Retirement rhythms

I retired completely in January. Ahhhh. 

Then, a pandemic dropped by. Aghhhhh!

I’d been easing into retirement over the past few years—retiring from patient care as I turned 65. Then working three-quarter time at my medical geek passions as designer-teacher-researcher-writer. Sandy and I had enjoyed the newfound freedom of no more weekend work or being on-call, now able to enjoy unlimited 3-day weekends. However, it took a bit of adjustment in the Rhythm of Closeness to balance our personal private time with the-two-of-us-together time. “It’s nice to have you around more, but NOW?! I had plans of my own.”

The pandemic required a new set of rules for the Rhythm of Closeness. Speaking for myself, and apparently for others, I can get a bit stir-crazy hunkered down indoors. Frustration easily finds our favorite targets, whom we married a while back. But over the years, we had adjusted to children with the accompanying disrupted sleep, constant need, and untimely illness. We WILL adjust to this. 

I had been riding my bike to work the past dozen years in all kinds of dry weather.  It was my multi-purpose morning exercise, mental health moment, communing with nature, and commuting to work. I had continued the cycling on my retirement journey, with stops at the coffee shops on my days off. Tuesday became my day to meet friends for coffee, or lunch, or our twice-a-month evening men’s group. With the pandemic, all of that required safety adjustments.  

Can we get some help here?

Heeding the calls for service to retired health professionals, I considered ways to apply my skills, but away from the personal risk of the patient care environment. Contact tracers! We needed contact tracers at our local health department. My offer was accepted with glee. I did my online training to learn the difference between isolation (the sick) and quarantine (the exposed who appear well), and joined the daily 8 AM health department Zoom calls as the medical expert of the hour. I could ride to the coffee shop, get my order before 8, sit outside on the patio, and join the COVID-19 team Zoom call. Eventually, I realized I could get back on the bike listening on Zoom, on my phone, on mute, waiting to respond if I was needed. The team knew it would take me about 20 seconds to pull over and unmute to respond. What a sweet combination of service, fitness, nature, and mental health.

How’s the family?

Our sons are scattered across time zones. Stuart, our oldest, works for Riot Games (maker of the video game League of Legends, and others) in Hong Kong where he’s been for 5+ years. He has a girlfriend, Dan, who we adore. They were able to come to Columbia for the solar eclipse in August 2017. We can do FaceTime calls with some coordination, and Sandy messages him often. Scott, the middle son, lives in Columbia in a house that Stuart still owns, so he likes the landlord. Scott’s splitting his time between work at a local book distributor and taking online classes in the information technology realm. He’s at our place a lot, so we each have two people to hug. Mark, the youngest, works in New York City at home now doing video production work for a small company that sells health and wellness products. We managed to squeeze in a trip to see his comedy improv class performance (think “recital”) in January, just before the shit hit the fan. 

Sandy will have some words to say for herself, but I’ll just say that she’s retired, too. Her empathetic heart has been busy and burdened by the suffering around us. She is my best teacher, having to adjust her lesson plans because of the pandemic. Her class can get rowdy. 

There has been loss—more of us experience it each passing week. My sister, Lori Belden Hainz, died in Saint Louis at age 60 in April after a lung transplant for severe lung disease (pulmonary fibrosis with pulmonary hypertension) as a result of a life-long version of scleroderma. The last few years were a quite a challenge for her and her family. She had such great support from her husband Scott and my wife Sandy, who was like a sister to her. We had a small celebration of life weeks later with our masks and sanitizer. There was Facebook-Live streaming for those who could not travel safely or fit in the limited venue space. 

——

Consider this a holiday letter. 

It’s been years since Sandy and I sent one. For a while, we still got them from most of our old friends Those letters tailed off except for the most hardy and dependable of letter writers. To you we are grateful. For the others with whom we have lost touch (except for Facebook, where I seldom tread), please forgive us. We forgive you. We love you. 

Jeff (mostly) and Sandy Belden

A public reading was held at the Blind Boone Home in Columbia Missouri on March 14, 2020 on the posthumous release of the book "Out of Lethe" by Dan Cullimore. Hosted by Vickie Holtz-Wodzak. Recorded by Jeff Belden. 

I remember 25 years ago, I was looking for more sustained, deeper connections to people when I found a book by M. Scott Peck called "The Different Drum: Community Making and Peace" that offered a vision of community and connection. A few men announced an effort to create a men's center in Columbia, and I attended the meeting, hoping to find a small group. That's what happened. We've met twice a month in our homes or around a campfire in warmer weather. It is a sacred space.

