The final iteration

As it turned out, Dad’s recovery was short lived. We had a good Saturday and Sunday, everyone so glad that he was home. He drank his thickened liquids and ate oatmeal and chocolate pudding cheerfully.

I took him and Hilda to a follow up appointment with his regular doctor on Monday afternoon. We discussed speech therapy for his swallowing problem. When Dr. V. saw the difficulty that Dad had getting on the examining table, he ordered physical therapy and occupational therapy as well.

I went speed shopping at Walmart for some groceries while Dad and Hilda waited in the car. Then I sat with Dad while Hilda went to Walgreens to pick up some prescriptions. Dad said he wished he could have a 7-Up. I explained about the problem with the epiglottis closing again, and said he’d just have to hang in there with the thickened liquids for a few more weeks before they tested his swallowing again.

Doug and Pam came for a visit Tuesday. Doug thought Dad didn’t look great, but I didn’t notice much of a difference. Hilda showed me the results of the blood work, which indicated the kidneys were failing again.

At 3:00 Wednesday morning, I heard coughing and retching. I thought maybe Dad was coughing so hard that he was throwing up. That happened to me once when I had a bad case of flu. It turned out that he also had diarrhea.

He was better in the morning. Hilda attributed the diarrhea to excessive fruit juice and possible laxative effects of the Thicken Up. I went to work.

When I came home, Hilda reported that Dad no longer wanted to drink water. She was at her wits’ end. He was supposed to take small bites, chew thoroughly, and take sips of fluid. He ate big bites, chewed very little, and gulped large swallows of liquids, as he has done his whole life. And now he didn’t want to drink anything at all. I told him that he had to drink because he was dehydrated. I gave him a cup of thickened water. “Sips!” I told him as he gulped, “Sips!”

And he started coughing and retching.

Then he had back pain. Kidneys? Pulled muscles from coughing? Hilda called the doctor. We tried Tylenol. No relief. We tried Tramadol. Nothing. We put on his shoes and took him to the emergency room.

“You need to go home,” Hilda told me. “I will stay with him tonight.”

“Call if you need anything,” I said. “It doesn’t matter how late.” If he died in the night, she would need to come back home.

It turned out that they did call at 9:30 for me to bring over his CPAP, but for reasons that I cannot explain, neither Terry nor I heard the call. Did the phone not ring? I was asleep, but Terry was sitting right next to the phone in the living room.

I left early the next morning so I could stop by the hospital before work. Hilda was in a state. Dad had been in horrible pain all night while the nurses tried to find something that would give him relief. She held his hand. At one point, he said, “Hilda, I’m so sick.”

An early morning x-ray indicated intestinal blockage. She had refused surgery. “I’m not going to put him through that.”

As we have told this story, friends have wondered that they offered surgery at all. I can only think that they had to, but if Hilda would have said yes, I strongly suspect there would have been serious conversation about the consequences of that course of action.

When she explained the situation to me, she asked, “Did I do the right thing?”

“Of course,” I assured her. “It isn’t very likely he could survive it.” In my mind, with the atrial fibrillation, pneumonia, and kidney failure on top of this, it was clear that his body was shutting down, one organ system at a time. It was over.

One of the nurses that we have known over the years stopped by. She said when she was in this situation with her mom, the decision was the hardest. Once it was made, things felt calmer.

She was right. I did feel calmer. I wasn’t afraid anymore. That was the hardest part of the various iterations of health crises that both my parents have had. Will they die? Will they not die? Is this it? But when I knew for sure that he would die, it was not as hard to accept as I thought it might be. Which is not to say it wasn’t tremendously sad. I have to cry right now, just typing this.

Dilaudid did the trick to relieve his pain, but it also rendered him fairly unresponsive. He opened his eyes, but didn’t speak. Dr. V came by and told Hilda that Dad would probably live another week. Doug got on the road to Harvard shortly after I got to work. Pam took care of some things she needed to do at work and took the train. I got to the hospital as soon as I could after my class ended at 1:00. The meeting with hospice was scheduled for 2:00. Terry came too.

We got set up for a hospital bed and oxygen to be delivered to the house, and for Dad to be discharged on Friday. Doug and Pam said their goodbyes and went back to Chicago. We braced for a week-long death watch. I was dreading it. Jane’s mom lingered nearly two weeks, during which I thought I would lose my mind with the waiting, and I wasn’t even there very much.

I took Hilda home after the meeting so she could take a shower and get warmer clothes for another night in the recliner next to Dad’s bed. The hospital bed arrived at the house 10 minutes after we went back to the hospital. The driver told Terry he’d been on his way to deliver the bed elsewhere when he got a call that the patient had died, so he brought the bed to us instead.

The discharge was planned for Friday. Somehow the message hadn’t gotten through about the oxygen. The transport drivers had to hang around with Dad using oxygen from their tank until an oxygen condenser was delivered and set up.

And there was some miscommunication with hospice as well, and we waited and waited for the nurse to come to do the intake visit. When she did get there, Dad was breathing 30 times a minute with a pronounced rattle. “The way he sounds,” she said, “I’d be surprised if he lasted the night.”

We got our instructions and filled out the paperwork. The nurse left.  I made dinner. I had a little turn when I got a pack of sweet corn out of the freezer, labeled in Dad’s writing. Next year’s sweet corn would be labeled by a different hand.

We were just finishing dinner at 7:45 when Dad stopped breathing. The nurse had just pulled in her driveway when she got the page to come back.

Over the next three hours, the nurse got back, pronounced him dead, filled out more paperwork (not sure what to call it when it’s all electronic), left a message for the doctor, spoke with the coroner, and arranged for the folks from the funeral home to come for the body.

And then all was quiet. Exhausted by the whole process, I slept quite well.

Jane brought us groceries and soup in the morning. We drank coffee and ate cookies, which was Hilda’s breakfast. Jane went home.

Doug and Pam arrived for lunch. We made sandwiches with the supplies Jane brought and talked all afternoon. Hilda was comforted.

I’ve heard stories of odd behavior of animals after a death—a favorite songbird tapping at the window, a wild otter holding the gaze of a human for a surprisingly long time—that is interpreted as a message from the deceased. Of course there are other, more logical explanations, but belief requires no evidence, and we can believe whatever we want to believe. That afternoon, a red tailed hawk soared over the field, much closer to the house than we usually see them. Again and again, it passed nearby, soaring and swooping in the afternoon sunlight, and I thought, “It’s Dad.” And the message was, “I’m free. Free from pain, sorrow, and worry. Free from the aging body that frustrated and betrayed me. Watch me fly, and remember me as I was when I was strong.”

Ridiculous, I know. I didn’t say anything at the time. But it comforts me, so I’m going to believe it. Because I can.