Journal of Gerontological Nursing

Endnotes 

The Legacy

Lenore B Weinstein, RN

Abstract

"Where are my slippers?" Gordon asked.

"Look. They are on your feet," we told him.

"Yes, but where are my slippers?" he asked again.

Gordon started to show signs of dementia and hallucinations. My heart sank. Having cared for my mother who had Alzheimer's disease for many years, I knew what Gordon was exhibiting wasn't Alzheimer's disease. However, other possible conditions could be equally tragic and difficult. But I am getting ahead of myself.

"Larger-than-life," "vibrant and alive," "powerful," and "stately" described Gordon, my father-in-law. When he entered a room, everyone would look at him. He had presence and commanded attention and respect. He had a brilliant mind and a positive outlook on life. People were drawn to him, they would ask his advice and seek his counsel. Gordon was an innovator, a dreamer who made things happen - he turned dreams into realities.

"Endnotes" features personal stories, anecdotes, fiction pieces, cartoons, or any other submissions regarding the elderly written by our readers. Please submit your "Endnotes" to: Managing Editor, 6900 Grove Road! Thorofare, NJ 08086, or fax (609) 853-5991, or e-mail: http://www.slackinc.com.…

"Where are my slippers?" Gordon asked.

"Look. They are on your feet," we told him.

"Yes, but where are my slippers?" he asked again.

Gordon started to show signs of dementia and hallucinations. My heart sank. Having cared for my mother who had Alzheimer's disease for many years, I knew what Gordon was exhibiting wasn't Alzheimer's disease. However, other possible conditions could be equally tragic and difficult. But I am getting ahead of myself.

"Larger-than-life," "vibrant and alive," "powerful," and "stately" described Gordon, my father-in-law. When he entered a room, everyone would look at him. He had presence and commanded attention and respect. He had a brilliant mind and a positive outlook on life. People were drawn to him, they would ask his advice and seek his counsel. Gordon was an innovator, a dreamer who made things happen - he turned dreams into realities.

My father-in-law had a colorful medical history. Gordon had high blood pressure, kidney and heart problems, macular degeneration, glaucoma, and reduced peripheral vision which made us crazy when he drove. He had a hiatal hernia, ulcers, and diverticulosis. He had multiple surgeries throughout his life. He had things put in and things taken out - for instance, he had lenses implanted and cataracts removed. He had a stent put in, and colon polyps removed several times. His gall bladder and part of his colon had been taken out. Gordon also experienced rare conditions such as transient global amnesia, a temporary, stressinduced condition. In addition, if a medication produced any unusual side effects or reactions, Gordon would have them.

However, his medical conditions were under control with medication, and all was well until his conditions became acute and he took on the role of patient. Gordon was the worst patient imaginable and, since he spent a lot of time in hospitals over the years, we often dealt with this side of his personality. He would become extremely cranky and i demanding. He hated not being in control of his situation.

Gordon had a Type A personality to the nth degree. He was driven always on the move, and competitive. He was always trying to get ahead, which he did, although not without experiencing both good and bad times. He was demanding of others, but no more so than of himself. However, this side of him was tempered by his good nature and generosity. He enjoyed living well and spending money, doing so when he had it and even when he didn't have it. During the last years of his life, he was financially successful and lived "the good life." He had nice cars, a beautiful home, traveled in style, collected art, hosted parties, and was able to do what he wanted. He had a joie de vivre and celebrated life. Lest you think him frivolous, he also devoted a lot of time, energy, and money to many different philanthropic causes. He enjoyed helping those less fortunate. Although he liked the prestige involved in being a "big shot" and showing off, he contributed to many causes anonymously.

Gordon was extremely generous to his family and frequently took his children and grandchildren on trips. He told my husband, Samuel, "Choose anyplace in the world you would like to go for your 50th birthday." Samuel decided, and so my husband's parents planned a safari in Kenya in honor of his 50th birthday.

Before the trip, we all started taking precautionary anti-malarial agents that would be continued during and after the trip. Samuel and I were prescribed a daily antibiotic dose for the duration of the trip, while my in-laws were prescribed Lariam® (mefloquine), a once a week pill.

