27 February 2009
As a geriatrician, Jerald Winakur, M.D., has dedicated his career to helping the elderly live well and, when the time comes, die with grace. Even so, he was unprepared for his own father’s descent into disability and dementia. “I may be a geriatrician, but coming to grips with the ravages and the realities of the aging process in my father has been no easier for me than for anyone,” Dr. Winakur wrote in a new book, “Memory Lessons: A Doctor’s Story.”
“Even though I have the experience to know what is coming, the training to describe in detail the pathologic progression of his disease, the medical vocabulary to document each step of his demise, I am powerless to prevent any of it.”
Dr. Winakur, a clinical professor of medicine and associate faculty member in the Center for Medical Humanities and Ethics at The University of Texas Health Science Center at San Antonio, wrote “Memory Lessons” to come to terms with his parents’ aging process, particularly that of his father.
Leonard Winakur was one of the “oldest old,” a gerontological term for those over age 85. The oldest old are the fastest-growing segment of American society: Their numbers will grow from about 4.5 million today to almost 10 million in 2030. Only one in 20 is fully mobile, and half are cognitively impaired. Leonard Winakur, who developed Alzheimer’s disease, was one of them.
At times, Dr. Winakur was able to draw upon his medical training. He knew which medications might calm his father when the elder Winakur grew agitated, delusional or abusive. And, with considerable assistance from his mother, his brother and a home health aide, Dr. Winakur was able to keep a promise he made when his father was in his early 80s: no more hospital stays.
But a medical degree could not prepare Dr. Winakur for the flash of anger he felt when his father, overwhelmed by the outside world, refused to attend the wedding of his first grandchild – Dr. Winakur’s eldest daughter. Specializing in geriatrics didn’t ease Dr. Winakur’s guilt as he wondered whether he could have been a better son. All of his training did not provide a solution when his demented father roamed the house at night, keeping his wife – who cared for him all day – awake until she was frantic.
“I am the doctor in the family; I have special knowledge, a learned patience, observational skills honed over decades,” Dr. Winakur wrote. “And still the nights are bad. My father is only getting worse.”
The story started out as an essay titled “What Are We Going To Do With Dad?” that appeared in Health Affairs, a health policy journal, in 2005. The Washington Post ran an excerpt, which was picked up by newspapers across the country. The essay struck a chord, and Dr. Winakur began receiving thousands of heartbreaking e-mail messages from people who were going through the same thing.
He was overwhelmed at first, but he came to the realization that those who wrote to him were not necessarily looking for answers: “They wanted to tell me their stories, just as I had told them mine.”
Dr. Winakur’s story had unexpected bright spots. While his father had been stoic all his life, dementia swept away those inhibitions, allowing him to freely express affection for his sons. “It was always a surprise when he said, ‘I love you, too,’” Dr. Winakur said.
His father’s final days also rekindled in Dr. Winakur the idealism and innate compassion that he had when he first went into medicine.
Even as he cherished these gifts, Dr. Winakur knew all too well that there was only one way his father’s story could end: “There is no triumph over aging, after all.”
The University of Texas Health Science Center at San Antonio is the leading research institution in South Texas and one of the major health sciences universities in the world. With an operating budget of $668 million, the Health Science Center is the chief catalyst for the $16.3 billion biosciences and health care sector in San Antonio’s economy. The Health Science Center has had an estimated $36 billion impact on the region since inception and has expanded to six campuses in San Antonio, Laredo, Harlingen and Edinburg. More than 24,000 graduates (physicians, dentists, nurses, scientists and other health professionals) serve in their fields, including many in Texas. Health Science Center faculty are international leaders in cancer, cardiovascular disease, diabetes, aging, stroke prevention, kidney disease, orthopedics, research imaging, transplant surgery, psychiatry and clinical neurosciences, pain management, genetics, nursing, dentistry and many other fields. For more information, visit www.uthscsa.edu.