Coercing My Father

At the age of ninety my father began to lose both memory and language. First he lost his proper nouns—the names of people he knew and the town he lived in—then common nouns like pencil and kitchen and robin. It made him unhappy, sometimes miserable. All his life he’d been a student of history, economics, art and archeology. He’d been the managing editor of Life and American Heritage, and now he had trouble talking about the raisins in his toast.

He retreated, as many Alzheimer’s patients do, into silence. He lay on his bed or his lift chair, neither fully awake nor asleep. He looked empty. He didn’t want to walk outside, not even to the mailbox. When I read to him he gazed into the distance. If I suggested a drive to the ocean, he said no.

The neuropsychologist who tested his memory concluded that he had advanced second stage dementia, most likely caused by Alzheimer’s. He urged me to take him to the senior center, for the social contact—but my father didn’t care about bingo or volleyball in a chair, and had no interest in other old people. “Take him anyway,” the neuropsychologist said. “Once he starts going, he’ll like it.”

I took him once but he didn’t like it, so I didn’t make him go back. I could have, because by then I was pretty much in charge of his life. I’d moved into his house on Cape Cod to help him stay out of a nursing home, the last place he wanted to live. Each morning I gave him his medications, helped him take a shower and dressed him in fresh clothes. I took him to appointments with his cardiologist, his dentist and podiatrist. All that he had to do. But when it came to the senior center, or taking a walk on the bike path, I felt awkward about coercing him—for he had always been permissive as a father. More than that, he believed in letting me make my own choices.

This is a great quality in a parent. Instead of urging me to do what he thought was best, he supported my own choices. In my twenties, when I dropped out of a PhD program in New York and moved to a backcountry farm in Chile to raise chickens, he didn’t try to dissuade me. Later, I ran a small truck farm in Ohio for ten years, and he never tried to point me in some other direction. He was glad when I started to write and publish books, but he’d been happy with me all along. Coercion was foreign to my father—yet after all those years of acceptance, I found myself trying to steer him through his old age.

We coerce the elderly as a matter of course. We make them stop driving, we decide what medications they should take, sometimes we put them in homes against their will. We tell them, as we make some enormous choice for them, how they should feel about it: Cheer up. Don’t worry. Just relax.

I didn’t put my father in a home, and I didn’t insist that he go to the senior center—but his days often went better when I roused him from his blankness and despair, especially in the late afternoon, that time of day when “sundowning” tends to engulf people with dementia. If I could convince him to leave the house and drive to Cape Cod Bay, or to the raw Atlantic, just looking out over the water would often stir him up and get him talking.

The next day, however, we’d be back to the same struggle. He wouldn’t want to go anywhere or do anything, and once again I’d try to persuade him. The truth was, starting with my cheerful greeting in the morning, I leaned on him all day long. I tried to get him to eat and drink, I urged him to do his exercises, I asked him a stream of questions—which were often a kind of coercion, because I was trying to keep him involved. Without my steady guidance, I thought, he might retire from life completely.

Easter Sunday, when I knew we’d be alone all day, I tried something new. I gave him his medications, then let him decide everything. I waited, ready to help, as he lay in bed. He went to the bathroom, but ignored the shower and didn’t change his Depends. Though I set food and drink on his bedside table, he didn’t touch them. He never asked for help, he stayed silent and inert, and we passed what felt to me like a long disconsolate day.

We’re coercive with both children and the elderly because we think we know what’s best for them. And some caregiving decisions are easy: we don’t let the toddler near the freeway, and we make sure that an old man with atrial fibrillation takes his Coumadin. But it was my brother Joe, after one of his visits, who pointed out that Alzheimer’s patients, when pushed too hard, sometimes need to crash. “They need to give up for a while,” he said, “and stop rising to the occasion.”

Soon after that a friend, Lois Gilbert, wrote to say that while my dad might look inert as he lay in bed, he was probably busy in his own way, preparing for death. “It’s like cramming for finals,” she wrote, “or the most important exam of your life at a really hard school. You learn new reflexes, new ways of untangling the soul from the body. You begin to travel away from it, and take scary little field trips out of your home flesh and brain.”

Lois’s comments, along with my brother’s, rattled some deep assumptions in me. Who was I to say that my father should be cheerful and involved? Alzheimer’s or not, didn’t he have the right to sit in a chair and be unresponsive? Did he have to perk up? Did he have to look after the rest of us, as he’d been doing his whole life?

So much is expected of the elderly and infirm, even when their minds are giving out. The hope I had for my father was that he would be as happy and engaged as possible. Also that he would respond when I said “Good morning,” or “Are you hungry?” But while he’d always been the politest of men, by now he’d had enough. He sank. He worried less about what anyone thought, and was often immune to the sound of my voice.

I didn’t repeat my Easter experiment, because our days went better when I took some control over them. But I tried not to worry when he sat and stared at nothing for hours. It was painful to realize how little he needed me, and how little I could help. But I couldn’t join him where he was going, and slowly I set aside the clutter of my good intentions. I could keep him as comfortable as possible, and be there if he reached out. Perhaps I could learn to be less coercive. After all, for my entire life my father had been showing me how.