THE VALLEY OF THE SHADOW

EARLY ONE MORNING, FRANK RADER, seventy-one, wearing shorts and an old shirt, pads barefoot into the first-floor bedroom of his Mesquite home. The room is sparsely furnished: a night table near a rented hospital bed, a noise monitor resting on a small dresser. Beth, his seventy-six-year-old wife, waits motionless in the bed, her dark eyes wide open. Though they have been married forty-three years, she no longer recognizes the figure who comes each morning to wake, undress, and wash her.

At 6-foot-5, Frank’s head almost grazes the top of the door frame; his shoulders stoop permanently as though burdened. Like a choreographer, Frank marks each movement out for Beth. “We’re going to get up. Let me have your feet.” He swings her legs over the side of the bed and takes her hands in his. “Can you stand up? That’s a good girl.”

Beth wobbles to her feet, her eyes darting back and forth. “She’s afraid she’ll fall now,” Frank says. Half asleep, Beth protests in a series of low grunts. Her cropped hair is dark and woven with gray, her thin, wrinkled body rigid next to his. They walk toward the bathroom facing each other and holding hands, like partners in a slow dance. Frank showers her and washes her hair. Then, soaked, he takes the soiled linens and tosses them in the washer. He has done this every morning for the past two years.

“These are the easy days. She is at peace now,” Frank says.

Beth is in the last stages of Alzheimer’s, a little-understood disease that hides away in the brains of its victims until the brain, as though programmed to self-destruct, forgets everything, including how to swallow, breathe, or keep the heart pumping. After years of slow suffering, the victim dies.

The silent killer that wreaked such havoc on the cells of Beth Rader’s brain has also claimed another victim: Frank. He not only lost his wife and companion, but was robbed of the retirement years he had looked forward to. They had planned to play golf and travel; instead Frank spends all his time at home caring for Beth. The woman who once took care of their home, reared three healthy children, and sewed all her own clothes cannot speak or complete the simplest tasks.

There are 25,000 people like Beth in Dallas, four million nationwide. According to the Alzheimer’s Association, those numbers are expected to double within sixty years. Researchers are trying to trace the cause of Alzheimer’s, which used to be called senility or “hardening of the arteries.” Doctors say they have no inkling of a cure.

Beth has already lived longer than most victims of the disease-the average life span after diagnosis ranges from three to twenty years. Frank never even considered putting Beth in a nursing home, where many Alzheimer’s patients end up. Being around family at home, her husband believes, helped slow the degeneration.

“If I had put her in a nursing home, she’d be dead by now,” Frank says. “Even though she doesn’t know me as her husband anymore, I think she still knows I’m a friend, someone she can trust.” He doesn’t consider himself a martyr. “I’d be over at the nursing home all the time anyway,” he says, “This is what I want to do.”

The disease has cleaved time and the Raders’ lives into broken pieces of before and after. They are living, the two of them, in the after.



A CHILD OF THE DEPRESSION, Frank remembers one incident from his childhood vividly: he was ten at tne time, one of eight children, when the family lost its farm near Austin to debt. The stock market had crashed the year before, and many men had already lost their farms and left their families to fend for themselves. With so many mouths to feed, Frank’s own father could have abandoned them, too, Instead, he moved the family to nearby Georgetown and sold insurance.

Frank learned to eat beans instead of meat, and he learned not to need the things he could not have. He vowed that when he had his own family, he would provide a better life for them.

In 1946, Frank met Beth while he was stationed at Fort Knox, Kentucky. She worked in the government employment office, helping discharged soldiers find work. “Beth was pretty. A little plump. She’d been raised on a farm in Kentucky, and she was healthy and strong,” Frank says. “She understood herself and she accepted people the way they were, There was no meanness at all about her.”

Beth wasn’t in any hurry to get married. She took a job teaching elementary school, and they married two years later, in 1948, and moved to Frank’s hometown of Austin. Now, looking back forty years. Frank wonders if he saw the first hints of Beth’s disease in Austin. “I don’t know for sure when it began, but Beth never could remember when our anniversary was,” Frank recalls. “I would bring home an anniversary present and she’d be surprised. I remember laughing about it because usually women never forget those things.”

Three years later, the couple moved to Mesquite, and Frank started working for Southern Union Company as a certified public accountant. Frank came home to Beth every night, to dinner steaming on the table, even on those nights when he worked late. He never missed a day’s work and often brought work with him-financial reports for stockholders, the books he kept for Southern Union. The end of the month was the most hectic, keeping him at work late until the reports were finished, the payroll met. These were the times Frank missed his family most.

