Archive for April, 2009

My father’s stroke: 4

The siblings have a standoff.

The siblings have a standoff.

Time to air the dirty laundry.

You might not know from my previous posts that in addition to Pesha, I have an older sister and an older brother.

My brother did stay in touch with me while Papa was in the hospital, but he couldn’t find time to visit. He told me he had several competing “projects” to deal with. I didn’t probe. My brother uses evasiveness the way a cat uses a paw to swat at the mouse in its clutches: With delighted dispassion. A project could mean that he himself had a health issue. It could mean that he had to rehearse with the three community bands in which he plays trombone. It could mean he was involved in the final details of selling a house he put on the market thirteen months ago. All three turned out to be true. But how many times is your eighty-four-year-old father hospitalized after a stroke?

“I was on my way to the hospital and got lost on the road,” he said.

Until my father’s stroke, my brother has had the homing instincts of a bat.

Then there is my older sister. She is sixty-two years old, a member in good standing of her orthodox Jewish community in Atlanta, a wife, mother and grandmother. During Passover she did not offer to help cook, serve or clean up the many dishes that went into feeding my parents’ four adult children, their spouses and six adult grandchildren. At one seder, I asked my sister to pass out some napkins. She peeled off a single napkin and handed it to me. She is a feminist and firmly believes that it is her husband’s job to deal with food-related matters.

Now you get to guess what she does for a living.

If you said warden at San Quentin — wrong.

My older sister is a family therapist with a flourishing practice. A couple of days into Passover, she said, “I’m really worried about my psychotic patient. She’s out of control.”

To my parents, their oldest child is more emperor than offspring. They have seen her as a demigod for several reasons: She was the first child born to them after the murders of their own families. She interpreted America for them. She was the first person since the revelation at Mount Sinai to go to college, and then the first — and only child, as it turns out — to get a Ph.D. When Genghis Khan unified the nomadic tribes of northeast Asia, he did not do more than my sister has done to unify the torn psyches of the Georgian (U.S.) hordes.

The one thing she is not equipped to do is unify my parents’ fragmented healthcare.

I don’t remember what sparked my argument with her.  

It had something to do with watching my eighty-year-old mother transport a pot of chicken soup up from the downstairs oven while the Emperor sat on the sofa leafing through a New Yorker magazine.

It had something to do with watching her deposit her breakfast dishes in the sink and leave them for somebody else to wash.

Or with her finding the time to take a walk around the neighborhood, but not finding five minutes to say a word to my father after he had what appeared to be a stroke-like episode two days earlier.

Or with remembering how my parents used to take twenty-hour train trips to Atlanta to help with babysitting because my father was too afraid to fly.

Or with her having been in Warsaw on the same Shabbat eleven years ago as my parents and me, but telling us she was having dinner with some friends. It had something to do with her using that trip to Poland as part of a speech she gave at her daughter’s wedding, and telling the invitees that we Jews would “never again” tolerate the extermination of the Jewish people.

“Why are you so upset, sweetheart?” she asked me when I sniped out at her.

“You could take a more activist role in the care of your parents,” I said. “You could offer to wash the dishes.”

“I’ve been washing dishes all morning!” she said.

“If I had heard about Pesach from you, then I might believe you. But I’ve been here the whole time. You have let your deaf eighty-year-old mother and sick eighty-four-year-old father wait on you like a princess. You have done squat.”

“I get the feeling that you and Pesha want me to take responsibility for Mama and Papa,” she said.

“We just want to see you do something. Call them at night to say hi.”

She began to shrink into the sofa. “You’re asking me to do more than I can do,” she said.

“Call them once a week.”

“You’re getting unnecessarily upset,” she said. “You and Pesha have everything under control.”

“We don’t have anything under control. Mama and Papa are sick. They’re old. They’re physically impaired. The family is your area of expertise. You could help them.”

“I don’t live here,” she said. “I don’t know doctors in Cherry Hill.”

“Don’t you have patients coming to you with problems about their elderly parents? You must have some strategic thinking on the subject of eldercare.”

She had enough sense to stammer something incoherent.

“You have shown more concern about your so-called psychotic patient than your own parents,” I said.

“My psychotic patient has a rational husband I can talk to.”

“Your psychotic patient has healthcare insurance that covers her ‘treatment’ with you. Do you only help people who pay you?”

