Tuesday, March 31, 2009

Dad's Last View


I'm at the assisted-living place, waiting for the Reno-Sparks Gospel Mission truck to pick up the last of Dad's furniture. They gave me a six-hour window, and so far I've been here three and a half.

I've gotten a bit of work done, but it's hard to concentrate. This was the last place where we had any hope that Dad might be happy, and while I want to be here to see everything through to the end, being here also makes me sad.

Dad liked his view of the mountains. He preferred his view in Ocean Springs MS, where his apartment windows looked out over the Gulf of Mexico, but this was a respectable second.

I just wish he'd had longer to enjoy it. He only lived in this apartment for a month.

Sunday, March 29, 2009

Getting Through the First Week


The last few days have been hard. On Friday, we donated Dad's medical equipment to Care Chest; that felt good, but was also much more emotional and difficult than I'd expected. The friend who used his truck to transport Dad's scooter, etc., also moved some of the bigger stuff we wanted (a bookcase and a medical scale) to our house.

I'd started Friday in an absolutely foul mood, no doubt in part because I'd forgotten to take my antidepressant the evening before. In the afternoon, I went for a long walk, which helped. Then I went to school for the first time all week to pick up mail and haul home piles of grading. I had some lovely condolence notes from students and colleagues, and also a long, comforting phone message from the nursing-home doctor, who told me I'd been a good daughter and made all the right decisions.

When I got home, Gary asked if we could eat out, since we were low on groceries. We ultimately decided to do our fancy-meal-on-Dad that evening, and, wonder of wonders, managed to get a last-minute reservation at the most expensive of our favorite restaurants. I dressed up in a black skirt, a red blouse -- since red was Dad's favorite color -- and the gold necklace he gave me when I graduated from college. Fittingly enough, we were led to a table with three chairs, not two, so we decided that Dad was there with us. We toasted him, and treated ourselves to the most extravagant things on the menu, and had a great time. It was really fun, and it felt like something Dad would have enjoyed and would have wanted us to enjoy (and it actually wound up being less expensive than we'd expected).

Yesterday was hard, though, because it was the one-week anniversary of his death. I got through it, and even got a little work done -- although the remaining amount is truly scary -- but it wasn't fun. Saturdays will be hard for a while.

This morning I went to church and got a lot of hugs. Now I'm waiting for a friend who'll be dropping by with food; her mother died right before Christmas, and we had a long talk on the phone last night about how disorienting it is to lose a parent, and about how much we wish our culture still gave people space for a year of mourning, instead of expecting them to be functional and competent after two weeks.

I don't expect to be functional and competent for a while. This is a problem, given those piles of grading.

People keep telling me to "be strong," which has become my new least favorite meaningless phrase. What does strong mean in this situation? What would weak mean? Is strong code for, "Don't be visibly upset, because then you'll upset the rest of us?" Can I still be strong when I feel like each limb weighs 150 pounds, the way I do today? (My sister feels the same way, and she has to take care of my mother, on top of everything else.) My body is having physical responses to grief over which I have no control, although I'm trying to be good about exercise. And then there are the people who say, "I hope you feel better soon," as if I have a cold.

Everyone means well. I know that. Nobody knows what to say; I know that too. When in doubt, don't say anything: give the person a hug.

My new favorite saying comes from one of our deacons, who wrote an article for our church newsletter that includes a quotation from Winston Churchill: "When you're going through hell, keep going."

I spoke to my mother today. She told me she no longer enjoys or wants anything. She's no longer interested in the cats or in television, her two mainstays as long as I can remember. My heart aches for her, and for my sister who's working so hard to care for her. My mom's brother is helping out with expenses, luckily. I wish I could be there, but I hope I won't have to be there too soon. I'd like to be able to get through the end of the semester without more upheavals.

But I'll do my best to keep going, whatever happens, as long as I can go very slowly, and limp a lot, and take plenty of naps along the way.

Thursday, March 26, 2009

Good Homes


Today I made arrangements for the stuff of Dad's we don't want or can't use, or that someone else can use more than we can. Tomorrow -- hopefully with the help of a friend with a truck -- we'll be carting Dad's walker, extra Ensure, low-vision equipment, oxygen concentrator, and scooter (that's where the truck comes in, since the scooter won't fit in our car) to Care Chest, a local agency that lends or gives medical equipment and supplies to people in need. Tuesday, the Reno-Sparks Gospel Mission will be picking up Dad's extra furniture and household goods for sale in their thrift shop.

Gary and I had already reimbursed ourselves for the concentrator from Dad's funds, and we'd been vaguely thinking of trying to sell it on Craig's List. But I've decided that I can't stand the idea of making a profit for helping people breathe, so the concentrator will go to Care Chest along with the other medical supplies. They'll be very happy to have it, I'm sure.

That left Dad's meds, most of which were partly used. I'd asked the nursing supervisor at the assisted-living place what we should do with them, and she said to mix them with clumping kitty litter and water and let them decompose outside somewhere. But in addition to environmental concerns -- how much Lasix do we want in the Truckee River? -- and waste of perfectly good meds, this would have meant spending hours popping pills out of bubble packs. I just couldn't see it.

So I asked Care Chest if they take meds. "No," the nice guy on the phone told me, "but the homeless outreach clinic does." So I called them, and was delighted when they said they'd accept our shopping bag of miscellaneous drugs. (I think Dad was on nine or eleven prescriptions when he died, down from a high of twenty-three a few years ago.) This is exactly where Dad would want his extra medicine to go, and when I told the assisted-living nurse, she was delighted, too, and wrote down the clinic phone number so she can donate there.

At my request, Gary went with me to drop off the meds. Reno's new homeless-services complex is beautiful, but predictably enough, it's surrounded by a small tent-and-mattress city, along with people just hanging out on the sidewalk, and I wasn't sure I wanted to be traipsing through there with a bag containing, among other things, a lot of Vicodin (not that the folks outside would have known that). Of course everything went fine, but I was still glad Gary was there.

If you're in the Reno area, please spread the word: don't discard good meds! Give them to HAWC! And give durable medical equipment to Care Chest!

Wednesday, March 25, 2009

Far Green Countries


Dad died on March 21, the day after the spring equinox. The days surrounding the equinox (March 20-25, say) have been difficult for me for years and years now; in fact, the first time we went to Hawai'i over Spring Break, it was because our friend Katharine said, "Bad luck can't travel over water." The March traumas aren't just bad mood on my part, either; they usually take the form of external events I can't have predicted. For instance, a beloved cat died in an especially hideous fashion on March 21 four years ago. When Dad went on hospice, I remember thinking, "Yeah, let's see if he dies on the Equinox." He didn't -- he died the day after -- but it was close enough, especially with the unfortunate cat synchronicity.

When Dad died on March 21, Gary said, "Okay, I believe you about this March thing now."

Today we did more work over at Dad's apartment. Among other things, I cleaned out his file drawers, where I found all kinds of fascinating and useful documents. He had an entire file devoted to Red Jacket, the wooden sailboat he lived on for twelve years. That boat was the love of his life. He was fond of me and my sister, certainly, but nobody could compete with the boat. She was never especially seaworthy, and I don't think he ever actually took her out sailing, once he and Fran managed to get her from Chicago to the Gulf Coast, but she consumed most of his financial and emotional resources. (I'm sure you've all heard the famous definition of a boat: "A hole in the water, surrounded by wood, into which one pours money.") The day in 2002 when Dad sold Red Jacket to his friend AJ, because he could no longer manage the work necessary to keep her floating, was a very sad one for him. AJ didn't have the time or wherewithal to take proper care of the boat either, though, and the last we heard, Red Jacket was basically a pile of scrap in a shipyard somewhere.

Among the documents in the Red Jacket file was the bill of sale. Dad bought Red Jacket on March 21, 1988.

He died twenty-one years to the day after he bought his beloved sailboat. During the days preceding his death, he talked a lot about travel by air and water, but the day he died, he kept saying, "He's working on the boat."

"Who's working on the boat, Dad?"

He couldn't tell me. When I asked if the mysterious "he" was AJ, Dad agreed. But I suspect the worker was someone else.

