* I feel the need to put one of those “reader discretion advised” warnings at the beginning of this post.  This is the 63rd day, the last goodbye to Papa.  It’s not an easy read; I’ve included a lot of details, perhaps too many for some.  I want to tell this story as completely as possible, so I’ve chosen to do so here.  This day is a big piece of the story for me, but if reading about death is uncomfortable for you,  please feel free to skip over this post. 

 

Text: (from me to a friend)

“Bringing meal to your friend tonight.  Can I get her # to call and let her know when I’m coming?”

 

My Reflections:

I’m in the drop off line for C Bear’s afternoon preschool.  I call a friend of a friend to arrange a time to drop off dinner to her – her premature twins are in the NIC-U and she can use a little extra help.  I’ve never met her before, but my friend asked if I could bring a meal and I’d agreed.

When I get home, I’m in the middle of prepping the black bean chili, not quite started on the corn muffins or salad yet, when Nana calls.

She sounds concerned, more than concerned.  I can tell by her voice that something must be wrong.

I hold my breath waiting for whatever she’s about to say.

Nana explains the situation:

She & Papa were just at an appointment this morning with Papa’s GP to get the stitches removed from his fall last week. Before they left, Papa ate a good breakfast and though weak, was able to get around and to and from the doctor’s okay with Nana’s assistance.  They’d even received a call that morning with the lab results from Papa’s latest blood work for his kidneys – the report was good, the best it has been in years even with all that Papa has been through of late.  When they were at the GP’s office, the doctor removed Papa’s stitches and checked Papa out too, saying he looked to be doing well (as well as possible w/ Papa’s current state of affairs).  On the way home from the appointment, Papa complained of his stomach hurting, something he hadn’t mentioned to his doctor just moments before.  Soon after returning home, he was tired and went to bed to get some rest.  A bit later, he needed to use the restroom and beckoned Nana to help him.  With her help and his wheelchair, they made it the bathroom, but he was unable to move out of the chair to the toilet, even with Nana’s help.  By Papa’s suggestion, Nana called a neighbor for further assistance, but even with this man’s, Nana’s, and Papa’s combined efforts, his weakness was too great to move him.  His GP was then called who advised Nana to get him to the ER and an ambulance was called to assist in the transport since Papa was too weak for them to get him into the car.

And now Nana’s waiting for the ambulance.

She’s not insisting I come, but she’s not urging me to stay home either.  Nana’s not one to worry, but I can hear the worry in her voice now.  And I know I need to get myself to that hospital ASAP.

She says she’ll call me back once the ambulance arrives and she has a better idea of what’s going on.

She hangs up and I’m left to my ground meat, browning on the stove, and my brain whirling with what to do.  I must go, but Little M is napping and C Bear needs picked up from preschool and J Jr. from the bus, and what about the friend of a friend with her NIC-U babies and her expectant dinner of black bean chili?

I call my friend who arranged this meal-thing in the first place, explain to her what’s going on, as much as I know.  She offers to cover for the meal, offers to take the boys too, but even though we try to figure it out, there’s just no realistic way she can be getting her girls and my boy from preschool, her boy from his bus, my boy from his, while juggling her baby and mine, no less.

And then it hits me, as if out of the blue: J.  In the craziness of the moment, I hadn’t even considered calling on him.  Yes, this situation definitely necessitates an early dismissal from work, and when I call him, J is on it, no hesitation, he’s on his way home, and a weight is lifted, no juggling required.

Nana calls back and tells me they will soon be on their way to the nearest hospital, the local “country hospital.”

Oh no, not there!, (I’m thinking, but not saying).

This local hospital wouldn’t be our first choice normally, and especially not at a time like this.  Papa’s hospital of choice, the one with all his records, his doctors, and state-of-the-art, top-notch care is just a bit further away – that’s where they should be taking him now.  But the paramedics say there isn’t enough time, Papa’s blood pressure is dangerously low (low 60s over low 30s), so low that he might not make it if they choose to drive the extra distance to the other hospital.  They must get him to the nearest hospital, and now.

There’s no arguing with that, and I inwardly sigh and raise my hands in exasperation once again.  The situation is out of our control, and not playing out as we see fit…

I tell Nana I will meet up with her as soon as J gets home and I can get myself there.

Ironically enough, as I wait for J, my health coach calls for her scheduled follow-up appointment (one of those get-a-discount-on-your-insurance-if-you-talk-with-a-health-coach sort of things).  I don’t feel like doing this right now, but it’s taken me months to get this thing scheduled in the first place, and I can’t leave till J gets home anyway, so I pick up.

