My father, Asael Tall, M.D., was a physician in Rigby, Idaho for nearly 50 years. He, and his identical twin, Aldon, opened the Tall Clinic shortly after WWII. Time spent in Island Park at the cabin was almost a sacred experience. He would have been content to spend the eternities doing all things Island Park. Of course, temporal happiness, the capacity to enjoy things, and life itself, are not permanent. Several years before my father died he told me that things looked different to him after he turned 90. For instance, he said that he remembered when he was younger thinking that being 85 was really old. He reluctantly accepted the inevitable aging processes.
We decided that his caregiver was the wrong resource when he fell one night and cut his head. She could not get him up and he sat in the hallway of his home until help could come. When my brother, Bruce, learned of this, he came up from California to help find a solution. He found an excellent care center with the right resources. We moved some of his bedroom furniture into The Turtle and Crane and my father spent the rest of his days there. His new “home” was a few blocks from my home and I was able to see him almost every day. He and I had former patients who were his fellow-residents. Those in the Alzheimer’s unit did not remember him, but he remembered them. I helped with some of his personal care and even cut his hair with a Flow-Bee. He became septic from aspiration pneumonia on two occasions, requiring hospitalization. As I drove him away from his last hospitalization, he held his feeding gastrostomy tube in one hand and asked what it was for. I explained that he had a paralyzed esophagus and could not swallow, and that the gastrostomy tube allowed us to put liquefied food directly into his stomach where it was supposed to go, rather than into his lungs where it had been going before he had the tube. He sat there with his hands folded for a moment and said, “I guess my hamburger days are over.”
My father and my mother in-law had many things in common as both had lost their spouses. They were an item for many years. They enjoyed grandchildren in common and it was just natural to see them together at the family gatherings, birthday parties, Sunday dinners, weddings, and funerals. They never married, but my father said to me one afternoon, “Roger, if I had known that I was going to live this long—I would have—gotten married!” When he could no longer take her on drives, out to dinner, or to family events, I wondered if she would still be interested in an aging man with increasing frailties. Theirs was a true friendship. Long after the party was over, she was there to the end. She taught me lessons of devotion that I could not have learned from anyone else.
He had an excellent 92 years, full of world class challenges and was blessed with the character, intellect, physical and spiritual health to rise to most occasions. His 93rd year was not so great and he needed ever-increasing assistance with most of life’s activities. He was always grateful and never complained.
Over the years I have cared for hundreds of patients in the same pattern of decline. The veil grows closer to them almost every day. Those who die suddenly and have unexpected deaths miss out on the suffering, but also miss out on what they learn and can teach others. For many years I have been of the opinion that when the dead relatives show up, the end is near. When the end was approaching, my patients often told me about visiting with their parents or loved ones who had gone on before. Sometimes they even spoke to departed friends and relatives that were unseen to me, while I was still in the room. In Washington, D.C., one patient was going to be discharged the next morning. He told me that I would not have to make rounds. I told him that I always made rounds and that I would see him before he left. He simply said that he had been speaking to his brother and would not be there in the morning. When I returned the next morning for rounds, the nurses said that he had died in the night. I told them that we should notify his brother. They told me that he told them that his brother had died about five years earlier.
And so it was with my father. I was sitting next to him on the couch when he said he needed to go to his room. I stood and helped him to his feet, holding onto his belt from behind while he made Tim Conway steps. The trip of about ten yards took five minutes and when we arrived at the room, he looked around and couldn’t remember what he needed. The trip back to the couch remained painfully slow. He could talk or shuffle, but not both at the same time. He told me that Aldon had been there earlier that afternoon and visited for quite a while. Aldon had passed on about five years earlier. Now, I had never patronized my father and thought carefully before saying anything hurtful. So, I gently said in a patient voice, “You know, Dad, Aldon has been gone for over five years.” I felt his back stiffen a little as I held onto the belt as he said insistently, “Well, he was here with me this afternoon!” I replied quietly, “He probably was.”
The nurse at the care center called me the next morning to tell me that Dad had passed. When I arrived shortly after 6:00 a.m., I walked by the dining table where Mr. Smith was sitting as usual with his early morning cup of coffee. Mr. Smith was a former patient of mine and, for some reason, thought he was in charge. He blurted out when I came through the door, “You’re too late.” I replied, “I know .... " Then I paused and slowly finished my sentence, " ... but he’s not here.”
Ever vigilant,
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Roger H. Tall, M.D.
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