More incoherent stammering from somebody who always has a category to fit people into, who always had an opinion about the Iraq War, the Bush Administration, the need for change.

“If Pesha and I ‘didn’t have everything under control,’ would you step in?” I asked her.

“The way Mama and Papa live is their choice,” she said.

Therapist cliches. And people actually seek counsel from her? Cripes.

*

Even after she learned that my father was taken by ambulance to the ER, my sister did not phone. She was in Oakland with her daughter and used her as her liaison. I suspect she did not want to talk to me.

The requested once-weekly phone call to my parents has not come to pass.

My parents do not have a harsh word for her.

“She lives far away,” says my mother.

“She has a business to run,” says my father.

My sister has “doctor” before her name and my parents remain in awe.

A friend of mine believes that most Holocaust survivors not only respected doctors but feared them. “If you argue with a doctor, he might hurt you,” Leon says.

Well, I don’t know. I think my parents see themselves as lowly, uneducated immigrants with heavy accents and their “doctor” daughter is their superior.

Pesha says, “Don’t even get upset about the older sibs. They are not a factor.”

I’m good with that. But I gotta ask: What was the point of spending all those thousands of dollars on Jewish education, of hearing that we should honor our mother and father? What was the point of reading Maurice Sendak’s “Care” to the kids when they were little — and now that we’re all big, nobody cares a damn?

There is only one thing that stands between you and an indifferent world. It’s your family. And you don’t need a Ph.D. to figure that one out.

NEXT: The road trip that is now our lives

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My father’s stroke: 2

My father’s stroke: 3

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My father’s stroke: 3

Emergency Room

Emergency Room

Six days into Passover, the temperature got up to 49 degrees. It had begun raining Monday night. The downpour continued throughout Tuesday. Of all days to find my father standing outside by the passenger side of his car and hissing uncontrollably. Saliva was shooting out of his mouth like water through the spray nozzle of a garden hose. He was soaked from his newspaper boy cap down to his K-Mart sneakers.

I got the passenger-side door open and my mother and I angled him into the seat. My father has always been a wiry guy, even in his atrophying diabetic state. Combined with muscular rigidity brought on by this attack, he had a hard time ducking into the car.

“Papa, are you able to direct me home?” I asked him.

He couldn’t speak. He nodded yes and pointed me to a right-hand turn using his stiffened right arm.

My mother got into the back seat and attempted to massage whatever was happening to my father’s face into compliance. This time her efforts had no effect.

Once I got onto Haddonfield-Berlin Road, I knew the way home. I kept asking my father for directions anyway. I had to check if he was still aware of his surroundings. He was.

Kennedy Memorial, a university hospital for the University of Medicine and Dentistry of New Jersey, has a center about a half-mile from my parents’ house. “Papa, can I take you to the emergency room?” I asked.

An enraged arm motion signaled, “Absolutely not.”

I am a guilt-ridden daughter who has spent at least the last ten years actively repenting for a lifetime of obnoxiousness toward my parents. I have not argued with either of them since 1998 when the three of us traveled to Poland together. My rebellious nature has gone into eclipse and I do what my father demands: I keep driving to the house.

At home my father sat down on the sofa. The hissing and spitting didn’t stop. I sneaked into one of the back bedrooms and called my father’s DO friend on my cell phone. He and a couple other of my father’s doctor-friends had paid a get-well-call the night before and told me to phone them if I needed help. I let the phone ring seven or eight times and gave up.

Next I called my father’s nephrologist, one of the doctors who had told me to call in an emergency. I told him that my father was having some kind of episode and I didn’t know what to do.

He said, “Call 911.”

I felt like an ass. These doctors told me to call them in case of an emergency. They should have told me to call 911.

I went back into the living room to call 911 from the wall phone. Even through his seizure, my father was wildly pissed off at me. He got up from the sofa. My mother intercepted him and walked him to the bathroom. While I was describing my father’s condition to who knows who on the phone, I heard my mother start to cry.

“Di hast zikh bekakt!”

He had soiled himself. At least now I knew I was right to disregard his wishes. I never knew this to happen to him. Ever.

My mother wept as she got my father into the tub. He was still seizing when she walked him back to the living room wrapped in bath towels.

I went outside to wait for the ambulance. I was afraid EMS would have a hard time finding my parents’ house, especially in the rain.