I pace and watch for J out the front window as I mindlessly answer the questions of my health coach (somehow the number of vegetable servings I’m eating daily seems so incredibly pointless right now).  When she asks me if I feel I’ll be able to reach my previously-set goal of exercising 20 minutes, 5 times a week, I mumble something about not being sure about that.

“And why is that?” she asks in a sweet, well-meaning way.

Because my dad might be dying right now.

But I don’t say that out loud.  I’m not sure what I say, but soon the call is over and I see J pulling in the driveway.  Relief & I rush out the door.

I meet Nana and Papa in a room in the ER.  One of their pastors is already there with them.  Papa is lying in a hospital bed, obviously weak and uncomfortable, and semi-incoherent (we can tell he’s only semi-coherent because when they ask him who the President is, he doesn’t know the answer; and normally, politically highly-opinionated Papa would have no problem answering a question like that!).  Every now and then he moans in discomfort and his stomach seems larger than usual under his hospital blankets.  The doctors and nurses are giving him meds to help raise his blood pressure and they conduct various scans, tests, etc.  We know things are serious, but the atmosphere is strangely calm, just a couple nurses coming in from time to time to take vitals or such.  At one point a doctor comes in and explains that they’ve found pneumonia on one of the scans, primarily in Papa’s right lung along with a bit in his left lung.  They will be giving him meds to treat the infection.  The doctor explains that the next 24-48 hours are critical to see how Papa’s body responds to the meds and that if he responds well, there’s a good chance he’ll pull through this.  He further explains that Papa’s condition is too unstable to transfer him to another hospital now, he will have to be treated here and will soon be moved to the ICU.

My heart sinks when I hear this.  I look around Papa’s room in the ER and inwardly cringe.

You mean we’re stuck….

Here?!

I feel like we’re worlds away from where we were just two months ago, in another ER room when this all began, when we found out Papa had a cancerous brain tumor.  I hadn’t given that physical ER room a second thought at that time; but now it’s updated decor and equipment stands in stark contrast to the room where Papa lies now.  Across from where I sit, I notice the old wheeled metal medical cabinets, with their drawers labeled in Dymo tape, and to my left I ponder a mini fridge, complete with it’s faux wood door, sitting oddly atop a circa 1960’s wooden end table, looking more like a set-up you’d find in a frat-house, not an ER room.  I half-wonder what’s behind that faux wood fridge door, some cold sodas for the nursers or vials of important medications and bags of vital fluids?

Clearly this is not where I’d choose for Papa to be right now, but clearly it is out of our hands.  What other option is there, but to hold my breath and hope for the best?

We ask the doctor if Papa’s condition is serious enough to warrant my brother flying cross-country as soon as possible to see Papa.  The doctor is on the fence; saying it’s hard to tell how things will go at this point.

I call my brother, Mark, to let him know what’s going on.  He’s in route to work, but turns around and immediately goes home to make flight arrangements to come out.  I let him know that I’ll call again when I know more.

Someone asks Nana if Papa has an advanced directive, a document listing his wishes for life support, etc., should his condition worsen and deem such.  But in the rush of getting Papa to the hospital, the document has been left at home.  We know what his wishes are, he doesn’t want any heroic measures taken if his quality of life would be compromised, but Nana decides to take a quick trip home to get it, as well as some other things, for what looks to be a long night of waiting and watching in the hospital.  When Nana tells Papa what she’s doing, he tells her not to rush getting back, but to “stay home and get some rest.”  Needless to say, Nana won’t be heeding his advice, but will be returning as quickly as possible.

Nana & Papa’s pastor has been here through all of this, a stable presence reading scripture to Papa and praying with us all and even trying to make small talk with me as Nana has been occupied with paperwork or questions from the nurses.  I appreciate that he’s come, but don’t envy his position.  How odd it must be to be called upon to play a supporting role to the sick and possibly dying, and offering up support for their families as well, some of whom you barely know.  I’m sure it’s not an easy or comfortable position to be in, yet somehow his just “being there” helps and I’m sure this same pastor must be of help to so many families in similar circumstances.

Before Nana goes, the pastor bids his goodbye, and soon it’s just me and Papa left in that ER room.  I sit there and pat Papa’s hand, but there are no profound words to speak, I’m sure I speak some words, but I’m not sure what; Papa is so weak, so clearly miserable and in pain.

