That Saturday Morning

The ICU is on a floor that gently curves along the south side of the hospital's second floor. The north wall of each room is about fifteen feet long and completely glass with sliding glass doors that must be over eight feet wide. Each room also has a curtain that can be pulled across the length of the room. I stepped outside the room. The door was slid open and the nurse had posted herself there at a rolling desk. Dad's body was lying there. It was now almost 8:30 a.m. At about 7:15 a.m. I had noticed the color in his face changing. Starting from the neck, it was blanching, and I recognized that this must be the sign that death was moving up his body. I knew he was gone then. He had no more color. He was no longer there. So many times during the evening and then again that morning, Sue and I had looked at him and commented on how ironic this was. He was dying exactly the same way our mother had died thirty one years ago, on a ventilator in a coma with dilated eyes and unable to speak to us. He was dying of the same cause: septic shock. It was eerie. It took me back those thirty one years. I had hoped I would never be in that situation again, that I would never have to watch another person die under those same circumstances. This was sad but I didn't feel robbed like I had when my mother had died. She was so young, 53. She hadn't seen a grandchild yet. She hadn't resolved so many things in her life. She had been devastated by her father's death two years before and had lost her way. He had been her rock, her strength, her confidante, and her rescuer. Without him she hadn't known how to reset the course of her life. But it was different with Dad. I hadn't been robbed. He was old. His body was breaking down. The only problem was that his mind wasn't deteriorating in step with his body. He was out of his pain and frustration. I still felt strange leaving him. I had an empty feeling. Was I abandoning him? Shouldn't I sit with him until they came to take him away? Did the nurse need me out of there because she had something she needed to do? A man came in and started taking the ventilation tube out of his throat. That did it. I was NOT going to watch that. I left.

5:00

I fell asleep at about 1:00 a.m. Dad had beaten death so many times in his life. It seemed incomprehensible to me that he would succumb now. My phone rang at 5:00 a.m. It was the nurse. His heartbeat was getting slower and slower and more and more irregular. If I wanted to see him, I had better come on over. "How much time do I have?" I asked. "Not much. Be careful on the streets." I jumped in the shower. I hadn't bathed in quite some time. I was stinky. I slapped shampoo on the crown of my head. I rubbed. It didn't budge. This wouldn't do. I figured I had better do it right. No matter what happened, it was going to be a long day and I didn't need to smell bad on top of everything else. It's funny how such a simple thing like shampooing your hair, an easy almost mindless little task, can seem so perplexing when you're under such stress. Would I make it to the hospital before my dad passed? Would this tussle with the shampoo be the reason I'm not at my dad's side for his last moment of life? I woke Sue and she was ready to go in what seemed like thirty seconds. She drove. I don't remember where we parked. We went to the room. The nurse said she could only feel a pulse in the femoral artery but it was still definitely there, getting weaker all the time. I talked to him. Again, I told him it was okay to go. We didn't want him to suffer. We knew he was in pain. We knew he was afraid. It's okay to go, Dad. It's okay. You've fought so hard for so long. It's okay to let go. You're going to a better place. We'll be fine. We'll be okay. You can go now. Be free. As the nurses changed shifts they told us we could stay in the room; they wouldn't kick us out like they do when ICU shifts change. They usually kick visitors out from 7:00 until 8:30. Both a.m. and p.m. The new nurse couldn't detect a pulse. The old nurse could find one in the femoral artery. They called the charge nurse. The first time the charge nurse could feel the pulse in the femoral artery. Several minutes later, he couldn't. It felt a little strange to have the nurses arguing in front of us, one saying there was a pulse, the other saying there wasn't. Susan and Beth. Their names were Susan and Beth. And so are my only two sisters. Susan and Beth not agreeing. How familiar that sounds. At 7:45 a doctor I had met in the ER came in. "If you can't feel a pulse in the artery closest to the heart, the chances are the heart is no longer working and you are only feeling the impulses caused by the ventilator." He pronounced Dad dead at 7:46 a.m. We stayed on. I don't remember what we did. I don't remember if I signed anything. He was dead. What was I to do? The nurse said, "You can leave him now." It felt so strange. Just leaving him there. Dead. It had been a long, long life. He had far out-lived any other male member of his family. He had lived life, for the most part, on his own terms and the way he wanted to live. He had had enough money and time to do the things he loved. He had traveled, he had loved, he had bought what he wanted and lived where he wanted. He had escaped the oppression of the village in Ohio where he had found his childhood stifling, where he had lost his mother at 10, where he had changed tires and pumped gas at his strict German father's filling station, where he had played high school basketball and graduated second in a class of 17, where he had decided to commit his life to medicine, and where he had tried to hide his true identity. He was now gone from this world and, ironically, his remains will soon lie in the family plot, in the last space in that plot, next to his mother, his father, his sister and his ancestors, in that little village he ran from so many years ago. By choice, that will be his final resting place.

