An Alzheimer's Almanac

My father was still driving in the late 1990s when my mother was hospitalized for a short length of time.
That hospital stay occasioned one of the first times we noticed something was wrong with my father. He seemed confused about my mother's condition and about the logistics of getting to and from the hospital. He masked his confusion by making jokes about having made a wrong turn on the way home from the hospital and ending up some place he didn't need to be. Taking a wrong turn or the long way home was one thing, but ending up on a runway at the airport near the hospital was quite another. Leaving the hospital, he had followed the car in front of him through a gate and ended up on the runway.
What we would understand increasingly over the next few years is that a stable environment and a daily routine that does not waver much are the glue that gives an Alzheimer's patient his or her fragile hold on the world. Some of us learned this lesson the hard way.
Trips out of town with my father were always an adventure, but over the years, he relegated the driving to me because I was more comfortable driving and he seemed more at ease with me taking the lead. Thanksgiving 2001 was an eye-opener for us about how important stability and routine were for him. Except for going to the ranch, it was also our last trip out of town. We drove to my sister's home in Angleton for a long weekend that would include a side trip to Houston to see my niece's post-Thanksgiving performance in The Nutcracker Suite. After arriving mid-afternoon Wednesday we jumped into preparations for Thursday's dinner. We had a few minor issues with my father on Wednesday night and Thursday morning, and despite the way he isolated himself and couldn't be coaxed from his reserve, our dinner was pleasant and uneventful.
We all discussed our trip to Houston and the logistics of getting to our hotel and what we might do while we waited for the performance Saturday night.
Friday morning, as some of us were preparing to leave for Houston, my father woke and told us he needed to see his doctor in Laredo immediately. I quizzed him as I usually do about aches and pains or an upset stomach. He couldn't articulate, but it was obvious he was in peril. It was later that we understood that removing him from the comfort zone of his own home and putting him in the company of a few unfamiliar faces had disoriented him.
We left Angleton for Laredo as quickly as we could, my father still anxious about seeing his doctor. We left my sister and my niece sobbing on the driveway. My father's urgency to see his doctor subsided as we got closer to Laredo, closer to what was familiar.
When in 2002 my mother was in the hospital for nearly six weeks with pneumonia, it became increasingly evident that things had changed rapidly for my father. He did not understand the concept of disconnecting the IV machine to help my mother move about the room or the hallway. I came back to the hospital from a 10-minute trip to Whataburger across the street to find a haz-mat detail in the room cleaning up a mess because he didn't know he could disconnect the machine and help her get up.
We decided at that point that if my mother was ever in the hospital again we would have to try to keep my father at home and let him communicate by phone with her.
On July 31, just a few short weeks ago, both of my parents fell -- my mother on the hard tile of the family room and my father in their bedroom as he was trying to get to her after he heard her cries. Linda, our caregiver called me frantically at about 9:30 p.m., and I ran over from my house next door. By the time I got there, Linda had managed to pick my mother up and put her in a chair. We both assumed my father was still asleep and had not heard my mother's cries. Linda and I discussed the possibility of taking her to the hospital ourselves, but it was evident she was in a great deal of pain. I was halfway to the phone in the kitchen when Linda began screaming frantically. I ran back to my parents' bedroom and found Linda on the floor with my father, whose face was a bloody pulp from a fall flat on his face. I ran back to the phone to call the paramedics. They took one look at my mother and knew they would need to transport her to the hospital. The blood coming from my father's face was worrisome, so they cleaned him up, but determined he didn't need stitches or a trip to the hospital. Linda and a friend stayed with him at the house and I took my first ambulance ride with my mother at about the same age as when my mother took her first ambulance ride with her own mother.
Sometime after calling the paramedics, I started calling my family. One sister did not have her phone with her and in my panic I mis-dialed Meg at the ranch. She did not answer her mobile phone either, and so I asked a friend to call the Zapata County Sheriff's department to get them to locate Meg and ask her to come into Laredo as quickly as she could. Somewhere along the way I called Mandy in Angleton and told her what had happened. It was a long night.
We tried to protect my father as best as we could so that he did not see my mother lifted into the ambulance. He had his back to the window and we had closed their bedroom door. He was mildly surprised my mother didn't come into the bedroom to see his wounds. Within 48 hours my mother was wheeled into surgery to repair a fractured hip, and we began what was to be the longest month in our family's history.
Without my mother in his daily life, my father walked around the house aimlessly. He paced. He was looking for something but could not figure out what or whom it was he was supposed to find. Normal activities with my mother at his side, like watching TV, walking, or eating meals together, were suddenly not a part of his daily routine. There was a drastic change in my father in the month my mother was in the hospital. His confusion escalated.
Just before my mother went into surgery, one of my sisters saw the necessity to bring my father to the hospital, a necessity borne of fair play, a necessity that outweighed the calamity his confusion generated. I thought we had all agreed after the last hospital stay with my mother that it wouldn't be an option for him to be at the hospital with us. My sister agreed to keep a close eye on him and watch for drastic mood swings that would be her cue to get him home as quickly as possible.
We stumbled from one week into another. For the first two weeks my father had some kind of idea where my mother was and that both of them had fallen. He was very embarrassed at the scabbed cuts on his bruised, swollen face. Georgie, their driver, would try to take him to the hospital on a regular basis; sometimes two or three times a day, but he would keep trying to get my mother out of her hospital bed and tell her to come home with him. In the first two weeks he would sob uncontrollably when he saw her because he knew something was wrong but he couldn't figure out how to fix it. The first time he saw her in her room, he kissed her and wept and told her aloud, "I love you," in a way that brought tears to the eyes of everyone in the room.
In the second two weeks of my mother's hospital stay, my father's mental state spiraled downward. His trips to the hospital became shorter and shorter. Once my sister dropped him and Linda at the hospital entrance and went to park. By the time she got upstairs, he thought she was his ride home and wanted to leave. He stopped asking to be taken to the hospital as he had insisted before.
We hoped that after my mother came home that his mental state would stabilize and we could get back to where he was before the accident. But the familiarity of his environment had been interrupted too long. He can't understand that my mother is still healing and cannot walk with him or help him with day to day tasks. We've hired home health care givers to provide 24/7 care for my mother while she heals. Now instead of only my mother and Linda in his daily life, there are strangers in his home who come and go in shifts.
It's clear that the falls both my parents suffered had a huge effect on my father's tenuous hold on the world. The challenges we now face include drastic mood swings, weeping, a surge in his temper, and the foul language that was never uttered in our house.
Recently during an interview with the home care agency, my father knew we were talking about him and he seemed to understand that what I was saying and doing was for his own good. In mid-conversation he came up behind me and gave me a big bear hug. He thanked me for taking care of him and in that moment we were who we have always been, daughter and father. About an hour later the hug was history and I was a stranger from whom he refused to take his medication. The journey continues.

Melissa Leandra Guerra