A circle of men 

I began to learn the power of just listening. To wait to speak. To allow silence. To sit with anger, grief, and fear without judgment, and to celebrate joy. I was surprised when a man told me "I thought about what you said last time." I had been heard, remembered, and what I said mattered to another man. I learned that being thoughtful, waiting, then speaking concisely was a powerful act. I learned the language of emotion – the vocabulary as well as the language of the body.

A training adventure

We all eventually attended a weekend-long New Warrior Training Adventure sponsored by The ManKind Project where we learned to go deeper, find more courage and emotional clarity, and gain lifelong tools to be better fathers, husbands, sons, and men. Our bimonthly meetings put those insights and tools to use. We joined groups of 40 to 50 other volunteers from time to time to offer that training to new men looking for meaning, purpose, or healing.

Role models 

Men modeled beautiful relationships to their wives or partners, to their children, and to each other. Men taught me how much their wives had taught them, and how they'd grown closer, wiser, and more loving. Men shared their fears, their disappointments, their shame. We also celebrated our successes large and small. Small successes came in the form of a "stretch": something I know I need to do, can do, can describe clearly, but might not do unless I promise to the group that I'll try. And I'll report back when we meet again. I know I won't be shamed for failing, but will be asked "What did you do instead that you considered more important? Is this a pattern? Is this something you want to change?"

Being known 

Over the years, we shared chapters of our struggles of being a father, a husband, a son. Over time, these men came to know my stories and experiences deeply. In 10 minutes I could tell of the latest concern, and they already knew years, sometimes decades, of backstory. They knew my strengths, my weaknesses, and could see what I could not. They spoke the truth that might support or challenge me, but always toward more accountability, authenticity, honesty, and emotional awareness. We all carry imperfections. I have a list of theirs, and I'm sure they have a list of mine, perhaps even longer. The imperfections make us richer, more compassionate, and stronger healers who share that wound.

If this sounds appealing to you as a man, or valuable to a man you know (if you're a woman), let me know.

My father died about a year ago. I believe I did the grieving that would give meaning to his loss and allow me to move on in life. Lately, he appears at my side when I least expect it.

I should have stopped. 

Just a week ago. It was late at night, driving home from a movie, nary a car in sight. The last stoplight just turned yellow. I could make it by speeding up just a bit. The light turned red in the last few feet. The police car I had not noticed behind me could easily see the color change reflected off the car's white roof.

The young officer, a woman, was kind in her directness, "I stopped you for running that red light". I didn't have to squirm through a gradual confession. I gave her my ID and insurance card and she returned to her car.

Faster than us

As I sat waiting for what seemed a long time, I recalled a time a few years ago when I was driving with my father (with dementia) back from a visit to his sister Alyce in Illinois. This was one of several meaningful trips to visit the people he loved, and the towns that shaped his life (where he was born, graduated high school, got married, and raised his family). I wanted to make those trips while he was still able.

Driving around St. Louis on an outer bypass on a dark, quiet Sunday night we were stopped for speeding. Not that fast, but I had not noticed this was a "work zone" (empty now) with a stiffer penalty. The officer was a kind black man, who only gave me a warning ticket (ironic to me now, having had several black male friends relate their frequent experiences of being stopped for driving while black). But during that lonely wait while he made his report, my father helpfully/unhelpfully kept repeating "The other cars were going faster than us. We weren't going fast." I wanted him to just be quiet and not get us in deeper trouble by antagonizing the officer with his unfiltered comments. I screamed to myself "Dad! Shut up!", but I mustered kinder words, "Dad, please be quiet. I was wrong. I was speeding".

I never dreamed I would recall that moment with wistful tenderness. My father had moments earlier expressed deep appreciation to me about making the trip to see Alyce and other family, and how much it meant to him. That was priceless.

So this ticket, which I have paid, put my father at my side again. That was also priceless.

"The car is totaled." The estimate for repair was more than it was worth. The market value dwindles with time, but the real value had grown richer. 

Our son had taken one of his many African friends (this man helped him with French translations) for a driving lesson, against his better judgment, but because he is a generous friend who cares. Things had gone well, once they found a suitable place to practice (not the State Farm parking lot where we taught our sons to drive years ago). In the last few minutes, though, the friend backed into a concrete post, deeply folding the rear bumper and the trunk lid. No one was injured.

