
On April 14th, my dad ran a high fever of 104° and was hospitalized. Antibiotics quickly brought down the fever to 100°, and my dad was diagnosed with a urinary tract infection. My son Brad wasn’t too worried and thought Dad would go home within a few days because he seemed pretty cognizant, lively and in a chipper mood. I was able to talk to Dad on the phone and he sounded good to me too. When I called and talked to the nurse, I got more information and discovered the doctor had said Dad had not only a UTI, but had also developed sepsis. Even so, he recovered from both the UTI and sepsis quickly with the right antibiotics. He was very chatty, in high spirits and eating. All appeared to be on the mend, and Brad snapped a picture of him, which you see here.
The next day when I called, Dad sounded rather congested, and I found out he had developed pneumonia. The type of pneumonia he had was aspiration pneumonia, meaning bits of food or liquids had gotten down into his lungs. His throat had also tightened up, and he was unable to swallow easily. The doctor ordered a barium test to try to gather more information about his difficulty with swallowing, but the test made dad aspirate, and they had to discontinue it. His lungs were filling up. He was unable to eat or drink anything. Everything he ingested – and the doctor tried all kinds of approaches that included thickened liquids, pureed food, liquids, and so on - went straight to his lungs.
My dad’s living will specifically stated no feeding tubes should his condition be terminal and his body start to fail. He never wanted to be a vegetable with artificial devices keeping him alive, and really, who could blame him? Neither would I. If the end is coming, prolonging the inevitable with a feeding tube just seemed like more torture for everyone.
A few years ago Dad had been diagnosed with other physical complications, including aortic stenosis, which is a heart condition where plaque builds up and the aorta narrows. Toward the end, the lungs may fill up, causing shortness of breath. This condition, while eventually fatal, was something that I knew about, and there were no medical reports alerting us that at this time his heart condition had worsened.
I called daily to check with the nurse on how he was improving. Dad was unable to talk on the phone at this point, and all information was coming through to me second hand. The nurse told me that the doctor thought out-of-state family should come to see Dad. In any matter of life, people deliver hidden communications, euphemisms, polite expressions, call them what you will, but they hold a deeper meaning. If you are willing to look and dig beneath the surface, you will find the true message. In this case, in so many words not spoken, I realized that my father was dying.
I flew to Alabama and drove straight to the hospital to visit my dad. Brad was there. Dad had trouble articulating, and you could hardly make out his words. But he was alert and aware of our presence, recognized us and tried to communicate through gestures and speech anyway. Unable to eat or drink, and with no feeding tube to sustain him, just an I.V., it was merely a matter of time now before my dad would pass on. Aortic stenosis was a fatal condition that had begun taking its toll. The next day the doctor decided to discontinue the I.V. Brad and I agreed it would be my dad’s wishes to do so. Upon questioning the doctor, I asked how long someone who couldn’t eat or drink anything would live without an I.V. He told me a healthy person would live 7 days.
We got permission to bring dad out for a ride and brought him to the Lake House in the afternoon. It was a beautiful sunny day in the 70’s with a nice breeze. Brad, Dad and I sat on the porch and looked at the lake. My dad’s speech had further deteriorated, and you could barely make out what he was saying. I asked him if he remembered the house and that it was his house and he said, “Oh, yea.” I told him how much I loved him, how proud I was of him and all his accomplishments—this beautiful house on the lake, his career as an optometrist, the golf tournament he won when was I was a kid as well as other things he had done. I let him know how wonderfully glad I was that he was my father. He smiled. It was hard to decipher his words, but we were able to make out that he was saying it was a beautiful lake, and he asked if there were lots of fish. He pointed to some leaves on the porch and asked if they were mine. To be sure I had understood, I asked “My leaves?” He nodded and said “Yea.” I replied, “Yes.” After about an hour it sounded like he said, “Let’s go.” I asked if he wanted to leave, and he said “Might as well.”