Gordon had received the go-ahead from his physician to take the trip and had taken his first weekly anti-malarial agent. We were scheduled to leave on a Monday night and Samuel and I flew to his parents' hometown to meet them the day before. Before we arrived, my father-in-law was not feeling well and had gone back to the physician with non-specific complaints. The physician could not find anything wrong and had told him that he could leave Monday night if he didn't have a fever. We offered to postpone the trip but Gordon insisted that he would be fine.

We departed at midnight and arrived in Kenya very early in the morning. By the time we got there, Gordon said he really was not feeling well, and needed a wheelchair at the airport. After checking into the hotel, he went to sleep. We figured he would feel better after a rest, and he did. However, as the days went on, he complained about being more tired than usual. He would fall asleep in the car, and did not join us for the afternoon trips because he wanted to rest. He seemed to be walking slower than usual, but still had no fever or even any specific complaints. We attributed this to the time change and the stress of traveling. By Friday night, he started insisting, "There is mething terribly wrong with me." He began repeating himself and his language became less coherent. Not knowing what to do, we offered to take him home, which he refused. The following morning, he was worse. "Where are my suppers?" he kept asking. "They are on your feet," we would tell him. "Yes, but where are my ippërs?" He would cry and insisted that something major was wrong with him. Then, he became cpnfused and delusionáL He also cried constantly.

After asking for a doctor; we were sent to the hotel's resident nurse. She took his blood pressure and found it was extremely high. She suggested we go immediately to see the doctor in the town's clinic. We were very concerned about a possible stroke, or a transient ischemic attack, and we quickly left for town. The physician gave Gordon medication that reduced his blood pressure and then sent him to the neighboring AIDS clinic to have blood samples drawn to rule out malaria, infection, or any other condition. The doctor strongly suggested a hospital stay. During a moment of clarity, Gordon made my husband promise that he would not put him in a hospital in Kenya. "Take me home," he cried repeatedly. We made arrangements to catch the first flight out.

Upon returning home, we started making the rounds to various doctors. Gordon's primary physician saw him and suggested that he was severely depressed after the neurologist did not find anything on the electroencephalogram. She prescribed anti-depressants and said to forgo the second anti-malarial dose. Different physicians sent him for a variety of tests and procedures, but the results did not reveal anything. This went on for several days, and although Gordon still cried easily, he was becoming less and less confused. His primary care physician took another look at all the test results and the medications Gordon was taking and found that the anti-malarial drug had rare side effects of depression and dementia. Neither the physician nor the neurologist had ever seen these side effects exhibited. At the time, there were very few references to this side effect in the literature, and such information was not widely available or disseminated over the Internet.

We then remembered that years earlier, following a hernia repair, Gordon had a similar, but short-term reaction to the pain medication he received. We reported this to the physicians, and they stopped all recently prescribed medications. The primary physician began seeing Gordon daily. The symptoms and reactions to the medication were reversed in a matter of weeks and, miraculously, there was no residual effect. A month following this episode, Gordon was functioning as if it never happened. What a blessing and relief.

This experience certainly proved educational. One lesson learned was that when watching television advertisements, listening to commercials, or reading drug information, pay close attention to the possible side effects, signs, and contraindications of medications. If you think these complications are so rare you will never see them, think again. Even if the incidence is less than .01% of the population, they still can occur. My father-in-law was that rare gem - there was less than a 1 in 1,000 chance of the occurrence of the side effects he experienced.

"He lived with class and died with class," Susan, my mother-in-law, said. Gordon, my fatherin-law, passed away of a sudden heart attack at the Ritz Carlton Hotel in Paris while on a pleasure trip. If he had any choice in the matter, I believe that is how he would have chosen to go. The legacy he left his family is to celebrate life and always live it to the fullest. As a nurse, he taught me to expect the rare and unexpected, and to seriously listen to patients' complaints - they know themselves ? and their bodies best.

"Endnotes" features personal stories, anecdotes, fiction pieces, cartoons, or any other submissions regarding the elderly written by our readers. Please submit your "Endnotes" to: Managing Editor, 6900 Grove Road! Thorofare, NJ 08086, or fax (609) 853-5991, or e-mail: http://www.slackinc.com.

10.3928/0098-9134-20041101-14

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