When they found they couldn’t have children of their own, the Raders adopted three-first a boy, Larry, and later a brother and sister. Rusty and Jane. Though they didn’t need the money, Beth missed teaching and took a job as an elementary school teacher. At night, Beth was busy tending the children and keeping up with the housework, but they were happy. The family bought a camper and a station wagon and traveled to state parks.

When she was in her late thirties, Beth developed a pituitary gland problem that enlarged the bones in her face, hands, and feet. She gained weight, at one point reaching 200 pounds. A benign tumor had grown onto the gland, but doctors decided not to remove it.

Frank remembers Beth’s forgetfulness appearing innocently enough, when she was only fifty-five: constantly misplacing her purse; forgetting to add oil to her car’s engine, damaging the motor; or forgetting how much detergent to use in the wash, causing the clothes to come out caked in soap.

Jane was in junior high school when she first noticed something was wrong. “We’d walk for hours in a parking lot at Town East Mall looking for the car. She got lost driving everywhere we went. I was relieved when I could get my own driver’s license.”

When Beth could no longer teach, she retired. She told Frank she wanted to stay home with Jane. At the time, Frank thought nothing of it. She tried tutoring out of her home, but finally gave up when she missed appointments or forgot who her students were. “One of the biggest signs was when Mom and I stopped fighting about keeping my room straight. She used to be a stickler about the house,” Jane remembers. “That’s when I knew something was terribly wrong.”

Beth began to forget what appliances were used for-the family would find an iron in the refrigerator. Though she had once loved baking, making pies from peaches and pecans grown in the back yard, Beth could no longer follow recipes, so she made only what she could remember. “We ate stew just about every night. Then she couldn’t remember what to put in it, and she’d put things in like cream of mushroom soup instead of potatoes,” Jane recalls.

As matters worsened, Beth developed a quick temper. Rusty, in high school at the time, remembers arguing constantly with his mother about things she believed she’d told him to do. “She honestly believed 1 was lying about things, not doing them,” he says. “I thought she was doing it on purpose, that she hated me. I didn’t understand at the time.”

Jane remembers the only times she ever saw her father raise his voice was in frustration with Beth. Whenever Beth was angry or hurt, she would pack her bags and announce she was going home to Kentucky to see her parents. Frank could only humor her. Beth’s parents had died years before.



THE RADERS LIVE IN A TIDY, COMFORT-able house in a pleasant neighborhood in Mesquite. The house is furnished with the antiques Beth loved to collect in the early years of their marriage. Five years ago, Frank removed the pictures from the walls and cleared the tables. “It’s like having a child around the house,” he says. “She carries off lamps and potted plants and pulls pictures from the walls.”

Using a pen, Frank pries open the door to an armoire in the breakfast room. “She twists the knobs off, so we had to remove (hem. Trouble is, I forget where I put them.” He laughs. Inside, the armoire is crammed with china and precious trinkets. “I spoiled her,” Frank says. “Whatever she wanted I’d try and get it for her if we could afford it.”

Frank perches on a small chair next to Beth to feed her, forkful by forkful, a breakfast of toast, ham, and eggs. An old ceiling fan spins and rattles overhead. Most of the breakfast dribbles onto a bib. Frank strokes the purple veins on Beth’s hand, soothing her with encouragement: “Here, sport, have another bite.”

As she often does, Beth fells asleep, her head hovering a few inches above the plate. Frank wets a towel from the kitchen and wipes the nape of her neck and her face. Startled, she pushes his hand away. He must do this, he explains, to get her to eat enough. Frank feeds her until she refuses more. She has trouble swallowing now, and he can already see a decline in her eating. “If my health is still good, Ml have to learn to feed her intravenously,” he says.

Frank gives Beth sips of a “medicine cocktail”-juice, vitamins, medicine for seizures and a thyroid problem. After breakfast, he brushes her teeth at a table by dipping the toothbrush in a bowl of water. He takes Beth to the dentist four times a year, with each trip taking almost a full day. The family dentist refused to treat Beth when her dementia worsened more than a year ago, and Frank scrambled to find one who would treat Alzheimer’s patients. A pediatric dentist in North Dallas, referred by the local chapter of the Alzheimer’s Association, agreed to take her last year.

“One of the things I miss most is the lack of freedom,” Frank says. “I can’t take Beth with me or leave her in the car. So I put off the things I want or need to do until she’s at day care or when someone can watch her. When she is at home, I let her wander as much as she wants. She needs her exercise. But I have to keep my eye on her.”

