The weather was being reasonable, which is unusual for November in Northern England. The rain had disappeared and had been replaced by cold, bright, rather cloudy days as if to ease our return to the country of our birth. I was in England with my son and daughter for just a week and for a very specific reason. Sitting alone now in the small meeting room, I waited for someone special to be brought in. My mind alive with confusing thoughts and feelings, I looked up as the door swung open, and a frail old man was wheeled in by a sadly smiling nurse. She knew why I was there, and I was moved to notice that her eyes brimmed with tears.  The old man's head had fallen to one side and he seemed almost asleep, but as the wheelchair accidentally struck the door handle, his eyes opened and he looked up and saw me. A small smile crept across his features. "Hello, dad." I said, fighting back my own tears - but only just. My mind was filled with emotion; I knew that if everyone's expectations were realized, I would never get to say those words again. My wonderful and gentle father smiled softly, the light of recognition in his tired eyes.

My dad had recently been admitted to the care facility close to his home after a deterioration in his health which had progressed rapidly over the preceding year. The trouble had begun back in the late nineties, when he had begun to experience chest pains whenever he exerted himself. Typically, he’d decided not to mention this to anyone, choosing instead to not create a fuss. He'd always borne pain of any kind with stoic stubbornness; severe back injuries and gall bladder problems (both resulting in surgery) had immobilized him over the years, but he’d rarely complained of his discomfort. Pain had never defeated him before, and he reasoned that just because there was now pain around his heart, there was no need to change this say-nothing approach. Having spent much of his formative years in the Royal Navy (he’d left home and joined up at the tender age of fifteen), whining was simply not his way, and for years he suffered his alarming discomfort in secret.

He began to realize that something was quite seriously wrong when a year or two later, his morning walks to the newsagent's shop began to trigger the pains. Walking more than two hundred yards, even  at a sedate pace, began to induce crippling spasms in his chest so that he was forced to stop and recover several times on the return journey. And still, true to form, he said nothing.

The tipping point was finally reached one day when, on the way home from buying his morning newspaper, he was gripped by a sudden crippling agony, much worse than he had experienced before. Unable to support his weight, he fell to one knee, clutching his chest. This time he couldn’t work around the problem - this time there was to be no manly gritting of the teeth and stubbornly pushing through the pain. A passing acquaintance fortunately found him in this state of partial collapse and, faced with a man who flatly refused to call for an ambulance, put him in his car and drove him the short distance home. A short time later, answering a call for help, I screeched to a halt in a cloud of smoke outside their house, worried sick about what I might find. In the lounge was my dad, looking suddenly old, pale and anxious, with his loving wife of nearly fifty years at his side. An ambulance arrived at the house and he was taken away.

The upshot of this episode was that he was diagnosed with angina, and angiograms indicated significant blocking in several major arteries around his heart. A multiple bypass surgery was the prescribed solution.

Eventually, he was admitted for a quadruple bypass operation and the family held its collective breath. What happened next has been the subject of debate within my family ever since. My dad came through the operation like the old trooper he was. Unfortunately, within a few hours of arriving in the intensive care unit, he was rushed back into surgery for a life-saving emergency operation. For the second time in twenty hours, my elderly father was deeply anesthetized and his chest brutally opened. For a second time, his already desperately bruised rib cage was spread open and the vessels around his heart worked upon - this time to correct 'a complication' or in lay parlance; a screw-up. He returned to the ICU where he then remained, fighting the consequences of the abuse his body had been subjected to; fighting, fighting and slowly healing.

He didn't stay there very long. In fact, unbelievably, he was discharged from the hospital only six days after his double operation. My mother, having arranged with my brother to collect him, found him sitting alone and in tears of pain and frustration in a waiting room. His bed had already been filled with another patient.

Despite (or, since he could be very single-minded, perhaps because of) such rough treatment, over the next few months my dad fought his way back to health bravely and determinedly. We would have been very surprised if he had done anything different. But fight he did, regaining his physical well-being, his mobility and much of his confidence, relieved to be able to do simple things such as go for walks without the onset of pain. He and the rest of the family knew that, despite the less than stellar treatment he had received, his life had been extended by many years. He and my mum began to pick up the pieces of their former day-to-day lives once again; traveling frequently into the wilds of the UK, Europe and beyond. Something, however, was different. My dad was never quite the same man after his operation; something seemed to be missing - he complained of short-term memory losses which annoyed him intensely, and to a number of us in the family, his cognitive abilities in general seemed slightly dulled following his double anesthesia. Under-educated (like so many of his generation) yet clearly highly intelligent, he was always very self-deprecating about his capabilities and lack of scholarly achievement, yet was erudite, articulate and well-read. Some of that sharpness seemed to have been left behind on the operating table.

