What patients don’t have, but need: A qualified counselor to fill in the blanks of “Here’s what I would do…and here’s why”

My 83-year-old dad this week was diagnosed with squamous cell esophageal cancer, Stage 3.

There are no options to cure it. So now dad must decide whether to do nothing or to seek palliative treatment with radiation, chemotherapy, or a combo of radiation/chemo.

Doing nothing means he will probably die this year. Treating it means he’ll likely live longer, but each option brings its own complications. Radiation, for example, will likely inflame his esophagus so much that dad won’t be able to eat, necessitating a feeding tube.

There’s no good estimate on how much longer dad may live with treatment or how long treatment could stave off some symptoms of the disease, like pain or internal bleeding.

So how do you choose what is best?

Thirty years ago, my dad’s father (my grandfather) faced the same cancer and needed a feeding tube to keep him alive.

Grandpa — in a nursing home at that time — couldn’t make his own decisions, so dad, at the strong urging of a physician, agreed to the feeding tube.

It has been one of the biggest regrets of dad’s life. Dad believes he unnecessarily prolonged my grandfather’s suffering for nothing.

But that was a different time: Physicians often told patients what to do and patients followed their advice without question.

Now, the medical pendulum is stuck on the opposite side.

Physicians often lay out the options and let patients sort it out for themselves — without any guidance at all.

I vastly prefer patients making their own informed decisions, but there are pitfalls.

These are often technical, multi-dimensional choices and patients might not consider everything they should: What will their quality of life be? What will their insurance cover? Are they more likely to die in an emergency room or at home?

Here’s what patients and their families need: An objective, battle-tested medical professional who understands their physical, emotional, financial and spiritual needs and then fill in the blanks — “Here’s what I would do…..and here’s why…..”

I don’t think practicing doctors have time for this holistic approach. And I’m not sure I would trust all of them since the medical system has built-in financial incentives that don’t benefit patients.

So then who? I wish retired doctors and nurses (and even those still working) would volunteer for this duty. And maybe this is a profession all its own, provided insurance would cover this service.

Last night, after dad got home from the hospital, my husband stood in the snow during a freezing rain and cooked dad a steak on the grill.

Tonight, in the comfort of my kitchen, I’m making dad’s other favorite: Pan-fried perch from Lake Erie.

I don’t how dad will choose to handle his cancer.

I’m researching and we’re still talking. We meet with the oncologist again Monday.

But I will stand by his choice, whatever it is.

P.S. Here’s a link to a great essay by a Boston doc…who uses her experience as both doc and, in the end, as family of patient….wrestling with this question: “Doc, what would you do?”

http://tinyurl.com/pngbcr4

In 1947, two 16-year-old boys rode to Washington, D.C., on scooters and U.S. Sen. Robert A. Taft gave them an extraordinary gift

My dad doesn’t remember who came up with the idea, but when he and his buddy, Ronnie Morse, were 16 years old, they decided to ride their scooters to Washington, D.C.

It was the summer of 1947, two years after World War II ended, and almost anything seemed possible to boys who grew up with ration books, Victory Gardens and news reels about battles they may some day have to fight for their country.

Dad and Ronnie spent about about a week mapping out their journey and then headed south out of Medina, Ohio — population of about 4,500 at the time — toward the Pennsylvania Turnpike for the 370-mile journey to the nation’s capital.

Dad was riding a used orange Salsbury scooter he bought from a relative with money he saved from his paper route. And Ronnie had a red Cushman. Neither wore a helmet. Neither considered it.

Everything was going fine until they reached the turnpike, where a toll booth operator turned them away, saying scooters were not permitted on the roadway.

They scrambled and found an alternative — U.S. Route 30, which roughly parallels much of the turnpike — and kept moving until they hit the mountains.

Ronnie’s Cushman wasn’t powerful enough. On the first few climbs, he blew his clutch. The boys could fix it themselves, but it took too much time.

So they improvised again.

They bought a clothes line. Every time there was a major climb approaching, they’d stop and tie Ronnie’s Cushman to dad’s Salsbury so dad could tow Ronnie and his scooter up the incline.

It took a couple of days — they stopped at tourist houses (what we might call bare-bones bed and breakfasts today) — but they finally reached the power base of the world.