Soon the nurse comes to wheel Papa to the ICU and as I follow behind her and the gurney, Papa moaning as we go, I silently pray.  And I’m sure my prayer seems like a horrible prayer to pray about your father at a time like this, but I pray it all the same:

 Lord, please take him soon and take him quickly.

I just don’t want him to suffer any longer.  For there my dad is on that gurney in front of me, a shell of himself, groaning in pain, unable to communicate clearly, weary and spent and discouraged.  He wants to be done with his misery and as I stand there witnessing it, I want him to be free from it as well.  But I know it’s in God’s hands; not mine, not Papa’s; so I keep walking, swallowing past the lump in my throat, and just moving forward, down the hall, into the elevator, out of the elevator, and into Papa’s room with him in the ICU.  Because that’s all… that I…. can do.

Shortly after, Nana returns and meets up with us in Papa’s new room.  There’s one nurse attending to Papa, asking questions, checking monitors, etc.  Again, theres a strange sense of calm, no panic or urgency.  Papa’s room is large, with a couch and a few chairs at one end of it.  Nana asks the nurse if she’ll be allowed to stay the night in the room with Papa, to which the nurse responds that usually they only allow that for patients in critical condition.  There’s a family lounge down the hall that Nana can use.  The nurse adds though, that maybe an exception can be made.  Nana and I are both a bit surprised by the nurse’s response, both of us assuming Papa to fall in the category of “critical condition.”  The nurse’s comment gives us a bit of hope that perhaps Papa is not as critical as we thought.

Mark calls and lets us know that he’s gotten a flight for tomorrow afternoon and we’re glad that he’ll soon be here with us.

Later, the nurse comes in to update us with the results of some of Papa’s scans.  Along with the pneumonia, sepsis has appeared on the scans and there’s also some sort of obstruction to Papa’s bowel.  This obstruction would explain why Papa’s abdomen has been growing more and more distended and why he’s been complaining of stomach pain throughout the day.

When we meet Papa’s attending ICU doctor, he explains that due to Papa’s fragile condition, he’s hesitant to put an NG tube down into Papa’s stomach to relieve the growing pressure Papa is experiencing.  After some deliberation between the doctor and nurses though, it’s decided that this is indeed the best course of action for the moment.

Nana & I wait in the hall outside of Papa’s room while the tube is being inserted through Papa’s nostril and down into his stomach.  From the groans we can hear coming from Papa, we can tell it’s not a pleasant procedure for him to go through.

1. I call Mark again to give him the latest.  I tell him about the sepsis and the bowel obstruction and the NG tube, but for some reason the reception is staticky and I can barely hear what he’s saying on his end and I can tell that he can’t fully catch all that I’m saying either.  I try calling from my phone and Nana’s, even trying from different locations in the hospital in hopes that the reception improves, but it does no good.   This is no time for static!  But yet again it’s out of my control despite my best efforts.

I send out an email to update family & friends and ask for prayer:

Dear Family & Friends,

This afternoon Dad was taken to the ER with very low blood pressure.  Pneumonia was found in his right lung, which is most likely a result of aspiration.  Sepsis was also found (this is a whole-body inflammation caused by the body trying to fight off a severe infection).  The sepsis has progressed to toxic shock and he is being treated for this and the pneumonia with IV fluids and several antibiotics.  If that weren’t enough for him to deal with, he also has some sort of bowl obstruction and was given an NG tube to help relieve the pressure and pain in his abdomen.

Dad is in the ICU of the hospital.  This is not the hospital where Dad is usually treated and where all his doctors are, but it is the closest hospital to their home and it was necessary to transport him there to get him medical attention as soon as possible.  We have been pleased with the care they’ve given him here thus far.

Right now Dad is in critical condition.  The next 24-48 hours are crucial as we see how his body responds to the meds.

Will keep you posted as things progress.  Thanks for your prayers!

Love,

Kari

 

Texts from friends start to come in response:

Oh Kari I’m so sorry saying lots of prayers

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Praying so hard!  Keep me posted as you can…

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Hi, Kari, praying for you all now… may God’s grace & love sustain you, & be everything that you each need in this moment.

