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Adventures of the mind

Barbecue with Dad, dementia and how our senses contribute to cognition

Part I: For sale — one Texas barbecue rig

I saw the ad on Craigslist, the site that hosts scheming Nigerian princes, soiled mattresses for sale and other random castoffs. The find was a real Texas barbecue rig, made of three-eighths-inch steel; a 10-foot-long main barrel; a separate offset firebox; and a tall, manly stack.

I imagined that sucker could hold 15 pork shoulders, maybe a dozen racks of ribs and more chickens than a Stanford math professor could count … all for my consuming pleasure. It was a real wood-burning rig, only $1,000 more or less, and shockingly, for sale about 5 miles from my house in oh-too-sophisticated Silicon Valley. It said, “Contact Fred in Belmont.” So I did.

I didn’t tell my wife, Elodie, about the purchase or announce the day of delivery. So when Fred drove up in a flatbed truck with that jillion-pound monster on the back, I went out front, trying to look like I was going to get the mail, and greeted him.

“Let’s roll it off — down the ramp, straight over that lawn and over to the gate on the right. We’ll stick it along the fence there.” Fred was nearly as robust as the barbecue rig, and it rolled easily ahead of him on a set of steel wheels. After pushing it across the hardened summer lawn, we parked it on the other side of the gate. I imagined — hopefully — that my wife missed the whole thing.

“What is that?!” Elodie barked, as I pseudo-innocently opened our back door. “Oh that? Just a barbecue,” I announced, as if the monstrosity was a 2-foot-tall Weber. “What in the heck? Why didn’t you tell me?!” she asked, as if there were an acceptable answer. “I’ve been wanting one. You know I loved Barney’s rigs, and you wouldn’t let me buy those. Besides, I got it on sale,” I replied. “On sale? How much?” she asked. “A thousand dollars … isn’t that great?” I asserted, omitting the $200 delivery fee. She snapped back, “You’re crazy. Was that guy in front the one who sold it to you? You just wait. In short order, you’re gonna look just … like … him!” I was halfway to that destination already, but ...

My Southern, food-centric brain drives my wife crazy. “Remember the wonderful reception for Catherine’s wedding? How beautiful it was outside at Green Cove?” she joyfully recalls. I don’t. I rarely do, but I don’t forget a good meal. “Did we bring ribs from the Pig Out up to the lake that weekend? Didn’t we do burgers on your grandmother’s dock?” I wonder aloud. It might have been the same weekend, but I’m focused on the remembered taste of caramelized onions and mustard sauce on the side. “Your stomach is your brain,” she replies in disgust. Indeed, life has taught me that taste and other senses share important links to seemingly unrelated parts of the brain.

And thus it was inevitable that my mind turned to barbecue while tending to my father.

Part II: Heart and soul of a farmer

My father, Vernon Rudolph Lorenz, was a dairy farmer who moved to Georgia with my mother, Lois, from his home state of Wisconsin in the early 1960s, searching for opportunities. Things didn’t work out at the Atlanta farm that first hired him, so we moved to Macon, Georgia, where he took up a decadeslong career as a mortgage banker.

Even though my memories of Dad are associated with standard office wear of crisp white linen shirts and featureless black leather shoes, I think of him as a farmer. His displaced occupation and passion are reflected in my memories of his hands on a shovel, fingers dirty with composted soil, smiling at the size of a summer squash.

My father’s keen observations of nature taught me to look critically at the world around me and indirectly empowered me to undertake a career in medicine. We took long walks in the Georgia woods behind our house where I would search for arrowheads and pottery fragments in the clear water burbling over colored gravel. “This is a hickory tree, son. See the leaves?” he would query me as he held up the characteristically pointed leaves on a pinwheel-like branch.

“My father’s keen observations of nature taught me to look critically at the world around me and indirectly empowered me to undertake a career in medicine.”

As a farmer, he had to be constantly aware of changing weather, so nearly every day included a close look at the clouds and sky, speculation about the temperature and the chance of rain: “Looks like that front is finally moving in. A soak will be great for the garden.” After I moved to California, “How’s the weather?” was a regular start to our conversations, even though it was always 75 degrees and sunny.

He and my mother encouraged my own close attention to details. Dad took me digging in the pits of local kaolin mines. Macon is on the geologic fall line where ancient seas met land, and kaolin deposits reflected the historic coast. Probing in the kaolin pits, we dug out massive shark teeth, sand dollars and strange fossilized lumps.

One day, the excavation for the foundation of a new building revealed a 19th-century garbage dump, so we took up shovels to pull out glass apothecary bottles, porcelain doll heads and other artifacts. In both cases, he queried me about our findings, encouraged me to reflect on them, and helped me understand the importance of contextual clues in making sense of the world.