This car had been my father's car. Seven years ago, he moved into a nursing home here in Columbia after my mother died. His car became our son's car. Despite his Alzheimer's disease, my father knew it was serving others.

My father kept possessions in perspective. When I, as a teen, kept driving the family car with a red engine light on, I caused $500 in engine damage to our only car ($3,700 in today's dollars). My father was understanding. I, his son, was what mattered most.

So, this parking lot lesson is an apt ending for the car. It died in service to a friend in need who hailed from another culture, as an act of generosity and service. I think my father would be pleased. Totally.

This week would have been both my parents' birthdays. Dad born Seven-25-27, and mom Seven 29-29. My nifty numerical nmemonic helped me remember the date and calculate their ages.

Different styles

"Bill, it's time to go" was a familiar refrain from my mother, Iris, when my parents visited. Mom was the punctual & tidy one (who might put away the plate I had just placed on the kitchen counter before going to the bathroom). Dad was the one who would get engaged and linger: playing on the floor with his grandchildren, stopping to chat while out and about, or figuring out how something works. They were a good pair, balancing each other's tendencies.

I don't want to be a bother

My mother died about 6 years ago after a fairly short illness, on hospice care, only days after arriving home. She didn't linger. It was time to go. 

My father lived for nearly 6 years in a nursing home here in Columbia, slowly declining year by year. He seemed in no hurry to go … that is, until he got the final call. 

My mother-in-law, Lydia, died in early February this year. Our dispersed sons made travel plans for a memorial celebration to be held a month later, coming from Hong Kong and New York. Then in late February, as if not wanting to cause anyone further inconvenience, my father quietly died days before Lydia's memorial celebration. Piggy-backing family plans, we held his funeral 2 days after Lydia's. 

It was as if, at Iris' cue, he heard the call, "Bill, it's time to go."

This photo reminds me of a lesson about savoring a moment. We had high hopes. They were exceeded beyond our wildest dreams. And it took very little more than to open our eyes and be present. The memories of joy and satisfaction warm me. 

About 6 years ago, widowed for a year, away from his home of 60 years, my father enjoyed a little core family reunion that we, his children, staged. The aim was to get Bill and his sole surviving sibling, Alyce, together with his children and my wife to enjoy a weekend while we still could. 

We went for a walk at nearby Ballard Nature Center. Wildflowers bloomed. A tree frog perched atop a post. The air clear and inviting. Filming as I trailed our little group, I saw my father pause to look around and savor the little wonders all around us. In this photo, we sat — allowing the wonder and sunshine to soak in. That's one lesson I take from that day. 

We may have some disappointment today. Hopes aren't met. Expectations were too high. But let us not miss the little wonders. Small blossoms. 

Today, I woke to the dawn chorus. I'll hike with some dear friends before the summer heat sets in. We'll walk in worship of the wonders of this world. Hearts will be open.  Allowing the little wonders.

Appreciating two mothers this Mother’s Day. One here. One gone.

Most days, our appetites serve us well. When we are hungry, we eat (if we can). When full, there's a signal to stop. In this image, the two mothers most important to me are communicating silently. My own mother's posture speaks of resignation. Her head in her simply adorned hand. The other hand rests on her tray, acknowledging its presence while signaling indifference. The bands identify her as "the one cared-for". The white towel protects the modest dignity of her gown. Her hair holds its coif. 

My wife (the other mother) looks on, patiently ready to offer whatever my mother may need. The signals are subtle, but another mother would recognize them. For this brief moment, nothing more is needed. 

Eating has been perilous in the preceding days, and hope has been fading. The simple food before her will not address the longing that will be satisfied at home in a few days. The longing is for her final home. Where all our needs are met, whether tired or hungry. 

After the kids grew up and scattered, my parents spent a lot of time on jigsaw puzzles. Visiting them, we would see the evidence of puzzles in progress atop the card table. The puzzles were a source of satisfaction and shared endeavor for them, and evidence of their intellectual integrity for us.

Our parents seemed to savor the completed puzzles a while, yet know when to surrender them back to the box (and not shellac them into rigid permanance). Savor, then surrender.

Remembering home

After my mother died six years ago, my father, already evidencing Alzheimer's Disease, was still able to solve 500 piece jigsaw puzzles and charm his nursing home staff. We kids were so happy to see his preserved puzzle-solving power that we ordered a Puzzle of Home – a contour-map puzzle of St. Elmo and the surrounding area. The map showed the streets where I ranged unsupervised on my bicycle, and the nearby roads to the oil field where my father made a daily living. 

