Eventually, though, those moments became too regular and too alarming to keep waving off as normal aging. Even my father’s famously hopeless sense of direction could not offer any cover on the evening when he got off the commuter train—at a stop three blocks from his house, from which he had gone back and forth to work for thirty years—and could not remember how to get home. In other ways, too, he began to lose track of himself in space and time. In conversation he grew confused about what year it was, about whether he was in Cleveland or Boston or Italy or Israel. I remember very clearly the completely incomprehensible phone call that finally forced me to confront the truth: the most remarkable mind I had ever encountered was failing—was, in many crucial ways, already gone. If you have ever lived through the cognitive decline of someone you love, you have had a night like the one that followed for me. That was the first time I ever grieved my father.
It was my sister, the scientist, who eventually put two and two together. One day, after a particularly alarming episode of confusion landed my father in the hospital, she called his doctors and told them to start pulling him off of every drug that wasn’t actively saving his life. No matter how long I live, I can’t imagine I will ever witness another transformation as astonishing as the one that followed. The night after he was released from the hospital—my sister and I had by then flown home to be with him—my father stayed up with us until well past two in the morning, talking about the origins of Italian anarchism, the role of the commerce clause in constitutional law, the family relations in Bleak House, and the rival positions on the nature of consciousness espoused by various philosophers. The next day he woke up early and cheery and, together with the rest of us, took his four-year-old granddaughter out sledding.
There is an old saying—of what origin I cannot say—about how to make a man happy. First you take away his donkey; then you give it back. I don’t know anything about donkeys, beyond the fact that the comparison would make my father laugh. But I can affirm that there is nothing in this world more wonderful than the feeling of being reunited with something precious that you thought was permanently lost. It had been upward of two years since I had seen my father even half so much like himself, a year since I had accepted that he would never again be the person I had always known. And then, almost overnight, he was back.
I learned an enormous amount from this experience, including something new about the relationship between small losses and serious ones. Most of the time, losing everyday objects is not indicative of any kind of underlying illness, but real mental decline does often manifest partly as an uptick in lost things. Dementia patients are prone to misplacing their belongings, and people with early-stage Alzheimer’s often can’t find something because they have put it in an unlikely location: the eyeglasses end up in the oven, the dentures in the coffee can. I knew all this, and so when my father began showing signs of cognitive decline, I fell into the habit of scrutinizing his every loss for indications that it might portend a larger one. The misplaced wallet, previously both characteristic and comical, became a potential source of alarm; the word he went looking for and couldn’t find sent me scanning, like an anxious parent at the edge of the ocean, the wide gray expanse between ordinary and ominous. I know now that countless people live with this habit and with this fear, either for themselves or for someone they love, and I understand why. The brain is the deepest and most mysterious of all the Valleys of Lost Things, and it is heartbreaking what can go missing there: the town you live in, the name of your wife, what to do with a hairbrush, the reason a caretaker is in your apartment, who you are, how to find your way home.
Of all of the losses my father suffered in his final years, this was the most terrible—but only for my mother and sister and me. My father himself was largely oblivious to his situation, and therefore largely untroubled by it; I have seen him, while in his right mind, more frustrated by failing to remember the name of the third baseman for the 1956 Detroit Tigers than he was by his whole long iatrogenic decline. As a result, even though he was manifestly a creature of his intellect, he was ultimately far more affected by all the others losses that beset him in old age—and, unlike the cognitive problems, none of these ever reversed themselves. On the contrary, they compounded, growing both individually worse and collectively more numerous with each passing year.
In that sense, although some of my father’s ailments were rare, his overall experience was perfectly common. Most of us alive today will survive into old age, and although that is a welcome development, the price of experiencing more life is sometimes experiencing less of it, too. So many losses routinely precede the final one now: loss of memory, mobility, autonomy, physical strength, intellectual aptitude, a longtime home, the kind of identity derived from vocation, whole habits of being, and perhaps above all a certain forward-tilting sense of self—the feeling that we are still becoming, that there are things left in this world we may yet do. It is possible to live a long life and experience very few of these changes, and it is possible to experience them all and find in them, or alongside them, meaning and gratitude. But for most of us, they will provoke, at one point or another, the usual gamut of emotions inspired by loss, from mild irritation to genuine grief.
I don’t mean to suggest that my father was unhappy at the end of his life; he was not. He had my mother, whom he adored, and who—increasingly out of necessity but always also out of love—seldom left his side. He had my sister and her family and me, and he got a huge amount of delight from all of us. He had a monthly book club that he relished, and a daily book club with himself. He had two cats he pretended to hate, and a group of people he kibitzed with at the pool where he and my mother went regularly to swim, and enormous concentric circles of friends and colleagues and acquaintances all over town.
And yet if “to lose” originally meant to separate, my father was increasingly separated from the man he once had been. He no longer practiced law, although he had a passionate work ethic and had always cherished his colleagues and his job. He no longer traveled, although he loved to see the world, because too many injuries and difficulties befell him when he tried. He no longer drove, although all his life he had maintained a kind of happy teenage pleasure in doing so. He had never been an athlete but he had always been vigorous; now he could barely walk to the end of the block. On top of all of this there was the pain, and pain’s dreadful handmaiden, shame. Even now, I turn away slightly from the memory of my father, sweating visibly in a restaurant from a sudden increase in the agony caused by that nerve in his neck, needing to make it to the bathroom quickly but being unable to do so.
It was terribly upsetting to bear witness to all of these changes. I hated to see my father diminished and suffering, and I worried, not wrongly, that what I was witnessing was the beginning of the end. But only belatedly did I start to reckon with the incompatibility between my sympathy and my fear: with the fact that the time would come when only death would release my father from pain. That is often true at the end of life, and so one way to think about the many losses associated with illness and aging is that they help us make our peace with the ultimate one. You hear people make this case all the time, especially retroactively. “At least he’s no longer suffering,” we say after someone has died. “At least she’s out of pain.”