Susie

Laura and I retrieved my car from the HCC parking and went to the bank. I had asked her to drive me home. I knew I wasn't up to the task. I had known that when she had called me early in the afternoon, before Dad had gone to the ER, and she had agreed. As we pulled out of the bank, my phone rang. "Where are you? I'm here." It was Sue, my little sister. "Where?" "At the hospital. By the ER." "We'll be right there. We've just left." Laura dropped me off and headed home in my car. Sue and I went back into the ICU to be with Dad. Sue went in and talked to the nurse. She went to Dad. She stroked his arms. She checked his legs, his arms, his sides. He was bruised from so many IV's. He was thin and frail. I hadn't seen all of his bruises. Then the nurse asked me if I wanted to see the photos. The hospital takes photos of all the patients when they are moved up to the ICU. He had so many bruises. I knew the blood-thinners caused him to bruise easily but I hadn't realized how much these trips to the hospital had done to his body, the pokings and proddings, the IV's and whatnot. Then the nurse showed me a very bad mark on his tailbone area. How did he get it? Had he tried to get out of bed and fallen? Had one of the caregivers not told me because they felt they had not done their job? Had they been asleep when he had tried to get out of bed? Did they feel guilty? Had the idiot agreed to help him walk to the bathroom again after I had specifically told him not to, only to have Dad fall in the process? It's too late now. It didn't cause his death. Sue leaned in close to his ear. "Hi, Jim. It's Sue, Donna's youngest daughter. I'm here with Cindy...." She continued speaking to him in a sweet, low, comforting voice. I wonder what she said. Did she thank him for being there for her at some of the times when her own father wasn't? Did she tell him everything was going to be okay? Not to be afraid? Did she say something about God? Or about forgiveness? I didn't ask her then. Maybe I will when I see her at Christmas. During the whole time after he was resuscitated, I only saw him do one thing. Once. Once he licked his lips. His mouth had been so dry the last week. I had brought petroleum jelly and lip balm to the hospital. His lips had become chapped. The idiot had decided to put wet lip swabs on them. I told him, perhaps not in my nicestvoice, that you don't treat chapped lips with water. How did that man manage to raise FIVE children without killing them? I don't know. Maybe he started with fifteen and only five survived. That would make sense. Sue was so comfortable with this setting and with Dad's condition. She was a paramedic for fifteen years and an EMT for many years before that. It is part of her domain, not out of her comfort zone. She would have not felt lost during Code Blue in ER Number 8. I was so glad to have her with me then. The nurse asked if I wanted to be called if he started making a turn during the night. I said yes. We went home about an hour later.