Nothing happened. An ambulance from nearby Cinnaminson passed the house on its way to Kennedy. The two pudgy EMTs could have downed a cup of coffee and some doughnuts between the time I called and the time they finally arrived in another ambulance. Maybe they are trained to smirk so they can keep themselves calm.

They wheeled out a stretcher. “I don’t know how you’re going to get him to go with you,” I said.

My father was still spitting and hissing when they came into the house.

“Oh, he definitely should be seen,” said one of them. The two of them looked like giant Pillsbury Doughboys.

They wrapped my father up in my parents’ towels.

“You have to get him into his boxers,” I said.

“They’ll only take them off at the hospital,” said an EMT.

“You can’t take him out like this,” I said. I insisted that they pull on my father’s boxers. They sort of did and sort of didn’t, like it wasn’t really their job. Morons.

I rode to Kennedy next to the driver. I turned around to look at my father in the back of the van. He wasn’t fighting his capture anymore. The seizing didn’t stop and he reconciled himself to care by aliens.

*

The triage nurse, a pretty, fit woman with a flip-floppy ponytail, apologized to one of the chubby EMTs for her bad mood the last time she saw him. He said, “Everybody’s entitled to a bad day,” and stared at her breasts. I thought, who cares about your moods and your lust? My father is going to die in this place.

Various techs and nurses took his vital signs. Somebody put an oxygen mask on his face. The hissing and spitting wouldn’t stop.

“Is this normal for him?” a nurse asked me.

“Does he look normal to you?” I asked her.

“Some of our questions are going to sound stupid,” she said. “We have to ask them.”

The exchange was like something from “ER” on TV.

I felt bad for my father that he was now a client to be processed, a statistic concerning end-of-life care. He had tubes in his nose and his neck and an IV stuck into the back of his hand. To the young medical staff, he was an old man in the middle of some bizarre episode the likes of which nobody seemed ever to have seen before. I was in everybody’s way, but nobody yelled at me to move. Their patience made me wonder if my father was deteriorating.

A seventy-ish Iranian Jew on the other side of the curtain was having a spat with his much younger wife. He threatened to call the police if she took the house keys out of his jacket pocket.

After half an hour, in the midst of his seizure, a black tech wheeled my father away for a CT-scan. He told me he had grown up near 164th Street in the Bronx and in Spring Valley, New York. “You look so worried,” he said to me.

Don’t cry in front of the staff.

I was about to call my mother when she showed up in the ER. She had walked in the dark, in the rain, on her sciatica-weakened legs from the house to the hospital.

She started crying when the techs wheeled my father back in.

My father spoke. His speech was slurred, but still relatively clear. “It stopped,” he said.

“It stopped!” I said.

The seizing was over and he was back to himself. The medical staff hadn’t even noticed.

My father joked with the nurses and then with the cardiologist and neurologist who came by to see him. He had no rancor toward me for having called 911. In fact, I hadn’t seen him so alert in almost two years.

This is what he’s normally like,” I told the nurses.

He didn’t even object when the doctors told him he should be admitted for observation.

“Tell my wife and daughter to go home,” he said.

“Pesha’s on her way,” I said.

“She doesn’t have to come,” he said.

“You gave her an excuse not to deal with her mother-in-law.”

My father managed a crooked little smile.

Just then the shul cantor came into the ER.

“I saw your mother walk into the hospital,” he said. “I was concerned.” The cantor is a devout man with a beard. He rarely acknowledges me in shul, but in this crisis, his eyes were kind.

What with my father’s visitors, the staff and the Iranian Jew calling the police on his wife, this section of the ER was starting to take on a party atmosphere.

At some point my father would have to eat. It was Passover and he wouldn’t touch bread, let alone anything unkosher. My mother and I went home to cook. Pesha arrived a short while later. She ended up camping out in my father’s room for the next three nights. A good thing she did because, after all the fun and good times were past, a night nurse gave my father ten times his normal dose of insulin and almost killed him.

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My father’s stroke: 2

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My father’s stroke: 2

Diabetes under scrutinyYou can’t always predict, you can’t always prevent, but I strongly suspect that my father’s stroke could have been avoided.

