RIP Dad; UN-dear E.R. doctor

sapphoq on life says: To the emergency room physician, no love. Dad indeed was dying when you saw him. He was dead within a week and a half, having gone peacefully and without pain thanks to the hospice that you didn't think he should be in. Hospice is not an easy decision for anyone to make. Dad wanted hospice and he signed himself up for their services. There comes a time in the life of a terminally ill human being that the burden imposed by continued medical treatment is very great. You had a lot of nerve trying to talk me into extending his life and insisting that he needed to be hospitalized for a possible bacterial infection that [as the lab results indicated] it turned out that my father didn't have. That "...do no harm" stuff wasn't written in to the Hippocratic Corpus for kicks. In my unasked for opinion, you are a bastard.



     After the unfortunate e.r. visit talked about in the last blog post, Dad went back to his assisted living facility. The hospice nurse and I struggled to get Dad into my car, then out of my car and into a wheelchair and up the ramp to his home. The emergency room physician who didn't think my dad should be in hospice would have had to sign off that an ambulance was needed to transport him back home.

     Dad spent the rest of that Sunday very weak and unable to stand up, never mind staggering around the house at will. On Monday morning, the hospice nurse noted an increase in congestion in his lungs but no signs of pneumonia. By Wednesday, Dad was very weak and bedridden. He had begun actively to die.

     I sat with him from last Wednesday through Christmas Eve about 8:42 p.m. (with private duty home health aides to fill in about four hours a day so I could have a bit of time off each day). Through Sunday, Dad was able to talk in hoarse whispers. He had long bouts of terminal restlessness. The hospice stopped his regular meds and ordered oral morphine gel and oral Ativan (tm) for pain and anxiety respectively.

     Because of a fluke in the law, the staff at the house are not allowed to administer meds unless the resident/ patient/ Dad was able to take it himself. Consequently, a family member or designee (the hired outside help) had to be there to do so. The house was also experiencing an outbreak of the flu. Although my mother's sister [Mom and Dad had been divorced for many years but Dad and my aunt had gotten very close during his time up here] and several members of my husband's family offered to take shifts with Dad so I could have time off, I was unable to take them up on their generous offers. This year's vaccine was found to be ineffective against this year's strain of the flu.

     I have an opinion. My opinion is that if a hospice patient is in an assisted-living home, the staff ought to be allowed to administer the meds when a hospice patient is no longer able to do so. Period. The law as it stands represented total fricking hardship to me. 

     Dad had the last rites administered on Thursday. When the priest said, "In the name of the Father and the Son and the Holy Spirit," Dad waved his arm across his chest in response. The hospice chaplain came several times during the week, something Dad appreciated. Staff people and residents started trickling in to say their goodbyes to Dad.

     By Sunday evening, Dad responded with facial expressions and bits of hoarse laughter-- if something I said was funny-- rather than with words. He was still able to move his hand away from over mine when he did not want to hold hands.

     By Monday, Dad was too tired to open his eyes. Mottling started up his legs but never did get to his knees. A swollen lymph node popped out on his neck. The house director told him "it is going to be okay" and he shook his head no.

     By Tuesday, there was veritable light show cascading along Dad's body. I watched as arms and chest and neck and face turned gray and white and blotchy in random [to me] sections.

     Christmas Eve Wednesday arrived and Dad was not scheduled to last past the afternoon, according to the best guesstimate of hospice. He did not experience any apnea until the very end. During the last three minutes of his life, he had a bit of apnea, then a few times where he breathed in but not out, a yawn, another breath in but not out, two yawns, two more breaths, and then a huge smile. Another breath in and Dad was done. Dad died holding my hand.

     I opened the window in a bow to an old Polish tradition [and because that seems to help the staff after a patient dies]. Phone calls were made. A hospice nurse came. I was really tired and went home. She called the undertaker and arranged for his corpse to be transferred.

   
     My Dad had Lewy Body Dementia for more than a decade, almost fifteen years. He struggled hard to keep functioning. He worked until he could not possibly work anymore and long past the age of retirement. He was always there for us kids. He never put a time limit on us when we needed him. I was honored to be there for Dad during his last week. Although the past several years presented many difficulties, hardship, and heartbreak for both of us, we also experienced as much joy as we could squeeze out of life. I wouldn't have missed the extra time I had with Dad during the last several years for the world.