Jane, now twenty-nine, teaches elementary school and visits her parents four or five times a week. She makes lunch for them and cooks dinner. Often, she says, it’s the daughters who help take care of a parent with Alzheimer’s. “Women are more nurturing, I guess. My brothers always had a hard time taking care of Mom. I don’t have a normal single life. Mainly I try and keep Dad going.” She cut a summer trip to England to one week. “I feel guilty sometimes when I go someplace and Dad is here.”

Last year, when Frank was hospitalized for (wo weeks with congestive heart failure, the children took care of their mother. It gave them their first real clues to how hard their father works every day. “Dad is drained, worn down,” says Rusty, thirty-four, who lives in Mesquite with his wife and stepdaughter and visits once a week. Rusty holds down two jobs and doesn’t have the time Jane does to babysit Beth. “It hasn’t had the catastrophic effect on my life that it has on Dad’s or Jane’s ” he says. Though Rusty wants to help, he admits he is uncomfortable with bathing his mother or taking her to the toilet. “She doesn’t like it either. She fights it.”

The Raders’ oldest son, Larry, was forty-two when he died suddenly of a heart attack in May. Frank says it wasn’t something he wanted to go through without Beth, but he never told her that Larry was gone.

This morning, Frank is getting Beth ready for day care, a luxury that was unavailable until two years ago in Dallas. Frank spends all of Beth’s retirement money-about $1,000 a month-on day care and doctors’ visits. He pays for the household expenses out of his own retirement funds. “After that, there is not much left over.”

Frank puts on her socks and shoes and guides Beth slowly to the car. For a few minutes, he cajoles her to sit. Finally, using a judo trick he learned in the Army, he bends her wrists slightly without hurting her and pulls her down.



SOME YEARS AGO, WHEN BETH AND Frank had decided to update their wills, Frank found a small, typed note attached to Beth’s. Signed by her, it began, simply, “Before I lose my mind completely, I would like the following to go to my children and to my dear Frank.” A list of items followed, but Frank remembers being too stunned by that first sentence to go on.

Frank called one of Beth’s sisters who was living in Dallas and asked her about the note. Yes, Beth had been worried for years about her memory. She had not wanted to trouble Frank with it.

When Frank confronted Beth with what he knew, she broke down. She had tried to cover up her memory problems from Frank and the children for years. It was getting too hard. She was scared and wanted help.

Beth had always been so strong and confident, but she seemed to be slipping away. Soon after the incident with the note, Frank called the family doctor and explained what Beth had told him. The doctor brought Beth in for an appointment, but said that her memory problems were normal. He advised them not to worry, but suggested they visit an internist in North Dallas.

The internist checked Beth almost every month during the next two years, but her memory problems puzzled him. Finally, he said he could find nothing wrong and blamed her memory loss on age. When Frank began taking Beth to another doctor, an endocrinolo-gist, the internist seemed relieved.

The endocrinologist sent Beth to Baylor Hospital for a CAT scan. The test showed that the pituitary tumor was growing again. For the next two years, doctors watched the tumor, but they had no idea what was making Beth’s memory so bad.

“Doctors told us that forgetfulness was normal, not to worry,” Frank says. “For a while, we thought everything must be okay.” But Beth was only sixty-three and too young to be forgetting so much. She couldn’t remember who the president was or even what year it was. A psychiatrist Beth visited only confirmed her dementia, or failing mental faculties. He offered no reasons.

Fed up with the blood tests and the lack of answers, Frank took her to a neurosurgeon who removed the pituitary tumor. “We thought maybe the benign tumor she had on her pituitary gland had started growing again and caused the problem with her memory,” Frank recalls. On Christmas Eve 1981, doctors removed the tumor. It was clear to everyone right away that the tumor was not the problem, Her memory didn’t improve.

One morning weeks later, Frank placed a desperate phone call to the family doctor. “He told me that he had already talked to the neurosurgeon. Since Beth had taken every conceivable test, he said it was probably Alzheimer’s. It was the first time anyone had mentioned the word.” Until recently, a diagnosis of Alzheimer’s wasn’t really a diagnosis, but an elimination of every other possible illness-depression, vitamin deficiencies, tumors.

Frank telephoned the children and told them. “It was like they invented a strange new disease,” recalls Jane, who was then away at college. In the early Eighties, almost eighty years after the German neurologist Alois Alzheimer discovered the disease, so little had been written about the condition that it remained shrouded in mystery. The family decided not to tell Beth, who could still drive a car and cook.

Armed with a diagnosis and hope, Frank sent Bern’s bulging medical file out to one experimental program after another. He pieced together information from medical journals and newspapers, but even that was not much help.

Each time Frank sought a new treatment, Beth’s file came back rejected. Medication she was taking for a thyroid problem made her unacceptable for experiments. One day Frank stopped sending out her file. “I had no idea how little hope there was for her.”

