By the time the trees begin to turn, my father is in decline. Over the course of one week, I take him to the hospital twice: first for a fainting spell, and then for a high fever a few days later. They diagnose him with pneumonia and a blood infection, and he stays in the hospital for five nights as we wait for the antibiotics to do their work.
My mother and Nina alternate calling me every day for updates, and I wish I had more to tell them. But for now, we are all holding our breath and hoping that my father is strong enough to fight off his infections.
“What is going on?” I ask his doctor. “He’s been relatively healthy for so long. What’s causing these new issues, and why all at once?”
It was my understanding that Alzheimer’s was a slow-motion disease that could go on for years and years. We are nearing the fifth anniversary of his diagnosis, but I had assumed he had plenty of time left.
“As you know, Alzheimer’s is neurodegenerative,” explains the doctor. “The pace of it is hard to predict and differs from patient to patient. But at this point, your father has entered what we consider late-stage dementia. As his brain changes, different systems are starting to falter.”
“Late stage?” I say, letting it sink in. I had been anticipating my father’s death for so many years that it became something of an abstraction—a fact of the future. But now the doctor was indicating that future was here. “What does that mean?”
“He could have six months,” says the doctor. “Or he could have a few weeks.”
“A fewweeks?”
She explains that it’s not the Alzheimer’s itself that is the main threat now. His other systems have begun to give out. His kidney function is deteriorating. There is also concern about his heart and his respiration.
“I would recommend you start hospice care,” says the doctor, “if that’s something you’re considering.”
Is itsomething I’m considering? Is it something I can afford? I try to put my emotions on hold as I consider my immediate next steps. I know I need to loop Nina in, but first, I want to gather some information.
As my father dozes in his hospital bed, I spend the next few hours on the phone with his insurance company, bouncing from one agent to another. Finally, I deduce that they will partially cover in-home hospice care, but we will be on the hook for fifty percent of the fee. I have no idea what hospice costs—I’ve never thought about it until now. My father’s nurse brings me a brochure for an in-home provider that might work, given our immediate need and remote location. When I dig a little deeper, I learn that it will cost us $500 a day—and it’s anyone’s guess how long the care will be necessary.
My heart sinks. The money I have on hand would only buy us two weeks at most. For a moment, Gemma’s offer flashes through my mind, but it’s too late for that. I could ask Nina to help, but I don’t want to burden her right now. There is only one person left to ask.
My mother picks up the phone immediately. “Cricket? I’ve been trying to reach you all day. How is Arthur?”
I am hit with all the emotion that I have been holding back. “Mom…”
“What? What is it?” She can hear the fear in my voice. “What’s happened?”
Her concern brings tears to my eyes instantly. I hadn’t realized just how alone I had been feeling until I heard her voice. “Dad isn’t doing well. His doctors think we should start hospice.”
“Oh, Cricket. I had no idea. Why didn’t you tell us it had gotten to this point?”
“I didn’t know either. It happened so fast.”
She is quiet for a moment, and instinctually, I worry she is going to scold me for something. For a while, I was proud of the way I’d taken care of my father, of the trust everyone had placed in me. I felt I had finally glimpsed adulthood. Yet here I am, as lost as ever. I wait for my mother to say I should have handled things differently, been more responsible.
But she doesn’t chastise me. “How can I help? What can I do?”
I don’t want to ask for help, but the truth is, I need it. I’ve done as much as I can on my own.
“I need help paying for it, Mom,” I say. “We were doing fine. I just hadn’t budgeted for this.”
“Of course I’ll help, Cricket,” my mother says. “Thank you for finally letting me.”
By the time my father is discharged from the hospital, the air has cooled and the leaves are a riot of red and orange. The hospice workers will start tomorrow—not a day too soon. When we get home, it takes us five minutes to get from the car to the back door, and though I would love to give my father a shower before tucking him into bed, it’s too risky. He is likely to fall, and I can’t support his weight on my own. For now, I do my best to keep him comfortable, knowing that help is on the way.
Our two hospice nurses are Nedra (who works the day shift) and Lawrence (who works the overnight shift). It’s a relief to have some backup, and it gives me a chance to fill everyone in: Nina, my mom, Carl, Paula, and Max. They all let me know that they are available to help, but I find that in this precarious moment, I want time to myself.
As things progress, I keep everyone as informed as I can, though my father’s condition is difficult for me to accurately convey. One day, he seems vibrant and healthy, and I am sure he is bouncing back, that westarted hospice too soon. The next, I wonder if the end is imminent. When I speak to Nina, I tell her what feels essential, but spare her details that I know will stress her. She is invested, of course, but she is also distracted—by exhaustion, by wonder, by the new world of motherhood. I don’t want to tax her unnecessarily.
One morning in late October, I look at the calendar and realize it has been days since my father last spoke. I don’t know what his final words were because I didn’t realize, at the time, that that’s what they were.Could the conversation between us really be over?I wonder, as I feel myself dissolve into sadness. I have to sit down, and I try to remind myself: talking is only one way of relating, and perhaps we rely too heavily on it, forgetting that we can also connect through gestures, sounds, glances. I think about the nonverbal and preverbal entities in our lives: animals, newborns. They don’t want our explanations of love; they want to see it in action.Do you feed me? Brush me? Soothe me? Am I safe?
I think about Nina across the ocean, building a foundation of trust with her newborn through consistent presence, feeding, cooing, snuggling. The intellect will come into play later, and it will complicate everything. For now, she cares for Anders in the most fundamental of ways, and I try to do the same for our father: dressing him in nice warm sweaters, combing his hair, making his favorite soups, always having a blanket ready to drape over his legs. He rarely leaves his bed now, and Dominic rarely leaves his side.
You can’t prepare for someone’s death, even if you sense it is coming, even if you have long anticipated it. For many years, I had assumed I would get a call from Nina saying Dad had died in his sleep or had suffered a heart attack or had simply evaporated into the ether. I imagined it as something definitive and already-over-with that I would absorb through my phone. An event, not a process. But once I moved to Locust and realized that I would not only be here for his death, but would oversee it, I developed a new set of assumptions based on what I had seen in Hollywood films. First there would be asad realization that it was time; then some sentimental words would be exchanged (maybe my father would become lucid and recognize me as his beloved daughter one final time); then he would expel one dramatic final breath before everything would go quiet. In my mind, it was a smooth, two-minute montage that leaves everyone sobbing.
