Administration and Leadership, Patient Care

The Slow Farewell

Issue 3 and Volume 38.

“Nothing is at last sacred but the integrity of your own mind.” —Ralph Waldo Emerson

The jovial cackle reverberated loudly off the captive walls—an unlikely resonance from such a sad and customarily dispirited place. I hate this necessitated habitat as much as I hate the disease that stole them from me. Yet, I could not help but generate a small grin knowing the incessant laughter I was now tracking would eventually lead me to them— beginning with my mother, whose laughter is so clearly identifiable, so boisterous and delightfully contagious that even those outside the circle hypnotically gather to its source. Find my mother and I will find my father. She’s the only person he now recognizes, and they’re inseparable.

Just as before, I found them sitting in the lounge of their Alzheimer’s residence home, holding hands. Today, however, it was my mother’s birthday and she was rewarding her self-imposed wit with nonstop laughter after complaining about the cook’s blender, which was no doubt being used to puree a patient’s food, not being subjugated to make her a margarita.

“Happy birthday, Ma!” I whispered loudly so I didn’t frighten my father. Her eyes grew large as she reached to hug me. My father simply looked at me with curious uncertainty. “Birthday? What birthday?” she blurted. “We’re celebrating your father finally paying off his college student loan.” Not waiting for a reaction, my mother once again laughed at her cleverness.

“How old are ya, Ma?” I asked as I smiled.

“Old enough not to give a $%#!,” she roars in between chortles. “All I know is I’m so old that all my friends in heaven think I didn’t make it… or is it hell? %$#! Where’s my margarita?”

Today was a good day for my parents. My father was alert and my mother wasn’t repeatedly asking the same questions over and over again. They appeared happy and, despite the series of small strokes (vascular dementia) that had raped my father’s brain, he was smiling each time my mother laughed. This is a sign of humor’s capacity to survive and sooth, I suppose.

My mother’s dementia was diagnosed five years earlier—fifteen years after my father’s symptoms first began to appear. My mother is old-school; despite how his disease profoundly changed her, she insisted on taking care of my father alone up until her own cruel collection of cerebral symptoms began to manifest themselves, thereby making it impossible for either of them to be without the consistent care of assisted living.

I had felt blessed that my father’s retirement would provide them with a safe, clean, and stimulating environment for the rest of their lives, so it breaks my heart every time I enter this regrettable facility—a facility so familiar to those of us in EMS.

“Where’s the music? We need music in this %$#! Place!” my mother cursed sarcastically.

“How about the Village People’s, Y-M-C-A… except that we’ll sing it A-A-R-P,” I proposed straight-faced. My mother furrowed her brow for a second, thinking about what I had just said and then imparted a high-pitched giggle that grew into a pulverizing snort. Delightfully surprised by the unexpected sound, she roared laughter until her eyes were filled with tears.

“Now look at what you’ve done,” she whispered back at me loudly. Not waiting for an answer, she turned to one of the aides standing nearby yelling, “Hey Marge. These diapers aren’t going to change by themselves!” Again, my mother cackled as I tried to find a tissue to dry her eyes.

As more residents began to gather around our small family get-together, it became increasingly clear that even in their late stages of dementia, these confused strangers hungered for more than just my mother’s birthday cake. They were invigorated by the smiles and laughter and wanted to be a part of it—except for one elderly woman who kept yelling out each time my mother laughed, “What’s so %$#! funny?!” (This, by the way, only provoked my mother’s laughter to an even more brazen level.)

It’s important to empower oneself with humor during those silly moments that Alzheimer’s can produce. Why shouldn’t laughter bargain its way in whenever possible? My mother’s mantra has always been, “What are ya gonna do? So laugh #@$!”

“Hey ma! Knock! Knock! “Who’s there?” I asked. My mother grinned.

“HIPAA,” I said.

“HIPAA who?” she eagerly asked back.

“Sorry, can’t tell ya,” I said.

She laughed on cue, just like I knew she would. “Get it?” I asked her.

“No,” she chuckled. “But it made you laugh,” she added as she playfully slapped my cheek. Mothers are good for that.

As I prepared to leave, I could see the smile slowly fade from my mother’s face, despite her best effort to show otherwise. Despite all the laughter, I knew she was ready to leave this world of confusion and separation.

I couldn’t hide my despair. Her scrapbook was fading before my eyes. As I averted my eyes, she grabbed my arm and said, “And don’t worry about your father. He’s always by my side. Where else am I going to apply my Post-it notes?”

Occasionally I see my parents’ eyes in those geriatric patients my ambulance responds to—especially those who use humor to maintain what’s left of their dignity while in transit. I now regret not being more compassionate during my novice years as a paramedic toward those who cannot recall what happened 20 minutes ago, much less 20 years ago. They deserved better from me.

As for my parents, I’m not sure how long their remembrances and laughter will last, but I treasure the gift of comical relief that my mother has instilled in me since the time the diapers were reversed, and I pray that it continues to allow my parents to thrive despite their undeserved clinical prognosis. Thanks, Ma. You are, and always will be, my favorite fan.

Until next time, remember: What are ya gonna do? So laugh $#@!