My wife reminded me last night that I never finished blogging about Dad's death. I have been so consumed with dealing with Mon's death, that I just haven't taken the time to finish what I started. But now I'm looking at my 47th birthday tomorrow, my first birthday as an orphan, and they are both on my mind.
So, where did I leave off in my post about Dad? I think it was Sunday night, and I had gone down to the nursing home to check on him and to make them give him his morphine more regularly. The next day, Monday, I went in to sit with him for a few hours. He was pretty much the same as he had been the night before. By late morning, my sisters were urging me to get out and take a break. My Mom came by and said the same thing. So I went to the office for a few hours, and then when I couldn't stand it anymore, went back to the nursing home.
By this time it was late Monday afternoon, and he was getting his morphine every two hours, which was as often as they were allowed to give it. The daytime staff were very good about this; it was the second-shift LPN that had a problem with it. Or, to be very specific in his own words to me and Mom that evening "he's not the only patient I have, you know." Incredible, what some people will say to the family of a dying man, isn't it? Are any of your other patients dying right now? No? Well, then, pay closer attention to this one, because he is dying.
Really, I could have killed the LPN myself for saying that in front of my mother.
But I didn't kill anyone. I stayed with her and Dad for awhile, until it was close to her bedtime. Then we both agreed that we would get some rest, and I took her up to her room, and then I went home. At home, I called the Hospice nurse and expressed my frustration and anger at the second-shift LPN. He was the same LPN that was on the evening before, who was not giving Dad his morphine frequently enough, and I wasn't going to have Dad suffer needlessly again tonight. She called the nursing home and talked to the nurse manager, and they promised to monitor the situation more closely. We also talked about the possibility of increasing his dose slightly, as the dose he was on didn't seem to be managing his pain as effectively as it had been the day before. The only way to tell whether or not he was in pain was by the degree of agitation in his body and his breathing rate. When people at this stage of the dying process start breathing at a higher rate, when they start shifting their body around more in the bed, these signs of agitation indicate that they are in pain. And the same dose of morphine that evening was not bringing down his respiratory rate, or decreasing his agitation, as effectively as it had done that morning.
When I went to bed that night, I felt more confident that he would not be neglected, but it was still difficult not to go back down to the nursing home and look in on him again. Exhaustion won out, though, and I was able to get some sleep.
Which was good, because my sister called at 3:30 to let me know that the nursing home had called her, and that it was time. MG and I threw on some clothes and drove over to the nursing home. When we walked into his room, it was obvious that things had completely changed.
The Hospice RN was there, as was the nighttime nurse manager. Dad's breathing was a lot louder, and his entire body was engaged in every ragged breath he drew. It was loud, louder than he had been all weekend. Every breath seemed to take forever, and every exhalation was a moan; it sounded awful. It is difficult to see someone fighting like that and not think they are in some kind of complete agony. The Hospice RN gave me a quick summary of the night, the rapid decline, the increased morphine dosages, and their relative ineffectiveness. And how his breathing had just started decelerating, his heart rate was dropping, and they knew that his time was coming at any moment. Mom had already refused to come down, but I sent MG again to offer to bring her, thinking maybe she was just afraid to be here alone and if she knew I was here she might come.
After MG left, the nurse who was monitoring Dad's vitals turned to me and said "it's time, if you want to be with him when it happens, you need to come over here now." Up until then, I had been standing, rather indecisively, in the doorway. Not sure what to do; afraid. So I walked over to him, and she walked away. The Hospice RN stayed at the end of the bed, and described how it might be - she said "he may stop and restart his breathing a time or two before he goes, so don't be alarmed." I laid my hand on his hand, which was curled up and clenched, so I couldn't hold it, exactly, but I tried. He became less agitated. I leaned down to him and reminded him of the loved ones who had gone before, because I knew he believed that in heaven he would see them again. I told him that I loved him, that Mom loved him, that I would look out for Mom; that his other children, who I mentioned by name, loved him. I repeated what the priest had said when anointing him earlier that weekend, that God would be on the other side of the door, but that it was Dad who would open that door. And I told him again what I had told him several times the previous days, that I knew he might be afraid, but that I also knew he was brave enough to go through that door.
It was probably a minute or two of me talking to him, and his ragged breathing, and then suddenly he stopped. I felt his body shudder for a second or two, and that was it.
The whole thing, from when I walked into the room, to when he died, took maybe 5 minutes. Five minutes that would haunt me for months, but really only a very short period of time. By the time MG came back to tell me that Mom had refused again to come down, he was already gone. I gave myself a few minutes to calm down, to say goodbye, and then I set out to go and tell Mom that he had passed. Walking down the hallway to her room, I couldn't quite believe that I had to tell her he was dead; that he was dead. It's funny how you can be in the room, see it happen yourself, and still it is so surreal as to feel like you imagined it... She was in bed, in her dark room. She cried a little, we talked a bit, I can't remember what we said. It was only 4 in the morning, so I told her to try to get some more sleep. And then I had to go back downstairs and make sure they called the funeral home and the church.
My mother told everyone that he died a peaceful death. I don't know why she thought that was true. Maybe it was wishful thinking on her part. But his death was anything but peaceful, at least, that's how it seemed to me. Sure, we kept his room quiet, and he had company, and he didn't die alone. We minimized his pain. But I will never forget how his body fought those last few moments; it seemed like torture to me, not peace.
My chief comfort in those last moments was the reaction his body had to my laying my hand on him. It felt like as far gone as he must have been, he still knew that I was there, and it helped him. The Hospice RN said that they saw this alot, people fighting like that until a loved one touched them or talked to them, and then the patient just lets go. Like they were waiting for the sign that their family was there. Other people wait until their family leaves the room, and they die while they are alone. My brother-in-law's grandmother chose to die like that, when nobody from the family was with her, after they had been sitting vigil with her for a long time. It's strange how people do seem to choose their moment, even though they seem so lost to us already, long before that.
I prefer my Mom's death. And I prefer to think that she also chose her moment. To roll over in the morning and just not wake up. Now that's a peaceful death.