Savoring strengths

I learned to savor his remaining abilities and strengths. He could walk around the lake at the park, where we both enjoyed smiling at the toddlers we encountered, hoping to speak to them.  Over time, the walks grew shorter. The upslope a challenge. Getting in and out of the car near impossible. The little losses accumulated in my heart. 

After our mother died, I was impressed by my father's adaptation to her loss. He had expressed his grief, had savored the long relationship that he so treasured, and then surrendered. Not in dismay and longing, but in soldering on. Not relenteless and destructive, but dutiful – dedicated to live as he always had. Loving God, and to loving one another. 

So, I use these little opportunities to write and savor the memories, to make meaning of what still puzzles, and then to surrender.

I came across a small sketch in my journal of a father and son sitting quietly together beside a campfire. In my notes, I recall an experience of a wordless powerful presence. I remember a time on a winter Boy Scout campout in the city park when my father held vigil over a fellow Scout who had fallen asleep on a log beside the fire, wrapped in his sleeping bag. This was a community of trust. 

The smoke and fire are a reminder. The magic worked by the presence of caring. We work that magic for others at work, in our relationships, and in building (or rebuilding) our communities. This generous listening is powerful beyond our imagination in ways we may never know. 

In warmer weather, I regularly sit 'round the fire with a group of men whom I've known for decades, whom I trust and to whom I am trustworthy. The foundations were built when I was in my teens, around the campfire with men like my father, a powerful presence. 

The last time I touched my father is not the one I'll cherish. At the funeral, in the open coffin, his body was cold, preserved for this final farewell. His face caked with stage make-up.

I'll remember other warmer touches. In the past year when he said little, I was charmed by our hand-holding as we walked slowly, me gently tugging, my tow cable arm aching from the stretch back. In the gentle caress of our hands, Dad's touch spoke with affection. Often in my own head, I'm surprised how much these memories are from the body.  

In my youth, the language of touch was having my back scratched as I laid across my father's lap. As I got older, he shifted to rubbing my bare feet. Both undeniably pleasurable for me, and selflessly generous on his part. 

After my mother died and he moved to Columbia near me, I had a sense of duty and service toward him. I owed him. I hope I shared some sense of his selflessness. 

Service has a devotional sense to it – of worship, of watching. I was like the acolyte who had a job to do, at the expected time, a part of the team. My time was now, in the twilight years of his life, while there was still light to let shine. While we were both warm to the touch. 

I came across a photo I don't remember taking. Of a nascent loss of a loved one. My mother, Iris, lies very quiet in her hospice hospital bed in the darkly-paneled living room. Just now, I'm tempted to call it the dying room, but hospice helps us see these last days as living to the fullest. Meager fullness perhaps, but none the sweeter. 

My wife and my sister sit at her side, quietly attentive, supporting one another with their presence. A generous presence. Unflinching. Unblinking. Steadfast.

Two men are in the scene, standing some small distance back, attentive in their own way. Lost in strategy. I am one, behind the lens, composing this compact drama delicately unfolding. Witnessing with the photographer's eye, capturing deftly. 

Across the room is my father standing in his undershirt about to speak. His face is a mixture of guarded concern, a bit lost in his own home, and casting about for a way forward. 

In the coming days, we, his family will guide him to the funeral home, to the church, and to the cemetery. A week from now, he will start his daily sojourn afoot to the graveside to remember his Iris. A few months later, leave his home of 60 years to live nearer to us. And within a few years, as his capacity for memory erodes, this loss of his beloved Iris will be a forgotten loss. 

This is the first weekend since my father, Bill, died where I did not find myself planning to go see him after a morning hike with good friends. I realized how much I’ve learned from him and my recently departed mother-in-law Lydia in the past few years. 

For decades, I’ve proudly told others that my father taught me how to dig a ditch properly. 

You don’t want to get a shovel full of dirt and lose half of it, only to lift it again. There is a proper technique. He also taught me that it okay, even laudable, to rest in the shade on a very hot day toiling in the field. It’s not being lazy. It’s smart, healthy, and a good example to set. 

