On that visit he wanted me to call the house to find out if my mother was home, the first time in the 33 years since she died that I'd ever heard him express that sort of confusion. No, I said. She's not going to answer. My phone rang, and when I hung up I said, That wasn't her, either. (Actually, I said, "That wasn't she." My father is probably correcting me now.) When I left the hospital, a few hours later, I quizzed him on who I was going to visit when I went to the house, the kind of current-facts quiz I popped fairly mercilessly. He said "Joan," and I said I'd tell her how many times he'd asked after her. He laughed delightedly--the most typical reaction he had to his own spotty memory, or to some unseen obstacle that his wonderful caretaker, B, would help him overcome. Even when he seemed to be staring into the distance while we were telling long and involved stories and not even trying to help him follow, just when I would lob in a sly punch line he'd let out a sharp burst of laughter. This happened time and time again. His humor never faded.
In the last few months, Joan reported that he would tell her he was going down to Wallingford after lunch to see his parents. He cheerfully told Bart he was leaving on a trip, but he wasn't sure where or how he was going to get there. These mentions, along with his declining health, seemed fairly clear signs that he was getting ready to leave us. But as Joan would say, slipping her hand into his warm grasp and seeing the warm, beaming smile he gave her right until the moment he died, "He's just so adorable. I never want him to go." We didn't either.
Original article, December 17, 2009:
Photo Courtesy of Dr. Bart Kummer
A few weeks ago I got the kind of morning call nobody wants to, especially after you've just gotten off two long plane trips to long-planned engagements: my sister saying our father had just had a stroke and was on his way to the hospital. Don't come, she said. She was driving from Boston to the hospital in Hartford he was being taken to; my brother, a gastroenterologist in New York, was driving up at the same time.
The story had a happy ending, and not just because I'm lucky enough to have such concerned and proximate siblings, one of them a superb diagonistican and a tenacious advocate for all his patients, let alone for his father. It was because my father--a longtime family practitioner who knew he was at high risk of stroke and had no desire to live an impaired life--keeps by his bedside a note asking to be given t-PA, a powerful clot dissolver. If administered within a few hours of the first symptoms, t-PA can break up clots before they choke off blood supply in the brain, causing the kind of permanent damage my father feared.
The drug, which is given intravenously, has been in wide use for just 15 years, and the risk of causing hemorrhage is so great that either the patient or a health-care proxy must give permission for it to be used. So my father had my stepmother, Joan, write out a note saying that in the event of a stroke he wanted to get t-PA as soon as possible, and authorized its administration.