Post CPR

Later a woman introduced herself to me. She said she was the head nurse, that they had been able to revive him, that his vitals were returning, his color was back, and they were impressed. Aha! I thought. He has cheated death once more! She said they were going to clean him up and move him to a larger bay in the ER. I went out to the waiting room. Laura and Kyle were arriving. Kyle looked pretty rundown from his wild birthday party, and they had the baby with them. Carmi had called David, and her friend, Gail, was there as well. David arrived. The first of the known doctors to arrive was the cardiologist, the man who, no matter how old or incapacitated Dad had become, always treated him with the regard of a highly-esteemed colleague, the man who the ICU nurse had said had saved patient after patient from death from congestive heart failure, the man who my dad trusted far more than any other doctor. He found me and said, "This doesn't look good. This looks really, really bad. They spent almost twenty-five minutes reviving him. His lungs are full of crud. He has a raging infection and his body is in septic shock. He has about a one in a million chance of recovering from this. I've known your dad for thirty five years. He wouldn't want this for himself." "I know. You're right. I was really surprised last week when the doctor asked me to ask him if he wanted chest compressions, intubation and paddles, and he said yes. I think maybe it was fear. His health care directives say he doesn't want heroics. He even wrote that if he's in a reversible condition that he wanted to be let go gently and comfortably." "I'm going to write that if he goes into cardiac arrest again that they don't do CPR. He probably has a couple of broken ribs from this as it is. If he makes it through the night we'll put him on comfort care in the morning. We'll keep him out of pain. We'll stop the meds and put him on morphine." "Yes, I understand. I think you're right. He wouldn't want this again." I visited Dad over and over again in that ER bay. His eyes were half-open. His pupils were dilated. He was on a ventilator. I knew that look. That's how my mom looked. Non-responsive. Not really there. We all went in to see him. I held his hands. We all held his hands. David came out shaking his head. "It's no good. He's gone." By 8:30 p.m. they moved him up to the ICU. They were wonderfully attentive. In that unit each nurse has two patients: one in great need of attention, and the other in fairly good shape and ready to be moved to a less intense ward. Dad's nurse was a woman about my age with spiked platinum hair about an inch long and a slight hint of dark roots. She wasn't a punker; she had adopted this hairstyle to combat thinning hair. Good for her! Be courageous. Make a statement! Laura and I stayed in the room for a couple of hours. Kyle was unhappy. He needed to sleep. We left a little after ten.

Code Blue in ER Number 8

I guess when you work in an ER, you learn to keep your cool in the face of any medical emergency. The intake nurse worked efficiently but didn't seem to look the least bit rushed. We were sent to a small room, number 8. By then Carmi and I were with Dad. He didn't look good. Over the past seven weeks, the intervals between the reemergences of his pneumonia had become shorter and shorter. This time they had barely stopped the IV antibiotics before his fever had returned. He was in pain. He was frightened. He had been looking at me to help him. And the delays with the doctor and now the ER admittance had felt like they had taken hours. I held his hand. I told him it was hard for us to watch him suffer. We didn't want him to be in pain, we didn't want him to suffer, and we didn't want him to be afraid. I told him please don't be afraid. I said that God loved him and was waiting for him and that he didn't need to fight anymore and he didn't need to worry. He was loved. He was forgiven. It was okay I said. You can go. Go home. Nurses came in. One said, "Sir. Sir? Can you hear me?" Then to the other nurse, "Call for the crash cart." She placed the palms of her hands on Dad's sternum. Then she looked at me. "Does he want this?" "Yes," I said. "He does." I stepped into the hall. I covered my eyes. I did not want to see that. I did not want the memory of my father, my elegant, sophisticated father, being thumped and jumped and defibrilated to be the last thing I saw of him. I fought not to see it or mentally conjure it. I heard the call go out over the loudspeaker, "Code Blue in ER Number 8." Then again, "Code Blue in ER Number 8." They didn't sound frantic. But the personnel descended on little ER Number 8. They didn't come loudly with crash carts clanging and running feet pounding on the linoleum. They came swiftly and silently like an owl flying in the night. Instantly the room was crowded with medical personnel. I went into the next room. It was small, dark, empty. Hospital stark. I sat on the lone metal chair, stuffed my fingers in my ears, pinched my eyes shut, and cried like a helpless child. I rocked back and forth. I had never seen my father frightened before that day. I had never felt so incapable. And my kneejerk reaction was that I had let my father down. I hadn't been able to see him on Thursday and I hadn't understood the intensity of his distress that Friday morning. I hadn't known that the stupid caregiver, the one I had told Carmi to fire, the one I subconsciously and unwillingly thought of as the 'village idiot', had been in charge of him that morning.I had let my father down. He had trusted me, and I had let him down. A woman came to comfort me. She introduced herself as Kathy. Did I want a glass of water? Yes. She left. She returned. I had water. She disappeared. I didn't want to hear. I didn't want to see. I wanted this not to be happening.