Both Bill and Lydia died from Alzheimer’s Disease. It runs in my family so I assume it’s my most likely cause of natural death. I’m not exactly obsessed about it – at least I wouldn’t call it obsession – but I have considered my options at finding the shortest path between diagnosis (of AD) and death. I’ve made it clear I would prefer to die of the very next illness after AD is diagnosed. Why? I don’t want to spend a decade needing assistance only to curl up and die in bed. I don’t want to inflict a burden of effort – emotional or otherwise – on others. I don’t want to spend anyone’s healthcare dollars or resources if I have AD. I believe it’s fine ethically, spiritually, and rationally to take my position on this. 

Bill and Lydia shed some light on this for me. 

Lydia had expressed a clear and consistent wish to die for years, more so after she was snatched from the jaws of death a few years ago when a well-meaning neighbor saw her collapse in the yard, called 911, and whisked her away to the ER to be “saved”. She was NOT PLEASED! She had already made her wishes made, AND she was taken away from a gloriously peaceful place she experienced as others struggled to bring her back. 

More recently, in the same breath, she would tell us “I just want to die, and I’m ready. I hurt and I can’t think straight,” on the one hand, while on the other hand say “I love my life. I enjoy this place and the people are so nice. I’m so happy to see Sandy every time she’s here. She is so good to me.” 

How could that be? 

I believe they were both true, both clear-headed, and both rational.  Yes, life carried a large burden of pain and suffering that would not improve. Yes, the time she spent with those who loved her was full of joy. But the burden was outweighing the joy. 

Bill, on the other hand, had slowly faded cognitively so that he no longer recognized any of us. We could tell he enjoyed eating. He might take your food if you didn’t watch out. He smiled when others treated him with kindness and respect, which seemed like always to both of us. So I’d categorize him as pleasantly demented – maybe even happily demented. Would someone who is pleasantly demented want to die? I would. I’ve considered the burden on loved ones and on society, and my choice would be to lighten those burdens even if was happy or happily oblivious in the face of AD. 

Some day, my family and my physicians will be considering my wishes. 

I’ve expressed them here. I don’t expect them to change. I’ve considered them in light of what I’ve learned from these wise parents, who taught me so much. 

At the funeral, the only time the urge to cry expressed itself was singing a particular verse of one of the hymns, How Great Thou Art. This was one of the songs my father had sung as a solo for others in my position, being comforted and supported by a community of friends and faithful on a day of final loss. Accompanied by the same organ, reading from the same hymnal, in the same choir loft that he and I stood in 50 years ago singing side by side. 

I think the sadness flowed when I pictured my father singing this now, about himself, for us all to hear in our imaginations. "I'm going home!" How easy to see him bow in humble surrender. And rise with a great beaming, familiar smile.

When Christ shall come, with shout of acclamation

And take me home, what joy shall fill my heart

Then I shall bow, in humble adoration

And then proclaim: "My God, how great Thou art!"

I'm sure it was the overflowing joy from my father's heart that washed over mine. That brought the tears. That invited surrender. 

The love of Jesus was washing over Bill Belden, and all those around him there. The faith of our fathers.

Life is what happens when you have other plans. 

I wanted to wrap familiarity and comfort around this day. I have the memory of long reflective bike rides accross the flat prairie of Central Illinois with an open, receptive mind. A memory of a few inspirational words that hang a framework. Of the quiet delight and soothing satisfaction of saying what I want to say. What I need to say. Sitting in Joe Sipper's Cafe in Effingham. Satisfied, and a little more complete. Finding meaning in life's major events.

Perhaps it is not to be today. I don't really feel inspired. I'm plagued by little details that want clarification. Did we contact the pallbearers? We did not. A few calls and we're done. 

Who picks up the funeral fliers from the printer in Effingham to deliver to St. Elmo? Was that clear? Will anyone? Should I call now? It's too early.

Will I cry? Yes, maybe. I have nice tight compartments, rated waterproof. We'll see if they will withstand the immersion. I don't really mind if people around me, who knew me, who loved me, who still love me, see me wet with tears. 

Today, a farewell. Farewells. To my father, Billy Lee Belden. To St. Elmo. Will I return? To Joe Sipper's? Is this the last bit of prairie writing?

Or does the Maker have other plans? 

[originally written April 19, 2015.] 

My father's Alzheimer's disease would now be called moderate. His experience of the world is less precise, less clear. His memories are no longer worlds of words, but fields of feelings.

Three years ago, he first told me the name of his Japanese girlfriend from when he was stationed in postwar Japan. Or one year ago, he remembered that his granddaughter's name was Violet, and it was she who frolicked on the hillside with her soccerball. That same year, he remembered the specific trees where we saw the amorous squirrels mating.

