Nowhere Else to Go

My dad Jack had four transient ischemic attacks (TIAs) in the past year, which had been coming at ever shorter intervals, in spite of clopidogrel and aspirin. He had a history of mild hypertension responding favorably to treatment.

Dad had the same clinical presentation with each of his admissions-namely, "word salad," involving Wernicke's speech area, although no abnormality was seen on magnetic resonance imaging (MRI) of the brain. Echocardiogram and duplex ultrasonography of the carotid arteries were also negative. Twice, in the middle of the night, I saw him in the emergency department and thought he was not arousable. The first time he was on a ventilator and the second he had pathologic neurological findings. Three times he recovered quickly.

Dad loved the Big Band era; he impressed the nurses with his boogie-woogie dancing prowess. He introduced me to his roommate Frank, another WW II vet who was dying of lung cancer.

His fourth episode was lethal at age 86. He had a good life and didn't suffer at the end.

Until age 84, he managed very well, and his only complaint was he didn't like getting old. With continuing reassurance, he still didn't like getting old. I told him he should be thankful.

If it hadn't been for an infectious disease physician, dad would have died of ascending cholangitis at age 48. Following a cholecystectomy, dad became delirious which was attributed to an adverse reaction to meperidine. Dad had just returned from a business trip to Mexico and was seeing sombreros floating by his bed. My mother knew there was something seriously wrong and requested an emergency consultation with a physician whom she knew had saved two other people in our apartment building. The ID consultant suspected dad was septic as a complication of removing gallstones impacted in the common bile duct. The antibiotic choices were not as plentiful as they are today and kanamycin was selected as an early aminoglycoside; it was a drug that was 11 years old and originally and still is used to treat tuberculosis. Klebsiella pneumoniae was isolated from my father's blood.

The consultant told my mother "we have done everything for now, he is in God's hands." Dad slowly got better and made a full recovery. He lost significant weight and experienced diminished auditory acuity in his right ear, but lived to tell the tale.

His recovery made it possible for dad to see his grandson John (IV) graduate from college and his granddaughter Elizabeth about to enter college, having just received the Gold award from Girl Scouts.

For the past year, my mother Mary, who is 84, took care of dad in their apartment. She has postponed cataract surgery, because she was afraid if she left dad alone she would "find him dead on the floor" when she returned. She always said: "he eats like a horse," which she interpreted as a favorable sign.

Mom has smoked two packs per day for 60 years. She has osteoporosis (Dower's hump) and is developing Alzheimer disease. She too is lucky, all things considered.

My dad grew up in Honesdale, PA (population 5,000). He was salutatorian of his high school class and received a BA degree in economics from Bucknell U. My dad would usually get 3 "A's" and 1 "B" on his report card; instead of saying "that's great, Jack" my grandfather would point to the "B" and say "what happened here?" My grandfather was Burgess (mayor) and this was a misguided attempt at motivation, which he apparently learned in WW I as a Sergeant First Class. He wanted dad to work with him in a car dealership. However, dad wanted to broaden his horizons. After four years in The Army Air Corps as a captain, bombardier/navigator stationed in Victorville, CA, El Paso, Texas, Iceland and Guam, my parents moved to Flushing, NY. In 35 years, dad worked his way up from assistant to the Personnel Director to Executive Vice-President of Melville Shoe Corporation (now CVS), a Fortune 500 company.

Dad came with me to Dublin, Ireland, Glasgow, Scotland, Charleston, South Carolina, Grenada, BWI and Dudley, England on my odyssey to become a physician. Many times, he told me he wanted to go on an African safari; he never made it. He asked me to take him to a Broadway play one last time; we never made that either.

I discussed with dad the options of places he could live: staying in the rehab facility in Greenwich, CT would be $10,000/mo (out of the question); staying with my family wasn't possible, because my wife and I work; moving to his cottage in the Pocono's would be boring; living in his apartment would require someone to live there 24/7. We agreed it made sense for dad to move to an assisted living facility in New Jersey close to my family. I filled out the paperwork and made a deposit for him to move on December 28^th; he died 10 days before I could move him.

In the event of his death, he asked me to play the following songs: Stranger on the Shore (Aker Bilk) and Is That All There Is? (Peggy Lee), which I did.

Dad was cremated; his ashes are in a bronze urn with the Air Force insignia. I was given a folded US flag to commemorate his military service.

I reconnected with the ID consultant, thanking him for giving dad an extra 38 years.

And I thanked the current internist for his excellent care. He said: "Jack was a good guy, he had nowhere else to go." Thus, the loving voyage between father and son.