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 could not work around the problem - this time there was to be no manly gritting of the teeth and stubbornly pushing through. A passing acquaintance fortunately happened upon him in this state of partial collapse and, faced with a man who refused to call for an ambulance, put him in his car and drove him the short distance home. Fifteen minutes later I answered the telephone in my own home and received the call for help from my anxious mother. As the nearest relative I was the obvious choice to answer the call and a short time later I screeched to a halt in a cloud of tyre 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 wife of nearly fifty years at his side. An ambulance arrived at the house within minutes of my arrival and Dad was taken away to be cared for.

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. While the family at first anticipated a speedy process, we were soon forced to settle into an agonising  waiting period, until, unbelievably, a whole eighteen months later, an operation was finally scheduled. The stress upon my parents had been huge; not knowing whether a heart attack or blocked artery was imminent, they lived on their nerves day by day until the operation notice came through.

At last, my dad was admitted for a quadruple bypass operation, at the age of seventy years. The family held its breath. 

What happened next has been the subject of debate within my family ever since. My dad came through the operation like the 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. Apparently, one of the grafts used in the bypass had begun to leak, and blood was collecting in his chest cavity around his heart; truly an emergent and life-threatening situation. For the second time in twenty hours, my elderly father was deeply anaesthetised and his chest 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 brutal  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 bloody - 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 in fact have been surprised if he had done anything different. But fight he did, regaining his physical well-being, his mobility and much of his confidence, much 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; travelling frequently into the wilds of the UK, Europe and beyond. Something, however, was slightly 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 anaesthesia. 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 - just some - however, 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 had spoken too quickly and as a result 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 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 wonderful sight rather than four drab, painted  walls and one framed picture of a field with an Oak tree. He cleared his throat again and looked at me. His mouth opened and his tongue moved, but no sound came out. My dad, the man who once prided himself on reading a broadsheet newspaper and completing the 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, visiting the land where, many years before, my Aunt (one of mum's older sisters) had lived for twenty plus years and sadly died while still only in her late forties.

Off they went for two months worth of travel and visiting (we have several family members in that farthest - flung country), and by all accounts a fantastic time was had by all. We were all so pleased that our parents had taken the plunge, and were experiencing something truly wonderful by any measure. The weeks passed - punctuated by a steady stream of postcards of course - and then it was time for them to come home. Having taken my mum's oldest sister, the wonderful 'Aunty Kath' with me, as a shift worker it had fallen to me to meet them at the airport. When they arrived, however, I was shocked at how frail my dad suddenly seemed to be. Pushing my mum along in a wheelchair (she was having problems with her hip) 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. But not all of it.

In the weeks after the trip, it transpired that my dad had 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, 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 and approval of my parents. I took with me my wife and two young children, aiming to find something fresh and build a new lifestyle. My 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, therefore, 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, mum and dad - maintaining their travelling tradition - 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 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 his 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 out of character and at the time I found it rather disturbing.  Another startlingly 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 my dad was different - again.

For various reasons, that was the only visit that they were able to make to Canada to see our family. Contact was therefore maintained mostly by regular phone calls and on a few occasions, the wonders of the internet and webcams.  In spite of - or perhaps because of - our intermittent contact, it began to seem that my dad was less and less able or enthusiastic about talking 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. I experienced it somewhat like a weakening handshake...

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 there, alone with my dad for the first time in perhaps twenty five years, and for a very special and agonising reason. Suddenly and very unexpectedly, and with a dexterous flick, he took hold of my hand in his in a way that was intensely, agonisingly 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 my dad's huge, strong  hands and wondered if my own would ever seem so strong, or so kind. Now with our roles somewhat reversed,  I was trying to hold his hands to try to reassure him, and here he was;  responding instinctively to his son. Here, after all, was the truth about him; the essence of my dad - kindness, love and generosity.  It was almost too much to bear. "Dad" I said softly, my voice trembling. He looked at me "Do you remember you used to hold my hand like this when I was little?" 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.