Now, that hillside is a misty memory about little girls. Those trees are about special squirrels.

We both still enjoy walking together in the park. He doesn't seem to remember my identity, but he speaks kindly of "Jeff" as someone special to him.

Today it was raining. Instead of going to the park for a walk, we went for a ride in the country. It has been decades since I was a child and my family would go for a Sunday drive in the country, when gasoline was cheap. The roads today were unfamiliar to me, as if I was the one losing memories.

But the experience was quite pleasant overall, as we drove through fields of feelings.

[I wrote this on July 13, 2015, but never posted it then. I was waiting for the other shoe to drop. But instead, Dad miraculously left death’s embrace. For two and a half more years. The last paragraph still applies.]

My father is almost 88 years old, he's had Alzheimer's disease for several years, and now he has pneumonia, the old man's friend.

He had barely moved into the memory care unit, where he would have a closer knit community to watch over him. When I came to find him on Sunday to take him out to lunch, he was sunk deeply into a low-slung soft couch in a very deep sleep. Not unexpectedly, he was hard to arouse, and even harder to bring to his feet. He seemed barely able to command his body to walk. He even seemed short of breath walking his tiny little steps. After some investigation, it became apparent that he has pneumonia and his oxygen level drops low when he walks.

His facial expression was saying "I can't breathe" but his meager complaint was "oh", [step], "oh", [step], "oh", [step] with each breath, with each step. He just wanted to pause a moment, as if to say, "if you let me rest a moment, I'll be fine".

Our life together the past four years has been going out to lunch, having a ride in my car, and going to the park to see little children to smile and chat with. We both got a lot of pleasure out of those weekend visits.

Yesterday though, I spent a lot more time witnessing his daily activity of walking and eating and finding the chair and finding the bed. All of those are pretty difficult now. Despite the difficulty, it was pretty easy to admire him. His complaints of discomfort were almost imperceptible. If we managed to get him to look up at us, a smile always came to his face.

His suffering is plain to see though, in this final illness. We always knew a day like this would come. We didn't know it would be now. My brother and sister, my wife, and other close relatives are rallying to support dad. In a few days I'm sure my work community will pick up the slack when I'm gone for a few days. Our neighbors will offer to help. People will offer their condolences. People will smile and recollect their stories of my father, appreciating who he was and what he did for them. We will all come together to smile softly and whisper one last goodbye.

That's the kind of man my father was. I remember him frequently scratching my back when I was a young boy and even later in life. What a pleasure for me! He was not expecting anything in return. None of this "if you scratch my back, I'll scratch yours".

He was always willing to serve others. When he was living at The Bluffs, our community nursing home, he was usually cooperative. On the rare occasions he tried to do something inadvisable (like elope, or intrude unwelcome into someone else's room), the staff knew how to redirect him. 

"Bill, would you help me out?" And he would follow. Service to others.

---

Somehow, he did it again.

My mother-in-law died February 5. We're planning her memorial service for March 10. Our son, Stuart, will be flying in from Hong Kong and another son, Mark, from New York to attend. 

Dad displayed perfect timing. With the scattered tribe gathering, this gentle warrior left to join the ancestors. 

Sitting at his bedside after he died, I placed my hand on his chest to feel him once again. To remember him. Moving my hand, I remembered all the times he had scratched my back, and later in life how I had scratched his. A pleasure for both of us. One way I could express love after language had failed, or when language was never really needed. Nothing expected in return. 

Dad, I'll scratch your back, one more time. Period.

As my father continues his slow descent into Alzheimer's dementia, some features of the disease strike me as blessings. We go out for lunch and a drive most weekends. He's gradually less able to express himself. However he commonly repeats this soft mantra: "yeah, … yeah, … yeah".

I'm retiring from patient care Sep 1, 2016

What should you do if you are a patient of mine?

What if you have not seen me in the past year?

What should you do if you can’t get an appointment before I retire?

What if you want to change your PCP listing now (rather than waiting)?

Do you need to contact your health insurance to let them know of your new PCP?

Should you request a medical records be sent to your new physician?

[originally posted June 19 2011, 5:40 AM]

My father has early dementia. 

The glass seems half-empty.

A couple years ago, he willingly agreed to no longer drive in St. Louis urban traffic to visit my sister. Instead, her family brings him there.