"How are you feeling, dad?" I asked  as the door closed behind the nurse to leave us alone, reaching over and taking his left hand in my own. He looked at me silently, with watery eyes, his mouth slightly open. I cursed myself silently.  I’d spoken too quickly and he hadn't understood me. I squeezed his massive hand gently. "Are you feeling alright, dad?" I tried, much slower this time. There was a pause while he looked away, closed his mouth and cleared his throat softly as if to speak. Raising his head a little he looked around the room, his eyes seeming to open wider by the second as if he were taking in a new, wonderful sight rather than four drab, painted walls and one rather dismal framed picture. He cleared his throat again and looked at me. His mouth opened and his tongue moved, but no sound came out. My dad, the uneducated man who once prided himself on reading a broadsheet newspaper and completing a cryptic crossword each day, sat before me, unable to form a response to my simple question.

Following his recovery, mum and dad would repeatedly take themselves off on short coach tours with friends, and it was soon clear that to a large extent they had picked up where they'd left off when he had fallen ill. Life began to settle into a normal rhythm once more, to the point that they announced a holiday of a lifetime was planned. In a wonderful example of 'just do it' mentality, they booked a flight and holiday in New Zealand.

Two months later, greeting for them at the airport, I was shocked at how frail my dad suddenly seemed to be. Pushing my mum along in a wheelchair, he looked totally drained as they came around the corner. At the time I put it down to understandable exhaustion from such a long journey, and no doubt much of it was.

In the weeks after the trip, we found out that he'd experienced some kind of unusual 'event', wherein his speech had become slurred and his coordination had temporarily deserted him. It sounded ominously like a stroke, but since it had been very temporary and had not shown any sign of returning, his – and our - general response was to dismiss it as a 'funny turn';  a one-off and therefore not something to worry about. 

Within a year of their trip, and after three years of planning, I emigrated to Canada with the blessing of my parents. I took with me my wife and two young children, aiming to find something fresh and build a new lifestyle. Dad was completely behind the idea. It had awakened his memories of travel as a young man and the concept excited him. After a huge effort, we found ourselves many thousands of miles away from the world we were familiar with, and seeking to learn about our new surroundings. A little more than a year later, my parents followed in our tracks and came to visit us on the west coast of Canada. They stayed with us for three weeks in our little house, and living in such close proximity brought me face to face with the undeniable changes in my father.

He seemed, in the intervening months, to have become more irritable, short-tempered and generally grumpy. Once the most taciturn of men, he was now very vocal about any discomfort or puzzlement with this different country. On one memorable occasion he became unreasonably angry about the fact that the cars ran on the opposite side of the road to the UK. It was ridiculous, he said, and it meant that he and my mum had to cross a busy street to get to the bus stop to go into town - the fact that if the direction were reversed he would still have to cross the busy road to get back from the bus stop was something he was – bewilderingly - unable to grasp. This was totally unlike the man I had grown up admiring, and at the time I found it disturbing.  A subsequent startlingly spiteful and generally unpleasant altercation over - of all things - the house being unusually quiet, led me to the conclusion that despite trying not to admit it to myself, I had to concede that he was different - again.

That was the only visit that they were able to make to Canada to see our family. Contact was maintained mostly by regular phone calls and on a few occasions, the wonders of the internet and webcams. In spite of our intermittent contact, it began to seem that dad was less and less able to talk on the telephone. His hearing began to deteriorate and so, my mum explained, he found that using the telephone was more and more awkward. In truth it seemed more and more like something else instead was happening - his cognitive powers seemed (admittedly from a great distance, which tempered my thoughts on the matter) to be steadily diminishing. He was diminishing.