March 21, 1988 was the first day of the grandest adventure in Dad's life. Knowing that, and having heard what he said before he died, it's now easier for me to see March 21, 2009 as the beginning of another grand adventure. Dad is certainly sailing somewhere, and I have to imagine that wherever he is, he and Red Jacket are both restored to wholeness.

Dad died at dusk, and when Gary and Sherry and I were waiting for the funeral director to come for the body, I told Gary that I kept thinking about the beautiful two paragraphs in The Lord of the Rings when Frodo sails from the Gray Havens, leaving his friends behind. "You should post those two paragraphs on your blog," Gary said, with tears in his voice. So here they are.
Then Frodo kissed Merry and Pippin, and last of all Sam, and went aboard; and the sails were drawn up, and the wind blew, and slowly the ship slipped away down the long grey firth; and the light of the glass of Galadriel that Frodo bore glimmered and was lost. And the ship went out into the High Sea and passed on into the West, until at last on a night of rain Frodo smelled a sweet fragrance on the air and heard the sound of singing that came over the water. And then it seemed to him that as in his dream in the house of Bombadil, the grey rain-curtain turned all to silver glass and was rolled back, and he beheld white shores and beyond them a far green country under a swift sunrise.

But to Sam the evening deepened to darkness as he stood at the Havens, and as he looked at the grey sea he saw only a shadow on the waters that was soon lost in the West. There still he stood far into the night, hearing only the sigh and murmur of the waves on the shores of Middle-earth, and the sound of them sank deep into his heart. Beside him stood Merry and Pippin, and they were silent.
When I teach the book, I always point out to my students how carefully Tolkien describes the difference between what Frodo sees and hears and smells and what Sam, Merry and Pippin are able to perceive. Although this passage isn't a description of Frodo's death, and although Tolkien abhorred allegory, I've always read these paragraphs as an affirmation of faith, a meditation on how those we love, when they leave us, indeed go to places we can't now imagine.

I hope you're heading towards a far green country, Dad, with calm seas and good winds.

Tuesday, March 24, 2009

Slogging


Grief's hard work. I'd known that intellectually, but I've still been floored by how exhausted and predictably-but-unpredictably weepy I've been. My crying jags have decreased from once an hour to four or five times a day, which is, I guess, going in the right direction. I've been gamely tackling chores, but much remains to be done (notably a mountain of grading, getting higher by the minute).

Yesterday, my friend Katharine picked me up to run errands. She told me that she and her friend Pamela -- among the few people here who've met and shared meals with Dad -- have been praying for him. Pamela told Katharine she'd sensed Dad moving confusedly among a crowd of people, and that when she pointed him towards the light, he said, "Thank you." I'm a little skeptical of that, but it's still comforting. (If I'd sensed it myself, I wouldn't be skeptical at all, of course.) They're the ladies with whom I often knit on Thursdays, and this Thursday we're going to do a sort of knitting vigil for Dad, including music and readings. I'm very touched that they suggested this idea, and I'm sure it will make me feel better.

Katharine took me to the funeral home, where I gave the funeral director information for the death certificate, to be picked up from the Health Department later this week. (This is all computerized these days.) I asked if I could see Dad, and the funeral director said yes, so Katharine and I spent several minutes with Dad's latest incarnation. He was very cold, of course, but still recognizably my father, and I had a good cry and kissed him, and Katharine cried too, and it helped with closure. The undertaker told me that Dad's remains have been accepted by the UNR Anatomical Donation program, despite the edema in his left arm which initially made them think they weren't going to take him. (Pamela told me that her 90-something grandmother was rejected from an Anatomical Donation Program for being too old. Jeez!)

From the funeral home we went to the nursing home, where I learned that I'm getting a full refund of the extra money I paid last week. That was good news. Then it was off to the bank, where I closed out Dad's account. We ran an errand of Katharine's, stopped for a yummy Austrian-food-and-pastry lunch, which I bought for us from the cash Dad had given me before he went into the hospital this last time, and then took a shopping break at a yarn store. From there, we went to Dad's old apartment to collect mail (I found a note that I could collect a parcel of mail at the post office today), and then to my and Gary's bank so I could open a separate account with Dad's small pool of funds, from which to pay his outstanding bills. I saw someone who looked familiar in the bank waiting room, and realized that it was the nurse who'd been with Dad when he died, and who'd wiped the tears off my face later. We talked for a few minutes before the account rep called me into her office.

From the bank, we went to the assisted-living facility to start packing up the newer place. I started crying the minute I walked in, of course, and was virtually useless while Katharine -- and, later, Gary, whom Katharine had picked up from home when he got back from his hike -- packed and cleaned and organized. I kept getting distracted by papers and sidetracked by photographs and sideswiped by grief, and around 5:00 I realized I was exhausted and announced that we were all going home. There's a lot more to do in the apartment, but Gary and I should be able to get it done this week.

Dad's file cabinet contains not only a wonderful assortment of family photos, but also the logs of his epic voyage, in a none-too-seaworthy thirty-foot wooden sloop, from Chicago to the Gulf Coast in 1989-90. Fran was with him on that adventure, and among Dad's DVDs, Gary found twenty-seven minutes of footage of the raising of the sailboat's mast in 1991. This effort involved many large young men, a lot of beer, and tons (literally) of arcane equipment. Dad lumbers through the footage like a slightly roly-poly whitehaired bear, and Fran runs around delivering cold drinks. Gripping cinema it's not, but Dad's years on that boat were the best time of his life, so Gary and I made a copy to send to Liz.

I meant to get to sleep early last night, but instead got to sleep late, slept badly, and was a zombie until about 2:00, when I went swimming for the first time since Friday. I'm still exhausted, though! Yesterday I notified the VA about Dad's death; today I canceled Dad's phone and called his oxygen company to pick up the concentrator -- they'll get back to me when they've received the official order from the VA -- and went to the P.O. to pick up the bundle of mail and put in two change-of-address forms (in the craziness, I'd never filed one for the first apartment) to have all remaining mail sent to my house. Anyone who calls Dad's phone number will get a message with my number, too, so I don't miss any of his calls.

Everyone was very kind when I told them that my father had just died. Many shared stories of their own recent bereavements.

Oh, this morning I also called the Anatomical Donation Program to find out where Dad's body is going, since the funeral director told me they'd be using it "soon," which doesn't fit with dissection by first-year medical students. The program coordinator told me that Dad's "remains" would be used in the next month, perhaps to train surgeons in new techniques or to teach flight nurses how to insert chest tubes. I wound up sobbing into the phone and blubbering, in one of the week's more surreal moments, "B-b-but I want him to be dissected by medical students! Because I teach narrative medicine at the medical school, and I want to go to the memorial service next year and hear what they've written about my Dad! Please, can't you make sure he's dissected by medical students?"

"We'll try," the woman told me, sounding slightly flustered, "but I can't promise anything."

I guess he'll be helping science no matter what, but I really do want him to be a first-year medical-school cadaver, in part because that way he'll be worked on longer and won't be cremated as soon. I'm not ready for his "remains" (oh, for heaven's sake, just say body or corpse, can't you?) to be burned up so soon. Weird and morbid, I know, but there you have it.

Oh, and here's another surreal moment. Before we entered the apartment yesterday, I wondered if Dad's poinsettia would be dead. The poinsettia was from church at Christmas: people donate them, and then they get given away, and our priest Sherry (the same one who came to be with us when Dad died) gave me this one and said, "I know you can't take it, because it's poisonous for your cats, but maybe your Dad would like it?" I accepted happily, because he loves red, and it's been on his windowsill ever since. I'd watered it once or twice, but was sure it must have died in the last few weeks, so I was delighted to see it still perky and red on the windowsill.

"Do you want a poinsettia?" I asked Katharine. "We can't take it, because of the cats."

"Sure," she said. But when she picked it up, an odd expression crossed her face. "Susan, this is a virtual poinsettia."

"What?"

"It's fake. It's not a real plant."

"It's fake?" Someone donated a fake poinsettia to church? Jeez! "But I've watered it a few times!"