Distress

As I started my workday, I received a text from Carmi. Dad had begun to run a fever during the night. He had been on antibiotics until Wednesday. I had seen him twice that day. On my second visit, I had felt his forehead and asked him if he thought he was running a fever. He said no. I trusted his judgment and anyway, he had just come off antibiotics only a few hours before. I knew Carmi had a doctor's appointment on Friday morning and that she would relieve the other caregiver as soon as her appointment was over. Dad's fever had been 104 during the night. As it turns out, Carmi's doctor ran over two hours late, and the medications that were prescribed for her took a long time to fill. She didn't get back to the Health Care Center (HCC) until after noon. I got there right after 1:00. The idiot relief caregiver had not notified the nurses that Dad's fever was returning. In fact, when the nurses had asked him, he had only pressed his hand against Dad's cheek to check, and then he told the nurses he didn't think there was any fever. In the meantime, the temperature continued to rise. By the time I arrived, they had discovered this raging fever, and he had ice packs jammed in Dad's armpits, in his groin and around his neck. They had given Dad Tylenol and had called the doctor. Unfortunately, Dad's primary physician was on vacation, and the doctor covering his calls was not responding. Carmi had gone to the nurse's station asking for a doctor. I went to the nurse's station twice. They said the doctor was seeing patients at the hospital. I said this was urgent. Then my cell rang. It was my youngest sister returning my call from last Sunday. I told her my dad was in distress. I was starting to cry. She asked if I needed her because, unbeknownst to me, she was just two hours away, celebrating her 20th wedding anniversary. I said yes. She is medically brilliant and she is great in a crisis. Then Laura called, and I told her the same thing. She headed on over. A few minutes later, the HCC administrator came into the room and said he had taken it on himself to call the doctor. He said that man had a colleague here who was in immediate need of medical attention and if the doctor couldn't get over to the HCC right now, he needed to send an ambulance to take my dad to the ER. I had only met this administrator once, he was new to the HCC since Dad had been there last. I was so grateful. An ambulance showed up. The EMT's invited me to ride with them. They made a U-turn right there on 20th Street and headed the block and a half to the hospital. As we rode, I gave them Dad's medical history. Arriving at the ER, someone had parked their Prius right where the ambulances park! Wow, someone has quite a sense of entitlement! Once in the ER doors, we had to wait for the intake nurse to finish with another patient from another ambulance. All the while I felt Dad slipping away. He had recognized me when I had arrived at the HCC. He had tried to say something to me but he could only move his mouth. No sound came out. I had noticed this inability to speak growing over the past week. He had also been sleeping a lot. I wondered, and I still do, what he had been trying to say. Now I'll never know.

Thursday

Kyle turned 25 on Wednesday the 14th. Laura had to coach that evening so she said she'd take him out to celebrate on Friday but she gave him his gift on Wednesday. She planned, though, to have a surprise dinner party for him at Benihana's on Thursday evening. She had invited his dad, his siblings, his cousin from Long Beach, and several co-workers. Laura and Kyle would drop by the house, I would mention what a great happy hour they had at Benihana's and that the free birthday dinners there were only good from Monday through Thursday. Laura would suggest they go right then, and I would volunteer to take care of the baby. That all happened as planned. Since Dad was in the Health Care Center now, I didn't worry about how late I would go to visit him. If Laura and Kyle got back at 8:30 or 9:00, I'd go over and see Dad for a while and then get home to be in bed by 11:00 because I was scheduled to teach until 1:00 p.m. on Friday, a minimum day. Laura and Kyle didn't get home until after 10:30, and by then I was ready for bed. Even running into his cousin in the parking lot and seeing his brother on the sidewalk hadn't tipped Kyle off to the surprise party. When they got to the happy hour, 10 people were there to celebrate with him. It went off beautifully. Kyle had lost count of the shots he'd had upstairs at happy hour. The party had migrated down to the restaurant where everyone ate dinner complete with chefs twirling giant knives and throwing eggs in their pockets and nesting them in their hats. The food and drink flowed freely, and Kyle was blissfully, obnoxiously drunk by the time they got to my place. They spent the night out in my guest house. Early the next morning, after Laura and I had had coffee and Kyle had purged himself of all of the prior evening's imbibings, we headed off to our respective jobs.