His attention wandered while my own mind wondered at the change in this once hugely strong yet gentle man. I decided that speaking was not the thing to do - at least not for the moment. Silence descended between us; a silence dad seemed unaware of, yet which I was uncomfortable with, because I was alone with my dad for the first time in perhaps twenty five years, and for a very particular and agonizing reason. Suddenly and with a dexterous flick, he took hold of my hand in his in a way that was intensely, agonizingly familiar. A flood of tactile memories washed over me, and in a flash, intensely, he was my childhood 'daddy' again, holding my hand and making the world safe. With his fingers he held my hand palm downwards, while his thumb gently began to stroke the back of my hand in that incredibly, heart-breaking familiar way, amplifying the surge of  emotion that had begun to overwhelm me. I looked at my own hand with a sense of shock. There it lay, in his, just as it had done so many years ago, so many times. So many times as a child I had looked at his huge, strong hands and wondered if my own would ever seem so strong, or feel so loving. Now with our roles somewhat reversed, I was trying to hold his hands to try to reassure, and here he was; responding instinctively to his son. This was the bedrock truth about him; the essence of the man - kindness, love and generosity. It was almost too much to bear. "Dad," I said softly, my voice trembling. He looked at me in surprise. "Do you remember you used to hold my hand like this when I was little?" Somehow I managed to smile with tear-filled eyes. He looked at me, directly and with deliberation; "Yes!" he said. I cleared my throat; "I do the same thing with my kids, dad. I got that from you." "Yes," he said again, and then, abruptly, he began to scan the walls once more for things I could not see. The connection was broken.

Five years after we'd seen them last, our little family of four was able to fly to the UK for a holiday of our own. Half of the holiday was to be spent in the company of my parents, the other half spent visiting other family members. In the intervening five years - I was yet again shocked to discover - my father had physically shrunk, become stooped and decidedly frail. I was moved by the physical change in him but also by the now obvious fact that he was struggling to keep up with anything other than one-on-one conversations, and frequently lost his concentration while trying to do so. He was, however, still well informed - courtesy of his beloved newspapers - and in some ways his mind was still sharp; the cryptic crossword (which I wouldn't be able to finish in a month) was still being completed daily. Fortunately, his irritability and grumpiness seemed to have waned, or at least subsided into quietness. He seemed to be retreating from the world little by little, and although his interest in his grandchildren never once wavered (he was never more energetic than when he was in the company of his children or, in later life, grandchildren and great-grandchildren), the energy that had once been in his eyes was obviously fading.  Flashes of his mischievous humor still rose to the surface, but he tired easily and his mobility was diminishing. It was sad to see, but I must admit that, while concerned, I obtusely perceived these changes to be simply a case of my dad aging more quickly than my mum, who still had all her faculties. With hindsight I wonder how much I was trying to protect myself from the truth.

Despite my parents being stuck in their ways (aren't we all?), we had a great time renting a cottage with them, and the kids enjoyed every minute of being fussed over and - of course - thoroughly spoiled by their grandparents. It was, all in all, a very successful and enjoyable holiday, meeting lots of family and a few friends once again after a six year break in most cases. We returned home well pleased with the break and the renewal of old and rather thinly-stretched ties to England.

A little later that year some major changes in my personal life took my attention away from almost everything else - including the events in England. Over the next six months my circumstances changed significantly, and almost all of my energy was devoted to my children and my own situation. Once matters had settled down I became more aware that dad had stopped talking on the telephone almost completely - just a few words were all that I could get from him each time before he passed the 'phone back to my mum. My mum was her usual self, but information about how dad was progressing (or otherwise) was vague, and in order to avoid distressing her, I didn't push the matter. Partly as a result of my changed situation, in early 2009 I visited the UK briefly, and this time alone. During that week I paid a visit to my parents.

My dear old dad was still getting about on his feet (although with some difficulty) and still driving his little car. Driving had historically been one of the things he excelled at; trained extensively by the police, he was a skillful advanced driver and had successfully taught all of his children to drive. Now, however, as illustrated by a ride he gave me, his driving had deteriorated to a level that I found truly appalling. It was simply too much for him to deal with mentally. His conversational skills had similarly waned, and now, for the majority of the time, he was quiet, interjecting occasionally and at times inappropriately. Physically he had become even more stooped, and he had obviously lost weight. Suddenly, it seemed, his face, hands and arms had taken on the look of a very old man, someone distinct from the memories of my dad which I habitually carried around within me.