Without CNN, the Internet or even a daily hometown newspaper, the boys didn’t recognize many of the Washington, D.C. touchstones we now take for granted.

When they pulled up in front of the U.S. Capital, dad at first wondered if it was the White House.

As the boys sat their talking about their next move, a man in a suit approached and handed them his card: U.S. Senator Robert A. Taft.

Taft stopped, he said, because he saw the Ohio license plates on their scooters. Neither boy recognized the Ohio Republican — who historians would later call one of the most powerful senators of the 20th century.

But Taft gave the boys an extraordinary gift, one that anyone visiting or living in D.C. would treasure but couldn’t have today — the use of a Senate parking space.

Taft said he never used his space and thought it might come in handy for the boys’ scooters.

It did. Dad and Ronnie only planned for a day in D.C. and the space gave them easy access to watch a session of Congress.

Dad doesn’t remember now what lawmakers were talking about that day, but he vividly remembers looking down and seeing this: A congressman reading a comic book hidden behind what appeared to be some sort of law book.

As darkness fell, the boys motored out of the city, with the clothes line, and began the long journey home.

Dad told me bits of this story before, but I heard the whole thing yesterday at the hospital.

When I asked him why his parents let him go, he said Ronnie asked the same thing — including his own parents in the question — a couple of months ago.

Dad said he figures it’s because he and Ronnie made it safely back and forth to Knoxville, Tenn., the year before on their scooters when they were only 15 years old.

He hasn’t told me the Knoxville story yet.

Outrage of day: No wheelchair for you!

When I ran into hospital lobby to grab a wheelchair for my mom today, there weren’t any there.

Two silver-haired women were at the lobby desk (unsure if employees or volunteers), one talking on a cell phone. I asked the other where I could find a wheelchair.

She said if I didn’t see any, they didn’t have any.

“Should I carry my mom to the third-floor appointment,” I ask, exasperated (my mom waiting alone in the car).

“No, we don’t allow that,” the woman flatly replied.

She was serious.

My husband was off today, so I called and asked him to bring up our wheelchair from home (about a 10-minute drive).

Just as he pulled up with the wheelchair, a patient exited the hospital and got into a car, freeing up a hospital wheelchair for our use.

I was too tired from this week’s chaos to complain. But my mother — who once sat on the board of the local Red Cross (that organization’s volunteers once staffed the hospital desk, but I’m not sure they still do) — gave the women a piece of her mind, from one end of the lobby to the other.

Sadly — and there is a repeating pattern here — I think the women behind the desk disregarded my mom as nothing but a crazy old lady instead of someone with a legitimate complaint.

I told my dad today he has cancer. Why me? Because the doc who found it apparently didn’t think my father was worth his time

Dad has a tumor on his esophagus that is almost certainly cancer.

Esophageal cancer killed my dad’s father at age 91. It killed my mom’s mother at age 83, which is how old my dad is now.

This cancer, my family knows, is an ugly way to die.

Yet the doctor who discovered the tumor didn’t talk to my dad about it, didn’t look him in the eye and answer his questions.

The doctor instead foisted that burden on me — by phone.

Before I started writing this blog about my outrage, I spoke with four R.N.s — three who work in different departments at the hospital where my dad is, plus an oncology nurse at another facility. I told each how my dad’s diagnosis unfolded today because I wanted to make sure my anger is justified, not just fueled by my fear and grief over the cancer.

Each assured me that my ire was righteous. Three called the doctor’s behavior unprofessional. I call it cold.

Judge for yourself. Here’s what happened:

I wheeled mom into dad’s hospital room just after 2 p.m. He had just returned from having an endoscopy, a procedure in which a doctor inserts a flexible tube with a light and camera attached to scope the digestive track.

This test, we hoped, would reveal the source of dad’s acute blood loss  — which had become so severe the test was pushed back a couple of hours so dad could receive a blood transfusion.

I told the nurse helping my dad I wanted to be there when the doctor came to the room with the results and asked her to get an approximate time because I had to run my mother one-floor up for a scheduled iron infusion at 2:45 p.m. and didn’t want to miss him.

The nurse, who was very helpful, hadn’t been able to reach the doctor by 2:40 p.m., so I scurried upstairs with mom and then rushed back downstairs to wait with dad.