Katharine and Gary started giggling, and so did I, and finally Katharine, snickering, carried the pseudo-poinsettia into the hall and deposited it on a knick-knack table. My. Amazing things they can do with synthetics these days. Evidently no one at church caught on either, which makes me feel slightly less foolish.

In the middle of all this other stuff, I've also been paying Dad's bills, answering condolence notes (both handwritten and electronic), talking to friends and relatives on the phone -- my sister and I have been talking every hour or two -- and crying a lot. My psychiatrist called today, and so did the people who run the study at Stanford (both the nurse and the doctor).

Various folks have asked about memorial plans. We aren't having a service in Reno, because hardly anyone here knew him. Liz and I will do something with his friends in Ocean Springs, MS this summer or (more likely) next. Dad wouldn't want anything even remotely formal, let alone anything in a church. We have talked about memorial contributions, though. I actually had the wits to ask Dad about this the day before he died. Liz and I haven't set up anything official yet -- registering or whatever one does in these cases -- but if you have money burning a hole in your pocket (really likely in this economy, I know) and want to give to a worthy cause, Dad was a big fan of the Southern Poverty Law Center, which works against hate groups and teaches tolerance.

And, as always, thanks for all of the incredibly moving comments people have been leaving on my posts. As I said when I last posted, I've decided not to respond to them individually, but they mean a lot to me.

Thank you.

Sunday, March 22, 2009

Twenty-Four Hours


By the time I post this, I'll have known of Dad's death for twenty-four hours. It's been such a surreal day: I kept thinking, "What was he doing twenty-four hours ago? What was I doing?" Approaching 7:00, when he died, I became more and more restless, and finally hit on a ritual that calmed me. A little before seven, I lit a candle, started playing "Lark Ascending," one of his favorite pieces of music, and wrote in my journal. The entry turned into a letter to him about how much I miss him. The music and the writing carried me safely past the moment of his death, as well as the moment when hospice tried to reach me and couldn't. Writing this blog post will carry me past the moment when I arrived at the nursing home and found him, and then realized what had happened.

Last night I fired off a lot of e-mails to friends, and my inbox has been flooded with wonderful condolence notes today. I know I need to answer all of them (Emily Post, iirc, points out that this is one of the activities that carries us through grief), but today I didn't have the energy.

I should also answer each of the seventeen comments blog readers left me today, but I hope you'll all forgive me if I respond with a blanket "thank you." Each comment meant a great deal to me; I cherish all of them. So please consider that written seventeen times in response to each of your notes!

I slept horribly last night -- very predictably, I know -- and got up this morning feeling like I was underwater. I've had periodic crying spells through the day, which has dragged very heavily. Gary tells me that time moved more slowly after his own father died, and that's true for me now, too.

I've been on the phone with my sister almost every hour, and I've spoken to my mother and to various friends. My friend Katharine is canceling appointments of her own tomorrow to drive me around to the funeral parlor, the bank, the nursing home, the VA hospital, and so forth. If there's time, we're going to shop for yarn, and on Thursday evening, we're definitely getting together to knit. She said I should bring Dad's favorite music so we can listen to it.

My friend and colleague Chris, who'll be covering some of my classes this week, came over so I could brief him on lesson plans, and also shared some of his own experience from losing his first wife to cancer ten years ago. He told me the best way to deal with regret: by realizing that if we'd done the thing we regret not doing, we'd only regret something else we hadn't done.

I've had many regrets today: for things Dad didn't get to do, for things I think I could have handled better, and most of all for the fact that I wasn't there when Dad died. I wanted to be. I told Dad I wanted to be. He had other ideas. Everyone I've talked to thinks that he left when he did so I wouldn't see him die, but even if he was sparing me, I'm angry, because I didn't want to be spared, and I'm not really spared at all anyway, and how could he not know that?

The hardest part about last night wasn't seeing him lying dead, because he was peaceful and looked like he was sleeping. The hardest part was when the undertaker came and -- after gently asking me if I'd had enough time with Dad -- picked up Dad's body to move it to the gurney. Before that, he'd looked like my father, but when his limbs started flopping around and his head lolled to the side, he was no longer my father, but a husk. Maybe it's good I saw that; maybe it's closure. I don't know. The undertaker carefully arranged Dad on the gurney and wrapped a sheet around him. Before covering Dad's face, he said -- gently again -- "Are you okay with this?" I said I was; I thought I was, but when the sheet went over Dad's face, I started crying again. My father had turned from a person into a package. I kept crying while the package was zipped into a plastic body bag and wheeled out the door, but again, I'm glad I saw all that. I just wish I'd gotten to see the moment that led to it. I'm glad the nurses were there and could describe it to me.

Dad's donating his body to the medical school, so I know that more people will have the chance to learn about and benefit from his life. Every year the medical school has a memorial service for donor families, and the students read pieces they've written about their cadavers. I've heard it's incredibly moving, but only families are invited, so I've never attended one. Next year or the year after, I'll be able to do that. The medical students who learn from my father will, in a strange way, know him better than anyone in Reno except me and Gary, because he didn't have time to make friends here.

Sometime this week, my sister and I will work on an obituary over phone and e-mail. She can't come out here because she's taking care of Mom; there wouldn't be much for her to do, anyway. Instead of a funeral, we'll have an informal memorial service with Dad's close friends in Mississippi, but that won't happen until this summer at the earliest.

As sad as Liz and I are right now, we're glad we can concentrate more fully on Mom.

My uncle (Mom's brother) called today, and I had a nice long talk with him. And someone from Dad's assisted-living facility called. She told me that she wishes all the residents' families were more like me. "You were your father's best and strongest advocate, and he knew it. There's very little more you could have done for him."

That was good to hear, but of course I'm still haunted by what "very little more" I could have done, and whether it would have made any difference. I'll never know in this life, most likely, although I've been half-praying for a sign -- or something I can interpret as a sign -- that Dad's happy somewhere now. I asked my sister to share any dreams she has about Dad, and promised to do the same.

Twenty-four hours ago, I'd known for fifteen minutes that he was dead. There. I'm past the first day.

I've been wearing his watch -- ludicrously huge on my wrist -- since last night, and I'm wearing his favorite shirt-jacket, too, a fuzzy plaid thing that makes me look like a scarecrow, but makes me feel wrapped in warmth. Tomorrow, probably, Gary and I will start packing up his apartment. There are some things of his I know I want, and others my sister wants.

My sister sent me a lot of great photos of him. I'll post them sometime, but not tonight.

Peace be to you all.

Saturday, March 21, 2009

Last Day of Hospice


Dad died tonight at about seven, when I was at home eating dinner. (We didn't find out until we went back to the nursing home at 7:30 and walked in on the body; hospice had left a message on my cell phone, but I'd missed it.) The nurses were turning him and he just stopped breathing. They told me it was quick and peaceful, and he looked peaceful to me and Gary and the priest from my church who came to pray with us, and who stayed until the funeral home had taken away the body.

I'll post more tomorrow. I'm exhausted now.

Rest in peace, Dad. I love you.

Hospice, Day Two


The nurse who came today told me that Dad's got a lot of stuff in his lungs that shouldn't be there: she strongly suspects he's developing pneumonia, which would downgrade his life expectancy from a month to a week.

I also learned that last night's nurse put him on the GIP program -- meaning hospice picks up room and board, but also that they anticipate death within two weeks -- and made him "Code Pink," which means, "Going downhill fast, needs extra attention."

The nursing-home people were as startled by all this as I was: they told me that they took Dad to the dining room for breakfast this morning, and he ate all his food (pancakes and ham). He refused anything for lunch when I was there, although I did get him to eat an entire cup of applesauce.

Since hospice is now paying the room and board that I paid for yesterday, I arranged to have the money we gave them go towards a private room -- it's only an extra $50 a night, a bargain under the circumstances -- and we got Dad moved to a corner room with more space and privacy. I'm home for dinner now, but tonight I'm going to bring our camping cot to Dad's room so I can stay with him. I don't want to miss any final moments of lucidity.

When I was there today, he was mostly gorked out, but (acting on the theory that he could hear everything, even if he couldn't respond) I'd told him that I was going to camp out in his room. An hour or so later, he suddenly opened his eyes and said very clearly, and with evident irritation, "You're doing too much! You're overdoing it! You're blowing this up into an emergency!"

