His Last Day

Monday, October 27, 2008

My phone rings at 5:30 in the morning. Startled awake, I have just enough time to think "this can't be good news" before I answer the call.

Dad has fallen, again. The fifth time in about two weeks. But this fall brought along the first injury. Seems as though he pulled his catheter when he fell. Not all the way out, but enough that the nursing staff had to remove it and try to reinsert it. Except that upon removal, they notice blood in his urine. Their first call was to the ambulance company, and the second call was to me.

Looking back on it now, I feel like a complete shit for what I'm about to admit. Instead of immediately getting dressed, or at least jumping in the shower, I went back to sleep. My alarm went off at 6:30, and I got up and had my morning coffee as usual. Debated the necessity of even GOING to the hospital... after all, they were just going to check him out, admit him for a few days, and then release him back to rehab. We've been down this road before. Do I really have to be there?

As it turns out, yes.

I got to the hospital around 7:30, but the door to Dad's ER triage room was closed. The nurses were in "cleaning him up". After a few minutes in the hall I was able to go in and see him.

But it wasn't Dad.

He was completely incoherent. Mumbling about needing his weapon (Dad was a wartime vet, serving during the Korean War both in Korea and in Germany), and about cleaning the lockers, and several other conversations that I couldn't make out details of. He didn't acknowledge my presence, at all. This was a first, and a painful one.

Doctors and nurses came and went, orderlies took him for x-rays and CT scans, blood was drawn and sent to the lab, and the decision was made to admit him.

I think it was around 11am when we finally got him up to the medical floor. The floor doctor and his RN were both incredibly kind, typical of the hospital staff we've encountered all along at this facility. The nurses had trouble getting his blood pressure on the digital machine, (not uncommon, especially when Dad was sick), so went off to find one of the old manual machines. And then another, and another. After 2 RNs, 3 LPNs, 6 machines, and at least 30 minutes, they finally got a reading.... 48/21.

Insert much hooplah and rushing around, including IV fluids and talk of a transfer to ICU. Dad seemed to respond to the IV fluids (his blood pressure came up to about 65/35), but it was still clear that he needed to be moved to ICU. The floor doctor pulled me out into the hall to ask how "aggressive" the family wanted to treat this situation. I mentioned the patient advocate form on file, naming me as decision maker, and clearly stating no CPR, no defibrillation, and no mechanical ventilation. The doctor seemed satisfied, and went off to do doctorly things.

I knew the transfer was going to take a little while, so I asked the nurse if it would be alright if I ran to the cafeteria to grab something to nibble on. She agreed that the timing was right, and that it was a good idea, stating I was likely "in for a long day". Upon returning to the floor after my quick lunch escape, I discovered the nurses getting him ready to move...

and off to the ICU we go.

More nurses, doctors, exams, blood work, paperwork. More incoherent mumbling from Dad, and still no sign that he's even aware of my presence. An hour or so passes, his blood pressure continues to fall, and the floor doctor comes in to see me. By this time it's clear that although the IV fluids are helping his blood pressure, it's worsening his congestive heart failure, and adding fluid to his already damaged lungs. I'm presented with 2 options:

1. Move to "heavy-duty" heart medications, in hopes of stabilizing his blood pressure through means other than the fluids that are quite literally drowning him. I asked the doctor what this choice would mean, and was told that it would require a painful procedure to start a central line through Dad's groin, and that the medications may help to stabilize him for "a while". When I asked if it would make Dad better, the doctor was unable to even make eye-contact, let alone give me an answer.
2. Do nothing, and call in hospice care.

I told the doctor that I needed some time to speak with my sisters, and that in the meantime I wanted them to do what they could to keep Dad comfortable, and hopefully keep his already precarious condition from slipping further downhill.

It's about 4 in the afternoon now, and after a few phone calls, Dad's 3 girls decided that he'd been through enough. The palliative care specialist had been to see him, and me, and said that she'd come back to see Sis1 upon her arrival at the hospital.

Less than an hour later we were in the little family conference room on the ICU. Talking of officially calling hospice, and whether or not we were looking at hours or days, and what kind of medications were recommended to try to keep Dad as comfortable as possible.

Sis1 sent Grumpy & I off to take a break & get some dinner around 5:30. She insisted, as I had been there for 10 hours already, and clearly needed a rest. By the time we returned around 7, all of the monitors and IVs had been removed, and we were just waiting on the transfer to a private room.

That transfer came around 8:45pm. Dad's breathing had gotten even more labored, so I requested a shot of morphine. He got his "good drugs" (as I call them), and off we went. By a little after 9pm, we were settled into the private room, Dad sleeping (or unconscious... probably the latter) and breathing heavily, me sitting and watching him.

At about 9:15, I noticed a change in his breathing. It switched from being labored and rattly, to almost... delayed. I remember there being enough time between breaths for me to think "was that it? is he gone?", and then he'd fight to take another breath.

At that point, I reached out to touch his leg, and my Dad & I had our last conversation. The details of that conversation are mine, and mine alone. But I will say that when I was done talking to him, Dad took one last breath, and was gone.