On the outskirts of Christiansburg, VA, and just off Interstate 81, the Shelor Motor Mile is Candyland for car lovers. Ten new car dealerships crowd and bulge Roanoke St, offering the biggest, most diverse, and most customer-friendly car buying experience in four states. Can’t decide between the new F-150, family minivan, or anniversary edition Corvette? At Shelor’s, you can try them all and get the best price in the Middle Appalachians.
Shelor is so big that it opened its own used car auction in 2000, quietly tucking it away on the hill behind the Chevy (now Kia) dealership. The costs of seller’s fees and moving a hundred trade-in vehicles ten miles down the road to Radford Auto Auction every week were enormous, so it made a lot more sense for Shelor to open its own auction. (Luckily for Radford, Shelor picked Thursdays instead of Mondays and didn’t totally ruin their business.)
A tiny Wendy’s restaurant is crammed in the middle of all this, about as tightly as a hamburger patty between cheap buns. My Dad always preferred the greasy buffet with saucy waitresses and overcooked vegetables down the street, but every so often, I could convince him to take a quick meal at Wendy’s. If he did, I could leave the auction and return to Virginia Tech in time to do my physics homework and party. If not, then – as I was a college student and all – it would just be partying.
While at this Wendy’s and slurping down a Frosty on a sunny spring day in 2002, I concluded I was observing the first signs of mild cognitive impairment in my Dad. We were stopped by a friend and fellow car dealer as we were about to exit the lobby – an encounter that deserves its own blog article someday – and my Dad introduced me to this fellow _twice_ in about five minutes, repeating a lengthy description of my studies at VT. Our friend nicely responded that Dad had already introduced us and that Virginia Tech was a fine school. While I noted this gentleman’s excellent taste in universities, I became fixated on my dad’s forgetfulness and how out of character it was. The problem was that Dad never forgot anything. He could tell you his first phone number from the 1930s or the address of the house where he was born, and the same for everyone he ever knew too. He could track the minutiae of a conversation for hours only to come back to some earlier detail that revealed the cause of a problem or the identity of some unknown actor. An encounter with Dad was like meeting a hillbilly Sherlock Holmes that loved cars or an Abbe Faria imprisoned in beautiful mountains instead of the Chateau D’if. And, if – heaven forbid – my mother found something missing from the weekly grocery order, she knew when she yelled at him for the lapse that it wasn’t because he forgot it – he did it to piss her off.
And, yet, here he was, forgetting that he had introduced me to this friend only a minute ago. He had started repeating things that people wouldn’t normally repeat, like an introduction just given, but not with a particularly high frequency. I noticed it, either because I inherited a touch of his observational superpowers or I wasn’t around as much due to school, but no one else did. There were some other “slips” too, like how he started counting money in a new, self-correcting way to have confidence in the answer or when he forgot one of those phone numbers that were etched in his brain. Something seemed off.
Dad knew what was happening too. He had seen it before, if not in anyone from his endless pool of friends and colleagues, then certainly in my grandfather, who will reappear later in this series. None of this was a mystery to him. It was just another day out of Dad’s last 26000 or so.
He was a proud man, though, and would never admit any amount of failure (except in cards), illness (except in someone else), or weakness (unless it meant he could get his tractor), and he certainly looked at this very natural process as one or more of those. Attempting to discuss his health without great care would inevitably lead to getting conversationally hoodwinked, pettifogged, yelled down, or possibly punched.
We spoke about it obliquely instead. He would tell stories or devise doomsday “what-if” scenarios, usually prefaced by “Daddy won’t be here forever, and you kids will have to…” Later, in the summer of 2002, he started dropping funeral and estate planning instructions on me when we were alone, but if I turned this into a health discussion, he would demur or change the subject.
My siblings also refused to believe that something was wrong or that even a single blade of grass would bend beneath Dad’s foot if there he so tread. So as he gave me more and more instructions and made his preparations, I decided it was best to keep it a secret, and I appeased him. He was only 72 or so, anyway, and certainly, Daddy would get help when he was ready.
He never did. Nineteen years later, he was arrested after wandering a mile or so from his house and admitted to a state psychiatric facility under an emergency custody order for refusing to comply with instructions from an officer and engaging in threatening behavior. No amount of subterfuge or the acquiescence of bystanders in the face of an angry old man would conceal it. Dad’s secret was finally out: he had advanced dementia, the exact cause unknown.
Two years later, he was gone.
Dementia
Dementia is not a disease but a description of symptoms. This class of symptoms can be caused by any number of underlying conditions, including Alzheimer’s disease, Lewy bodies in the brain, hearing loss, or venereal disease. Vascular atrophy, the shrinking of blood vessels in the brain due to trauma, stroke, or age, is another common cause of this condition. To make matters worse, these things can overlap, each contributing in its own way to the destruction of the mind. Some of these underlying conditions can be cured and dementia arrested (e.g., hearing loss can be addressed, and syphilis can be treated with antibiotics), but others cannot (e.g., Alzheimer’s disease).
The general progression of dementia begins with a few slips, like Dad’s, and more abilities are impacted over time. While most people associate dementia with memory loss, that is only one of many symptoms, and other cognitive abilities can be impaired as well, such as language or reasoning. There are a number of common physical symptoms, too, including loss of motor function and balance, incontinence, and a change in appetite, often a marked increase in sugar consumption. The exact set of symptoms and the amount of time from good to OK to being in dire straights that defines a person’s journey with dementia depends on the underlying disease and the person’s overall health.
Taking care of dementia patients is extremely demanding. It is rough on the patient, their family and associates, and on medical staff and facilities. “The 36-hour Day” by Nancy Mace and Peter Rabins illustrates the challenges very well in the first chapter, in which they weave a narrative about a woman who finds herself in a strange place, with people she doesn’t know, and things going on that she doesn’t understand.
Helping folks understand the many facets of caring for dementia patients, especially the challenging ones, is one of my many motivations for writing this series of articles. I also hope to share some of the good and the bad, such as how we grew closer as a family and how each of us grew closer to Dad too.
My father’s dementia was caused by overlapping conditions that layered together to create two decades of slow decline. He had hearing loss in both ears due to years of running heavy equipment without hearing protection. He slept only a few hours a night and had plenty of trauma from getting knocked on his head and fighting. We worried that his endless womanizing might mean he had picked something up too. A couple of mini-strokes in rapid succession finally put him in bed for six months, and the vascular atrophy that followed became the single biggest factor in his decline. He had so many overlapping risk factors that his first doctor at the psychiatric hospital told me he had no idea what was going on.
Dad was proper old, too, only retiring from work after his strokes, just before turning 90. Physically he was in great shape, and were it not for his cognitive decline, he might have blown out a hundred candles in a few years or met more great-grandchildren. 93 at his death, he had lived alone for decades, buried children and a wife, and watched his last friends pass away one by one. His later years became a guessing game of who would leave or pass next, figuring out whether he knew his customer’s grandparents or great-grandparents, etc. We suspect that he lived through one or more cancers. We don’t know how, but maybe they just gave up because he never stopped moving? So it wasn’t much of a wonder for the family that, having outlived everything else, he went ahead and outlived his mind.
Next time
Thanks for reading this first part of what I hope will be a series about my father’s struggles with cognitive decline and what we did to help him. I hope you’ll enjoy the next part, in which I’ll discuss how his disease progressed and some ways families can get support.
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