving him was not an option. After an argument the three of them left us alone. We looked across the hallway at the woman who was ushered in about the same time we were with her daughter, who was running a high temperature. We asked her if she thought we were rude and disrespectful. She laughed.

Melissa L. Guerra