Wednesday, January 14, 2009

When Death Comes*

My father died at 1 p.m. on Monday, January 12. My mother and I were with him, one on each side, as he quietly, peacefully took his last breaths. I almost missed it. I had gone for lunch. This would have been a great irony. I am, as my Gentleman Friend (GF) likes to say, a good eater. So was my dad. We could always eat. Any time of day. Even if we had just finished a large meal. We appreciate food in our family. Eating was the last of Dad's pleasures to go.

So, I had gone to the hospital cafeteria where I had salmon in creamy dill sauce, wild rice and roasted italian vegetables. I bought my mom a sandwich (her request -- I didn't mean to have a nicer meal than she did) and was heading back up to the room where dad had been moved from emergency only an hour before. As I turned onto his floor a gaggle of nurses and CNAs saw me and exclaimed, "There she is now." They were paging me to come because my dad's death was imminent. I ran into the room. A friend of the family had arrived in my absence. He left the room as I entered and I took dad's side. I can't remember what Mom and I said at that moment. Nothing to each other, but maybe to Dad. We had been singing hymns to him that morning -- Holy, Holy, Holy and For All the Saints, that sort of thing -- and quoting his two favorite psalms -- the 121st and the 23rd. We both know all of these by heart and have for most of our lives and yet we stumbled over words and phrases again and again. We didn't know that Dad was going to die when he came in by ambulance that morning or else we might have packed a bible and a hymnbook for the moment. We weren't prepared for death.

What happened was this: four days before Christmas Dad took two bad falls. He was falling more and more, so this was not especially significant, except that Mom was unable to get him up and had to call in help both times. That was a Sunday. On Tuesday morning he had another bad spill, knocking the back of his head against the corner of a metal table on the way down. This time Mom managed to get him up and to the shower where she was busy trying to clean up all the blood when she realized it was a pretty bad cut. So she finished his shower, bandaged his head, changed his clothes, got him in her car and drove to the nearest urgent care clinic. They put 10 stitches in his head and sent him home, asking Mom to note if he seemed confused. Dad had beginning stages dementia, was mostly blind, mostly deaf and took too many painkillers for the various physical disabilities that kept him in chronic, crippled pain. Knowing whether he seemed more confused than usual was not a simple task.

But rather than complain about his head or his osteo-arthritis or degenerative disk disease pain, all day Dad complained about a sore place on his foot. Mom had taken him to the podiatrist a hundred times in the preceding months for this sore spot, but it clearly had become much worse -- the hole widening and deepening, the area around it turning odd, dark shades not usually associated with Caucasian skin. By the next morning, Christmas Eve, his foot was red and swollen and hot and the sore spot was black. Mom managed, once again (I'm not sure how), to get him into the car and off to a podiatrist. A different one this time, as she was fed up with the lack of help the previous one had been. This one examined Dad's foot, looked up at Mom and said, "I'll do what I can to save his foot." What???

So he cleaned and tended the wound, ordered an oral antibiotic, drew a line in red magic marker across Dad's upper foot and told Mom that if the redness and swelling got higher than the mark to go immediately to the emergency room. My son and I came to her house later that day. My ex was going to a 5 pm service at his church and then coming over to sit with Dad, so Mom, son and I could attend the 7 pm Christmas Eve service at her church. We got home from the service, looked at Dad's foot and knew we had to go to the hospital. Because my ex was there, the three of us managed to get him into a car (how had Mom done this on her own earlier that same day?) and Mom and I went off to the hospital, leaving the ex to put the son to bed and fill the stockings.

Around 2 a.m. they had run every test imaginable and admitted Dad to the hospital. He had cellulitis in the foot, as well as wicked bed sores on his rear end and signs of a small, recent heart attack. He was a mess from head to toe, quite literally. Dad stayed in the hospital for a week, one problem leading to another, but finally getting the infection under control. From there he went to a skilled nursing facility for rehab. With his fever gone and his medications more controlled than at home, Dad was actually quite lucid and in pretty good spirits for a few days. But when the first week in rehab turned to the second, he began insisting that Mom get him out of there and take him home. A week in the hospital, not moving out of bed, had greatly weakened him and he was having trouble even sitting up and holding a cup. There was no possible way he could go home. In spite of his generally good mental capacity, he could not comprehend this. Of course Mom could take care of him. She'd been doing it for years!