Now that we are aware of his dementia, the risks and the losses seem more apparent. Is it safe for him to drive? How about on the interstate? What about at night? Or in bad  weather? Or if he feels sick? The answers aren't so apparent.

I've watched dad drive. I've actually videotaped him driving, both to the local bank and to the McDonald's restaurant 6 miles away in Altamont. He did OK. I get nervous thinking about him driving on the interstate, or needing to navigate through less familiar distant neighborhoods.

This is one area where he gets defensive and resists our caring interventions. I've been framing it in ethical terms: "his autonomy is threatened". This week, we learned from the caregiver team that it's also more emotional. "I feel less like a man when the women (caregivers) drive me around and I'm not allowed to drive". So losing the freedom to drive is a powerful loss of autonomy, of independence, and of manhood.

Maybe I'm wrong.

I've been thinking he's not safe to drive because so much is missing. But the glass is also half-full.

He has decades of experience and learned, automatic driving skills. He's familiar with the areas where he would drive. He has always been a cautious and non-agressive driver. He is a complex person with feelings, and a lot of wisdom. He has developed a lot of successful coping skills as he realizes his accummulating limitiations. I should mention that I, too, have begun coping with my limitations: I now wear glasses, can't turn my neck as far when backing the car, and can't sit on the floor cross-legged.

He has to take the driving test next month. I guess we'll see how he does.

Whether he passes or not, the glass already looks more full to me.

[originally posted February 3 2012, 7:19 PM]

I was riding with my father yesterday along a winding blacktop road with no shoulders. We came across the spot where my son ran his car off the road and had to be extracted with the tow truck a few years ago. It reminded me of the time that I ignored the idiot lights on the dashboard of my parents' station wagon and burned up the engine. I reminded my dad of that story without identifying the culprit. My dad now has dementia, so he didn't really remember the story so well, let alone the identity of the perpetrator. 

[originally posted November 7 2011, 6:33 PM]

My father went AWOL this week for the second time in his life, that I know of. The first time was when he was in the Army after World War II in postwar Japan. He snuck out the window in the barracks to say one last goodbye to his Japanese girlfriend.

This time he was just enjoying the nice weather, went outside into the nursing home courtyard, and then wandered through the unlocked fence gate. He says he spotted some broken glass in the roadway and was just going to pick it up to save someone from getting a flat tire.

The staff promptly spotted him where he shouldn't be, and now he is staying in a more secure area, and subject to excessive supervision, as he sees it. 

My wife and I picked him up and took him out to lunch at the local Taco Bell. We needed to wash up in the restroom, so dad went into the men's room while I waited outside. I thought I'd let my father wait outside the men's room while I washed up. My wife thought I was being imprudent, and a 3rd AWOL would be likely.

So she encouraged me to just use the ladies room and she would guard both doors. When I came out, of course there was a woman standing there waiting to use the ladies room. I told her that I could explain everything. She said "I hope you didn't pee on the seat".

Boys will be boys.

[originally posted September 2 2011, 6:43 AM]

Two things on my mind today. OK. Two hundred things. I'll just focus on the two main themes.

Dad needs a haircut. Just a trim. His hair is actually longer than mine.  St Elmo, like a growing number of American small towns don't have barbershops anymore. Or blacksmith shops. But this isn't really a social commentary. 

Looking at my dad, it's not just the hair that strikes me as shaggy. He's 84, more stooped than I remember, and more unfocused and scattered than ever. He manages to get his breakfast, but he looks like someone who has a dozen other things on his mind. Dad has Alzheimer's Disease, and today is a very big day. His children are aware, but he won't be until a little later in the day.

Today, we plan to move dad to his new home in Columbia MO, called The Bluffs. He won't be thrilled to hear this news. He's likely to be concerned that we are going to get rid of his car, or throw away more of his accumulated treasure. We kids have examined the treasure, and it's mostly saved plastic detergent bottles, Little Debbie boxes, empty Kleenex boxes, all stuffed with McDonald's receipts, napkins, straws, plastic grocery bags, etc. Part of the treasure is his kingdom of electrical Rube Goldberg devices.

That stuff needs a trim. 

There is a network of dangerous electical cobwebs (take the video tour) that have accumulated in the upstairs and the garage, the sacred domains of my father. After Dad hops in the car to go to my sister Lori's house, my brother Brad and I plan to remove miles of old extension cords, adapters, splices, half-broken lamps, and other odd parts to reduce the fire risk, and to set our minds at ease. We could never have done this with Dad in the house. 