It was all rather horrifying, and the truth was laid bare before me - my dad was disappearing, being pulled away from his previous life by some unseen force. The only consolation was that, aside from an occasional reference to becoming a little more forgetful, he seemed to be unaware of the changes that were overtaking him.

The silence between was no longer awkward or embarrassing, but it was difficult. Dad continued to ceaselessly look around him, pausing occasionally to stare out of the sole window which looked out onto a driveway and a red brick Victorian wall. He would slowly lick his lips and raise his right hand - a hand which had tremors constantly as a result of his Parkinson's Disease - to his face as if to touch it, but then suddenly allow it to fall into his lap once more, the reason or thought lost. I didn't observe any distress, which provided some small comfort - but I saw puzzlement, bewilderment even, and perceived a sense of general confusion about him. My once strong, quietly proud father sat slightly hunched and a little twisted in his wheelchair - whether he was comfortable or not I couldn't tell, and my efforts to help him were met with no response at all. He seemed happiest when I sat in front of him quietly and he could cast his eyes over me. For my part, I wished with all my heart that I could make a connection with him, that I might somehow ignite a spark behind the familiar features once again, and provide him with a happy memory, if only for a fleeting moment. I wanted more than anything to make this horrible condition go away and leave my dad behind, so that I might say what I had come to say, the latter out of necessity rather than desire. I was willing to take it from him and upon my own shoulders if need be - more than anything, I wanted my dad back, if only for a minute, one last time.

Twelve months on, and from far away in Canada, all communication with my father had come to a halt. He was unable to use the telephone at all. I’d listened to the stories of his decline - collapsing in a supermarket, collapsing at home, and a rapid descent into what had finally been diagnosed as vascular dementia. My mother, a fighter and a trooper as always, refused to give him up or give up on him. Steadfastly, this eighty year old lady took care of his every need - from feeding him to washing him and seeing to his ablutions. He had become doubly incontinent, yet still she toiled, often trying to support a man (in every way) twice her own weight from bedroom to bathroom in the middle of the night. Her strength, courage and fortitude defy description.

Throughout the summer of 2010 she fought a pitched battle against the onslaught of my dad's failing faculties and physical abilities. Night after tortuous night their bed would be soiled, and every night she would help him to the bathroom, strip the bed and replace the bedclothes, and then wash her husband like a child, a man who had for his entire life been fastidious to the point of obsession about his personal hygiene. Emotionally and physically drained to the point of exhaustion, she became ill, yet still she carried on as the principle care provider and somehow overcame the odds and kept them both in one piece. Finally, with autumn approaching, she was forced to accept the inevitable when dad lost his ability to walk more than one or two steps. Mum was emotionally devastated but acknowledged that she was unable to continue providing a standard of care which provided dad with any kind of dignity ( a job which required at least two fit, younger people). After a struggle of titanic proportions, facing another sudden rapid deterioration in his health and having fought through heartbreak which I can only imagine, she finally and tearfully agreed to place her beloved husband into full time nursing care. That was September, 2010.

Thousands of miles away, I’d been spared the regular experiences of my siblings, who had watched dad slip away little by little. Moving overseas to pursue a different lifestyle carried with it a price, and this kind of situation was part of that price. I knew what the deal was when I made my choice - I could have no complaints about the way things had turned out. Speaking with my emotionally exhausted mum on the phone, she had expressed grave concern over dad's health and a continuing decline he was experiencing after being admitted to the care facility. I asked the question; "Mum, do I need to come and see dad before...it's too late? Do I need to come sooner, or later?" She knew, of course, what I was really asking, and her quietly desperate response had been definite; "Come soon, son." And so, three weeks later, there we were, my children and I, back in the UK, visiting for one reason only; to say a final goodbye to my wonderful father - and their awesome, doting grandfather.

The first shock was my mum's appearance. Never a large woman, she had simply melted away in the intervening eighteen months, and when I hugged her there was nothing but skin and bone under my hands. It was obvious that she'd taken herself to the very brink before relinquishing responsibility for dad's care. Unaware until that moment just how terribly difficult it had been for her, I was moved beyond any words, and held her close to me as the tears rolled down my face, and hers.