On Friday, January 9, Mom and I went to the financial planner's office. I am now the executor of the estate should anything happen to Mom, but this was my first time getting a real lay of the financial landscape. We needed to figure out the situation should Dad be spending months or years in nursing care, which is what we all believed we were facing at this point. The good news was, in spite of huge losses in 2008, Mom and Dad had been so frugal and wise with their money over the years that the planner assured Mom she could keep Dad in nursing care for 12 years before they'd run out of money. We all knew he wouldn't last that long, so this greatly put her mind at ease.

I spent that afternoon with Dad, so Mom could be home alone for a while. He was fairly lucid, but certainly more confused than he had been a few days before. I read him Christmas cards. He kept calling on the nurses to help him get up to pee. He could barely make it from the bed to the wheelchair even with two skilled helpers. As the afternoon wore on he got more agitated and kept saying what a mess things were. I couldn't get him to say what the mess was. Finally, I knew he needed to sleep, so I kissed him, told him I loved him and left.

I had plans to go out of town that weekend which I kept. There was no reason I shouldn't, as far as we could tell. We were gearing up for the long-haul. Months of a man miserable about being in a nursing home. He had said to Mom for years, "Don't ever put me in a nursing home! I'll die if I have to go to a nursing home!" I stayed in touch with Mom and she said that he developed an intestinal infection on Saturday. She was still able to feed him (a good eater, to the end) and get him to respond to commands ("Open your mouth a little wider"), but he stopped communicating verbally and rarely opened his eyes that weekend.

Then Monday morning came and the call that he was being sent to the hospital. Even then, Mom figured he'd gotten dehydrated from the infection or in need of IV antibiotics. As they took his vital signs, his fever was 106. His breathing was labored and his blood pressure was dropping rapidly. Just before I arrived the doctor asked Mom if she wanted extreme measures taken or just comfort care. She asked for comfort care. "Then I give him 24 to 48 hours to live." Death. We didn't know. When I arrived I spoke with the social worker and asked a hospice representative to come meet with us. I thought perhaps we could move him into a hospice facility and out of the emergency room for his last days. I knew from my time as a volunteer hospice chaplain that people could inexplicably hang on longer than expected and I wanted to be ready for the possibility of several days of bedside vigil. Hospice came, but the doctor arranged with the nursing home for us to take him back there, as he didn't think a hospice bed would open in time and knew we could get palliative care at the home. Discharge papers were in place when the doctor came in and told us that he had changed his mind. Dad wouldn't survive the transfer, he thought. They promised to find a bed in the hospital and admit him as quickly as possible, which they did, with great kindness and efficiency. Around noon, Dad was finally settled into his new room -- a quiet one with a beautiful view of the mountains. It was a gorgeous, bright winter day.

Mom and I sat with Dad for a few minutes and then we both realized we were hungry. Even at this point, we figured we had hours ahead of us. Mom asked me to go eat and bring her something. So I did. And almost missed the last moment. But not quite. I'm glad I was there.

I have no regrets, nor does Mom, but one can't help but think about some "what ifs" in those final moments. Mom would have spent the night with Dad, had she any idea of the severity of this infection. I would have gone to see him when I got home on Sunday. And more than that, I would have been kinder to him on Friday.

When I last saw him, he seemed so like he had for months. Demanding, irritable, but pretty lucid and generally OK. I was frustrated with him for not trying harder to sit up, to feed himself. He seemed perfectly happy to have it all done for him, but then angry that he couldn't go home even though he was making no efforts at rehabilitation. He complained about how tired he was. When he asked for water, I tried to insist that he hold the cup himself and get the straw to his mouth. I put it directly in both hands and shaped the one hand around the cup and the other around the handle. He dropped it. I caught it before it spilled and tried again. I snipped at him for not holding on, for not listening to what I was asking him to do. After a third attempt, I held it for him and put the straw in his mouth. But not compassionately. I did it with a huff.