"It's not an emergency, Dad, but it's a life passage,and I want to be with you. And if I decide it's too much, I'll go home, okay? It will be nice to have the cot here anyway, in case I want to take naps during the day."

He grumbled assent to that, but the nurse and I laughed about it later. "He's being a parent," she said, "worrying about you."

I'll be curious to see if he eats any dinner. He said he'd like to see Gary tonight, so Gary and I will go over with the cot etc., and then I'll drop Gary home before going back to stay with Dad.

I'm arranging for coverage for classes next week, at the hospice nurse's recommendation. "This is the time you have with him." Yup.

Friday, March 20, 2009

Hospice, Day One


We got Dad onto hospice today, although not without difficulty. The hospice guy actually told me that financially, it would be better for us to keep Dad on Medicare SNF coverage until that ran out (another seven days), but Dad asked to be on hospice yesterday, and we want their services, and I don't wait to wait seven days. I don't know how many days he has left, and I want them to be as comfortable as possible.

So here's the deal: Medicare covers hospice or SNF, but not both. Medicaid covers SNF once assets are low enough. Dad's assets aren't yet low enough for Medicaid, so Medicare will cover hospice, and the SNF room-and-board will be out-of-pocket until one of the following two things happens: 1) Dad's assets get down to Medicaid levels or 2) Hospice determines that he's within two weeks of death, at which point he goes to "general inpatient" status and hospice picks up the entire tab.

Dad's nursing home costs $7,000/month. They normally require each month's payment up front, but the business manager could see that I was reeling and very kindly prorated the rest of this month, so I only had to write a check for almost $3,000. This came out of Dad's savings, and it's a huge start towards Medicaid eligibility. That sum buys us another ten days, at which point we'll see where we are. He needs round-the-clock care, and can't possibly go back to assisted living.

Man. Dying's expensive! (Of course, if he were at home, Medicare would cover everything, but not everyone has the luxury of being able to die at home.)

He wasn't in great shape today. We made another little video to send my sister, but otherwise, he mostly slept. I'd hoped to get him outside today, since the weather was beautiful -- tomorrow we're expecting a snowstorm! -- but I don't think he'll ever get out of bed again. I hope I'm wrong.

Anyway, so I went to the bank and got the check and paid the fee and gave everybody lots of copies of end-of-life documents, and then we sat around waiting for the hospice nurse to come. Or, rather, I sat around, trying to read, although my concentration wasn't very good. I was crammed into a small space by Dad's bed, holding my book open with one hand and holding his hand with the other. He was asleep, but whenever I tried to work my hand loose, his grip tightened, so I just stayed there. One of the aides brought me a pitcher of water and poured me a glass, since I couldn't do it myself.

I'd been told that the nurse would come after four. I planned to go home for dinner after her visit, and then return in the evening. But she got held up at another nursing home and didn't show up until 7:00. She examined Dad, who wasn't very with it at all, and noted happily that his edema had gone down; he's not producing much urine, though, and he's not eating or drinking much. So his survival estimate's still a month, less if he continues to refuse food and liquid. (I got him to eat a little bit today -- a small bowl of soup and two spoonfuls of yogurt -- and I'm told he ate about half his breakfast, but I don't think he had any dinner at all.) Then she gave me more paperwork to sign, and then she went to the nursing station to write orders. It was now 7:40 or so. I was saying goodbye to Dad to go eat dinner when I noticed that he was gurgling when he breathed, so I raced down to the nursing station to ask the hospice nurse if this was normal.

She followed me back to his room, listened to him, and told me that the gurgling was mostly from his throat, not his lungs, but that she'd order some liquid morphine (given under the tongue) which would both make him more comfortable and "dry him out a bit." She went to take care of this. Dad and I waited, and waited, and he seemed more and more scared and miserable and disoriented. Earlier he'd clung to my hand even while he was sleeping; now he pushed me away whenever I tried to touch him. After fifteen or twenty minutes, I went back to the nursing station, where the hospice nurse explained patiently that morphine was an "emergency supply" and that someone had to trek down to the other end of the building to get it. I went back to sit with Dad.

The SNF nurse showed up with the morphine, in a plastic syringe like the one we use to give our cats liquid antibiotics. Dad calmed down a little, but a vein in his forehead was throbbing very visibly, so I raced down to the nursing station again and asked plaintively, "Is that normal?"

"Yes," the hospice nurse said. "Honey, sit down." She pointed to a chair. "Sit." I sat. She scooted her chair over to mine, took my hands, and started to pray, just like I do with my ER patients, and I started to cry, just like my ER patients do, and she reminded me that hospice will be there for me after Dad dies -- "I think you're going to need us" -- and she asked if my sister was "doing okay with all this," and I asked her to define okay.

"We're both still standing," I told her. "Under the circumstances, I think that's as okay as it gets."

We chatted a bit. She assured me that Dad's doing fine, that he's less uncomfortable than he sounds -- "he can breathe around that gurgle, don't worry" -- and that someone will call me if there's any dramatic change in his condition. "Now go home and eat dinner."

So I did. I left the building at 8:30, having entered it at 1:30, with only a short break to go to the bank. (I did swim for forty-five minutes before I went over there, though.) I think that both the SNF and hospice people are finding me higher maintenance than Dad is, but I also suspect that's kinda normal. I have a hunch that hospice is one of those specialties, like pediatrics and veterinary medicine, where the families are harder to deal with than the patients.

And if my frequent trips to the nursing station aren't normal, well, the SNF and hospice folks will just have to cope, poor souls. They're probably wishing they could give me morphine.

Two Patients


My latest column is up at Hope and Healing. It's very apt right now.

Thanks again to everyone for all your comments and prayers.

Thursday, March 19, 2009

Clearing the Decks


Thanks so much for all the comments on my previous post! I really appreciate everyone's ideas and support.

I was with Dad today when the doctor came in and told him he had about a month to live. Dad seemed stunned, but quickly opted for hospice once he realized that the alternative was bouncing back and forth between the ICU and nursing homes. "Let me die," he said. "I'm tired."

Having made that decision, he acted on it with characteristic directness: promptly (and somewhat gleefully) dismissed all his rehab therapists, announced that he didn't want to eat anymore because his throat hurts too much -- that part freaked me out, I must say -- and demanded that I bring him wine, if not a martini.

I went through a cyclone of emotions: relief, followed by guilt at my relief, followed by grief, followed by numbness. I've settled back into relief, though, more or less. I've also cleared my own schedule so I can spend more time with Dad: my priorities right now are him, my job, and my own health. I was supposed to preach this Sunday, but got someone to cover for me (I'm not even sure I'll be going to church), and I also e-mailed my volunteer coordinators at the hospital to let them know that I'm taking yet another leave of absence.

This afternoon I went for a walk; after dinner, I went back to Dad's, bringing a small container (an empty spice jar) of wine and a comfortable lawn chair for myself, since the nursing-home chairs have been killing my back. It turned out that the doctor -- who hadn't stopped back to talk to us after dropping his bombshell; I know he's busy, but I find that a bit annoying -- had dutifully written a prescription for Dad to have four ounces of wine in the evening. The spice jar holds four ounces, so that worked out fine. The doctor had also written a referral to hospice (we're going with the one we met with yesterday, but will switch if we aren't happy). They'll presumably come on board sometime between tomorrow and Monday.

Dad and I had a nice visit. He was awake and coherent. He'd refused dinner, but I got him to eat a few spoonfuls of a nutritionally-fortified orange sherbet, in addition to the wine. Any food now makes him cough and choke terribly, and I can understand why he's reluctant to eat. But we had a good talk about all kinds of things: music, how hospice works, his current physical and emotional condition. He was worried that taking care of him would interfere with my job, and I found that touching.

My sister had asked me for some photos of him, so she'd feel more connected, and I'd taken some earlier in the day. Then I got the bright idea of taking a short video so Dad could say hi and tell Liz he loves her. She e-mailed me that she really liked the video, so Dad and I are going to try to send her one every day. I don't know how long that will last, especially if he's not eating, but it's a nice goal.