This Post is NOT for the Feint-Hearted

This is a Monday post. Think of the worst Monday you've ever had and then put it on steroids. That is today. Last night my biggest worry was how to access Season 3 of Downton Abbey. Today that is nothing. I'll get right to it. Laura and Kyle couldn't get the baby to my house before work because Kyle left their apartment with the baby before Laura realized she didn't have her car keys. Kyle had to go back which cost him the time he needed to get the baby to my house. I had to go get him and got stuck in ridiculous traffic. I literally crawled to their office. Someone's Bmer had broken down at one of the busiest intersections in the city. When I got there, the office was in turmoil. Someone had decided to shuffle everyone's workspace. Laura no longer has a private office. She is in a larger space she shares with another worker. It is also the place where all the files are kept, and people are constantly going in there to access them. The married couple who used to work in that room with another guy have been moved out and separated. That's too bad because they really worked well together. The supervisor who is in charge of the apartment building where Laura and Kyle live had fired off a barrage of emails trying to get Kyle fired because Kyle is asking for improvements at the building. Kyle was volunteering to quit when I came in. Laura was stressed out. She and I left through the back door. The baby screamed all the way home. He would only stop if I held his binky in his mouth while I drove. I chose screaming bloody murder over risking an accident. When I got home my foreign exchange student was still there. She had skipped her classes that started at 9:00 a.m. She was sitting at the table, exactly where she was when I left to get the baby. Her head was down. She was crying. Her girlfriend had broken up with her. Dad was wheezing and gasping for breath. I have never heard him like that. His chest was heaving. He could barely talk. It broke my heart. I put my arm around him and sat with him while Carmi pulled her car up next to the house. We helped him into the wheelchair and then took him out to the car. I had spoken to two of his doctors and they both agreed that it was time to go to the ER again. The sweet side of my dad is something I have always been able to access. We have had a closeness over the years most of my friends have envied. So many of them had huge distances between themselves and their fathers. I was able to talk about almost anything with my dad. Except sex. I didn't talk about sex with my dad; that was just too creepy for me. But we could talk for hours. I accepted his relationships; he accepted mine. We could discuss politics, race, religion, work, secrets, indiscretions, money and whatnot. I spared him most details about Bill's gambling and how Laura had tortured me during her 'difficult' years, and there were things he spared me. The last few years have been hard on us. I saw the side of him that had always bothered other people but not me. I wasn't able to slough it off like I used to. I saw how his criticisms cut others to the quick, and I was unable to sway him to channel Grandma instead of Grandpa. Those were the grim realities that tarnished us but, through it all, I worked hard to remember that as we age, we lose our social filters, and move into an insidious, slow-evolving form of dementia. And sadly, because I have the baby today and Laura and Kyle's lives may be changing as well, I can't go to the hospital with Carmi. The blessing now is that KJ feel into a long, peaceful, much-needed nap without any resistance, and I am able to write this.

