The psychiatrist who comes to do my father’s Alzheimer’s assessment, an expensively dressed man in his forties, is late and in a hurry. Still, he takes time to settle himself facing me and my father in the living room, crossing his legs and tenting his hands before beginning his checklist.
First, we go through the charade of getting my father’s permission for me to be present at an interview which is going to confirm his mental incapacity, and therefore his inability to give or withhold said permission. It’s a Kafkaesque scenario which would amuse my father if he could appreciate it.
On top of that, the doctor’s heavy accent defeats my father’s hearing aids, and I have to repeat all the questions for him. It sounds as though I am asking, not the physician. Squirming as I speak; I hope my father doesn’t think I am aligned with the psychiatrist against him. My father says to the doctor, “Yes, I want her here,” and leans forward in his chair, gripping the arm rests so that his knuckles turn white.
Next, the doctor states his credentials, which are impressive. While I am thinking this is excessive, but no doubt the normal process in these meetings, my father tenses. Hope seems to gather in his clear eyes as thoughts—long dammed up—flow like tributaries into a single river. First at a trickle, then in stronger streams. I imagine him thinking,
This expert can rescue me from the prison of my dotage. Here is someone who will understand that I am being held against my will, condemned without cause to the dungeon of mental infirmity.
The psychiatrist moves on to the reasons for the assessment. Although my parents have done well, living in their own home and semi-independently into their nineties, my father’s cognitive health has crumbled in the last few years. A major fall, uncontrolled diabetes, dehydration, wandering, a refusal to take his medication, paranoia where he insisted police officers had been stationed in the house to spy on him, incontinence, leaving the stove burner on, waking up the caregiver by banging saucepans around at 3 am. I shift in my chair. Why does the doctor have to list all this? It’s cruel. I look at my father to see if he has grasped the clear evidence of disease.
A couple of feet away from me, my father’s tight jaw and pursed lips display his dis-ease. He frowns, as if from the effort of furrowing thoughts into sentences with a rusty plow. The phrase ‘muscle memory’ pops into my head. I imagine his brain juddering into action in bright fire-red sparks, bridging the blackened dead areas. His mouth works, the blink of a green modem light rebooting but not yet reconnected to the Wi-Fi. I expect him to stutter when he speaks.
But when the psychiatrist asks (I assume out of protocol only) if he has any concerns, my father says a firm “Yes,” and is ready with two very concrete things which he considers impingements on his autonomy. He wants to enjoy a drink of wine, and he doesn’t want the kitchen locked at night so he can’t access it. Astonishingly, he delivers these complaints as he always used to when making a point; prefaced by a commanding “Now,” and underlined with his right forefinger slapped in the centre of his left palm.
Now I am caught in the middle, snapped between joy at witnessing a snippet of my father’s former sharp intellect, and regret for engineering the circumstances which produced this cognitive revival. This is going to cause him anguish. Both requests have to be turned down. The alcohol because the caregivers will refuse to look after my parents if he’s allowed to drink, access to the kitchen at night because it’s dangerous. He’ll electrocute himself or set the house on fire.
So I testify against my father. I explain the background to the alcohol and kitchen restrictions. The psychiatrist takes notes, emits “I see, yes, quite, uh huh,” and then tents his hands again to uphold the prohibitions, like a judge pronouncing sentence. My father slumps in his chair. A croak of protest leaks from the back of his throat.
A snag in my gut tells me I am a betrayer, a trickster, an inadequate daughter. Why did my sisters and I get his medication under control, restore his sight and hearing, badger medical staff for follow-ups, cajole caregivers, on and on, re-linking the synapses in his brain? So he could make us happy by regaining some speech and mobility and then understand—when informed today by the highly qualified head of the Community Mental Health Team—that his mind was failing?
My father used to be so clear-headed. He never obfuscated or manipulated, always beat a logical path to what he knew was right. That he should be condemned to helplessness, without even these slight comforts and reprieves—
“It’s not fair!” I used to say as a child.
“Life’s not fair.” My father would reply.
Having dismissed my father’s requests, the psychiatrist moves on to the real purpose of the visit, the cognitive test. He asks questions; what day of the week is it, month, season? Who is the Prime Minister? What county are we in? On and on the questions come, maybe fifteen, twenty of them, though by question one it’s obvious there will be zero responses.
My father always had the answers. A prodigious memory, deep curiosity, encyclopedic interests—all these combined into someone you’d want on your Quiz Night team. Now he’s given up saying even “I don’t know”. He opens and closes his mouth, a pleading light pooling in his eyes. I shift in my chair. The doctor holds up a hand to me–he thinks I’m going to answer for my father. If only I could. Dense clay clogs my voice box.
While the specialist writes notes after the last question, everyday sounds seep into the room. The caregiver bustles, the TV commentator exclaims, and in the garden, a robin calls. I think like me, it wants this to be over. I imagine the bird is chiding,
That’s it that’s it that’s it, hurry along. Wha’ yer staring at then? Hup, hup, hup, hurry along, nothin’ to see here and yer getting on my nerves. Hurry along, hurry along.
The psychiatrist replaces the top on his pen and squares his papers before once more tenting his fingers and looking up. He stills, as if preparing his tongue for launch,
“Michael, Mr. Collis. I believe you have mild Alzheimer’s disease.” He pauses, remembers the next line in the script. “This can be a difficult diagnosis for you and your family to hear.”
I think, mild? To look at my father is unbearable, so I continue observing this professional’s church-like hands, raised in front of him to offer comfort, or sanctuary, or to form a barrier.
My father has levered himself upright and his jaw juts out. A forefinger wags toward the psychiatrist, “No.”
“I don’t have—that—” he struggles for the right phrase. A sharp burr twists up his throat, “thing.” The last word is spat.
The tented hands open in surprise.
“Mr. Collis, I assure you we make these diagnoses very carefully.” The psychiatrist describes the procedure, his certainty.
“No.” My father interrupts him, slapping both hands down on his knees. “I am not—” He searches the room for the term he wants but finds only his three daughters smiling at him from our wedding photos. “Mad. I am not mad.”
In the silence which follows this pronouncement, a dreadful and dreaded heaviness settles on my shoulders. I have snatched my father’s last hope from him, and I cannot lift my traitorous head.
In their senior years, my parents were dementia deniers. My father hoped to follow his father, who died without pain or fuss of simple old age at ninety-five, his brain still healthy. My sisters and I went along with pretending there was nothing wrong with our father’s mind as much as we could. This diagnosis comes so late it’s useless. Still, I insisted on the assessment, and regret, as powerful as quicksand, engulfs me.
I must have emitted a croak of my own, because the psychiatrist looks at me, startled, then gathers his papers and stuffs them in his briefcase. He’s getting the hell out of here.
“Yes, well, nevertheless, that is my diagnosis.” He says. “Look, you need time to process this.” He levers himself out of the chair. “I’ll leave you with your family to absorb the news. If you have questions or concerns,” he glances at me and then his watch, “please do get in touch.”
The psychiatrist must pass his patient to reach the front door. My father gathers the words in his mouth as if he’s about to hawk. “I AM NOT MAD.” He hurls at the fleeing doctor’s back.
A tart apple bittersweetness collects under my tongue. It’s over. My father’s last stand; done. He pushes himself back in his chair with stiff, brittle arms and sits there, staring straight ahead. His heaving chest releases adrenalin in sour breaths, while the chivying call of the robin chases the psychiatrist down the garden path to his car. I never witness my father emerge from dementia again.