Death Vigil: the Ultimate Zen Loss Experience
The hours leading up to 1:23 am this morning are not a blur at all. They are remarkably clear. I recall details that would normally escape notice. I am acutely aware of what I was thinking and feeling daypart by daypart. From the minute we left the house yesterday morning, I knew it wasn't just another trip to visit dad in the hospital. As others have said in their hubs about losing a loved one: I just knew.
Friday night I spoke with his sister in Connecticut. They are symbiotic, those two. She knew something was up. She said he seemed "not himself" the last time she spoike to him. Basically, she confirmed what my gut was telling me.
The signs were all there: sleeping more, eating less, losing interest in present activities. Confusing early childhood memories with recent events.
Still, we always hold out hope, don't we? If only they could get his gout- infected knee under control he could continue with his walking therapy. If only they could take him off the pain meds his appetite would return. I
And yet... in the back of my mind, I knew. I knew that he was getting ready to check out. I know he knew it, too.
My husband and I were sipping coffee in bed, luxuriating in a Sunday morning with no obligations. I planned to forego my usual Sunday visit with Dad in order to be there with my brother for a "care meeting" with his nursing home staff this morning. Something sparked Hubby to ask, "Have you talked to your dad today?" So I picked up the phone and called the facility.
They said Dad was incoherent, that my brother and the ambulance were both on the way.
Incoherence? This was just the latest symptom to be added to the list. Two weeks ago my dad was ambulatory, living more or less independently in a lovely senior retirement facility. Two weeks ago Sunday he suffered a fall and went to the hospital. Not fully recovered, he then went to a "rehab hospital" -- ostensibly to regain the strength in his legs.
From that day on, he declined. The change in his appearance was drastic. He lost both weight and muscle mass. His cheeks became sunken. He lost interest in eating and even in hearing about his beloved grandkids.
I Spied a Snowy Egret
We quickly dressed and grabbed our overnight backpacks. We keep them perpetually packed for just such an occasion (and there have been many medically necessitated "sleepovers" in the past few years).
On the drive through Napa/Sonoma I happened to turn my head at exactly the right moment to spy a lone egret standing in a field. Immediately I knew it was an omen.
The Heron or Egret is symbolic in many cultures. In Egypt the Heron is honored as the creator of light. In Africa, the Heron was thought to communicate with the Gods. As a water bird, the heron is also a symbol of going with the flow, and working with the elements of Mother nature rather than struggling against her.
Clearly, this last symbol is exactly what we'd be encountering.
What are we trying to accomplish here?
Arriving at the Emergency Room I was shocked to see my dad's condition. His eyes, though open, were rolled upward. They had him on a breathing mask and were pumping fluids and antibiotics into him.
He was so dry they couldn't find a decent vein to pull a blood sample from. No urine was outputting from his catheter. To all appearances, his organs were engaged in a race to see which would shut down first.
I sat by his bedside and stroked his hair. I calmed him and told him if he was ready to go, it was ok. He'd talked to me extensively about not fearing death. He was adament he did not want to live to be "old" like some of the nonagenerians at Springfield Place. I can't say I blame him. In fact, for quite some time I've been feeling guilty that my dad's life is not as purpose-filled as it used to be. Not that that is my fault, of course. Just sad that he was reduced to living so much through his kids and grandkids.
My sister and brother feel somewhat differently about it. My brother, god bless him, said as late as 8 pm that he thought Dad would "rally." I wasn't as kind as I could have been when I responded, "you DO?" My sister, the resident nurse of the family, is all about managing the caregivers. She talks tech with the nurses and docs, advising them of things they should or shouldn't do. She has this stern way of looking over the top of her glasses, combined with a slight "tsk" noise that lets you know she's NOT satisfied and you'd BETTER try harder.
So her objective yesterday was to push and push until the ER staff, and later the ICU staff, exhausted every measure.
By the time my dad moved into ICU at 5:30pm he had briefly shown improvement. He was able to sit up, recognize us, and even sip cola from a straw. But that didn't last. He regressed to his intake state and then degenerated from there.
My sister and the doctors explained the delicate balancing act they were attempting with drugs to kill the systemic infection vs. fluids to replenish him vs. drugs to keep his heart rate from dipping too low. It struck me as an exercise in futility. But I knew better than to suggest this to my siblings.
In the ICU he was hooked up to no fewer than five (!!) IV bags. The doctor continued to prescribe medication to keep his heart rate up, although on the natural it wanted to dip. Still no urine output. Still no response from Dad.
We All Process Differently
Here we were, the two people I had shared two parents and a home with during my formative years. And here I was, feeling (as always) like the odd sibling out. At least I had my husband there by my side.
I cannot find fault with their coping mechanism. Truth be told, they were frantically trying to decide whether to cancel a lacrosse tournament this weekend in Palm Springs. So as they sat hovered over their blackberries talking about players, coaches and travel arrangements, I had nothing to contribute. So I sat and prayed. And prayed some more. And then prayed aloud to my dad, just for good measure.
Watching the Monitors
Time is so surreal when you're in a hospital. At 6:30 it felt like 2a.m. When you're staring at a monitor for any sign of improvement, every minute feels like eternity.
My husband and I called it a night at 8:30 and headed to our hotel to get a few hours of sleep. The ICU nurse promised to call if there was any change. Knowing she was going off shift at 11 I called there at 10:40 and was told he was still the same. "Do you think he'll last the night?" I asked. She couldn't (or wouldn't) say.
I slept fitfully with my cell phone under my pillow. At 11:40 it rang. They said we should come. And so we did.
My hubby, my brother and I met back in ICU. My sister had driven home -- too far to come back at that hour.
While Dad was "maxed out" on the meds he'd been given, the law requires the hospital to continue with chemical treatment unless the designated medical power of attorney (who of course is my sister) speaks directly to the doctor to change the treatment plan. This took some doing -- the doctor was busy in the ER. But we finally got the two of them on the phone together and decided to stop the blood pressure elevating drug.
Instead, we switched Dad to "comfort care." This consisted of a little bit of morphine and some atavan to ease any anxiety. Although I wondered if he hd been in pain all this time, I understand why they couldn't give him pain medication before. It's contraindicated for his low blood pressure.
Sure enough, shortly after the med switch, his numbers started dropping.
Dad's nurse heard me saying The Lord's Prayer by his bedside and offered to get a priest. Thank goodness -- I had been asking for that all day!
A lovely priest from Dad's parish named Zomo came out at about 12:30. We prayed together, he read scripture and made the sign of the cross on Dad's forehead. Even unconscious, I believe Dad knew he was being annointed.
The Power of Prayer
When my mom died in 2005, my dad was not with her. At the exact moment of her death he was in church praying for the angels to take her.
I couldn't take my eyes off the monitor as the numbers crept ever downward. Hubby, however, continued praying. He told me later that he had been praying for the angels to come and when he opened his eyes, at that moment Dad's heartrate flatlined.
Coincidence? I think not.
A Burden is Lifted
The nurse pronounced him dead at 1:23 a.m. The vigil was over. He was at peace, and so were we.
Not quite knowing what else to do, we hugged my brother, then drove off into the night as if nothing extraordinary had happened.
Resources for End of Life
- Hospice Foundation of America - End-Of-Life Info
Hospice Foundation of America is a not-for-profit organization that provides leadership in the development and application of hospice and its philosophy of care. Through programs of professional development, research, public education and information