When the nurse saw me, she assured me she was still trying track down the doctor. A few minutes later, the phone in dad’s room rang and the nurse bolted in saying it was the doctor on the line.

The doctor — whom I have never met, but who is part of the gastro practice that both my mother and father use — never asked to speak with my father, nor did he offer an explanation about why he didn’t stop to see us before leaving the hospital.

He instead told me he discovered a tumor that was almost certainly cancerous on my dad’s esophagus. The doctor didn’t have the results of the biopsies yet, but he already called in two oncologists to consult.

I was stunned. I figured a phone call was good news, or at least neutral news — maybe he wanted to run more tests. But not this. A doctor doesn’t drop the cancer bomb by phone.

So I slipped into my most comfortable suit of emotional armor — my newspaper reporter facade — and grabbed a nub of broken pencil from my dad’s bed tray and started asking questions.

The doctor spelled the names of the oncologists for me and told me what would likely happen next — a CAT scan, the assigning a “stage” to the cancer and a treatment plan.

All of this, of course, is happening at the bedside of my dad, who is listening to my side of the conversation and trying to figure out what was going on.

Was this the source of dad’s blood loss, I asked, trying not to say the word cancer until I could talk to dad.

The tumor he found was covered in dried blood, but wasn’t actively bleeding, the doctor said.

Tumors, he told me, bleed intermittently.

The phone call lasted less than three minutes.

When I hung up, I told dad he had cancer.

Dad asked a couple of questions that I had no answers for.

A few minutes later, I picked up mom from her iron infusion on the floor above and told her dad has cancer.

She, too, had questions I had no answers for.

Is this the way medicine is supposed to work?

P.S. I haven’t yet decided whether to post the doctor’s name. I most certainly will write letters to his medical partners and the president of the hospital where this happened. We are not using the oncologists this doctor brought in for consultation.

Sometimes an old lady in a faux fur and hot pink sneakers has dementia, sometimes she’s just an old lady who likes faux fur and hot pink

When a hospital aide yesterday asked my mom where she was going, my mom couldn’t find the word “Maternity” — a perfect one-line response for an 80-something woman in a wheelchair.

So she said, “I’m having a really old baby.”

I laughed because I knew what she meant. But the aide frowned and gave me a knowing look, as if to say “I’m so sorry your mom’s lost her mind.”

Both responses were right: Mom, who always had a wicked sense of humor, can still be very funny, especially when she’s trying her best in public. But it’s also true she’s losing her mind to a combination of vascular dementia and Alzheimer’s.

It’s often difficult for outsiders to tell the difference and they look to me for clarification — as if I can speak dementia.

When I was at college, one of my favorite classes was The Evolution of the English Language, which traced the roots of words and revealed the clear paths of their changing meanings.

It doesn’t work like that with dementia. Word meanings zigzag, sometimes moment by moment.

That doesn’t mean someone with dementia isn’t trying to convey a coherent thought — or even a joke.

Unraveling the meaning —  or even figuring out whether a statement is dementia-related or merely human blunder — isn’t always easy.

Yesterday, when my mom made the maternity wisecrack, she was wearing a faux fur coat, navy-blue ankle pants and hot pink sneakers with no socks (throughout her life, she has refused to wear socks, even in the snow).

She looked crazy.

But here’s the thing: My mom would have worn that same outfit before she had dementia.

Once she turned 60, she said she was going to wear whatever she wanted. And she has.

Sometimes an old lady in a faux fur and hot pink sneakers has dementia.

But sometimes she’s just and old lady who likes faux fur and hot pink.

What happens when someone with dementia and/or Alzheimer’s is admitted to the hospital?

It’s 6:30 a.m. and dad hasn’t called yet demanding to come home.

I’m surprised.

He was admitted to the hospital after midnight following several long, boring hours parked at urgent care waiting for a bed to open. He’s in no immediate medical danger, but he’s weak from unexplained blood loss and that’s left him especially wobbly — both on his feet and with his thoughts.

This if the fourth time he’s been admitted to the same hospital over the past four years and, each time, his mild/moderate dementia ramps up — especially the anxiety.  Unfamiliar surroundings. Strange sounds. And the inability to reach for that red box of Pall Malls, his adult pacifier, adds up to trouble.