Part III: A sweet, crooked smile begins to fade

Some decades later, in early 2018, I found myself in Severna Park, Maryland, where my mother and father had moved to be close to my sister and her family. My dad ended his eighth decade of life in the fog of worsening dementia.

Just a few months before, when I’d most recently seen him, his shaven, round face was still occasionally transfixed with a crooked, sweet smile. He was trying to crack typical corny jokes, as best he could, even though his gait was faltering and I could see dementia haunting him, lurking just out of view.

Now, like a wraith, it was hiding just behind his eyes, pulling him slowly and more deeply into himself. His sweet smile was disappearing — gradually replaced by a plastic, expressionless mask.

In June that year, Elodie and I were driving to a restaurant in the Richmond neighborhood of San Francisco when my mother and sister, Melody, called. I had never heard such suffering in my mother’s steady voice. Warbling on the edge of tears, she recounted how my father had tripped. He hated using his walker, and in a moment of neglect, his foot met an errant corner of something.

“He was trying to crack typical corny jokes, as best he could, even though his gait was faltering and I could see dementia haunting him, lurking just out of view.”

They had recently moved to a senior living community, and he was sent from there to a local emergency room. It was an “age-friendly health system” I recalled, on a list of systems lauded for making special efforts to gently care for older adults. Indeed, they treated him carefully, but my stalwart mother was crying. Her husband of over 50 years didn’t recognize her.

“They want to admit him, but I’m not going to do that,” said Melody. “It will just be that much worse, deconditioning and everything.” Although he received timely care and minimal pain medication for a humeral fracture, the injury, combined with the sleeplessness of an emergency room stay and lack of food, pushed his mind into inner space.

He was talking nonsense and didn’t recognize anybody. My sister, who is a nurse, inherited my mother’s steely backbone and insisted, “I’m taking him back to their apartment. He’ll recover more quickly. I’ll make a bed on the couch, and give you a call when we’re settled.”

Although he got better quickly, it wasn’t better enough. A quiet room, tender touch and a warm bed brought him to 80% of his baseline. By the second week of his convalescence, our mother was about to break.

Dad never had problems at night before. But, without warning, he would now pee in his bed. Voiding before bed, fluid and caffeine restrictions, and other measures to prevent bed-wetting didn’t work. And every time my father wet the bed, my mother arose, undressed him, and washed and dried his clothes and linens. She and my father lost hours of sleep. They and my sister were all nearly at wits’ end.

“I’ll come out and see what I can do!” I reassured my sister. How could I not try? I’m a general internist and a palliative care physician. So I flew out and camped on their sofa. I didn’t get much sleep as I shared the night watch with my mother, and I couldn’t keep Dad from wetting his bed either, at first.

Because I imagined that sleep deprivation was making things worse, I tried a condom catheter to break the cycle, and thankfully, on the first night it worked. Everyone slept and in the morning, everyone was refreshed. Dad was still confused, but better. I showered and felt a stirring of hope, but it was gastronomy that really saved us.

Part IV: The healing magic of one savory bite

My father loved barbecue as much as I do. Macon is steeped in Southern culture, and its necks, religion and politics are all red like the bloody clay. Macon is where Flannery O’Connor’s short stories read more like newspaper articles than religious allegories run amok.

I may live in California, where people think barbecue means hamburgers on a gas grill, but Macon taught me that real barbecue is pork ribs, shoulders and chicken lovingly slathered and tended over fire for hours. The happy result is a conjoined explosion of flavors and textures of spicy rub; softly yielding, smoky meat; and crispy burned edges.

One of my earliest memories with my father is heading out for barbecue. When I was knee high to a cockroach, we took a weekend trip to the Swampland Opry House. Yankee immigrants who write about it now ignorantly call it an “Opera House,” but it hardly deserves such a sophisticated title. It was a place for foot stompin’ local music, trucks and everyday folk.

What I remember about it was my first encounter with Brunswick stew, a soupy Georgia barbecue specialty of melted meat, summer corn, okra and other vegetables, swimming in a vinegary sweet liquid that all intertwined on the tongue.

The morning after Dad finally slept without wetting his bed, I felt the freedom to stretch our legs a little, and because of our mutual love, I suggested lunch at Mission BBQ. Although Mission BBQ isn’t the down-home joint of my childhood, it was a place my parents adopted after moving to Maryland.

“The first flavorful bite turned on a switch, and his dull, withdrawn eyes popped awake like lightbulbs. He smiled and offered nearly his first coherent words of the week: ‘Hi, son,’ he said with a weak smile.”