My father’s runaway diabetes has been a huge problem for the past couple of years. Early one morning in January 2008, I witnessed my father go into diabetic shock. He managed to get up out of bed, wander over to the thermostat and ask my mother where the blintzes were. My mother and I knew something was wrong. His face suddenly looked the size of a cantaloupe. His eyes gazed wonderingly at the temperature gauge as if it contained the mysteries of creation. If he were younger and it was 1968, I’d have said my father was tripping.

After this incident, my younger sister, Pesha, and I jumped up and down in front of my father’s primary care doctor, his nephrologist and the affable doctor who is also the president of my parents’ shul. “We think his medications are off,” we said.

The primary care doctor is to blame to a large degree for not keeping on top of my father’s medications and blood sugar levels. But an equally culpable actor is my father. He doesn’t keep all of his doctors informed about his various doctors’ visits. “I don’t want to insult any of them,” he says.

“You’d rather die?” we ask him.

“I’m going to live forever,” he says.

Don’t go away. The silliness has only just begun.

Around seven o’clock in the evening on March 26, my father took a fall. One of his rabbis had given him a ride home from shul, so my mother was waiting for him. When he didn’t appear, she opened the door. He was lying on his back at the bottom of the front steps. The rabbi was just about to pull out of the driveway. My mother flagged him down. The two of them roused my father, got him on his feet and walked him into the house.

If your diabetic eighty-four-year-old husband had just taken a tumble, what would you do?

Might you have told somebody? A doctor? Your children?

“I didn’t want to bother you,” my mother told me.

I said, “Do you think I call you every night so I can tell you I went to a movie?”

“You have your own life.”

I found out about the fall by chance when I visited for Shabbat. When my father mentioned it, he was almost bragging. It was one more terror he had survived.

I didn’t learn for weeks that my mother had held a cold compress to the back of his head the whole night.

Two weeks later, on the first two days of Passover, my father was more tired than usual. On Friday night he walked over to shul. I was in the kitchen when my sister Pesha came running in and began opening and closing cabinet doors.

She said, “Papa needs aspirin.”

The two of us ran down the street to the shul. When we got there — Pesha in a casual skirt, me in my inappropriate yoga pants — the right side of my father’s face was slack. One of the men, a regular at evening prayers, got my father a Dixie cup of water. The aspirin were downed, and as far as my father was concerned, he had dealt with the situation. Period. The end.

It didn’t help that another one of his DO friends said there was no cause for alarm. This doctor, a long-time family friend, insisted that he himself wouldn’t go to the emergency room in the same circumstances. “Looks like Bell’s Palsy to me,” he said.

Back at the house, our whole family was on hand for our annual Passover get-together. That’s a twisted story in itself, but I’ll get to that later. Everyone wanted my father to go to the ER. My brother-in-law Paul, a medical researcher, said he would go with him.

“You can all leave me alone,” said my father. “I’m not going anywhere.”

The voice of another esteemed doctor — my niece’s husband — voiced his opinion from a hospital in Oakland, CA. “He has the classic symptoms of stroke,” he said. “There’s a small window of opportunity for anything useful to be done. Get him to the ER immediately.”

The long-time family doctor-friend was sure that my father had Bell’s Palsy.

“I hope your malpractice insurance is up to date,” my brother-in-law muttered under his breath.

My sister Pesha sneaked a phone call out to my father’s primary care doctor. The doctor covering for him recommended that my father go to the ER. My father was furious at Pesha.

*

Over the next four days, my father had trouble chewing, swallowing and keeping his food down. He had no sensation in his lower right lip and in his jaw so he didn’t even know when food was falling out of his mouth.

Intermittently, perhaps two or three times a day, he found himself in the grip of something like a petit mal seizure. Food that had found its way into the non-feeling side of his mouth burbled out onto his lips. He started slurping involuntarily. Because he never lost consciousness, he was able to convince my mother that he still didn’t need medical attention. These episodes occurred two or three times a day and lasted no more than a minute or so.

By Monday afternoon when everyone but me had gone back to their own lives, my father’s face began twitching. Once again my father refused medical intervention. He was satisfied to let my frenzied mother hold his forehead and attempt to massage the twitches into placidity. Whatever the effect of her massage, these episodes also lasted just a minute or two.

Meanwhile, Pesha called my father’s primary care doctor and asked him to make a follow-up phone call to my father. I answered his call on Monday.

“Dr. Pearson wants you to come in for a check-up,” I told my father.

My father adores the guy, so he was willing to see him.