When I made the urgent care doc aware of dad’s dementia issues, he pushed me to meet my dad at the hospital, saying  I should “tuck him in.” (Luckily my husband was with my mother at home, who has more severe dementia. What happens to other caregivers who don’t have backup?)

At the hospital, I handed the nurse a printout of dad’s medications. She patiently listened as I ticked off a list of dad’s needs: A walker, a bedside commode, a nicotine patch, lots of water — sans ice — at every meal to help him swallow.

But when I brought up dementia, she looked at me — just a quick sideways glance — and then back at her notes and asked where I was going to be. I told her I would be at home, just a mile or two away, and gave her the numbers of both my husband and myself.

She said nurses would put a bed alarm on dad — a simple device that clips to a hospital gown and alerts nurses should a patient start to get out of bed. And that — and the hospital’s ability to reach me — was the only dementia help provided.

I’m not naive. Any dementia patient must be a pain in the butt for nurses who are often already struggling to take care of a full load of sick, non-dementia patients.

But a demographic shift looms. People with dementia will fill more and more hospital wards — people whose children don’t live nearby or whose caregivers have other obligations that make it impossible for them to be on call 24/7.

What happens then?

Caregiving doesn’t end with humans: My parents’ dog has dementia, too

No one knows how old my parents’ dog is.

They adopted her about eight years ago from the county shelter after another family — with an aggressive larger dog — surrendered her. At the time, my parents’ veterinarian guessed she was about 7 years old.

Missy, a long-hair Corgi mix, was thin and nervous, especially around men. But my parents — particularly my mother, who rarely went anywhere without a dog at her side — quickly changed that. Despite daily 2-mile walks around a nearby pond, Missy plumped up — ballooned, really, doubling in weight. And whatever fears she had seemed to fade within a year.

She has been, by any measure, the best dog my parents have ever had (and I can recall five) because someone trained her  before my mother could turn her into the yapping, nippy monster dogs that haunted my youth.

So when my parents moved in three years ago, there was no dispute: Missy could come, too. Missy adapted faster than any of us. She ignored our two cats and goofy mutt and seemed happy curled at the feet of my father, who had become her primary caretaker.

But there’s been a change over the past year.

At first we thought she had cataracts and couldn’t see. She’d walk into things or fall off the front stoop.

But then she started pacing nervously at night and panting, almost frantic at times, unable to get comfortable.

I recognized that behavior almost immediately:  Missy was sundowning, just like many people with Alzheimer’s.

Indeed, Missy has doggy dementia, or what vets call cognitive dysfunction syndrome.

Some studies show that half of all dogs over age 10 will have some symptoms. Disorientation — getting lost in familiar surroundings like the house or yard — is most common.

But some — like Missy — also pace in circles, start messing in the house and fail to respond to their own names.

Like Alzheimer’s, cognitive dysfunction syndrome in dogs is progressive and there is no cure.

And that leaves me, as caregiver, in a pickle.

As unstable as Missy is, her presence brings stability to both my mother and father.

Most of her behavior (so far) is more annoying than troublesome. I’m nervous just being around her. It’s like seeing someone helpless and panicking amid traffic on a busy street and being unable to reach them, to pull them to safety.

Most dog owners end up euthanizing their pets with cognitive dysfunction.

And that will likely happen in our case, too, but I’m dreading it — more for my parents than for Missy.

I don’t know how to help them grieve, but I’m hoping our other pets will see them through.

Satchel, our 75-pound Shar Pei-Lab, greets them every morning and mom and dad both fuss over him, rubbing his wrinkly face and talking to him as if he were a child.

One of our cats, Jack, sits on the table while my dad eats cereal and they both watch the birds that come to feast at a feeder attached to the window. And at night, our other cat, Claire, sits upright in an empty chair at the dining room table when I serve supper, as if she’s always expecting a plate that never comes.

Our pets give my parents joy.

But they are not Missy. She is one of the few remaining chapters of their independent lives yet to close.

And when she is gone, I know my parents will want to go, too.

Inspiration for all of us: At 102, after losing her independence, Judge Jean Murrell Capers found her purpose again — on the radio

I usually sneer at news stories featuring exceptionally beautiful, feisty, healthy seniors citizens because they set an impossibly high standard for most to follow — like willowy super models with large breasts or brainy athletes who earn academic scholarships only to turn pro and haul in a sports fortune.