It was wonderful having Brad here to help me make decisions. I don’t know what I would have done without him. We brought Dad home to the house the next day as part of hospice care. My son’s wife had offered up the idea of hospice. It was what her family had done with her mother, and I instantly knew this was what my dad would have wanted. Medicare funds hospice care for the end of life and provides whatever you need which includes a nurse who visits the home to check on the patient. A man from the hospice service came out and set up a hospital bed, an oxygen tank, a tray table and brought a wheelchair. He also left me a suction pump device to clear flem out of the lungs. This pump looked like a rather ominous contraption to me and after explaining its use, the man mentioned I could call for directions again should I find it confusing and need to use it.
An ambulance drove Dad to the house a few hours later. His lungs were very full and his breathing was quite labored. The paramedic told me they had laid him down flat in the ambulance, and he had been failing fast, unable to breathe well. So they sat him up and increased the oxygen from 2 to 4 liters. The ambulance attendant had feared they were going to lose Dad before ever reaching the house.
Dad kept trying to take off his oxygen tubes that looped around his ears and went into his nose. The ambulance attendant told me it was a good sign that he could now move his arms. I would let him take it off, wait a minute or so and then gently put the tube back on. He only removed it about three times and then seemed okay with it, realizing his breathing without it was more difficult. I worried about all the flem in his lungs. His breathing sounded very gurgle-y. I panicked at the idea of using the suction pump, fearing I could hurt him and that he wouldn’t want it anyway. I can honestly say this was my only moment of fear or panic after bringing him home - that darned contraption was a source of confusion. How you were ever supposed to jam the attachment on the end of it down someone’s throat was baffling.
Brad came over after work. He confirmed my decision to not use the suction pump, and I was relieved. Apparently the hospital staff had used a suction pump to clear out dad’s lungs and he fought it tooth and nail. Brad said he thought forcing it on him had hurt him. The decline between the day before and the day they brought Dad to the house was tremendous. Neighbors visited—Brenda and Jim and Wydean. My dad really was only semi-conscious and didn’t appear to recognize visitors, but seemed comforted to be in his house and did know that people cared. Wydean told me the best thing you could do was not to disturb him, not speak.
After about 9:00PM at night I was alone with Dad. His breathing was very congested, and he seemed to be running a slight fever. I wet a wash cloth with warm water and lightly sponged his arms and forehead. In a few hours he felt cooler, and the fever seemed to have gone. I slept in a bed we had put beside his hospital bed. His breathing had cleared up slightly, and he finally closed his eyes. Around 3:00 AM we both went to sleep. I woke up at the crack of dawn, unable to sleep anymore. Dad still appeared to be sleeping although his breathing was a struggle of short breaths. I didn’t sense dad’s presence, and his body was like a little engine that just kept going, rhythmically chugging along with each fleeting breath. I brought my laptop into the bedroom and sat where I could face him.
A very close friend from California had called the night before, giving me her support and told me that she wished she could have been there with me so I didn’t have to be alone with my dad when he passed. In the morning she called again, at 10:20 AM and asked how my dad was doing. I looked up at him, and he was asleep. His breathing sounded smoother, without the loud gurgling noise of full lungs, but his breaths were shorter and quicker, slightly faster than they had been the previous night.
I answered her, saying that he was resting and that his full effort focused on being able to breathe. However, no sooner did I finishing saying this than I watched him take his last breath. It was one of those moments where time seemed to stop, like a freeze frame in a movie. It took a few seconds to register, but I realized that he had stopped breathing. I felt so blessed that my friend was with me in that moment, that the timing of her call was perfectly matched to the moment of his passing. He never woke up and was able to go very gracefully. Everyone has their time. To have been able to allow him to go in dignity, within the privacy of his own home fulfilled his wishes.
The nurse from hospice care was supposed to have arrived at 10:30AM, but she was 45 minutes late. I truly believe my dad was ready and wanted to go when there were no other nurses or professionals around. He seemed at peace now. I knew the nurse would come and call the coroner. I called Brad’s cell phone and left a voicemail. Time was moving in slow motion now. I called Jim and Brenda, and they arrived just after the nurse, who began to clean up my dad. The flood gates to my heart burst open as I shook with grief and tears while Brenda hugged me. May 1st, exactly a month from his 91st birthday, my dad passed on.