The hoarding has resulted in the accumulation of so much broken stuff that it will take a few dump trucks to do the job. Today is a more focused effort. Only the wires.

Just a trim.

[originally posted August 26 2011, 7:10 AM]

Some days it's a scarce commodity. Or misplaced. 

My 84 year-old father is confident he can drive just fine, thank you. He may be right. In the daytime, in good weather, on a familiar road shared by responsible, attentive, sober fellow drivers. 

But he has Alzheimer's Disease, and I don't feel confident about his safety or the public safety. 

Neither of us are confident that he will remember where he hid that last wad of cash he withdrew from the bank. 

He's generally a quite agreeable person, attuned to the comfort of others. I'm losing confidence that he will go along with his hired care-giver when they suggest that it may be too slick or icy this winter when he's hell-bent on taking a walk to "clear his head". 

I'm confident that today will be one of the most challenging days of my life. My brother and sister and I will spend the day with Dad, telling him about his fairly new diagnosis, what it means, how much we love him and care about his safety, and about the difficult decision we've been wrestling with for months. This will be the last day he will live in the house where He spent the last 60 years. It is moving day. He doesn't know yet. On the sage advice of geriatrician colleagues, we decided to have one difficult conversation, rather than repeat a series of misremembered painful ones. 

I'm not completely confident this is the right decision. It's permeated with ambiguity. 

Will this day be filled with tears, tenderness, integrity, and loving-kindness? I'm confident of that.

[originally posted July 17 2011, 10:58 AM]

I visited my father who has mild dementia. 

...oh, and hoarding.

My brain was swimming in war metaphors this weekend as I engaged the battlefield of safety hazards that is the upstairs of his house. Dad has been frugal, saving every empty detergent and juice bottle, every fast food receipt, every plastic shopping bag, and every broken scrap of industrialized society he encountered. There is only a solitary mouse living among this treasure trove, so he apparently is emptying the crumbs and rinsing the juice bottles.

So, in effort to reduce the clutter (there's a reason for that, more on that later...), I attacked the upstairs this weekend. It was daunting. My first strategy was to "take that hill", a throwback to the Korean War. I saw an unused electical outlet behind a 5 foot high stack of hoarded stuff. My goal: clear the tabletop, fix the outlet, so we could later get rid of the rat's nest of old extension cords criss-crossing the landscape like barbed wire from No-Man's-Land in The Great War.

I acheived my mission after hauling away numerous large trash bags, only to find an empty machine gun nest. The outlet was dead.

So, as our leaders did during the VietNam War, I shifted my measure of success to "body counts". In all, I hauled away 10 bags of trash. 

No, the enemy didn't surrender. We have no armistice. There is no change in the forward line or the DMZ. The air is still filled with electricity ... from the maze of old extension cords.

But I did not walk away defeated.

... or empty-handed.

[originally posted June 13 2011, 5:37 AM]

The rain is falling here in Columbia, Missouri. I have adjusted my plans. Life calls on us to adjust our plans often, and we labor under the illusion of control.

In St. Elmo, my father will wake up and adjust his plans. For the past 61 years, he'd check with Iris and make plans. In the last week, after her death, it was my brother and sister and I who were making plans with dad. Today, we've all gone home, and he's at the house with his new adopted daughter-sister, Stephanie. 

The rain is sometimes a disappointment, if your plans include picnics. It's a blessing when you've been needing it to water your growing things. And it happens on its own schedule. Flexibility is called for.

I heard my forgetful father talking about his flexibility, while acknowledging his sorrow. It's what we have to do. Adapt, adjust. But we don't have to forget.

I'm sorry, dear reader, but posts in early 2015 will be out of temporal sequence

So, I'll post the remaining old essays once a week in a proper chronological sequence until I'm caught up. 

I'll do better, I promise.

[originally posted June 12 2011, 4:29 PM]

I was a Boy Scout, and I learned the 12 points of the Scout Law.

Reverent

[originally posted May 22 2011, 8:01 AM]

My parents, both in their early 80's, are showing their frailty ever faster. A few phone calls with my father talking about his long-dead brother alerted me, and my brother and sister and I are now finding more chinks in their mental armor. Email and conference calling are a blessing that allows for quick communication, but they upset the digestion of what's unfolding. I feel heavy with sadness after each revelation of my parents' deficits. But I feel grateful for such solid, caring siblings, for my wise, loving, and generous wife, and for a community that offers such rich support.