When my dad was diagnosed with Alzheimer's, he was in the mild cognitive impairment stage. People with mild cognitive impairment (MCI) have mild changes in their memory and thinking ability. These changes aren't significant enough to affect work or relationships yet. The trip to the doctor for testing that will render a diagnosis of dementia most often occurs when it becomes clear to family and doctors that a person is having trouble with memory and thinking that impacts daily functioning.
My dad's ability to drive was questioned even before he was diagnosed with dementia. Dad had a stroke while my mother was spending three months in the hospital following open heart surgery and myriad hospital errors that kept her there. Though he was staying with me at the time because Mother was in a hospital in Miami, where I lived, I didn't immediately realize he had suffered a mild stroke. But as his Health Care Surrogate, I was responsible for his health and wellness, and certain things about his behavior and recall caused me enough concern to take him to a neurologist, fearing that dementia was setting in.
After I got the diagnosis from the neurologist, I said to him, "Good news, Dad! You don't have Alzheimer's, you just had a stroke."
He looked at me and said, "Huh. That's like saying 'you didn't get hit by a bus, you just got hit by a car.'" Because Dad could still come up with humorous retorts like that one, I didn't worry too much about his overall mental health. An aside: His sense of humor was his last personality marker to submit to his Alzheimer's.
But when all treatments and facilities had failed to restore my mother's health, and it was time to bring her home where she longed to be, Dad slowly became more disoriented. Looking back, I can largely chalk that up to his grappling with the reality that his wife, whom he loved very much, was dying. This dawned on him in stages. She never walked again unassisted. She had an oxygen tank going twenty-four hours a day. Hospice was coming in twice a week to assist. In addition to hospice, I hired a wonderful live-in who took care of Mother and as time passed, Dad, as well.
This angel of a caregiver, Josephine, stayed six nights a week. On Sunday mornings, Dad would drive her home and then return on Monday to pick her up. I lived a hundred miles away from my parents, and though I was at their home three-to-four nights a week, I needed to be with my husband in my home, too--especially on weekends, when he wasn't working and we could catch up on everything that made our marriage such a wonderful one.
One day I walked into my parents' home to find my dad overwrought. He handed me a letter he had received "from the government" which said it had been reported that he should not be driving, and he was required to come in for a test to determine whether or not he could retain his driver's license. This spelled disaster in so many ways. Josephine couldn't drive because she had never learned how. Dad was the one who had to run errands and grocery shop. He had to drive Josephine home and pick her up each week. Without a license, their structure would collapse.
Though I never knew where the accusation came from, I feel certain it was one of the hospice aides who watched my dad disengage when mother was getting treatment and personal care. He was in denial, and his actions reflected those of a man removed from his current reality. I remember dad being in a sort of stupor much of the time. While I recognized it as coming to terms with Mother's impending demise, a hospice worker in a two-hour visit saw it as something more organic.
In that letter, Dad was given an appointment date for his evaluation, and of course I was the one who took him. From the day he received the letter, to the day of the appointment, there was a great deal of fear and consternation on both Dad and Josephine's part. We all sat down together to say prayers that he would be of clear mind the day of the evaluation, and that God would guide and comfort him.
I wasn't allowed to be in the room with Dad while he was taking the exam. When the door opened, Dad came out with a smile on his face. The interviewer followed him out and spoke with me, telling me that Dad had done very well. But was rubbing his chin as someone who's wondering if they "missed something" might do. He then said, "Compared to the people who usually come in here, he's in good shape."
"So he can keep his license?" I asked. There was a moment of hesitation when my heart clutched. The interviewer was still considering revoking his license because the complaint had come from a reliable source. I decided to pull out the ace I had been holding and play that sympathy card. "Sometimes he's disengaged, but I believe that comes more from lying beside his dying wife every night."
Dad kept his license, and I handed him the keys to drive home. He was one happy fella!
On the way home, I praised him for passing the test with flying colors while reassuring him it was the silliest thing in the world he had even been reported. Though he was greatly relieved, he was still shaken at the prospect that someone could take his license away.
In time, that someone would be me.
Part Two: When Dementia Patients Become Dangers to Themselves and Others