But here I surrender: I’m finally embracing a local columnist’s love for 102-year-old Jean Murrell Capers, a retired Cleveland Municipal Judge who has led — and continues to lead — an extraordinary life.

I’ve never met the judge, an honorary title she still retains. But I’ve come to know her through more than a dozen columns penned by Plain Dealer writer Phillip Morris. Over the years, he has described her as mother figure, mentor, sage, historian, civil rights leader, pioneer and a fearless Wonder Woman of sorts.

And to be sure, she is all of that. Among other things, Capers:

— sipped tea at the White House with her hero Mary McCloud Bethune and First Lady Eleanor Roosevelt (also meeting President FDR)

–became, in 1949, the first black woman elected to the city council of any major U.S. city (Cleveland)

–served as an assistant state attorney general in the 1960s and a Cleveland municipal judge in the 1970s and 1980s

— drove herself to Texas and back when she was 95

–specialized in eldercare law until a few years ago, once telling Cleveland Magazine, “The elderly are still believing 98 percent of what they’re told, and 96 percent of what they are told is not true.”

But here’s where her life offers a real-life lesson for those of us who haven’t been so extraordinary.

Two years ago, Morris wrote a frank, honest column about the judge’s failings: She was deeply depressed after being stripped of her driver’s license and forced by a court to move from her apartment into Judson Manor Retirement Community.

Today, Morris followed up with the judge and revealed that she somehow overcame that and reached deep inside — beyond the sadness and anger of losing her independence —  and again found that brightly burning spark that has always propelled her.

Judge Jean Murrell Capers — at 102, a little wobbly, even with her walker — has remade her life.

She’s still at the retirement community. She still can’t drive. But she’s perhaps the the oldest person in the world to co-host a weekly radio talk show.

Her on-air partner, Art McKoy is the Jack Klugman to her Felix Unger.

As precise, thoughtful and focused as the judge is, McKoy — a community activist who for years has often drawn eye rolls (and sometimes ire) from local journalists, police and politicians — is blunt, often abrasive and inexact.

Yet the judge credits McKoy for helping her re-find a purpose.

Every Sunday, from 5-7 p.m., the two talk on air about aging, public service, relationships and families on WERE 1490.

At a recent surprise party to celebrate her 102nd, Morris reported that the judge conceded she is fading.

“But then,” Morris wrote, “without a trace of false modesty, (the judge offered) this rejoinder to the inevitable ravages of age: ‘I’m the best. And when you’re the best, you don’t make excuses for anything.’ ”

That’s something to be celebrated.

If you want to read more about the judge, a link to Phillip Morris’s most recent column follows. From there, you can find his previous writings about her and what an extraordinary woman she was — and still is.

http://www.cleveland.com/morris/index.ssf/2015/01/jean_murrell_capers_continues.html

It’s been a deadly week for senior citizens in Northeast Ohio: Are we, as a nation, doing something wrong?

The bad news here started before daybreak Monday.

A snow plow driver found a 94-year-old woman dead from hypothermia outside an assisted living facility in the Cleveland suburbs.

A few hours later, a 78-year-old man hit the gas instead of the brake on his SUV and plowed through the front of strip mall diner, hitting two women inside, including a 76-year-old who later died.

And a search Wednesday for a couple — ages 88  and 79 — missing from their home in a tiny town ended within 24 hours when a passerby spotted their charred 1986 Pontiac on a dirt road about 30 miles away. Police said the bodies of the man and his wife were burned inside the car, but authorities don’t yet know how they died or who killed them.

The only thing connecting these incidents, other than proximity, is age: Everyone involved is between 76- and 94-years-old.

And it’s made me wonder what we should be doing differently since the U.S. senior citizen population — now more than 43 million people — will nearly double over the next 35 years.

I don’t have those answers, but I have questions:

Why isn’t there a thorough, dependable, free, up-to-the-minute Internet-accessible rating system for all senior citizen living facilities and care agencies? 

Martha Jendrix, 94, died of hypothermia outside of Elmcroft of Sagamore Hills. She had a first-floor apartment in an assisted living section of the facility. Another part of the facility houses residents with dementia.

Police don’t suspect foul play, but they are still investigating how Jendrix ended up outside.

Four years ago, that Elmcroft location faced similar scrutiny after a patient with dementia wandered away from the facility twice, according to Cleveland.com.