The staff at Mission adopted my parents, in turn, to the point where my mother would bake a special cake for Mission employees and they would reciprocate with a complimentary meal. Mealtimes there are distinctively weird, with photos of veterans and first responders on the walls, a fleet of Army green delivery Humvees parked outside, and patrons rising out of the blue to say the pledge of allegiance in unison.

Our trip there began with a slow, patient ritual of pulling on Dad’s pants, helping him fasten up, and awkwardly getting his arms in his shirtsleeves. We walked slowly behind him, unsteadily making progress behind his walker, and arrived at the apartments’ atrium.

Opening the door to a warm summer day, we folded the walker in the hatchback, gently helped Dad lower himself into the front seat and headed off down the road flanked by a ruptured canopy of waving green leaves and whitish gray clouds hinting of rain. We parked near the Mission BBQ entrance and helped Dad out, ambling up the disabled ramp to the door.

It was the forkful of pulled pork, or maybe the sauce on the pork, or maybe the combination that resuscitated Dad. The first flavorful bite turned on a switch, and his dull, withdrawn eyes popped awake like lightbulbs. He smiled and offered nearly his first coherent words of the week: “Hi, son,” he said with a weak smile. He scanned the room with growing awareness of his surroundings, and I nearly dropped my fork in astonishment.

Although he was still confused, I could see renewed expressiveness in his face and hear a restored clarity to his voice. During nights to come, he would finally get up to the bathroom with assistance, instead of peeing mindlessly in his sleep. It was the beginning of the end of the worst.

Part V: Navigating life by the power of our senses

Now, when I go out on morning runs, our retriever-mix, Charlie, reminds me of how profoundly essential senses other than sight are to our ability to navigate the world. As we head out on the Bayshore trail, Charlie apparently navigates our various routes by smell.

He seems to sense progress from one spot to another along bushes and posts where other dogs stopped and maybe marked the occasion. He’s so good at consistently identifying these locations, even when I’m doing my best to pass them quickly, or when we’re revisiting a route we haven’t taken for a while, that it seems like his mental map of the world might be inscribed with smells.

Before the coronavirus pandemic, I co-piloted a tandem bike with a blind rider who has become a good friend. I discovered as we were riding together that I could share my experience of the world by describing what I was seeing in tactile terms.

My riding partner found it meaningful as we passed between huge palisades of trees in Golden Gate Park to hear that they looked like upside down stalks of very long broccoli; or as we were passing along the beach in the Outer Sunset to hear that the clouds in the sky looked the way long, pulled-out tufts of cotton balls appear when floating in upside down water.

“I have come to increasingly recognize that our mental lives exist in a matrix of thought intermixed with smells, sights, tastes and touch.”

And so I have come to increasingly recognize that our mental lives exist in a matrix of thought intermixed with smells, sights, tastes and touch. The command of our mental faculties might depend on the flavors of a well-loved meal or the plush seat of a familiar chair.

This brings to my mind synesthesia, a medical term I learned from neurology that refers to a blending of the senses. A person with synesthesia experiences and expresses one sensation in terms of another, as in, “My coffee tastes blue.”

My experiences made me wonder if synesthesia might represent overexpression of a higher potential that all of us possess: Having shared linkage of various senses to cognition might sometimes be adaptive. For example, sensory commingling might have aided hunter-gatherers who relied on senses to flexibly navigate the world — promoting survival when sight was diminished by injury or by travel in absolute darkness. In the case of my dog, my blind friend, and my father, different senses have triggered common cognition.

Whether related to synesthesia or not, this reminds me that appealing to multiple senses can be a powerful stimulus to mental awareness and that one sense may mitigate losing another. As a palliative care physician, I find this a crucial reminder of why sensory-rich environments can help maintain persons coping with dementia.

My wife and I still get into minor tussles about food. “You’re so food-centered!” she will say in exasperation, especially when, after a long day of work, I still insist on taking the time to cook something appropriately delectable.

I notice my wine collection doesn’t come in for a lot of criticism when she’s drinking it, but she’s often unhappy when I’m weighing the merits of particular Italian blends for a random Tuesday night pasta.

A recent mealtime conversation focused on estate planning, including wills, trusts and advance directives. While it was difficult to work through, I knew one thing for sure. I’m attaching a note to my directive: When I’m dying and confused, push a plate of smoky ribs my way.

Karl Lorenz, MD, practices general internal medicine and palliative care at Stanford, is section chief of the VA Palo Alto-Stanford Palliative Care Program and co-directs the Stanford Palliative Care Center of Excellence. Vernon Lorenz’s dementia worsened during COVID-19 isolation and he died in November 2020. Karl loves to use his smoker and enjoys a plate of barbecue whenever he can. He can be reached at kalorenz@stanford.edu.

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