I am not haunted by this interaction. I know that I am forgiven by God and by Dad, if that is a post-life possibility. I can forgive myself. But forgive does not mean forget and I believe that I will remember this moment for a long time. I hope I do. Because it is easy for me to think that had I known this would be the last time I saw my dad with any real life in him, I would have been so much more kind and gentle and patient. I would have compassionately given him the water as he asked and not scolded him. I would have gently rubbed his bald head while he drank. Had I known death was coming in a matter of days rather than months, I'm sure I would have been kind. I was kind on Monday, when it hardly mattered any more.

It's so utterly predictable to learn this lesson now. We never know which interactions will be our last ones. And so every single moment we are called to compassionate presence. There is not a one of us that doesn't know this. But how easy it is to live out of the grudges, the impatience, the frustration. How very human.

Dad is gone. We had a wonderful and difficult relationship for many years. We loved each other fiercely and wounded each other deeply. We fought and we made up. We criticized and we praised. We prayed together and we yelled at each other. We both clamored for Mom's attention and affection in our own ways and often in competition with each other. We could stay angry at each other for too long, but we were never estranged. We both knew we were the apple of the other's eye.

People have been saying this week, "Now he can see again and hear again and walk again!" I really don't know about that. I believe in resurrection, but I have no earthly idea what it means. What it looks like. Does Dad really have a healthy body now? We have joked about him being reunited with some of his obnoxious friends, about them all giving God hell together. Maybe. I don't know. What I do know is this: he lived 81 years. He touched more lives than I will ever know with his own compassion and faith and preaching of the gospel, in both word and deed. He loved Mom passionately, even though he demanded far too much of her for far too long. He did much good in his life -- serving every community he lived in with civic zeal, every church he pastored with vigor and enthusiasm. He loved life. He loved people. He loved God. He loved me.

And now he is gone. Blessed are those who die in the Lord.


*With apologies to Mary Oliver

21 comments:

pj said...

Oh dear. Here's me, being the first to comment as usual, and so under-qualified.

LJ, I'm so very sorry for your loss. Don't berate yourself for not being a perfect angel over those last couple of days. I believe that it's a healthy, self-protective response to lose patience with an ailing loved-one. Everyone does it, and your Dad knew that. Trust me, no one -- on earth or in Heaven -- is disappointed in you.

When my father died I had just turned 20, and I was terrified. I saw him on the afternoon that he died, but not that night because I was just too scared to go back to the hospital. My mom, my two older brothers and my older sister let me get away with it. I was the "baby," after all. I felt guilty for years, but now, as a parent, I know that if the situation were reversed I wouldn't be angry at all.

Again, I'm sorry. It's quite obvious to me where you got your take-no-prisoners attitude, your excellent critical mind, and your stubbornness (and I mean that in the best sense), all of which are evident even over the internet.

And yes, the good appetite. :)

(((((((((())))))))))

lj said...

PJ, who could be more qualified than you? A doctor? Death hits us all. Sorry that you lost your dad so young. Thanks for your gentle response.

You know, I'm really not berating me self, just observing. It's almost amusing how completely self-evident the lessons we need to learn are. Compassion. Duh.

And you're right (though too generous) about the ways in which Dad and I were so alike. Though Mom ain't no intellectual slouch, herself.

Thanks, PJ. Hugs.

eileen said...

((((((((((LJ)))))))))))

Beautiful and true, all of it. We never realize that we should not take each moment for granted until there are no more to take - all of us do it. I know I do.

Ann said...

Prayers for you and all who were loved by your father -- your story is so true - and in telling it you gift us all.

Wormwood's Doxy said...

These wise women have already said everything I wanted to say---so just feel the love and prayers I am sending in your direction.

Jane R said...

((((((lj))))))))

Thank you for this profound and beautiful witness. I think your son will treasure it when he is old enough to read and understand it.

Much love to you and many prayers.

Diane said...

((((lj)))))) your words about your dad are so beautiful, so true. praying for you at this time of loss.

what can I say? Your own words are so wise.