“We always bring him something,” my father said. “Latkes, strudel. He loves everything.”

On Tuesday morning, I drove my father to see Dr. Pearson. My mother sat in the back. I considered it a coup that my father let me drive at all, especially in a cold rain.

Dr. Pearson was a nice young man. He is a dead ringer for the slightly balding, pudding-faced doc in a ten-minute play I wrote about a guy of ordinary intelligence who put his nose to the grindstone and against all odds became a doctor. Maybe I feel I already know him because I have encountered him in fiction. Dr. Pearson kindly accepted the little brown bag of matzo meal pancakes that my mother handed him.

In the examining room, where I sat with him, my father and my mother, Dr. Pearson crouched at my father’s side and talked to him about getting a CT-scan.

“It probably is Bell’s Palsy,” he said, “but we want to rule out stroke.”

“Whatever you tell me to do, I’ll do,” says my father. My father has never spoken to his rabbi with such humility.

“We’ll set up an appointment for you this morning.”

“So soon?”

“The whole thing won’t take you ten minutes.”

We drive the twenty-two miles back to Cherry Hill, grab a bite to eat and then hit the road again for the CT-scan.

*

Don’t think that my mother is a perky little eighty-year-old caregiver. As she tells it, “I woke up one morning to a silent world.”

My mother’s deafness was not as immediate as she would like us to believe. My sister and I nagged her for a year to get her hearing tested. I wish now that I had made a doctor’s appointment for her, taken a day off from work and driven her in myself. We knew her hearing was failing incrementally and we shouldn’t have tarried.

Once I lost my job at IBM, I told my parents I would get them to their doctors’ appointments — and that included a doctor for my mother. After my father’s CT scan, it was my mother’s turn to meet with her wonderful, brilliant physician.

“He’s not Jewish himself, but he loves the Jewish people,” my father said. As far as I’m concerned, the guy could play a Praetorian guard in an antisemitic passion play every weekend and I wouldn’t care, as long as he could help restore my mother’s hearing.

My father signed my mother into the office. I noticed that he wrote out her name with great deliberation. He omitted the “in” at the end of “Finkelstein.” I noticed but didn’t think to comment.

My mother left the waiting room to take a hearing test. My father’s eyes looked glassy. He often gets that sick, blank expression. It was the same look he had when his blood sugar went too low and his face shrank to the size of a cantaloupe.

After the hearing test, my mother and I consulted with her doctor. He showed us her MRI image and said that the white dots on the brain possibly indicated that she had experienced a series of small strokes, culminating in the total deafness of her left ear. The good news was that she still had some hearing in the right ear and even a smidgin in the left. She had to see a neurologist as soon as possible and then come back to him to be fitted for a hearing aid.

A father with Bell’s Palsy and a mother with transient ischemic activity. Within a matter of a few weeks, my parents had gone from old to elderly.

We went back into the waiting room to meet my father. He wasn’t there. We checked the bathroom. Nope. We asked the staff if they had seen him. “Does he have a history of wandering around?” one of them asked. He hadn’t until now.

A patient in the waiting room told us that she had seen an older man standing by a car. My mother and I went out into the rain to search.

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My father’s stroke: 1

 

Sticking it to yourself

Sticking it to yourself

Eight days have passed since my father stroked out in a south Jersey parking lot. I am just beginning to piece together how he — and some of his doctors — contributed to this latest of his health crises.

This afternoon as my father was sitting down to eat dinner, he realized that he had run out of his Novolog insulin. He wasn’t concerned. He said he had some other insulin stored in a cardboard box with a bunch of medications he used for treating gout, high cholesterol and a low-functioning prostate. I asked him what that “other insulin” was doing in this pharma mix.

“Somebody in my doctor’s office gave it to me,” he said.

“Who?”

“He’s kind of like the doctor’s deputy,” he said.

“Where do you go to school for that?”

My father shrugged.

I asked, “Is he a doctor?”

“No.”

“So who is he?”

“He wears a suit.”

My father does not have Alzheimer’s Disease and the last thing he is is stupid. The problem is that he has a chronic case of veneratio immodicus — excessive reverence — for doctors and for the drug pushers who visit their offices.

“Did you ask your doctor if it was okay to take this 70/30 insulin combo?” I asked.

“No. Read the box and see if I can take it.”

“Do I look like a doctor to you?”

