Multi-Infarct Dementia

3:27 AM Thursday, December 30, 1999

I found the subject line today scrawled on the back of an envelope in my mother's perfect, 1930's-vintage, handwriting. She was taking notes. My mother was studying up on her own death. It's my guess that my mother, and those around her, suffered from irreversible dementia that results from a series of small strokes in which cerebral infarction occurs. Infarction is the death of body tissue caused by a blockage of the blood supply to that tissue. To be with my mother was like being with someone who had quiet little grenades going off in random places throughout her head. I have to guess about the location of the infarctions but I have an exquisitely detailed map of the one-of-a-kind dementia that they produced. She was like a civil war soldier on a horse, fatefully charging the enemy, while musket holes were being ripped through her body. How's that for melodrama? I think I watched that unfold for about 15 years.

The quiet grenades were what was happening to my mother, but watching her get shot to pieces was what was happening to us.

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My cousin David blew his head off because he couldn't handle the Post Traumatic Stress Syndrome. None of us saw what he saw in Vietnam but we all seemed to accept the way he shot heroin for years and then shot himself. We gave him the benefit of the doubt, as they say. My mother wouldn't give herself that kind of break. I kind of wish she would have. She wouldn't admit that she was walking wounded through this whole decade. We all had what we thought was "proof". And I'm not just talking about the hoarding. Everyday life was a struggle.

We say someone's guilty of murder only if they posses "mens rea" which is basically "guilty mind". The act is not what makes them a murderer but whether they knew what they were doing. We can't ever really know this about a person but we condemn people to the gas chamber or not based on our guess about it. 12 people guess, to be exact.

She wrote down the detailed symptoms of Alzheimer's disease on the back of an envelope. She listened to her children moan about it for years. She watched her sister and brother die a gradual brain death. She completely destroyed the home she'd made for 30 years. All the evidence is there that she knew what was happening. There are two possibilities as I see it: she knew and accepted her own death (but wasn't going to go bragging about it) or that part of her brain that recognizes those things was one of the first things to die.

The longer I think about my mother the more I'm inclined to favor the first possibility. I've been firmly supporting the latter but I keep hearing stories about how people experience old-age death as choice. People have been telling me their personal death narratives for 3 weeks solid and they include stories about old couples where one of them dies and then the other just kicks-off unexpectedly a short time later. People accept "boredom" or "loneliness" or "suffering" in these cases as a cause of death almost as if it were a shotgun blast to the head.

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So we're too stupid right now to know why people die. (I say, "right now", only in deference to stupid people like me who are trying to figure it out.) We think there's something equivalent of "mens corpus" that people possess when they kill themselves. Another reason I'm favoring the first option is that I'm thinking that the will-to-death is something that is much deeper in a person (or more decentralized) than a specific part of the brain. People in various states of brain disease and trauma seem to be able to make the decision to die.

Which brings me to this question (really the only one that is relevant to those of us living): If someone accepts their own death, who are you to fight against it? The most profound moment of my first 20 years was when I first recognized in my father's eyes the acceptance of his own death. I swear to God I saw it.

I stood there in his hospital room and watched the green line of his EKG bounce. He'd had a heart valve transplant 8 years earlier. He was back in the hospital this time because of chest pains and now they were talking triple-bypass. He'd been retired only 2 weeks! My sister Dani had told me in the car on the way there that, for his sake, I had to be as positive as possible. After all, she had heard that a triple bypass was a piece of cake now days - as compared to the valve transplant back then. She held his hand at the bedside and told him, "You're gonna be alright."

My father smiled. The look said he was trying to hide from her some pain. Then he turned to me. I was letting Dani do all the talking and standing with my arms crossed surveying the hospital room. She said, "Really, you know you're strong enough. You just mowed the lawn last Wednesday. It'll be fine." I knew the question the conversation was leading to and my father didn't let me escape: "What do you think David?"

If I had been a murder trial juror, forced to tell the truth, I would've had to say, "The look in your eyes tells me you are going to die." But I was just a kid and I felt the need to keep up appearances. I just said, "Sure." It probably sounded to Dani like I was agreeing with her, but what I meant, and what I'm guessing/hoping my Dad heard was, "Sure, you can die. It's OK with me." I really was alright with it. Who was I to fight against it? The next day my Dad was a fat, white, unreal lump on an operating table. There's more life in a rock than in something that once held life and no longer does.