A Personal Lesson

Some of the most vivid memories of my childhood are of the times I spent with my grandfather. My mother's dad had been widowed for many years as he entered his eighties. He lived alone in the upstairs flat of our family's duplex; my mom provided him with his evening meal. At age seven, I inherited from my older sister the assignment of taking him his supper. I would climb the stairs, gently knock on his door, and wait for his "Come in, Jimmy boy!"

Stepping into his home was like stepping into the past. There was a musty, slightly acrid, but not unpleasant odor in his quarters, a scent that I have ever since associated with old things and aged persons. There must be a clear childhood relationship between our olfactory sense and memory. When a detected musty smell is just right, I can clearly visualize and hear my long dead grandfather.

His kitchen stove had a small coal fireplace within it, and was connected to a vent in the wall by a tarnished large gray smokestack. The stove had a gas oven, which needed to be ignited with a match. I used to wait with awe and some anxiety when he would turn on the gas oven and fumble with the matches while the escaping gas made an ominous hissing sound. The pop of the ignition first frightened me, but then relieved me since I knew we were not going to be blown to smithereens.

The kitchen sink was a metal structure with its porcelain coating chipped and worn. The faucet dripped with a staccato rhythm. The linoleum on the floor was worn and cracked; shuffling feet had long since erased its pattern. The enamel-topped kitchen table was covered with a yellow oilcloth, stained brown at his place setting from years of spilled coffee and the burns from his pipe.

Later on, he permitted my exploration of the rest of his home. Most impressive was the huge bathtub, perched on what appeared to be the four clawed feet of some prehistoric animal. Above the toilet was a structure affixed to the wall, with a chain hanging from it. He pulled the chain, and the toilet flushed! Sepia colored photographs adorned the walls of the dimly lit bedroom and sitting room. These were pictures of his wife and earlier ancestors, stern plain people who seemed so forbidding and lifeless in the elaborate frames. I thought the images were frightening, and hurried back to the kitchen, my familiar territory.

I would sit at Grandfather's kitchen table, watching him eat, listening to his stories of the past. While we talked, he drank his coffee, staining the edges of his sagging white mustache brown. He was a handyman and had pursued many and varied occupations. After two years as a lumberjack, he opened a cheese factory. He came to the big city as a young man and worked as a streetcar conductor. He then went into the newspaper business; he hinted that he was a writer, but I could never verify that. Appropriately enough for a Milwaukean, he closed his employment years working at a local brewery.

My favorite stories were a handful that I made him relate time and time again. There was the one about the corncob pipe he made and smoked as a ten-year-old, starting a small forest fire. Each retelling escalated the acreage devastated by the glowing cornsilk embers. His life as a lumberjack, with its attendant perils, consumed my interest. I was fascinated by the tales of hauling the logs to the river, directing them downstream, and the dangerous work of breaking up the invariable logjams.

But I always made him come back to the story of the sturgeon, the mammoth ninety-six pounder that he speared and caught while ice fishing on Wisconsin's Lake Winnebago. After some of our sessions, he would bring out two apples which he had stored in a cool place, and bake them in his oven. They were split in half, dusted with brown sugar and cinnamon and devoured by the two of us. "Food for kings," he said, and I agreed.

As the months and then years slipped by, my evening visits became shorter and eventually perfunctory. I took Grandfather his supper, but seldom spent time in discussion. He was noticeably feebler, almost frail. His huge sagging white mustache was still stained by his coffee, but he rarely finished his meal. One day, he forgot my name. I was unacquainted with senility and was frightened. When I asked him about the sturgeon he had caught, he seemed confused. The beloved curmudgeon of a few years before was becoming crusty and at times cantankerous. He was a proud man, and his loss of mental function surely must have made him angry.

I began to note changes in my mother. She looked tired, even haggard. Her eyes were often red, and I suspected she had been crying. I would hear my parents conferring in hushed voices behind their closed bedroom door. I began to worry about the two of them. One evening my older brother told this ten year old that the grand old man upstairs was becoming senile. He would be up most of the night, casting out his personal demons. His daughter was there constantly, trying to calm him, to humor him, to help him. On occasion, he would be incontinent, and his daughter would change him, reversing their roles of fifty years previously. Mom was anxious and very tired. The whole family was worried. Would he fall down the stairs? Could we ever leave him alone?

One day, I came home from school to find a fire truck in front of our house. Grandfather had started his sofa on fire, by setting his lit pipe on it. Had he been daydreaming about his corncob pipe of his childhood? We had to monitor his activities hourly, it seemed. All of his children met to plan his care. None of them suggested a placement in a nursing home. None of my mother's siblings offered to take him. She agreed that movement from his home would only worsen his deterioration. The uncertainties increased family tensions.

He survived for two more years. My mother aged dramatically during this time. We children understood but also resented the burden she was enduring. My father wanted his old wife back. Grandfather's death, with his daughter at his side, was a relief to all. The stresses of these last difficult years seemed to have obliterated the positive memories of his earlier vital life.

When I entered the practice of medicine, I carried my own life experiences with me. In dealing with families whose parents or grandparents were aging and losing competence, I revisited the memories of my grandfather. "Should we place mom in a nursing home?" families would ask me. I urged them not to underestimate the burden of caring for mom at home, but suggested that they make their own decision. In retrospect, I clearly must have influenced them to try to avoid the stress my family had experienced.

After my grandfather's death, his home was completely remodeled, and our family moved into his old quarters, steeped in memories. Thirty-five years later, my father was a widowed eighty-seven year old occupying the former bedroom of his father-in-law. He lived alone; a grandchild assigned to take him his supper did not occupy the lower flat. But he was happy and relished my frequent brief visits. My father's greatest joy was his music. He played the guitar and loved to sing the songs from "the good old days." He would go each week to a nearby nursing home to entertain the elderly with his songs. "They are so old!" he would tell me about people who were not nearly his age. But his memory began to fade. Every spring, he would prepare his garden for his tomato plants and would prune his raspberry bushes. I had been away for two weeks one June, and dropped by for a visit. I decided to see how many tomato plants he was trying to squeeze into his little backyard plot this year. No plants. The ground lay unturned. That was my first serious warning.

I won't recount my father's deterioration in detail. His nocturnal wanderings led to our hiring a live-in college student, who quit in frustration after a month. My siblings and I were all too busy and occupied with our own lives to bring him into our homes. We showed him several nursing homes, assuring him he would be comfortable and could always leave if he was not happy. "You think there's something wrong with my mind, don't you?" was his disarming question. And the answer was yes. This was not my grandfather whom I could ignore, but my father. There was something wrong with his mind, and it would get worse.

Father moved to a nursing home and for the first several months continued to entertain the aged with his guitar and songs. He wanted to go home, but would always reluctantly agree to stay for another week. His memory deteriorated. First, he forgot my name, and then he forgot me. He would probably have recognized me if I could have appeared to him as the five-year-old son who was his constant shadow, but he didn't know the middle aged man who had placed him in these strange surroundings. I didn't visit as frequently after that, it was too painful to behold this once vibrant man whose body had outlived his mind and spirit. One day, when I handed Father his guitar, he didn't know what to do with it. I cried as I watched him fumbling with the strings of the instrument that had brought such joy into his life and so many other lives. He died during his sleep in his nursing home bed; no family or friends were at his side.

"Shall we place dad in a nursing home?" the relatives of my patients ask me. I'm not sure how to answer them anymore.

Jim Cerletty, MD
Former Professor of Medicine
Division of Endocrinology, Metabolism and Clinical Nutrition
Medical College of Wisconsin

"Reflections" is a collection of essays by the health professionals of the Medical College of Wisconsin.