When I dialed his primary care doctor’s phone number to ask him about the insulin, my father got angry at me. Why was I bothering the doctor? A few minutes earlier he had chewed me out for talking to a family friend about a neurologist for my mother. “I don’t need favors from anybody!” he said.

Two minutes later, when we learned that the neurologist had a good reputation, my father suddenly remembered that he had met the guy in synagogue. “Such a nice man,” he said. “He gives me his hand every time he sees me.”

*

I get on the phone with the primary care doctor’s office and I ask a nurse there about my father’s insulin.

“We don’t have that information,” she said.

I am an idiot and I don’t know what to say. Why would I expect a primary care doctor to know what medications he has prescribed to his patient?

The nurse comes to my rescue. “They changed his insulin in the hospital, didn’t they?” she asks.

“He’s still using the same insulin since before the stroke,” I said.

“You’ll have to check with his endocrinologist,” she said.

As it happens, my father has an appointment with the endocrinologist this afternoon. But what if he didn’t? What if he had used up his insulin, say, yesterday, or on Shabbat when my father would refuse to use the phone to call anybody?

*

The endocrinologist is an older man with silvery coifed hair and good teeth. Straight out of the “Mad Men” era. He is delightfully rough around the edges and chews my father out for not keeping his blood sugar under control.

“Do you stick your finger regularly?” he asks him.

We are in the thick of a Clintonian moment because my father’s answer depends on what “regularly” means. He says yes. I bite my tongue.

“What’s your sugar level in the morning?” the endocrinologist asks him.

My father appears to search his memory. “Around 150,” he says.

This doctor homes in on my father’s equivocation. “Is it ever in the 200s?” he asks.

My father says yes.

“What about later in the day?”

“It can go up into the 200s.”

It routinely goes up into the 400s.

“How long have you had diabetes?”

My father gives an answer that should be shocking, but I see that it entertains him. “Thirty-five years,” he says.

Time for me to play Goneril. “My father has been checking his blood only since he had the stroke,” I say.

“When was that?” asks the doctor.

“Last Tuesday.”

Dr. Mad Men surveys my father sitting on the examining table in his bare feet. For an 84-year-old man one-week post-stroke, my father looks good. He jokes with this nuts-and-bolts gent, who keeps shooting me a look that says, “Your dad’s a real card, eh?” My father tries to tell the doctor that he can’t share his family medical history with him because everyone was killed during the Holocaust. The doctor doesn’t comprehend what that means and asks him again if anybody in his family had diabetes. 

“I was fifteen years old when they were all killed!” my father says.

“Do you remember if anyone had diabetes?” the doctor asks.

“How could I possibly remember?”

My mother wisely explains that nobody in pre-war Poland had gotten a diagnosis of diabetes.

The upshot of my parents’ remarks finally seems to register in the doctor’s brain. 

“What’s this?” he asks. He examines my father’s toenails. One of them is blackened by a fungal infection. My mother wears a mortified expression. She has tried to get my father to see a podiatrist, but he always refuses.

“Make an appointment with a podiatrist and get this taken care of,” the doctor says. Blunt.

He wants to know why my father won’t let anybody get his blood sugars under control.

“You are not going to experience any further old age if you don’t take your diabetes seriously,” the doctor says.

Up until my father’s stroke, I have had a prejudice against osteopathic doctors. But this crusty coot is knowledgeable in a way that doesn’t waste anybody’s time. He has none of that condescending happiness I have encountered in some of my own interactions with MDs. I am starting to think that for a disease like diabetes, you do not have to be a brilliant. You just need to pay attention to the matter at hand. You just need to be good at your job.

“In one week from today, you will fax me your blood sugar levels,” the doctor said. “Without knowing what they are, I can only guess at the amount of insulin you need. And guessing will never get it right.”

Why hadn’t my father’s primary care doctor insisted on seeing a record of his blood sugar?

“Am I going to get that from you?” Dr. DO-right asks my father.

My father nods in agreement.

Meanwhile, I tell the doctor, my father doesn’t have any more insulin. The doctor thinks he has some in his office and leaves the examining room to retrieve it. Nobody, including me, talks about a prescription renewal. I am just as bad as my father. As soon as the immediate problem is solved, I don’t think farther out into the future.

At home, I remind my father that he has agreed to check his blood sugar four times a day.

“Three times is enough,” he says.

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