Their house was missing something - someone, of course. Mum seemed philosophical yet underneath the heartache was evident, and we shared her sorrow, knowing that there was no coming back home for dad now. The second shock was, of course, finding him in a home, surrounded by very sick people, the final confirmation that he was indeed extremely ill.  When we arrived at the facility we walked in through what was euphemistically called 'the lounge', looking for him. All we could see, my mum, included, was a group of old people in high back chairs.

We walked towards the office, my mum first followed by my kids and myself bringing up the rear. The moment plays out in my memory quite vividly; the enormous TV was on, the volume masking any conversational sounds. I was concerned that dad was not in sight - was he in his room? Was he ill? For some reason, suddenly I stopped - I still don't know why - and turned around. There, sitting in a an enormous wing-back chair and with a smile from ear to ear, was my lovely, loving dad. He had seen us walk past him, and had against all expectations, recognized not only the kids (whom he hadn't seen for two years, and whom had consequently changed considerably), but me as well. Overcome with pent-up emotion, I almost ran to him and hugged him, the tears running down my cheeks. Stepping aside to let my kids hug him and be hugged by him, I watched this gentle, sick old man respond to his grandchildren in a way I had seen countless times before – with obvious joy. Some instincts, it seems, run very, very deep.

During our time there, we visited dad a number of times, the kids being quite upset by the sight of their beloved 'granddad' in such a state. They adored him, and the clear deterioration in him was difficult for them to deal with. On one occasion I took my eldest nephew to see him and then, finally, the day before our departure for our distant home, came the moment I had made the journey for, but which I had been anticipating with a cold, icy dread. Calling ahead to the care home, we made arrangements for me to see dad on my own, in order for me to say a final goodbye and what would in all likelihood be my final words to him, ever... We felt that his health wouldn’t hold up very long, and with the likelihood of a quick end being fifty-fifty (he had suffered a number of small strokes by this time), the sensible thing to do was to say goodbye while he was still capable of recognizing us, if not understanding the bigger picture. It was a horrible, heartbreaking decision, but, I felt, the best one.

One bright November day, therefore, I found myself sitting in a small, quiet room, completely alone with my father for the first time in a very long time - and although only I knew it, probably for the very last time.

The brutal truth, of course, was that he wasn't coming back, ever. The man I had once called 'daddy' had gone. The man I called 'dad' since I was eight years old had faded away, his faculties and his dignity slowly stripped from him through the ravages of his disease. He still looked like my dad; older, frail, confused, yes; but he was still the man I had looked up to all my life, and the man whose best qualities I still aspired to. I loved him deeply and instinctively, and suddenly that was the most important message I could ever give him. "Dad" I began, speaking slowly and carefully; "Tomorrow we're going back to Canada, the kids and I. We have to go...home, dad, so..."

I had to stop to steady my voice. He was looking at me intently now. "Yes. Go home. Yes," he said. I stifled a sob - surely the last thing he needed was to be disturbed by me breaking down at this stage. Our surroundings receded until they ceased to exist for me;  there was just dad and me. This was after all to be the very last time I saw him and I had never not had him in my life.  I had never imagined things working out this way - after all, according to all the best stories, weren't we supposed to gather at the bedside and say goodbye as a family? The difference here was, if the doctors had it right, that dad no longer had any capacity to understand what was happening, and was therefore blissfully ignorant of what was approaching - he had finally managed to escape his life-long fear of death.

I took a deep breath. The moment had arrived and it was my duty to do my best for him. "Dad, we have to go home. I wanted to say...goodbye." My voice broke on the last word. He looked at me, a slight smile playing across his lips despite my sadness. It suddenly hit me; this was it - this was, really, the last moment I was ever going to have with him, the very last time I would see that slow, subtle smile or feel his touch. "I want to say goodbye, dad." I said, suddenly, almost violently aware that I had probably never used the word properly before. "But, most of all" I continued haltingly; "I want to let you know...that I love you very, very much...and that I have always...loved you and...respected you." He looked at me, wordlessly for a long silent moment.  He opened his mouth, looked me in the eye and clearly but softly reached out to me one last time with these words; "Love you."

My stomach rose up into my chest, my heart felt like it exploded into a thousand pieces and my mind screamed. The pain in my head was sudden and intense.

Desperate to avoid him seeing me so deeply upset and therefore getting upset himself, I clenched my jaw until I felt my teeth would shatter, stood shakily, and stepped to his side. Without showing him my tear-streaked face, I hugged him long and hard, dreadfully aware of the utter, bleak finality of the moment - of every split second.