Saintly Ramblings said...

(Sent here by the Mad Priest - and I'm glad he did)

Thank you for writing this.

I wasn't with either of my parents when they died. My mother had been keeping vigil beside Dad for a couple of days. She neeeded a break, and so the next morning I took her out to collect some new curtains she had ordered. We would go to the Care Home in the afternoon. We got back to find a phone message saying he had died that morning. We both felt that he had been waiting for the opportunity to slip away - that somehow us being there had made him hang on.

For my mother, I received the phone call from the hospital and arranged to go across the next day. She didn't wait but died in the night having seen both my brothers.

Both died around the Christmas/New Year time, and a loss at a time of celebration can make it seem even more intense, and the season will be forever linked to it in the memory. But the positive memories grow stronger and the negative ones fade.

My prayers for you and your mother as you adjust to a new way of living.

lj said...

Oh, you all are so kind and so dear. I am so grateful for this virtual community. What can I say? I've been holding vigil at Mom's house all week -- the visitors began arriving as soon as we got home from the hospital and haven't stopped yet. My family is all in town now. It's exhausting, really. This afternoon is the memorial service, but this morning is the time I have chosen to fall apart. I am here at home by myself crying like a baby. I guess I knew this would happen eventually.

SR, thank you for coming over. I haven't been much of a blogger for the past year, but I still feel blessed and loved by this community and I'm glad that you are part of it.

lj said...

And Ann, too, welcome. Sorry -- I'm not completely here, I'm afraid. I'm sure you all understand.

Diane, Jane, Doxy, Eileen -- y'all know I love you. Diane, I hope you haven't frozen to death.

lj said...

And hey, everyone -- look at my Bush Countdown. Four days! I wonder what will happen when it ends?

Dad was a life-long, yellow-dog Democrat, so I know he's enjoying this.

Wormwood's Doxy said...

Crying is good, honey. Let it all out. And then let it all out again, whenever you feel it coming on. (There were many years when I was so numb emotionally that I couldn't cry---tears are a gift, I have found.)

(((LJ)))

Grandmère Mimi said...

LJ, my deepest sympathy to you and your mom. I shall pray for you both for comfort, consolation, and God's peace that passes understanding.

We never know which interactions will be our last ones. And so every single moment we are called to compassionate presence. There is not a one of us that doesn't know this. But how easy it is to live out of the grudges, the impatience, the frustration. How very human.

Oh my! How that resonated.

You were blessed to be there for your dad's last breath of life. I left my mom in the hospital to go home to take a shower, and I got word that my mom died before I had time to shower.

Beautiful writing, LJ.

terri c said...

MadPriest sent me over, and you don't know me, but wanted to let you know another voice joins yours in prayers of celebration and remembrance for your Dad.

Ann said...

As a priest I often see that - the person dies when everyone leaves the room. Like they want to do that part alone.

James said...

LJ, my new fried: Mad Priest sent me here and I'm so thankful that he did. Your post was simply beautiful - stunningly beautiful.

Thank you for sharing your journey with me today: i really needed it.

My prayers for you and for your dad, and for your mom. You'll be listed on the prayers of the People over at my place.

Grandmère Mimi said...

Ann, I was felling guilty for leaving, and the doctor and the nurses both told me that often dying people seem to hold on for a moment when family members step out of the room, and then let go.

lj said...

Oh my, this is such a blessing. I just came home from the church -- interment, memorial service, reception. It was all beautiful and moving and wondeful. But now I am escaping into the quiet of the computer for a moment and I find your beautiful words. Thank you, thank you, thank you.

You are each precious to me, even those of you I've just "met" today.

Kirstin said...

Oh, ((((you)))).

Your words are beautiful and wise. I'm sorry for your loss--and I'm happy that you are who you are.

Paul said...

I am sorry to read of your loss (coming to this late). May deep peace sustain you and love surround you.

lj said...

Welcome, Paul and thank you. And thanks, Kirstin.
I think I'm finally collapsing this week ... first time I haven't been too busy since his death to just stay in bed and let life pass me by a bit.