When we were talking about music, he told me about a Paul McCartney song he likes, "The End of the End," and asked me to look for the lyrics on the internet. (Hurrah for BlackBerry!) When I found the lyrics, the chaplain in me perked right up, as you'll understand the second you read them:

At the end of the end
It's the start of a journey
To a much better place
And this wasn't bad
So a much better place
Would have to be special
No need to be sad

On the day that I die I'd like jokes to be told
And stories of old to be rolled out like carpets
That children have played on
And laid on while listening to stories of old

At the end of the end
It's the start of a journey
To a much better place
And a much better place
Would have to be special
No reason to cry

[Whistling]

On the day that I die I'd like bells to be rung
And songs that were sung to be hung out like blankets
That lovers have played on
And laid on while listening to songs that were sung

At the end of the end
It's the start of a journey
To a much better place
And a much better place
Would have to be special
No reason to cry
No need to be sad
At the end of the end

I read Dad the lyrics. He said he doesn't believe in the better place -- he doesn't believe he's going anywhere -- but he likes the parts about jokes and stories and songs, and about how there's no reason to be sad. As long as I can remember, he's told us not to be sad when he dies; he wants us to have a party instead. I told him that Liz and I are sad anyway, because we love him and we'll miss him.

We also teased each other. When I told him that I wasn't preaching this weekend, or maybe even going to church, I said, "See, Dad, aren't you happy about that? You got me to stop going to church! It worked!"

He smiled, and later, when I asked him if he had any regrets aside from not sailing around the world, he sighed and said, "Having two daughters! How do you undo that?"

"I dunno, Dad. That's a tough one. You'd need a time machine."

We held hands a fair amount (when I wasn't wiping wine dribbles off his face), and I left after the nurse gave him his evening meds, which included a sleeping pill.

So, all in all, not a bad day. We'll see what tomorrow brings.

Wednesday, March 18, 2009

Yo-Yo


We've been up and down around here, with the latest emphasis -- unfortunately -- on down.

To recap: As you'll recall, Dad was released from the hospital Thursday after treatment for severe edema, and went to a nursing home. On Friday, I noticed that his left arm was swollen. It hadn't been in the hospital, and his right arm was normal. I mentioned it to the nurse and doctor, but didn't hear anything.

On Saturday, his right arm was really swollen. I pointed this out to a nurse, who called the doctor, who decided to send Dad to the ER to make sure he didn't have a blood clot. No, he didn't, thank God; but the ER doc, who'd seen Dad before, said, "You really ought to start thinking about hospice or palliative care, because otherwise he's just going to spend the rest of his life in and out of the hospital."

Back in the nursing home, Dad was sleepy on Sunday -- not surprising, since he'd gotten to sleep at 2 a.m. after the hospital adventure -- but cogent. Monday he did really well: ate all his lunch and dinner, went to PT, and (according to the doctor; the physical therapist disputes this) rolled himself back in his wheelchair from PT. The doctor, whom we like a lot, went over his lab values with me. His kidneys were doing great; his BNP was still high at 1475, but at least had gone down from the 1900 he had when he was in the hospital. I mentioned what the ER doc had said about hospice/palliative, and the nursing-home doc said, "Well, call hospice and make an appointment to talk to them, just to get your ducks in a row. You'll want to talk to the social worker, too. But's let give him a week to see how he does in rehab."

On Monday, I left much cheered. Dad was with it and reasonably cheerful, and had asked for his cellphone so he could make long-distance calls.

Yesterday, Gary and I went to the nursing home with the cellphone and a new portable radio for Dad. He was in horrible shape: very swollen and in some other reality. He recognized Gary, but thought I was my sister. He told us about the bugs who came to visit him, ten or fifteen at a time. They're his ancestors but look like Disney characters, and they help him by telling him when to go to sleep, but then they disappear under a mushroom. He had bizarre tremors and jerking movements. I summoned a nurse, who checked him over and found no immediate reason to send him to the hospital, but told me it was up to me. "This is baseline for him."

"Being this altered isn't baseline for him," I said, but meanwhile Gary was explaining that we didn't want to torture Dad by sending him back to the hospital, which was true, and the nurse said she'd call the doctor (although we never found out what came of that) and tell me if he advised rehospitalization.

I was in tears, but I was also hungry, but I also couldn't stand to leave Dad. Gary said, "Let's go home and have dinner, and you can come back later," and that was a good compromise, so that was what I did. I got back to the nursing home around 8:30 and stayed until around 10:30, just sitting next to Dad's bed. He was asleep, but talking and moving around, reaching for things; at first he kept reaching for something over his head, but then the arm movements changed and it looked like he was trying to turn an invisible doorknob, and meanwhile he was carrying on gibberish conversations I couldn't make out. He didn't know I was there. The nurse stopped by and showed me how he was a little less swollen than before; his extremities were warmer and his color was better, and she'd gotten him to eat some dinner, so that was all good news. But sitting there, trying to decode his dream or whatever it was, I felt absolutely helpless (which, of course, I was).

I went back home and crashed. Oh, I forgot to mention that the day before yesterday, we also took Harley and Figgy to the vet; today was Bali's turn. Harley's lost a bit too much weight, and Bali's gained a bit too much weight, so we're supposed to limit his diet (ha!), and Harley has a UTI -- what is it with UTIs right now? -- and has to take antibiotics for the next two weeks, and may also have early kidney disease. They've been tracking that for a while, but I really hope it's not actively developing. No more chronic medical crises, please!

Anyway, after today's vet appointment, we went to the nursing home to meet with the hospice lady, who was very nice. (In the meantime, the very diligent nursing-home doc called me to report that he's adjusting Dad's meds to try to get more fluids off him.) Gary and I spoke to her in a conference room, and after she'd asked me about Dad's history, she said, "It sounds like he qualifies for hospice." Then we all trooped down to Dad's room so she could meet him.

She introduced herself cheerfully and did a basic exam: looking at the edema in both arms and legs, listening to his chest. He was coherent enough to have a simple conversation with her. "He definitely qualifies," she said quietly. (I'd told Dad we were meeting with someone from hospice today, "just in case," but when I told him who she was, he grew suddenly quieter too.) When she was leaving, I followed her out into the hall and asked her for her assessment of how long he has left. "I'd say a month," she said. She emphasized that she could be wrong, but that estimate feels right to both me and Gary.

Gary and I went back into the room. Dad was being hauled out of bed -- a complicated process, rendered more difficult by his water weight -- to be taken for a shower. When he got back, he was pretty out of it again, and showed no recognition when I said, "I love you, Dad. I'll see you tomorrow."

Leaving, I was in tears again. I got hugs from several people at the nursing station (including someone from church who works there), and managed to have a helpful conversation with the social worker about finances. Medicare covers hospice completely, but won't cover hospice and an SNF, so if Dad stays in the nursing home -- and I can't imagine his being able to go back to assisted living -- we'll have to use his assets to pay those costs until he's eligible for Medicaid. The social worker gave me the Medicaid application.

Oh, I've also had periodic conversations with Dad's physical therapist, who says she can hardly get him to do anything because he's just too weak. I gather speech therapy's going a little better; I don't know anything about occupational.

But, barring a semi-miraculous turnaound of the type Mom pulled off, I suspect that on Monday, we'll be putting Dad in hospice and arranging to let go of the assisted-living place. ("Another move," Gary said gloomily as we walked back to the car.) I hope I'm wrong about all of that.

Meanwhile, the good news is that Mom's back home and doing decently, I think, although both she and my sister are being slightly guarded in their reports. Today, though, my sister reported that she'd given Mom a shower and washed and styled her hair, so they were both feeling cheerful about that.

Yesterday I swam, and today I walked. I'm knitting my first-ever baby blanket, a rush job for a shower a week from Saturday, for a young woman whose first two pregnancies ended in miscarriage and stillbirth . . . so the blanket's also a prayer shawl, woven with fervent requests for this pregnancy to end with a live, healthy birth.

This week is Spring Break, but I'm exhausted and strung out, with that scratchy feeling in my throat that comes from crying too much. Helluva way to spend a vacation.

Maybe Dad will have bounced back tomorrow.

