The beginning is difficult to pinpoint, and I suspect that my daughter-in-law recognized something wasn't quite right before the rest of us - perhaps because she didn't live with the gradual changes and perhaps because, while studying for her Bachelor of Nursing Science, she worked in a residential care home.
In January of 2013, Dad and I took the 2-1/2 hour flight to be present at my granddaughter's and his first great-grandchild's baptism. We arrived on Friday. Already during the flight his "cantankerous" side was showing, and it was much more pronounced than he and I flew to Panama in 2010 for my son's wedding.
In 2010 he was 85 years old and it was a little over a year since he had had 5 stints put into his main artery. His recovery had been remarkable, and he excelled in the fitness classes given for heart patients He did not then, nor never has, liked anyone to tell him what to do. Aware of that, and being charged by my sisters to make certain he took his medications on time and had his proper rest, I formed an easy enough game plan.
During the Panama flight, I kept snacks he liked in my purse because flights are not always at convenient times. When it was close to time for his medication, which he had to take with food, I would just say, "It is almost 5 o'clock. Would you like x or y to take your medication?" or something equally benign and then wait for the decision to be his. I would also feign a need to rest every afternoon, so he could get out of the heat; and I decided to return to our room after the evening wedding supper rather than join the others at the party so that he would get a proper night's sleep - because I knew he would try to keep up with me if I chose otherwise. Throughout the trip he remained energetic and upbeat, joining the young people in the pool, carefully sunbathing 10 minutes on each side in the afternoon, and shopping at the little booths down the beach.
I have never quite understood this need of Dad's to be independent and in control, but it would play an important part in ensuring his comfort and happiness when we were trying to find a suitable full-time care home for him. My sense is that, for Dad, the ability to be in charge of the situation is tied to his feelings of self-respect.
The Panama trip was a success, the trip to the baptism in January of 2013, not so much. He began resisting attempts to remind him of taking medication. When we visited my son and his wife of Saturday, he refused to take a nap, though he was clearly tired. He got visibly upset when I asked about his medications. It turns out that he lied to me about taking them. The baptism was the next day in the afternoon followed by supper. He again got upset with my inquiries insisting that he had things under control. When we got back to our hotel room at 7 pm, he was in trouble and we had to call 911. He admitted then that he had forgotten to take his medications.
I won't go through all the trials of the next few days as he reached delusional heights of paranoia, taking out his intravenous and then proceeding to "rescue" the patient in the next room. He insisted the 3 security guards standing over him to keep him in his room after a code white was called, were abusing him. At that time, he was but through a full battery of tests. The psychologists and doctors found no signs of dementia and concluded that this was a psychotic episode brought on my medication By Thursday we got the "o.k." to fly him home with my nephew accompanying us on the first leg of the journey.
My daughter-in-law asked me if Dad was showing any signs of dementia, because when we visited on Saturday, she noticed that a couple of times he had a vacant look on his face, a look she associated with people experiencing episodes of dementia. I may not have worded this correctly, but I now know what she was talking about. While he was still living with my younger sister, I tried speaking to him when he had a blank or vacant look, and when he did eventually acknowledge that I was speaking he seemed confused for a few minutes. Once I even thought that he did not know who I was and he got angry at me for being there.
Dad seemed to recover well from the episode after my granddaughter's baptism, and the doctor's said there was no sign of dementia or Alzheimer's that they could see. However, we all concluded that he should not travel ("like he was going to listen to us"), and yet he persuaded my younger sister and I to accompany him on one more trip to Scotland that fall. We are forever grateful that we were able to help Dad fulfill his wish to visit the Blackwatch Museum in Perth, Scotland, but that was definitely a turning point for us in our relationship with our father as reasoning with him became increasingly difficult with my oldest sister taking the brunt of his unpleasant, hurtful remarks. We began to notice that more than ever there seemed to be, in his mind, a good daughter and a bad daughter. Later, this dichotomy of thinking, like the need to be in charge, would play a role in his adjusting to long-term care.