By 1984, the darkness was closing over Beth. One day Frank saw her trying to drink from an empty glass. “She knew how to turn on the water, and she knew how to pick up the glass. She had forgotten how to fill it.”

Frank took her car keys away. “She used to go sit in the station wagon and just dream about going places again. I still have that car because it reminds me of her.”

At age sixty-two, Frank retired after thirty years with Southern Union. He bought a computer, taught himself how to use it, and did his accounting work from home. He hired a caregiver to come to the house twice a week, and he cut his business down to a few clients. Reluctantly, he chopped down all of Beth’s pecan and peach trees in the back yard because she tried to eat the nuts and seeds.



BETH HAS BEEN GOING TO MESQUITE Adult Day Activities center for about a year. The low-slung building has three long rooms lined with easy chairs. There are about forty-five elderly men and women making crafts and sleeping. Frank helps Beth to an empty chair and covers her with a blanket. She will sleep most of the day. The staff wakes her for walks or for lunch.

Lynn Davis, the center’s administrator, says there are about a half-dozen other licensed adult day care facilities in Dallas: “We try to provide a home atmosphere for senior citizens who have some kind of medical need.” The cost of day care for many families is prohibitive, she says, and there is a long waiting list for financial assistance. The service is vital to Frank, who must squeeze several days’ worth of errands and accounting work into six hours.

In 1985, Frank joined the Dallas chapter of the Alzheimer’s Association, which had been organized a year before. The association provided a volunteer respite program that he used when no one could babysit Beth. “We were luckier than most at the time. Between family and the caregivers I hired, I could still get out and coach baseball, do things like that.” He took Beth to her last party, a fundraiser for the Alzheimer’s Association, that year. She could still eat by herself then.

Until four years ago, Beth took walks around the neighborhood by herself, and Frank took her with him to the grocery store. They’d walk the aisles holding hands. “She’d pull things she wanted off the shelves. If I put them back she’d pout like a child. I’d have to sneak them back when she wasn’t looking, or I’d buy them.” She started wandering out of unlocked doors. She once ate a bar of soap and had to be hospitalized for several days for the burns in her mouth and stomach. Now, Frank watches her every moment.

Once, Frank had an idea that he thought might help Beth improve. He had watched his grandson Patrick, then eight, grow and learn new things. So he bought Beth an erector set to see if she could learn how to put it together. “I finally gave up,” he says, “She couldn’t learn anything new.”

Beth stopped recognizing Frank and her children two years ago. Through the association, Frank counsels other husbands who tell him that their wives forget who they are and order them out of the bedroom, or confess to affairs that never took place. “I was spared,” he says. “Beth has always known that I belong to her and she belongs to me.”

Frank automated his life to relieve the stress. He bought a new car with electric locks and windows so he could keep Beth safely in the car, and a noise monitor to listen to Beth’s breathing at night; he bought a VCR and attached a timer to the television that switches on the news three times a day.

Last year, Beth began losing her balance and needed help walking. Today she is down to 120 pounds and sleeps most of the time.

Friends are rare now. Frank says. Sometimes Jane and Rusty bring their friends over to play cards or dominoes, and recently, Frank built a small pool in the back yard for the grandchildren. On Wednesdays, if the caregiver is available. Frank treats himself to lunch at a neighborhood Mexican restaurant and orders a Pina Colada, a drink he first tasted with Beth on a Caribbean cruise.

Late on a Friday night, Frank rocks in an antique rocking chair that belonged to Beth’s mother and holds her hand as she dozes in an easy chair next to him. At ten p.m. the television flickers to life, and Frank watches the news. In the den, he has kept portraits of their two sons hanging over the fireplace; a vase of plastic flowers and three baseball trophies rest on a small shelf. A shadow box that Beth made twenty years ago, filled with photos, seeds, and nuts, hangs on one wall.

Frank knows difficult days lie ahead. “From all I’ve read about the disease, her mind will deteriorate until she goes into a coma. She’ll die soon after.”

After the news, Frank takes Beth’s hands and gingerly lifts her to her feet. She kisses him on the nose; he blushes and smiles. He speaks to her quietly about bedtime and guides her in their slow dance toward Beth’s bedroom. He pulls her arms down until she sits on the bed; she doesn’t resist.

Frank removes her shoes and socks, raisesher feet, and swings them onto the bed. Shesighs and rests her head on the pillow. Hecovers her with the sheet and turns off thelight. Briefly, he presses his forehead to hersand smiles. “She was a wonderful companion. She still is.” Frank says. He pauses,listening for the steady rise and fall of herbreathing, and closes the door.