Today's exactly five months since he moved out here. I'm grieving for everything I hoped to do with him that I haven't gotten to do. My church friend at the nursing home that that they could arrange to drive him out to Pyramid Lake in a wheelchair van, but at this point, I'm not sure he'll even be able to tolerate or enjoy that.

At this point, I'm just hoping that sometime before he dies, he'll know who I am again.

Tuesday, March 17, 2009

His Royal Adorableness

And yes, there's also parental news. I hope to catch up with posting today or tomorrow.

Saturday, March 14, 2009

Friday, March 13, 2009

Upswing


Today went much better, even though I'm in the middle of an absolutely miserable allergy attack which has, so far, remained impervious to Claritin.

Today I got phone calls from Dad's speech therapist, occupational therapist, and doctor, so the nursing home's really on the ball about getting his therapy program rolling. The doctor enjoyed talking to Dad, and said that while he qualifies medically for hospice, they're going to try an aggressive rehab program first, to see if Dad can go home. Works for me! The doctor did say that Dad's lungs are "junky," which is a bit worrisome, since he just got out of the hospital to get rid of lung junk. They're going to do another BNP on Monday; I'm curious to see if that's improved.

I spent the morning and afternoon doing work stuff, and then swam for an hour. (Yay!) I went to see Dad around 5:00, when he's often, lately, been completely tuckered out from the day. But I found him sitting up in his wheelchair and very coherent, although he said that last night was the worst night's sleep of his life. His lunch tray was still on his bedside table, and it looked like he'd eaten a lot of it. I wheeled him down to the dining room for dinner, and he ate a lot there, too, and chatted with the two other people at his table.

I couldn't believe how much better he seemed today than yesterday! I'm much heartened, although -- based on experience -- I wouldn't be surprised to find him completely done in again tomorrow. But a decent day is good; we'll take it. (One day at a time, and so forth.)

I left at seven. The evening metamorphosis seemed to be underway: there were plaintive howls for help from the room across the hall, and the wheelchair brigade was collecting around the nursing station. But when I walked through the crowd, the residents in the wheelchairs smiled at me and said hello, instead of looking lost and terrified. (I hope I didn't sound uncompassionate in yesterday's post; I ached for all of them, but the scene was still chilling.)

I hope they don't become lost and terrified as the evening progresses. I hope Dad doesn't, either.

Thursday, March 12, 2009

Nursing Home Blues


So Dad went to the nursing home today. In the afternoon, he was completely exhausted and out of it, but I was really impressed by the place. There were lots of people bustling around -- residents, staff, and visitors, including kids -- and we got prompt and attentive service, and I met Dad's doctor, who hasn't visited him yet but who's board-certified in geriatrics, hospice and nursing-home administration, and promised to evaluate Dad for hospice. The doc's also very personable, which is a plus for anyone, but especially for Dad, who thrives on social contact. Dad's roommate was nice, too.

I zipped home to pick up Gary, and we delivered some stuff from Dad's apartment to the nursing home. Dad was a little more awake, but very confused. He asked plaintively if he was going home with us, and I had to tell him that he couldn't. He asked if I'd come back in the evening, and I told him I'd be back around seven, after dinner. His left arm has become very swollen since yesterday, which alarmed me.

About half an hour after we'd gotten back home, my phone rang. It was Dad. "I'm scared. I just woke up, and I'm scared!" I promised him I'd be there at 7:00. Under the circumstances, I was amazed that he'd a) remembered my number and b) figured out how to work his new phone, which has smaller buttons than he's used to and also requires the caller to dial "9" to get an outside line.

I went over after dinner with a teddy bear for comfort and some family photos for familiarity (not that he can really see them, but I thought he might recognize the shapes). After dark, the nursing home had been transformed into an eerie shell. The halls were empty of both staff and visitors; residents in wheelchairs had congregated, gaping and muttering, around the nurse's station, which was manned by a lone LPN. The wheelchairs and their occupants were everywhichway, as if they'd all rolled downhill down the halls and fetched up in that one spot, and as I passed, the residents muttered more loudly and reached out to me with shaking, skeletal hands. Meanwhile, someone was screaming down the hall. It was like a scene from a zombie movie. (I'm not trying to be unkind here -- Dad's as zombieish as anybody, at his worst -- but I was really expecting George Romero to pop up at any second and yell, "Cut!")

I got to Dad's room. He was in the bathroom. I turned on his radio so he could have some nice soothing classical music, and his roommate asked me to turn it off. Dad's aide came to help him back to bed, and there ensued a string of technical difficulties. She'd rolled his entire O2 concentrator -- one of the big ones -- to the bathroom so he could breathe, but she had to unplug it to get it back to his bed, so he was announcing in tones of increasing panic that he needed air while she pushed the wheelchair and I pulled the concentrator back to his corner and plugged it in. Then the tubing wasn't long enough for him to transfer back into bed comfortably. The aide went to get longer tubing, but wound up disconnecting the tubing and not having the right parts to put it back together. Luckily, Gary and I had put Dad's portable concentrator in his closet (I didn't want it out in the open), so I put him on that until she could find the right connectors, which she eventually did. While she was gone, Dad looked at me and hissed, "What a godawful place!" He was much more cogent than he'd been during the day; I wish it had been the other way around.

We got him into PJs and back into bed. He wanted his meds, which he usually takes between 8 and 9. I went looking for his nurse, and couldn't find anybody. I went back to the room and sat with him a while, and then I heard the nurse's voice and shot out into the hallway to waylay her. But she was already in with another resident, so I glumly told Dad we'd have to wait.

While we waited, I listened to her fielding crises in the hall. She was trying to mix an IV for someone; her aide had vanished; the guy across the hall was screaming "Help!" while she called out, "Just a minute, I'm coming, I'm fixing medicine, I'll be right there!"

Finally she arrived with Dad's meds, and was very kind and patient while he took them. I commented that they seemed to be understaffed tonight, and she told us wearily that she was working a fourteen-hour shift, because another nurse hadn't shown up and they'd asked her to cover, and then the aide had vanished. She was amazingly calm about all this and apologized for the delay in Dad's meds, which evidently he'd been supposed to get at five (it was now nine). When I told her that he was in fact getting them on his usual schedule, she seemed cheered.

Oy. Well, I hope things go better tomorrow. Some of this was just new-place snafus -- we now have an oxygen tube that will stretch to China, if necessary -- and I certainly hope the understaffing isn't chronic (although it may well be, given the nursing shortage). Tomorrow Dad will be evaluated for rehab and will also be seen by the doctor. I'm going to wait to see how all that goes before I pass judgment.

Before I left, Dad told me he was glad I'd come over again. I was glad, too.

Poem, Published


My poem Pneumonia Admission, 10 Y.O. F is now posted at The Yale Journal of Humanities in Medicine.

Cat in Boxtop II

This one fits better!

Wednesday, March 11, 2009

The Conversation


Last night when I got home from the hospital, I sat down to work and instead wound up obsessing about Dad and hospice issues. Among other things, this meant that I had to grade fourteen papers this morning before I went to work, but it was also a sign, I thought, that I should talk to him about it (which many people have been urging me to do).

So this evening when I went to visit, I asked him how he felt about going to the nursing home tomorrow (he's supposed to be transferred at 1 PM). He said he felt neutral towards both that and everything else. He's been sleeping most of the time, not eating much, and very lethargic, reporting some shortness of breath and pain even at rest: classic end-stage CHF symptoms. He sounds doubtful that he'll do well in rehab. So am I, although I'd love to be surprised. I asked him what he hoped for, what would make him happy. He told me that he wanted to be better, but that if he couldn't be better, he wanted to be out of pain.

I said, "So if there's a program that would focus on pain relief and quality of life, you'd be interested in it?" He said he would, and I told him about hospice, emphasizing that it didn't mean giving up, that he'd still be given his cardiac drugs for comfort, and that he could leave the program if he wanted to.

He thought it made sense. "I don't want to lie around being a test tube," he told me. "I know I'm going to die. I'm not afraid to die." I asked if I had his permission to request a hospice consult, and he said yes. So I'll get that ball rolling as soon as he gets to the nursing home tomorrow.