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Soon after the tube has been placed, while Nana & I are still waiting in the hall, Papa’s oxygen levels drop dangerously low.  Since he’s been admitted to the hospital this afternoon, his pulse had been challenging to detect, with probes needing to be placed on his head rather than his finger.  But now things are getting worse, much worse.  Nana & I are still waiting outside of Papa’s room when a nurse rushes by calling to another nurse that if they don’t act quickly they will have a “code blue” on their hands (since then I’ve learned “code blue” is used to indicate a patient requiring resuscitation).  So Papa is hooked up to a DPAP machine in hopes to bring his oxygen levels up.  Nana & I return to the room to see Papa in quite a miserable state. A nasty brown liquid is draining from the tube coming out of his nose from his stomach, and it’s obvious he’s in considerable discomfort.  We watch as the doctor & nurses keep monitoring his oxygen levels and such, but things seem only to be worsening.

The doctor asks if we’re willing to have Papa intubated.  We both know Papa would probably consider this a “heroic measure,” but Papa has given Nana final say and both Nana & I feel it’s important to try to keep him with us at least until Mark can arrive to see him.  We give our permission for Papa to be intubated.

They ask us to wait in the family lounge while they do the procedure for the intubation.  They inform us Papa will be sedated.

We wait for what seems like forever.  When we’re finally able to return to Papa’s room, there is no encouraging news.  At this point they can no longer get a reading for Papa’s blood pressure except for pricking his finger for blood and testing that to determine his blood pressure.  A nurse lets us know that Papa’s lungs have started to fill with fluid, especially his right lung, and they are calling in a pulmonary specialist (from his home) to scope Papa’s lungs and drain the fluid.  She goes on to warn us that soon things will be getting pretty intense and she gives us the option to leave the room if we would be more comfortable with that.  Nana & I look at one another and both agree that we want to stay and so that is just what we do.  Papa remains to be sedated, seemingly asleep and unaware of the tubes, beeping monitors, probing nurses, and breathing machine causing his chest to steadily rise and fall.   I’m grateful that he’s seemingly unaware of just how bad off he is right now.

I try to call Mark again, but all I get is some message about phone service not being available in his area at this time.  My heart hurts and I want to scream,

Why now?!  Why now of all times is there no way to reach my brother and let him know that our dad could be dying?  

I text him hoping that that will somehow go through.

Nana & I are sitting there in two chairs, a couple yards from Papa’s bed when the pulmonary specialist arrives and there’s suddenly a group of 8 or so doctors and nurses surrounding Papa’s bed, a medical cart wheeled between us and them.  We can see what’s going on, but can’t see Papa very well with the flurry of people and activity going on around him.   But I can see well enough to see the “fluid” being drained from Papa’s lung via a tube coming out of his mouth; and I must admit that I’m horrified when I see all the blood passing through it (for some reason I’d imagined “fluid on the lungs” would be some sort of clear fluid).

The doctors and nurses are working feverishly, and it’s apparent they are literally doing all they can to help Papa survive.  But as Papa’s levels continue to drop, I can visibly see the worry in both the doctors’ and the nurses’ faces.  They look at the monitors and look at one another and I realize in that moment that they are unsure of what to do next.  I realize that there is only so much they can do and that that might not be enough to save Papa.

And Nana and I sit there and watch in silence, grasping each other’s hand and looking from time to time at each other, wide-eyed.  I’m blinking back tears, some spilling down my cheeks, and my heart is racing and my breath is caught in my throat… and in my head I’m thinking,

This is it.  This is Papa’s time to go.  It’s out of our hands.  It’s out of these doctors’ hands.

The pulmonary specialist comes over to Nana & I and explains that Papa’s lung is filling too fast, so fast that the right is spilling into the left, so fast that Papa’s heart can’t keep up.  He says that there is nothing they can do to stop it at this point.  That it’s too hard on Papa’s heart and it will soon stop beating.  He says that when it does, they could try to start Papa’s heart again, but he wouldn’t recommend it.  That if they did, Papa would need to be on machines to survive and would most likely be in a vegetative state and need to be in a nursing home for the rest of his life.

We know that’s not what Papa would want.  It’s not what we want for Papa either.  We let the doctor know that no heroic measures are to be taken.

Shortly after, a nurse comes over and says that we should come over to say our final goodbyes, Papa will soon be gone.

The machines are turned off and suddenly the frenzy of just moments earlier has turned into a surreal stillness.  From what I can tell, it’s just me, Nana, and a couple of nurses now.  Perhaps the rest of the staff has left to give us our last moments with Papa.  And, more so, perhaps there is nothing left for them to do here.

Nana goes over to say goodbye and I’m right behind her, saying my goodbye and kissing Papa’s cheek, squeezing his hand while the nurses are checking for a pulse; and I wonder if he’s already gone before I even finish, and seconds later the nurse checking for the pulse nods to the nurse next to me that yes, he’s gone.

Papa is gone.