Dad was doing better the next couple of days in the ICU after the last bout of low blood pressure, so that Friday, the 17th, they decided to do the tracheotomy as well as a stomach tube. It was the one procedure, of all my mom had agreed to have done to Dad, that she could have refused, but they thought there was a good chance this could help him heal better--allowing him to breath on his own for periods without the invasiveness of putting in and taking out the breathing tube, and the stomach tube would increase the nutrition they were getting to him. It was not meant to be permanent, or extraordinary means, so we went with it. As much as my dad had asked us to let him go, there was no point where we could have made that decision.
It didn't go well--after the procedure, my dad started bleeding from the tracheotomy just as mom got to the hospital. Not one thing in all that they did to him went smoothly. She called me at work very shaken up, of course. It was a horrible couple of hours until they reported that they had it under control and he was recovering. We were having a Thanksgiving potluck at work, but, needless to say, I wasn't much in the spirit for it and hid in my office. Then that evening Dad started bleeding again and they rushed him into trauma surgery and cauterized the incision, and he stabilized. I don't know what we would have done without the cell phones.
Dad did all right that weekend, except for some bouts of low blood pressure which he soon recovered from. That week, they started taking him off the trach for periods to have him breath on his own. One of the first sessions, they left him off it for as long as he could manage it--10 hours--which I think was crazy. They kept pushing everything too fast instead of moving gradually. But after that, they kept him to shorter sessions of 3-5 hours and he did pretty well through that week. I went up Thanksgiving and visited him. He couldn't talk still with the trach, but he looked better than he had since the surgery--his skin seemed to be healing and a better color and we got through the weekend without an emergency or set back, which made us all feel hopeful.
Sometime that weekend, as they kept putting him on more marathon sessions of breathing on his own, after I went back down to Maryland, they moved him to the step-down unit--which I wasn't happy about--again I felt it was too fast, besides the fact that care and conditions in the step-down unit really suck, as described in a previous entry here. I don't think he was there a day or two before he developed a fever and a serious drop in blood pressure, so they moved him to the CCU--the place my mom liked much better than the ICU. I determined right then that I was going to fight hard to keep him there if they tried to move him again too soon.
The tests indicated that Dad had a yeast infection, which are very hard to get rid of, and had a good chance of attacking his heart valve. They put him on antibiotics and he was doing better by the next day. He did well the rest of the week. Which is why they wanted to move him again to the step-down unit on Friday, the insane bastards. Not only did they have no evidence that the yeast infection was gone--they were still doing more tests--but there is less staff on weekends to respond to any problem that develops and might be exacerbated by the stress of the move, and Friday is the worst time to move someone when they are most busy checking out patients.
My mom and brother protested the move, but it didn't do any good. And I wasn't going to accept that, and I would not be denied. So I sat at my desk and made calls. I got a hold of the PA who had been following my dad, a very nice guy, though annoying in that he interjects "God talk" wherever he can in his speech, which I always find terribly inconsiderate--hello, atheists exist and if they are trapped in your care, they can't assert their own beliefs as you impose yours on them. So I spoke with him and he gave me the official hospital song and dance saying the nurse who tends my dad is the authority and thinks Dad is ready. I told him if he moves my dad, he is doing "the Devil's work." That got his attention. And then he listened to my other points. He said he couldn't promise my dad wouldn't be moved on Monday, but any time we could buy him, especially on the weekend, was all I wanted. And then he contacted the floor manager. My dad was not moved.
So Saturday my dad was doing well in the CCU, in a quiet room with a window, well enough to be wearing his glasses and watching a football game. Sunday the fever came back, on and off. They had to give him more meds to get his blood pressure stable and his kidney function was not going well. So we braced. I talked to the nurse that evening--a nurse my mom really trusted who was giving him good care--and she said the prognosis was bad, but she didn't think I needed to come up then.
But his condition deteriorated faster than expected. Monday, five in the morning, my mom called me--they had just called her and said his kidneys and liver were failing and to come in. I was on 3 hours sleep, so I took a shower to wake up before throwing things together and hitting the road. Mom called at 6 in the morning after she and my brother had gotten to the hospital--Dad was unconscious and dying, and they were going to take him off support and give him morphine to ease the pain. Mom asked me if I wanted them to keep him on support until I got there. There was no other answer I could give but no, but I must always remember my mom asked me--I will always be grateful she did that.
He went very fast when they took him off support, before I left the apartment. I settled the cats with enough food and water to keep them a couple of days, called my mom when I got in the car, and she told me he was gone already. I expected as much. She asked me if I wanted the funeral home to lay out his body that afternoon, so I could see him one last time, and I did. That was a hard drive--none will ever be harder. I was very practical though--stopped to get some breakfast, drove carefully.
My mom, brother, and I went to the funeral home that my Dad had picked, run by a man he knew from the Rotary club. He asked us if it was really true that Dad didn't want services and really just wanted his ashes put in a black box, like he had told him. We assured him of that. Dad's face looked good and peaceful. The top of his hair black as ever. My brother said he looked much more like himself than when he died, so I think it was probably good for my brother and mother to have seen him laid out as well, a more peaceful face to imprint in their memory. In my past experience, the last sight of the face imprints over the other memories, so this was important to me.
The funeral director deftly worked out the details with us as painlessly as possible. He asked us to help write the obituary--I kicked myself for not having realized to prepare for this before, but there was good reason not to be. And later I kicked myself for not checking the draft of the obituary that evening online, before it went to the newspaper and the funeral homes website, because they left out his Ed.D. in psychology--something he was very proud of. But my dad's reaction would so be, "I'm not there. What do I care?" and I comfort myself with that each time.
And we grieved. We were a very functional family through this--my brother and I both concentrating on supporting my mom. Like they say, we've been more a "we" through this than ever before--I've been in more contact with them the past 8 weeks than I've been for years. I cried so hard that day my eyes burned nonstop, and my body felt twisted and sore from the drive. My mom felt like she had a cracked rib, but it was really her heart breaking. My brother had to go to the dentist the next day and get a tooth pulled--the one next to the wisdom tooth he had pulled last week became infected. But there was also relief for us. That Dad wasn't in pain in the hospital wanting to die anymore. That mom didn't have to go in everyday, usually twice a day, to the hospital anymore, and could start getting sleep and taking care of her health, as she was beginning to do those last couple of weeks. That we didn't have to worry constantly and be prepared to make decisions and fight the hospital when necessary.
The grief isn't any harder for us than those 7 weeks Dad was struggling and suffering. Mom's doing OK--many people have called and her support net has been strong. Friends and family are being kind and there for us. The siamese kittens, now 8 months old, that my mom got my dad for their 50th anniversary, that Dad so wanted, that he named Auri and Bori, Aurora and Borealis, the Northern Lights, the light at the end of the world, bring laughter, annoyance, and soft purrs, and that's a big help for my mom and brother, just as my herd of cats is for me. My brother is hanging stronger than he's ever done before. I did my big grieving that first day--it just comes in short spells since then--and I know how to pull out when I start finding myself sinking into the grieving spots. We're hanging strong.
Sunday, when my dad started to fail, I realized he might be dying on his birthday, but by that evening I pretty much guessed it. This is Dad. If dying on your birthday is perfect circularity, then Dad's going to die the day before, just to be sure he arrives early. And that's what he did. He was himself to the end.
And that's about it.