Jerald Winakur
The Long Goodbye
As a geriatric physician in San Antonio, I’ve spent the past thirty years battling against the gradual decline of my Alzheimer’s patients. Now the disease is stealing my own father.
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These days, between the Food and Drug Administration and Big Pharma, I hang suspended in a netherworld of prescribing angst. The FDA has pulled more than twenty drugs off the market in the past two decades, drugs they first assured me were safe to use but then ended up damaging livers or kidneys or hearts. I have always tried to protect my patients, wait if I possibly can for aftermarket studies to bring more data to light. It is one thing, I tell my patients, to judge a drug’s benefits and risks after it has been given to a few thousand patients in clinical trials; it’s quite another after it has been prescribed to hundreds of thousands upon its general release.
In the parlance of the technology and pharmaceutical industries, doctors like me who are cautious, who do not immediately jump on the company bandwagon every time it trumpets its “latest and greatest” product, are known as “slow adopters.” Now these industries have figured out a way to circumvent my judgment should I fail to join the chorus of cheerleaders for their newest breakthrough. On television, in magazines, they promise an end to arthritis pain, a good night’s sleep, a cure for incontinence, a firm erection. My phone rings off the hook with patients who worry that I may have blocked their path to the Fountain of Youth when I decline their drug requests. Some even change doctors.
I have no sympathy for Big Pharma. I resent its intrusion into the doctor-patient relationship, resent the constant introduction of new—often rushed—products into a marketplace crowded with me-too drugs. Big Pharma is right where it has always wanted to be—smack-dab in the middle of my decision-making process as it tries to influence consumers who also happen to be my patients. And yet here I am, in my parents’ home, rummaging through a basketful of medicines I take down from a high shelf. This is where I store the unused pills—all the psychoactive drugs prescribed by my father’s physician for his recurrent bouts of anxiety or agitation, for his depression and his insomnia, for his memory loss and lethargy, for his confusion and paranoia, for his belligerence and sadness.
I take down a dozen orange plastic pill bottles with white, almost-impossible-to-remove lids. My father’s name is on every label: Some are six months old, some several years. We have been dealing with this for a long time. Haloperidol and risperidone. Olanzapine and quetiapine. Paroxetine and citalopram. Alprazolam and trazodone. Donepezil and rivastigmine and memantine. Organic molecules, various combinations of carbon and hydrogen and nitrogen, oxygen and sulfur—the atoms of which we are all made—bioengineered to slip across the blood-brain barrier, to stimulate one receptor or block another, precipitate a rush of ions through neural membranes, flood synaptic gaps with potent neurotransmitters, flip a switch here, throw a breaker there, block a surge somewhere else.
I settle on the bottle of risperidone. Although I am reluctant to use this drug—any drug—in treating my father, I know that he has taken it before with success. It has worked. It has settled him down, albeit with an added degree of cognitive impairment. My hope is that by continuing to use this drug judiciously, I can maintain the status quo and keep my father at home for a bit longer, delay the decision to relegate him to a long-term facility where I know he will only deteriorate faster.
I bring my father a bisected tablet and a cool glass of his nutritional drink.
“Here, Dad, take this. I think it will make you feel better.”
His eyes, still wild, stare at me. “What’s this for?”
“Dad, you’ve got shpilkes,” I say. I use this Yiddish word, retrieved somehow from my own memory, because my father has lately been interspersing his speech with snippets of this language, his mother tongue—the mamaloshen—the first words he ever heard and therefore the last ones to abandon him.
He smiles. “Az ich habe shpilkes,” he says. And he swallows the pill. “For the shpilkes,” my mother and Yolanda tell him when it is time for the next dose. Before long he is back to his usual demented but pleasant self. This time I have made the right decision.
Three days later, on my parents’ anniversary, those of us who love them assemble in their home. My wife brings a dozen yellow roses and arranges the table. My brother stops at the grocery store for a side of sliced smoked salmon, some cream cheese, a few tomatoes, and a red onion. I drive over to the bagel bakery, and pick up a dozen—onion, poppy seed, and sesame—just out of the oven.
It is a small gathering. Family-oriented to the point of insularity, my parents have made no close friends in all the years they have lived in San Antonio. Everything is ready, and I wheel my father into the living room.
“What’s the fuss about?” he asks as he enters, seeing all these faces he recognizes but can-
not place. For a moment he is frightened.
“Dad,” I say, speaking into his good ear, “today is a special day. You and Mom have been married for sixty years.”
He searches for my mother’s face in the small crowd around him.
“Really? Is that true, Mom?”
“Of course it’s true,” she says. “Do you think we made this up?”
“It doesn’t seem like sixty years,” he says.
“It seems like a hundred to me,” she says. We, the assembled family, laugh nervously.
My brother leans in and asks our father, “So what do you think about all this?”
“I just want to say that I love Mom more today than I ever have.” He reaches for her hand, but she doesn’t take it. I want to believe that because of her terrible eyesight she can’t see this gesture, but I’m not so sure. We all applaud my father’s words.
I push him up to the dining room table, festive with cards. He picks out one. “Did you see these, Mom?” he says.
“I can’t read them,” she answers.
He begins to read to her.
“Have we really been married sixty years?” he asks her.
“Every bit of it,” she says.
“I hope you know I love you.”
“I know,” she answers.
Excerpted from Memory Lessons: A Doctor’s Story, by Jerald Winakur. Copyright © 2009 Jerald Winakur. Published by Hyperion. All rights reserved.
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