The first time, a motorist pulled over, stopped traffic and saved the man who had wandered onto a major highway. Two weeks later, the same man wandered outside, but apparently never left Elmcroft’s campus.

The state ultimately cited Elmcroft for failing to come up with a plan to ensure the dementia resident stay inside.

Since then, Cleveland.com reported state of Ohio inspectors have documented other issues at Elmcroft, including:

–A residential assistant was fired after grabbed a dementia patient by the throat

–Insufficient staffing during night shifts. No one licensed to administer certain medications, oxygen and insulin was on duty even though 42 patients could have needed that help.

–Failing to monitor a 93-year-old hospice care patient with dementia after she fell twice in the same month and fractured her ankle.

Is Elmcroft doing better or worse than similar facilities? Who knows.

Caregivers trying to find a good place for their loved ones could pull state records. But that takes time. And even then, those records can paint an incomplete picture — for good or bad — because what is measured and reported may not be one of the family’s top priorities (like a particularly tender caregiver or an activities director who refuses to give up on a patient).

Online, Elmcroft consistently scores four out of five stars on three Websites where users can rate care centers.

And those ratings, of course, can be skewed because reviewers are anonymous. Anyone from spiteful former employees to the director of a facility trying to boost numbers can post a review and rating.

Should states re-test senior citizen drivers? And, are some seniors less likely to surrender their licenses — even though they know they should — because there are no transportation options available?

As soon as news broke about a senior citizen crashing through a diner, on-line commenters began calling for wholesale re-testing of senior citizens renewing driver’s licenses — or even an all-out ban on drivers over 80-years-old.

In this case, 78-year old Thomas Herrick told police that he (along with his wife and their dog) was pulling his 2014 GMC Yukon Denali into a parking space in front of the diner when he accidentally hit the gas pedal instead of the brake. The SUV smashed through the brick building and plate-glass window where two women in their 70s were eating.

One of those women later died, but her cause of death has not yet been made available.

Was Herrick’s age to blame for this incident? We don’t know.

To renew a driver’s license in Ohio, most seniors only need pass an eye exam. If a senior reports a medical condition, there may be other forms to fill out and driving limitations, but that is usually based on the driver ratting himself/herself out to the state.

The state doesn’t test reflexes or the driver’s ability to turn her neck so she can use all the mirrors to see what’s around. The state doesn’t test for dementia or night vision or scores of other important things that help keep drivers safe on the road.

From my own experience, no senior citizen wants to give up driving. I clearly remember my parents — dressed all in black — sneaking up to my grandparents house in the 1980s and “stealing” my grandfather’s car after my dad noticed how many nicks, dents and scrapes were on it.

My parents took the car because grandpa refused to give up driving — not only because of pride (although that certainly played into it), but because there were places he wanted and needed to go.

Once his car was safely hidden from him in our barn, grandpa agreed that buying a new car at his age — about 86 at the time — was impractical. That was true, but it wasn’t easy. For the next three years — rain or snow — he walked four miles every day he couldn’t find a ride (most days) to see my grandma in a nursing home.

But he also needed to go the grocery, the pharmacy and doctor’s appointments. There was no bus service. No taxi service. No concierge. That burden fell to family, like it does for many today.

Many seniors who can no longer drive can no longer walk either — at least long distances.

If we are going to strengthen the testing for driver’s licenses — and I think we should for all drivers, not just seniors — we need to come up with excellent sources of alternative transportation.

Should there be laws that carry extra penalties for hurting or stealing from senior citizens,? What else can we do to protect the old among us?

Doyle Chumney, 88, and his wife, Lillian, 79, were supposed to drive their son to a nearby airport early Wednesday.

When the couple failed to show up, their daughter went to her parents’ tidy Strasburg — population 2,608 — home and found it ransacked, their car missing.

After the Chumneys’ bodies were discovered Thursday in their burned car in another county, police said they are looking for more than one suspect, but they haven’t speculated on a motive for the crime or whether the Chumneys may have known their attackers.

What a nightmare — for the Chumneys and their family. My sympathies to them.

This crime follows scores of other reports about criminals preying on seniors.

Often its an unscrupulous family member, caregiver, lawyer or financial advisor who drains a senior’s life savings.

