Not long ago, I walked into the family room, where Dad was sitting in his wheelchair.  I was a bit consumed in thought  and was just passing through on my way to the kitchen.  As I walked by Dad, he spoke a couple of sentences that I could not understand–a very common occurrence.  I may have had a puzzled look on my face when I turned to him.

Clearly as I could have spoken the words myself, he said, “I just wanted something to say,” apparently, partly acknowledgment that his first words were thrown together and may not have made sense and that his simple, partly apology, and fundamentally a basic expression of a compelling need to make contact, to communicate.

Of course, at that point I stopped and talked with him for a while, gave him a hug and told him again that I was glad to see him.

There are many “over-learned” phrases and sentences that Dad is able to speak with perfect clarity. It is when he needs to create a new sentence to express new thought that he lapses into mumbling and incoherence.  He often seems to have  a clear idea in mind, but is unable to express it.  Though most what he says is not decipherable, the inflections, tone, volume changes, all suggest the structure and characteristics of normal speech.  Rather than remain silent, he says what he is able to.

The world of Alzheimer’s is a lonely one–the fear of losing connection to others is great and persistent.  Frequent opportunities to communicate, whether by speech or touch, seem to be crucial to Dad’s well-being and good temperament.

Communication is a huge subject, and I will return to it many times here.

Years ago, when I would visit home, my parents and I would  go out shopping together.  I usually drove, as they were intimidated (rightfully) by traffic. Dad had always been a bit of a backseat driver, but not too annoying. As time passed, however, he began to give me directions for every turn we would make. Though I didn’t show it, I was irritated by this constant instruction.  Did he really think I wouldn’t remember how to get us home every time we went out?

Later it became clear to me that he was demonstrating his capacity to remember, to me, but more to himself.  Not long after, in one significant incident, when I was in Maryland, he apparently was trying to drive to a neighboring small town, but somehow lost his way. I’ve never gotten a clear account of what actually happened, but the upshot was that he stopped at a highway toll booth for directions and the worker deemed that he was not fit to drive his car. Was he going the wrong way? Was he just incoherent? I wish I knew.

He managed to call home, and Mom and her sister came to get him, and the sister drove the car back.  He must have been quite shaken by the incident. He never asked for his car keys again.

Mealtime demands alertness. Dad hasn’t been able to feed himself for a couple of years. Every bite and every swallow now are delivered by the hand of another. Until recently Mom fed him breakfast (usually oatmeal) and lunch (often a sandwich or a salad), and I fed him dinner. But his increasing frequency of choking prompted her to ask me to start feeding him breakfast a couple of months ago.

For as long as I can remember he has had the habit of taking drink and, before swallowing, swishing the liquid around in his mouth. Now, this habit has the downside of causing him to swallow air each time, which inevitably leads to burps followed by hiccups, before the meal is done. Most people can successfully manage a burp or a hiccup while their mouths hold food– some extra attention is briefly required, but it usually doesn’t result in choking. However, Dad’s loss of capacity makes it difficult for him to manage these unwelcome coincidences, and he has come close to choking a few times.

In the most serious incident, I had just fed Dad a very small piece of the pork  roast we were having for dinner. Very soon it was clear that he had inhaled,  rather than swallowed, it. He grabbed his chest and  just stared ahead. He managed to blurt out “oh my lord” and then began to cough.  He was soon stuck in a gagging reflex and gobs of sticky mucus began coming up his throat and out of his mouth. After a few minutes of unsuccessfully trying to help him clear the mucus, I called 911.  I had never seen this reaction before. He didn’t have total airway blockage YET, but I thought he might be in danger of literally drowning in the mucus. I reached my hand inside his mouth to pull out as much of the sticky stuff as I could. He continued to struggle and occasionally coughed. We kept that up for perhaps ten minutes until the EMTs arrived. Just as Mom let them in the front door, Dad coughed forcefully and that little piece of pork, perhaps a quarter inch square, spilled out with the mucus.

Although he appeared to be recovering the EMTs thought he should get a chest x-ray and they quickly got him into the ambulance.  As I filled out the required paper work, I could see Dad through the ambulance window, sitting upright, fully composed, looking around and taking in the odd surroundings.

To make a long story short, his x-ray showed no problems, and we spent the next five hours, until about 2a.m., trying to get out of the hospital and back home.  The next day, I sought out some tips from a speech therapist on how to improve swallowing and I will pass those along in another post.