Five years after we had 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 and become 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 year) was still being completed daily. Fortunately, his irritability and grumpiness of several years earlier seemed to have waned, or at least subsided into quietness. Dad 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 in life 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 humour still rose to the surface frequently, but he tired easily and his mobility was diminishing. It was sad to see, but I must admit that, while concerned, I perceived these changes to be simply a case of my dad ageing 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 my 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 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 more stooped, and he had obviously lost weight. Alarmingly (to my eyes at least), his face, hands and arms had taken on the look of an old man, someone distinct from the memories of my dad which I habitually carried around within me. His life seemed to be increasingly controlled at a detailed level by my mum, who issued instructions to him almost by the minute - and when she was not around, he quickly became anxious and disoriented.

It was all rather horrifying, and the truth was laid bare before me - my dad was slowly disappearing, being pulled away from his previous active 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 Victorian brick wall. He would slowly lick his lips and raise his right hand - a hand which tremored 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 distress, which provided some small comfort - but I saw puzzlement, bewilderment even, and perceived a sense of 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  ascertain, and my efforts to help him were met with no response at all. He seemed happiest when I sat in front of him and he could cast his eyes upon me as he wished. 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. More than anything, I wanted my dad back, just for a minute.

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, and had been so since the previous Christmas. I had listened to the stories of his decline - collapsing in a supermarket, collapsing at home, and a steady 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 dad's every need - from feeding him to washing him and seeing to his ablutions. He had become doubly incontinent, yet still she toiled, trying to support a man twice her own weight from bedroom to bathroom. He had lost all his interests in life, even to the point where he would no longer watch his beloved football on TV.

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 dad 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 carried on as the principle care provider and somehow she 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. She 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 agreed to place her husband into full time nursing care. That was September 2010.

Thousands of miles away, I had been spared the regular experiences of my siblings, who had watched dad slip away bit by bit. I had been lucky, if that is an appropriate way to phrase it. 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 had 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 had 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 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; to say goodbye to my wonderful father and their awesome grandfather.

The first shock had been 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 had taken herself to the very brink before relinquishing responsibility for dad's care. Unaware until that moment just how difficult it had been for her, I was moved beyond words, and held her close to me as the tears rolled down my face.

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 dad 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, recognised not only the kids (whom he had not seen for two years, and 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 face. 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. 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 'grandad' in such a state. 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 to him - what would  in all likelihood be my final words to him, ever. We felt that his health would not last 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 capable of recognizing us, if not understanding the bigger picture. It was a difficult decision, but, I felt, the best one.

And so, one bright November day, I found myself sitting in a small, quiet room, alone with my father for the first time in a very long time - and of course, for the very last time.

The brutal truth, of course, was that dad wasn't coming back. 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 my dad, 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 suddenly that was the most important message I could give him. "Dad" I began, speaking slowly; "Tomorrow we're going back to Canada, the kids and I. We have to go home, dad, so..."

 I had to stop for a moment 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. I took that to be a very positive side of his condition - 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  would ever 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 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 moment, then said, softly; "Love you.".

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

Desperate to avoid him seeing  me 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 finality of the moment, of every split second.

Through my tears I said to him one more time "Goodbye Dad, please remember I love you very much.".

 Then, at last I completely lost my voice in my 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.

Dad had not moved when I stood. I placed my hand on his shoulder and summoning my best whisper, said goodbye 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 realised what was happening. I had no choice but to go home anyway; there was no other course for me. I simply 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. Ever since I didn't, I have been haunted by the memory of those final moments with my dad. Sometimes I think that I should put my own grief to one side, I should have gone back to make sure he was not upset. But I didn't, and I live 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 he did not.

The lesson I realised that 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 had never for a moment doubted (well...alright, maybe once or twice as a teenager when for a week or two I became convinced I was adopted!), had always struggled to be demonstrative, yet in that moment which I will carry with me until my own last breath, he found the strength, through all his difficulties, to use those two little words. 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 in my moment of sorrow.

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 (symbolised by his loving touch that day) and the smallest 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 am still learning more about the meaning of those moments each time I reflect upon them. I have the opportunity to give my children the same kinds of gifts, 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"