I remember the case of David Dadante, a crooked Cleveland broker who destroyed the financial lives of more than 100 investors in a $58 million Ponzi scheme. Some of the retirees impacted said they had to go back to work as Wal-Mart greeters or some other similar job.

Just last year, the duped investors got their money back through a federal civil lawsuit — but it took 8 years. I’m guessing not all the older investors lived long to benefit.

Meanwhile, Dadante — a cocaine user who snorted and gambled much of that money away — is more than half-way through his 13-year prison sentence for fraud. It seems a small price considering the huge destruction he caused in so many lives.

Then there are the violent attacks. Nursing home abuse, domestic violence, rapes, robberies and murders.

The still-unsolved Georgia slayings of Russell Dermond, 88, and his wife Shirley Dermond, 87, sticks in my mind.

In May, after the Dermonds failed to show up for a Kentucky Derby party, friends in their gated community went to check on them and found Russell decapitated in the garage. Shirley’s body wasn’t discovered for weeks. It had been weighted down somewhere in the 30-acre lake behind their million-dollar home.

If police ever solve the case, the killer(s) would likely face the stiffest penalties under existing law since murder is the most serious of criminal offenses.

But why were they targeted and what can we do to protect the most vulnerable among us?

History repeating itself? Echoes of guilt, fear and resentment among my grandparents, my parents and me

I used a wheelchair for the first time yesterday to take my dad to a doctor.

He’s walked with a cane for several years to take the pressure off of a hip he’s had replaced three times. But this week, something went wrong and that nagging hip pain — which he never complains about — skyrocketed.

As we sat in the tiny examining room waiting for a nurse practitioner, dad started talking about his own parents and his struggle to care for them 30 years ago, unleashing echoes of guilt, fear and resentment that we both were experiencing now.

“One day, grandma just refused to stand up,” dad said, an edge of anger and exasperation creeping into his voice that surprised me.

“I don’t know why,” he said. “I still don’t know why, but it changed everything.”

Grandma, like dad, had hip replacements. And dad, like I was doing now, had taken her to doctors to figure out what was causing new pain in her hips.

X-rays taken shortly before she refused to stand showed nothing was wrong, dad said. And X-rays taken after showed nothing wrong, either.

Dad said he assumed grandma was faking it, a last-ditch ploy to get away from my grandfather who for years raged against old age and any weakness that came with it.

When grandma couldn’t climb the steps to their bedroom and only full bathroom on the second floor, he put in a stair lift and insisted she ride it even though she was terrified.

When grandma couldn’t carry things or reach canned goods because she used a walker, he invented things to keep her going — a wallpapered shoe box wired like a basket to the front of her walker, a modified pair of kitchen tongs that worked like an extended arm with a hand (this is before most people had ever heard of such devices).

Even after grandma caught a skillet on fire and fell — sprawled helpless on the floor while flames crept over the kitchen — he insisted, once firefighters were gone and they bought a new stove, that she continue to cook meals.

All of these things are hazy memories for me. I was disconnected, in high school and then away at college and my first couple of newspaper jobs.

But this history is etched into the mind of my dad — an only child like me — who had the lonely responsibility to figure out what to do. My mom, who took care of her own mother in our house for more than a year before she died, refused to do the same for my dad’s parents.

So grandma ended up in a nursing home, where she lived nearly a decade. She never walked again.

When the nurse practitioner knocked on the exam room door,  I was so distracted over my dad’s memories that I jumped.

But I welcomed the diversion. Michele, the nurse practitioner, always radiates warmth, optimism and good humor and I was glad she was there that day.

The exam was inconclusive. She said dad’s pain could be arthritis, a muscle pull or, worst case, something had gone wrong with his hip revision. She told us to continue with the Tylenol he had been taking, prescribed Tramadol for pain if needed and ordered an X-ray.

If nothing improved in two weeks, she said dad should see the orthopedic surgeon who put in his hip (the third replacement on that hip).

When we got home — before we found out the X-ray showed nothing wrong and before I picked up the Tramadol — dad reached for his cane and started puttering about like he had before this new hip pain sidelined him.

The Tylenol helped, he said.

But I wonder how much talking about his own parents’ struggles — and his own, as their caregiver — pushed him to carry on.

My Dad, for now, is refusing to sit down.