It was a huge relief to talk to him about it; I felt like we were no longer dancing around the elephant in the living room. I also feel like the last thing I can give him is the best possible death. He said, "I've lived a pretty full life," and I asked him what he most regretted not being able to do, and he said that he's sorry he never got to sail around the world, which was one of his dreams for years. That won't be possible now, of course, but I'm hoping that I can get him out to Pyramid Lake, which he loves, and maybe up to Tahoe for a boat ride.

I was afraid that he'd be hurt or upset if I raised the issue of his dying, but he said it was a relief. It's been hard to have good conversations with him with that issue in the way, and he said he feels better when he can connect with me.

While we were having our own conversation, the guy in the next bed was being informed by his doctor that he has 3-4 months to live. The physician did an exceptionally good job breaking the news -- she and the patient clearly feel respect and affection for one another -- but this man's much younger than my father, and he was in shock. I went to talk to him and his wife at one point, and when I came back, Dad (who felt very sorry for his roommate) said, "That conversation you had with him, were you being . . . what do you call it, what you do in the ER?"

"Being pastoral?"

"Yeah, I guess. Were you doing that?"

"A little bit. Not as much as I would if I were wearing my chaplain's badge; I mean, I didn't offer to pray with them. But when I asked him, 'How are you getting through this?', that's the quintessential chaplain question. You try to help people find their sources of strength." Dad nodded, and I said, "So, Dad, what's your source of strength?"

"You," he said. "And bits of life, like listening to the news on NPR."

I told him how sorry I am that his time in Reno has been so horrible. I so wanted him to be happy here and have fun, and instead it's been one bout of misery after another. I cried a little bit, and he pulled my head down on his chest and stroked my hair.

And then he went to sleep, and I came home for dinner. Gary and I went to the supermarket, where I was very spacy. But I'm glad the end-of-life issue is out in the open now.

Cat in Boxtop

Cat in Bag

Monday, March 09, 2009

Existential Distress


I had an odd conversation with my father tonight. He asked me to talk to him about the difference between sin and evil, which I did very cautiously, emphasizing that I was only sharing my own opinions. Then he told me that evil doesn't matter anyway, because both the participants and the victims become numb to it. He proceeded to go off on a long existential riff about how life is meaningless, how there's no ultimate reality, and how the world is just an illusion. He allowed as how he loves me and my sister, but then said, "But how important are you, really? You only have the meaning I assign to you."

I gently pointed out that my sister and I are also important to other people, and asked Dad if he wanted to talk to a chaplain. He said, "I am talking to a chaplain." Before I left, I asked the nurse to ask the chaplain to stop by anyway: it may be easier for a stranger to make sense of all this than I can, and anyway, chaplains aren't supposed to minister to family members any more than surgeons are supposed to operate on their friends and relatives.

It turns out that there are articles about existential distress at end of life. There seems to be a fairly extensive literature about whether such patients should be sedated out of their unhappiness.

Dad's nurses are happy with how physically strong he is: evidently he transferred himself to a wheelchair today, and he lifted himself by his grab bar when they were changing his bed, although the effort left him gasping for breath. He may be transferred to a nursing home as soon as tomorrow. We're not sure where he's going -- the VA place or the community facility I requested -- but wherever he lands, I'm going to see about getting some spiritual counseling for him.

And yes, I know: this is what hospice is for. All the medical folks I've asked, though (at least those who know Dad personally) have frowned at me, as if I'm being undaughterly for raising the subject, and said, "Oh, no, it's not time yet!" Tonight I asked Dad if he thinks he's dying, and he doesn't think so, either.

Over dinner, I discussed Dad's distress with Gary, a card-carrying existentialist. We decided that the meaning of life is that motto so beloved of emergency personnel, environmentalists and Girl Scouts: "Leave the place better than you found it."

Works for me. I think that's a lot of what the world's spiritual teachings are about, when you get right down to it.

Sunday, March 08, 2009

Quality Time


I had a pretty good visit with Dad today; at least, I think so, and I hope he does. I offered to read from The Once and Future King, but instead he requested a gigundo hardcover history of the Reformation -- which, for some reason, I can't find on Amazon (ah, never mind, here it is) -- so I raced back to his place to get it and then returned to the hospital. My father, the fundamentalist atheist who knows more about church history than most priests I know!

As it turned out, though, he was too sleepy to listen to me read, so instead we listened to some jazz on NPR, and talked to both my mother and sister on the phone, and I got a little knitting done. Dad's nurses are impressed by his upper-body strength -- he lifts himself with a hanging bar when they're changing sheets and such -- which would seem to bode well for PT. His vitals are good. He has some blood in his urine, which they think is just irritation from the catheter, but if that clears up, he can be discharged any time.

My friend Sharon called today to tell me that the nursing home closest to us has a revamped, and supposedly very good, rehab program, so I'm going to request that he go there, since it's also the place I'd want him to be if -- as we all fear -- he flunks rehab and needs to be in a nursing home full-time. He hates the idea of going to one at all. I'm telling him that he has to work very hard at PT to have any shot at going home. I don't expect that to happen, but he's surprised us before, and look what Mom just pulled off!

If he does flunk PT, it will be time to start thinking about hospice. But I'm not quite there yet, and I'm certain that he isn't, either.

Meanwhile, Gary's been coughing for almost a month, since the most recent Palo Alto junket on February 19, and finally allowed today as how maybe he should see a doctor. So I'm going to try to get him squeezed in tomorrow, when I also have to talk to Dad's case manager.

And now I have to grade like a maniac.

Feral Grooming

Saturday, March 07, 2009

Update-A-Rama


Dad's out of the ICU and in a regular hospital bed (with a gorgeous view, which he unfortunately can't see). On Monday, probably, he'll be transferred to a rehab place. The social worker called me yesterday to find out where I wanted him to go. I said, "Wherever they have the best PT," and she told me that she isn't allowed to express opinions about facilities, that it isn't ethical.

I blew a gasket. "I don't know this stuff! You know this stuff: that's your job! I'm really tired of having medical people tell me that they can't give me advice, that I have to decide things like whether my father should go to the hospital. The paramedics on Monday night told me it was my decision! How should I know? Isn't that what they're paid for?"

The social worker listened to all of this very patiently, and suggested that I research nursing homes over the weekend.

"I don't have time for that. I don't have time to visit five different facilities!"

I finally told her to send Dad where he was last time. It's yucky -- all nursing homes are -- but they had excellent PT, and someone had told me it was the best in town. If he winds up having to stay in a nursing home permanently, which is my fear, I'll do the research. This buys me a few weeks, probably, to catch my breath.

Meanwhile, my sister called yesterday to say that Mom was off to the ER again with high potassium, although when she got there they couldn't find high potassium but did find -- you guessed it -- a UTI, so they sent her back to the nursing home with antibiotics. I don't know if this has changed her going-home date of Friday. I haven't talked to her for a few days, which makes me feel lousy, and I have to call.

Dad feels lousy because he has nothing to look forward to. I tried to have a conversation about things he could look forward to -- if he can ever ride in a car again, I want to take him to Pyramid Lake, which he loves and has been wanting to visit since he got here -- but it didn't cheer him up much, and who can blame him? He misses the quality time he spent with my sister (she used to make him dinner and stay to talk and listen to music once a week), and I feel bad that I haven't been doing that for him, but on the other hand, when have we had the chance?

Gary and I went to sit with him today for a few hours, but he dozed and we couldn't think of much to say. Tomorrow I think I'm going to start reading to him; he loves The Once and Future King, as I do, so I'll ask him if he'd like to hear it.

Today was better than yesterday, though. Yesterday I hit a wall: I felt absolutely exhausted and drowning in uncompleted tasks, especially at work (where everyone's being very kind). I felt like I wasn't doing anything well, like I was paying insufficient attention to Dad, Gary, myself, and my job; a colleague to whom I vented said sympathetically, "Well, when everybody's mad at you, at least you know you're dividing your attention evenly." Gary and I had planned to go to a concert last night, because several dear friends were performing, but I just couldn't. I arranged a ride for him, put the fireplace DVD on the flatscreen, and settled down with piles of grading, a pot of tea, and chocolate. It was exactly what I needed, and I've ordered a DVD of the waves at Big Sur for my virtual spring break.