I've Held Off but Now I'm Really Upset

For weeks now I have resisted the urge to write a political rant. I get very charged up every four years. I was absolutely stoked in 2008 when Obama won. I felt that the eight-year-reign-of-evil had finally come to an end. It was akin to the feeling I had when Clinton became president---and that one ended a twelve-year-reign-of-evil, one in which a "tax reform" had amounted to me losing all of the write-offs related to my work. Both times I breathed a huge sigh of relief. I thought Reagan was the worst president we'd ever, ever had. Not only did I lose my write-offs, the economy was in shambles when he left office. Then I looked back through U.S. history and saw that starting with Herbert Hoover and the Great Depression, every single time the economy had tanked, it had been with a Republican president at the helm. The only possible exception to that was the Carter Administration when interest rates and inflation went nuts. Republicans have a habit of deregulating concerns that should stay regulated. Then something happens in either banking or on Wall Street and some greedy rich guys pull a fast one, a fast one that would have been prevented had the regulations not been 'de'regulated. That's one part of my rant. But today, in church, I had it. I absolutely had it. I almost got up and walked out. Geeeeezzzz, sometimes some Christians can be sooooo stupid and shallow. Since my father has been ill, I haven't been obliged to take him to his church. Actually, it's my church, too, but I have long since given up on getting anything out of it. I call it The Incredibly Shrinking Congregation, and the message has been so watered-down that all I walk away with is 'God Loves You'. I know that already. The last couple of months have afforded me the opportunity to go looking for a new church. I have been visiting one church the last four weeks. I like the pastor; he's dynamic and his sermons are Bible-based. I like the music; it speaks to me and it's well-done. This morning the pastor was supposed to start a series of sermons on Joseph. But instead, he told us he had decided to put off the series on Joseph for another week, and this morning he wanted to talk about voting. Even though he said he wasn't going to tell us who to vote for, he told us who to vote for. And I left the service feeling like he had told us to vote Republican. BUT! His message lacked depth to the point that I was even more convinced than ever I should vote Democrat. The pastor told us we should consider these Biblical principals when we vote on Tuesday: 1) Vote for who protects human life. To illustrate this he gave us Bible verses, one of which was about how God knit us in our mother's womb. Now I AM one of those people who believes life begins at conception and I DO feel that abortion is murder. That is my opinion. However, when I scratch the political surface on this one, here's what I get: the Republicans will fight tooth and nail for babies to be born but do NOTHING for them after that. They don't believe in providing healthcare, they'd love to cut funds to education (they've been behind all the voucher initiatives), they oppose welfare, etc. They are also the more 'hawkish' party, and if you want to talk about protecting human life, they have been the ones sending troops into battle over the years thus ending thousands of human lives. So, after my surface-scratching, my 'takeaway' on that issue was to vote Democratic. 2) Next the pastor said we should vote for who promotes Biblical marriage. Uh-oh, I thought. There's not a lot of wiggle room here. Ah! But again I scratched, came to my own conclusions, and this is where I probably come off as pretty radical. And please consider my personal history when you read this. I don't think our society does a particularly good job at marriage. People are constantly getting married and unmarried. Marriage has become ephemeral. It's difficult, too! We have to find a better way of doing marriage! And I speak for myself. I am guilty, guilty, guilty of going into marriage and then giving up. I will still say I tried very hard in my marriages, and much, much harder in my second marriage than in my first. I had even gotten to the point where I thought I was good at marriage. In my marriage to Bill I did everything I thought a wife was supposed to do. But, even then, I threw in the towel. I had a breaking point. Even though I thought I had married for life, even though I felt sure both times that there was nothing that could tear us apart, they ended. So, here's where I'm a bit radical: I think marriage is something that should be more difficult to get. I think very few people should get married. Gay marriage? Can they do it any better or any worse than heterosexuals? Nope. I don't think they should do it either. So, do I want to vote for the party that upholds Biblical marriage? Nope. Again, that misses the real point. I believe Americans don't do marriage very well. It's not about what gender people are. It's about how we enter into and maintain our commitments. That's my wacky opinion. Maybe it will change in time. The pastor's message was very clear about for whom he thinks we should vote. His final point was that we should not be in the elephant or the donkey party, but in the lamb party, that is, the party of the Lamb of God. Ok, here I go again. Scratch the surface. What would Jesus do? If he had to vote on Tuesday, and he HAD to choose Democrat or Republican, I think He'd go Democrat. I think that when He said, "....Whatever you did for the least of these, you did for Me...," He didn't mean the least of these to be the top 1% of the population. I'm pretty sure on that one. Jesus would have gone with Obama. The part where Mormons believe God was a man on another planet before He became God, and when you die you go to the planet Kolorg, probably wouldn't sit too well with Him either. Just a guess there. I know, I'm off the chain sometimes but this religion and voting thing pushes my buttons. In any case, my search for a new church will continue. There are three more I am seriously considering. Then there's also the church on the corner.... 1)