Last moments

Ever since October, I’ve been going over my Dad’s last moments in my mind. Over. And over. And over. Can’t get ’em out. Probably never will. But maybe writing them out will make them run through my head less frequently.

Be forewarned: this post is about the death part of life, and it may not be pleasant reading.

The day before, my Dad, Joe, got a call from his doctor, telling him his kidneys were failing, and that he needed to come in for another transfusion. That was it. Joe had had enough. He declined the transfusion, and asked to go on hospice care.

Somehow, it became my job to dose my dad with morphine, administered
orally. Actually, I may have volunteered. I was supposed to start with
just two or three drops every two hours, and
increase the dosage gradually to a maximum of ten drops. If Joe wanted
more than ten drops, I needed to get permission from the hospice nurse.
Now, Joe’s not a small man: even after losing 20 or 30 lbs from the
cancer
eating away at his bone marrow, he was 6’2" and still probably 200 lbs.
Trish–my sister’s life partner and an ER doc–just laughed when I told
her I was giving Joe three drops. I doubled the dosage. By the
afternoon, we were at eight drops, and Joe was resting/sleeping
quietly.

The morphine wasn’t for pain. It was to relieve the anxiety of not
being able to get enough oxygen. Joe’s cancer meant he wasn’t producing
mature blood cells, and the lack of red blood cells made walking up a
flight of stairs like running a marathon for him. Just lying in bed was
like walking up three flights of stairs. He could never get enough
breath. The morphine helped with that. He didn’t even want the other
meds they offered. He wouldn’t take the prosac, or the atavan. He just
wanted the morphine.

When Dad was resting, Mom and I scrambled to move furniture around,
and by the end of the day, there was a hospital bed in my dad’s
bedroom.

After he was settled in his new hospital bed with a fresh dose of
morphine, and mom had run off to take care of something, I grabbed my
dad’s hand, which was lying resting on his chest. I squeezed his hand,
and told him I was going to miss him. Alot. He couldn’t even look me in
eye, he didn’t squeeze my hand back (I’d only dosed him a minute or two
prior).

It’s difficult, knowing that my dad wanted to die because life with
his body had no longer become worth living; while at the same time,
knowing he would give anything to hang on if it weren’t for his body,
to experience what he still could of my life, of my mother’s, of my
sister’s and her family’s. I don’t know if that was what Joe was
thinking right then. There were moments when I thought he might not
have wanted me to see him in his last days. But I think he received
some comfort from me being there.

So mom and I set about making things as comfortable for him as
possible. I upgraded my Netflix subscription and ordered a bunch of
DVDs based on the novels of CS Forester and Bernard Cornwell. We moved
the extra TV into the bedroom and had the cable guy coming to put in a
new jack the next morning so he
could watch the West Wing and CNNfn. My dad was set. He was going to
die in his own bedroom. We were going to make it as comfortable as
possible. And with my sister arriving in two days, we would all be
together when it happened.

But it wasn’t as comfortable as possible. The new bed had this
mattress pad with lots of little pockets of air, and a device that
pumped air in and out of the pockets. The idea is that support wouldn’t
change, but the pockets pressing on the skin would. No bed sores. The
fellow who installed the bed said we should start at the firmest
setting, and work down.

Firm didn’t work for Joe, though. He couldn’t sleep (not that he’d
slept well for weeks, mind you), and in the middle of the night when
Dad asked for some relief, mom forgot she could adjust the firmness
setting. They put on a big thick mattress pad on top of the air pad
instead.

Next morning at nine, mom and I were with him, joking around,
cheerful to the point that we joked that Joe probably just wanted us to
leave him alone. He said "yeah!" characteristically mixing humor,
annoyance, and affection. So we did. I went downstairs and logged onto
my laptop. Probably sent some emails for an hour or so. Mom worked in
her office next to the bedroom.

Around 10 am, mom yelled out "Michael!"

I didn’t quite catch the tone, and called up the stairs "what?"

"I need you up here now!"

I got it. And this was more urgent than two nights before, when Dad
slipped on the floor in the middle of the night and couldn’t get
himself up off the floor and back into bed.

I ran. Dad was lying at an angle across the bed, his legs dangling
over one side. The back of his head was pressed against the hard, sharp
edge of a low bookshelf next to the bed.

"I need your help to move him back onto the bed," mom said. "I’m worried the bookshelf will hurt him."

All I saw were his eyes. They were wide open, unfocused. I tried to
move him so his head would be on the bed, but the guy’s big. I couldn’t
move him an inch. So I put my hand under the back of his head so he had
something softer than the edge of the bookshelf, and sat on the bed
next to him. A position that meant I couldn’t avoid those empty eyes.

It didn’t even occur to me to use the pillow. All I could think of
was that his eyes were going to dry out because he wasn’t blinking at
all. I tried to close his eyes. They resisted. I still can’t believe
how hard it was to close his eyelids. I only got them halfway closed
before I asked my mom to get on the phone with the hospice nurse,
because I thought Joe was dying. Mom said wait, the nurse told us there
would be times when he was non-responsive. He was still breathing, we
could both feel a pulse–however faint. So she got the flyer describing
the different stages.

Amazing what goes through your mind when this is happening. Here we
are, reading a flyer about what to expect in health crises during
hospice care. Seems so ridiculous in retrospect. Reading a flyer. Made
perfect sense at the time, though.

The flyer wasn’t clear. There were some things it said we should
expect if Joe was dying, and they weren’t happening. Mom went to her
office to dial the hospice nurse. The nurse told us she’d be there soon.

Dad was now taking these gasping, deep, ragged breaths punctuated by
unnervingly long pauses in between. Then his arm began to twitch. Not
big twitches. Just a tic. A really fast, constant tic.

Then he stopped breathing. His face was pale, the area around his
left shoulder was way darker than it should have been. Cardiac arrest
maybe? I thought "CPR." This is when you do CPR. I should do CPR, so
that my sister can see him one last time, so she can say goodbye, too.
Except that my Dad had signed an advanced directive, he’d made it
perfectly clear: no resuscitation, no extraordinary measures. He wanted
it to end. As he’d told his old friend Gene M. a few days before
"that’s just the way it is."

Then there was this gurgle from the back of Joe’s throat. No more
twitching. No more breathing. No pulse. That was it. I’ve never heard
anything like it. Trish told me later that ER docs call it a death
rattle.

Mom said it wasn’t necessarily over. The flyer said there would be
times when he was non-responsive, when you couldn’t detect a pulse. I
called Chanel, told her I thought Dad had just died, but that mom
wasn’t so sure. Chanel said to wait for the nurse.

I made another try at closing my father’s eyes. This time, I succeeded.

I don’t think more than ten minutes had passed since mom called me upstairs.

Mom and I sat on the chairs next to the bed, me slightly behind her.
We held hands over her shoulder, watching Joe. The only thing either of
us could think to say (and this was all mom), was "poor Joe."

The hospice nurse arrived ten minutes later, around 10:20 am, and
confirmed that my dad had just passed away. Less than twenty-four hours
after he went on hospice care. One day before my sister was to arrive
with Joe’s grandkids. Four days before his seventy-second birthday. Not
even two years into his term as mayor.

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