"Cause of Death"

My dad's death certificate lists "Alzheimer's dementia" as his immediate cause of death, and "chronic renal insufficiency" as the secondary one.

The inaccuracy of this bothers me. I was trained as a historian, taught to pay attention to minute details. In writing fiction and drama, I had to "un-learn" a lot of that training, shelve it in a drawer in my mind. After all, details in literature can be fudged for "art's sake."

But sometimes, my "just the facts, ma'am" persona pops out again. And she says that this isn't literature, it's real life. My dad died, I believe, of the long-term complications of diabetes - renal failure being one of the biggies, heart failure near the top of the list, too. He never had a diagnosis of Alzheimer's, and indeed his mental deterioration seemed to fall into that vast valley called "… and other dementias" - related to chronic illness, rather than an illness in itself.

There was never any talk of an autopsy, as my dad had been through so much with his body in the past nine months that it seemed cruel to do that to him for "research." Furthermore, he would not have wanted it.

And I suppose the immediate cause of death doesn't matter now; it's kind of a "chicken or egg" question anyway. Diabetes set everything in motion, but dementia was, in a way, his undoing. After his first fall, he was learning to walk again, and we all expected him to be able to go home again - his brand-new walker was waiting for him. But then, in an instant, it was all over - in his demented state, he leaned too far out of his wheelchair and fell again, breaking his hip and requiring surgery that plunged him further into the fog of dementia. And although he still had moments of clarity in his last six months, he was never really the same.

The doctor at the nursing home only saw my father after that second fall, so he never witnessed, as we did, the path of my father's descent. Dad must have just seemed like a classic Alzheimer's case. But in his obituary, we set the record somewhat straighter - we suggested contributions to the American Diabetes Association.