Through my tears I whispered to him one more time "Goodbye Dad, please remember I love you very much." Never has the word ‘goodbye’ been so meaningful, and so painful.

Then, at last I completely lost my voice in pain. He returned my hug as best as he could and patted my arm; that familiar, reassuring touch for the final time in my life. I stood, noticing the nurse hovering on the other side of the door, a tear running unchecked down her cheek.

The old man didn't move when I stood up. I placed my hand on his shoulder and summoning my best whisper, said goodbye - that word again - one more time. He didn't respond - he couldn't respond. With a massive bubble of emotions welling up inside me once more, I opened the door and stumbled from the room, the nurse appearing before me through a blurred curtain of tears. "Are you alright, love?" she said. I forced a wry smile while my eyes overflowed; "No, not really, but that's life, isn't it?" I said - and I meant it -  before thanking her for her sensitivity. Turning away and walking into the lounge area, I heard the door open, a short pause and then the nurse's voice "Awww, lovey!" before the door closed on them. I couldn't see anything at that stage, and the thought came to me that maybe dad had suddenly realized what was happening. I had no choice but to go home anyway; there was no other course for me. I couldn't bear it, and I staggered through the lounge filled with sick, confused lonely people, and into the outside world.

I wanted to go back, but found it impossible. The pain was just too great. Ever since, I have been haunted by the memory of those final moments with my dad. Sometimes I think that I should've put my own grief to one side, I should have gone back to make sure he wasn't upset. But I didn't, and I live now with the fear that I gave him cause for sorrow, that he was, after all, aware enough to know what was happening. Nobody has ever mentioned it, but still I wonder about it.

Fourteen months longer my dad lasted after that visit; fourteen months of further disability, further retreat from reality and the world I live in. Not long after I last saw him, he lost the ability to recognize his loved ones, so the visit's purpose of allowing him to see my kids while he still knew them was at least, after all, a success. A glimmer of light in that particular darkness. Dad died - thankfully not alone - after a number of further stroke events and a short period of even more serious illness. When it happened, it all happened suddenly and I never had a chance to speak to him again - if I had, I know that I would have told him the same things. In the end there was simply no time to arrange to see him once more - indeed until the final few days he remained in that no man's land of 'he could last for months or years yet'. It's another part of the price to be paid for living a great distance from the family.

Missed opportunities, lost moments. I miss him. I think of him often, and the last conversation we had. I continue to hope that he understood me, yet also that in some way that he didn't. The lesson I had learned without knowing it, was that as I myself had matured, I had developed the ability to express my feelings for my parents. They had grown up in a world where expressions of emotions were discouraged, yet somehow as they grew older they had also learned to say the important, tiny things which I now remember when the need arises. Sometimes, you see, I still need to hear his voice.

My dad, whose love I'd never for a moment doubted (well, alright, perhaps once or twice as a foolish teenager when for a week or two I became convinced I was adopted!), had always struggled to be a demonstrative man, yet in that moment - which I will carry with me until my own last breath - he found the strength, despite all his difficulties, to reach out to me in the best way possible. In the end, for me the essence of those moments can be condensed into the two words that he picked out to share with me: "Love you."

What an amazing, fitting gift he gave me even through his confusion. Are there any better final words to be said? I doubt it. I hope that I can be so articulate and insightful when that time comes for me. The smallest action (symbolized by his loving touch that day) and those two small final words from my father reverberate through my life to this day, and will continue to do so.

The gift that he gave me is the gift I in turn give to my children each day. I'm still learning more about the meaning of those moments each time I reflect upon them. Now, because of him, I have the opportunity to give my children the same kinds of gifts during my life , and I hope that in the future they will have a very great deal to remember as a result.

I'm so very sad to be without you now, Thomas Anthony Simmons - but your presence in my life - and our final moments together - taught me so much. Thank you for that last selfless gift, the very last time you were able to teach your youngest child something huge, by simply telling him, "Love you." I will always love you, too.

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Leo Simmons is an embryonic writer, still trying to find the most efficient neurological pathways. A former British Bobby, Leo lives with his family in BC, Canada, where apart from writing he pursues a number of interests, including hypnosis therapy.