This morning I felt sufficiently caught up to go to the hospital. Yeah, I know: I should have been researching nursing homes instead, but I decided to distract myself with other people's problems. The case manager who was there this morning saw Dad and Fran when they were in the ER in October, and he sent me first thing to visit an elderly patient and his daughter. The patient was exactly my Dad's age, had lived in Dad's assisted-living place, had then moved to the nursing home where I'll be sending Dad for rehab -- "he went there for rehab, but it didn't do any good," the daughter told me sadly -- and was now in the ER for issues very similar to Dad's. The daughter was making plans for hospice. We commiserated. I went back to the case manager and said, "That guy is my father."

"That's why I sent you to talk to them," the case manager said gently, although he can't have known about the assisted-living and nursing-home synchronicities.

So much for distracting myself with other people's problems.

I'm still trying to process this, which is probably one reason I didn't have much to say to Dad today. "Hey, Dad, I met someone just like you whose daughter is putting him into hospice! Small world, huh?" At some point, we need to have that conversation, but I'm hoping against hope that a miracle will occur in rehab.

I'm now babbling. Anyway, after we left dad, we went to Office Depot so I could console myself by browsing. Stationery stores make me happy. I bought a new clipboard case for the hospital, since I've had my old one for four-plus years and it's showing its age. Then we came home and ate dinner, and then I did a bunch of grading. I have lots more to do tomorrow, but the stack's a little less terrifying than it was yesterday morning.

Good stuff: YJHM accepted a second poem, and I submitted two others to other journals. I've gone swimming twice this week. I think I helped at least one person at the hospital this morning, and several staff thanked me for trying to help someone else -- by calling an outside agency -- even though the patient walked out before I could arrange the help. I felt good about my own efforts, though. That's all I can control.

And the world still contains chocolate.

Wednesday, March 04, 2009

Lotsa News


Good News

Mom's going home! My sister called me today and said that since Mom's walking now, they're going to try it. We have no idea what will happen and how long she'll be able to stay there, but she wanted to go home, and now she is.

Pretty amazing! This is the woman who couldn't move herself in bed last week, and now she's walking!

Also, my freshman comp students rock. Usually it's difficult to get three-page essays out of this population, but three of my current students have come to see me with drafts that are seven-to-ten pages. They've been worried that the papers are too long, bless them! And the students have been writing about really brave topics; I even had one guy volunteer to workshop -- which means he'll be showing it to the entire class -- an essay about a very painful family situation.

I'm impressed!

Less Good News

Dad's better in some respects, but still rocky. His vitals are good and his lungs are better than they were, but he still has tremendous edema in his legs. The first lasix they had him on, furosemide, didn't work very well: he's producing urine, but only a third of the amount they'd like to see each day. So today they switched him to a more powerful diuretic, Bumex. We'll see how that works.

Meanwhile, his nurse tells me that he has a "big, boggy heart." His heart isn't contracting very well, so they're going to fuss with meds to try to change that. They're hoping that losing the extra fluid will help. One of the tests they do to assess congestive heart failure measures something called BNP, a hormone produced by the heart when it has to work too hard or when the muscles are stretched. A normal value is below 100, and 900 is considered a marker of severe heart failure.

Dad's BNP is 1,900.

Ouch. The minute the nurse told me this, I whipped out my BlackBerry and started doing Google searches. The higher the BNP, the higher the mortality rate (duh!). The nurse says they'll measure it again tomorrow, and at some point cardiology will be called in -- I'm not sure why they haven't been already -- and will tinker with meds to try to improve Dad's condition. The nurse said that if they can get Dad's BNP down to 1,000, everyone will be really happy.

So Dad's going to be in the ICU for at least another few days; from there he'll go to a medical floor before being sent, probably, to a nursing home. That's if he makes it out of the hospital, of course; we're basically in watch-and-wait mode. He was more coherent today than when I saw him yesterday: he's been giving the nurse a hard time (the nurses love him because he has so much personality), and asked me to feed him the mashed potatoes and apple sauce on his dinner tray. He also talked very briefly to my sister on the phone, but at least it was a conversation. He's very sleepy, though, and was pretty out of it during most of my visit.

At least I know he's getting the best possible care. From that standpoint, it's a relief to have him in the hospital.

Cute News

Today on campus I saw this guy, The Littlest Snowman. Someone built him on a wall next to the campus daycare center. I love the outstretched arms: he looks like a toddler asking to be picked up, doesn't he?

And here's a wider view where you can see the flowers near him. Even with snowkids on campus, spring's not far away!

Status Report


I just called the hospital and spoke to Dad's nurse and doctor. Medically, he's improved: producing urine, down to two liters of oxygen from six, vitals all normal. He's still altered, though, and they've had to mitt his hands to keep him from pulling out his IVs. They may transfer him to a medical floor today, if the nurses there can deal with the IV issue. I hope he won't need restraints, but if he does, he won't be the first person.

Meanwhile, I turned into a giant blob of jelly yesterday and got nothing done. So now I have to grade like a crazy person.

Which, of course, is pretty much what I am right now.

Meanwhile, my mother had a great day yesterday: went to PT twice, did some stair exercises, walked back to her room -- a long way -- with her walker. This is the woman who couldn't move herself in bed a week ago.

My sister and I have commented on how they flip-flop. Usually, one's doing well and one isn't, and periodically, they trade places.

Tuesday, March 03, 2009

Another Day, Another Ambulance


Yesterday was a very busy day: I upped Dad's care level in the morning -- bringing the bill to the maxiumum Gary and I can afford -- got yelled at by the assisted-living nurse about his meds management in the afternoon (she wants them to do it, which we simply can't afford) -- and went to his apartment in the evening to make sure he'd taken his bedtime meds, since he wasn't answering his phone.

I found him profoundly disoriented (as in talking to people who weren't there) and ramming his wheelchair into furniture to try to get to Congress to work on the energy bill. Righto. Dad's politically engaged even when he's demented. After some dithering, I called 911, who came and said that his edema was halfway up his thighs and that his lungs were almost full of fluid, and oh yeah, he had pinpoint pupils which meant he'd overdosed on his pain meds, which made me feel horribly guilty, although now it turns out he may have taken the normal amount but been unable to handle it because his kidneys aren't doing so well.

Off to the VA ER. Up to ICU, where they said he'd stay overnight while they put him on IV lasix to try to get the fluid out of him.

When I called this morning, the nurse told me the lasix isn't working well. He's had very little urine output. He's oriented but still groggy, with good O2 sats but so-so BP. He'll stay in the ICU at least through today. I'll go over there in a few hours; right now, I'm still recovering from last night.

Oh, and yesterday I also swam, taught two classes, met with three students, took care of paperwork at the VA, picked up my own meds from the pharmacy, and, uh, I think there was something else, but I forget. Oh, right: we also met with the social worker in the morning.

Everything's fading into a blur in through here. But I have a purring cat on my lap, which helps.

Sunday, March 01, 2009

A Little Better, Thank You


Dad felt terrible this morning, but called me this afternoon to say he was feeling a tiny bit better. In the meantime, I'd gone over there, coaxed him into eating some lunch, and instructed the caregivers to bring meal trays to his room (without dairy, which he can't have while he's on the antibiotic, but with extra gravy, because he finds "juicy" food easiest to eat). I also changed the dressing on his leg -- the gauze had slipped down around his ankle -- and took his temp and BP: both low, but not drastically so.

We're meeting with the home-healthcare social worker tomorrow. The agency's been threatening to discharge him, since they say he doesn't need nursing care. Since he now has open wounds, however minor, and an infection, I hope to make a case for getting him recertified (which several of his therapists are trying to do anyway).

We had a good church service this morning, with a liturgy-committee meeting afterwards. We divvied up preaching dates, and I asked for (and got) the Great Vigil, my favorite service of the year. I've preached that service twice before, and I love it.

Also, I'm almost -- if not quite -- caught up on grading, although I'm behind on lots and lots of other things.

Two more weeks until Spring Break, when I plan to get tons of sleep. And exercise! And maybe chocolate, even though it's Lent! Lent is always when I most need chocolate.