Moments I Just Can't Forget.. Final Installment

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.

Moments I Just Can't Forget... Installment 2

I started writing about my Dad's death on the 10th, because as we were approaching the anniversary, the details of his death were weighing heavily on my mind and my heart. I think the experience of attending your parent's death is probably one of the most traumatic events of a person's life.

After I finished that post, I felt better, and I was able to stop thinking about those details so much. I was still sad, and the anniversary was still weighing on me, but not in the same way.  Perhaps the 14th wouldn't be so bad, if I could just write it all down.

But the week got busy, and I never got back to my blog.  I guess I thought I would have time that Friday, which was the actual anniversary, and is a relatively unscheduled day for me on campus.

Instead, however, I was awoken that morning, September 14th, at 6:30 by my sister, who has just spoken with the nursing home, because my mother had passed away at about 6am. Even as I write that sentence, in my mind I doubt it's reality. And this is two weeks later, so I should be more accepting of it by now.

Her death was so very different from his. She just didn't wake up, probably didn't even know what was happening to her.  By the time I got there, they had prepared her for viewing.  Her coloring had already changed drastically. By now, I am familiar with what people look like when they are newly dead, before the funeral director prepares them for calling hours.  I don't know if I'll ever get used to it, but I recognize it.  She definitely had that look - you could tell just from the doorway that she was gone.  But I leaned over and put my ear to her chest anyway, hoping for a heartbeat; there was none.

She was so very still.  For years now, she had been shaking from strong Parkinsons' tremors, and the disease had been advancing lately, affecting her facial muscles and also causing her to start falling (2 falls in the last week of her life). But all of the tremors were gone. I don't know if she looked peaceful, but she looked at rest - Dad didn't look like he was resting, his body had been through such a struggle in dying that I could still see the effects of that struggle even after it was over. But Mom looked like there was no struggle at all when she passed.

No more shaking. No more difficulty breathing. No more coughing. No more cruel lows or highs.

No more grief. I was not the only one who was carrying around the details of Dad's passing.  Mom wasn't there in his final moments, I don't think she could bear the thought of it. But she spent several hours with me every day, watching him struggle, listening to the "death rattle" as he fought for, or against, each breath.  She was constantly lonely without him, lost without her 50-year reference point.  Good or bad, happy or sad, their lives had been in orbit around each other, and she was lost. 

At one point, while we were sitting with Dad in those final days, she started talking about how afraid he must be. She wondered if he understood that we were there and that he was not alone.  I can remember reassuring her that research has shown that people in his condition are still responsive to voice and touch, and that this probably means they are aware when people are near.  He certainly responded to my voice and touch very differently than he did to Mary's, or to the staff, which I had to assume was because as his daughter, I was more familiar.

I also promised my mother during that talk that when her time came, whether she was aware of it or not, I would be with her just as I was being with him. That he wasn't going to die alone, and when her time came, she wouldn't either.  It didn't work out that way. She snuck out when I wasn't looking. And some times I feel cheated, or like she didn't trust me to do my job.  Other times I feel like I failed her, broke my promise.

Don't misunderstand me - she passed in her sleep without pain or suffering, and I was relieved not to have to watch her suffer.  But I would have liked to say goodbye.

I guess you just can't have it both ways.

Moments I Just Can't Forget... Installment 1

This might be depressing to read, but I think it will be helpful for me to write it, so read at your own risk. Some of the details of my Dad's passing are fuzzy, but some are painfully clear. And today they weigh heavily on my mind, so I'm going to write them down and hopefully stop thinking about them for a while.

Two years ago this morning, Dad had his last seizure. We didn't know it was his last seizure; it wasn't his first, though, and he had already been on Hospice for 6 months.  I think my sister called to tell me about it, because she was the nursing home's contact person. When I called the nursing home later in the day to see how he was doing, they said all of his vital signs were normal and he was stable.  I was supposed to be going out of town to help one sister watch the other sister's kids for the weekend, so she and her husband could go away to celebrate their anniversary.  Should I come by and see him before I leave?  No, he's stable, he's fine.

That's what they said, and that's what my brain heard, but my gut heard something else.  My gut heard the warnings I ignored in 2002, when the attending physician at the hospital said I could go out to dinner first and come see my mother later that night because she was stable. I didn't feel right about it, but I wanted to believe him, so I chose dinner first. But by the time I got there after dinner, she had already slipped into a 20-hour coma, and all I could think about was that I should have been there to see that happening - how could they not see it coming?

So, when my gut heard those same warnings on September 10, 2010, I couldn't ignore it.  I decided to just stop by and look at him myself.  I worked until mid-afternoon, until I just couldn't stand it, and then I left work early to go by the nursing home. I was already packed for my weekend; if he did really look fine, I could go away with peace of mind.

When I got there, I wasn't able to see him at first, because the aides were in there changing his sheets. He had apparently started throwing up.  I sat outside his room and watched them bring in 3 sets of clean sheets over the next hour.  There are only two residents in that room, how many clean sheets do they need? Then the nurse went in there, and she was in there for a while.  None of it felt right to me, not at all.  I think I called my wife, perhaps even my sister, to let them know what was happening.

Eventually, the nurse came out to talk with me.  After his seizure, he really did seem fine, but at about 4pm, just a little while before I got there, his body started shutting down.  They had to change the sheets multiple times because every time they got clean sheets on the bed his body expelled more waste, one way or another, and they had to clean him up again.  He had a pretty high fever, and he was working hard to breathe.  You could hear him out in the hallway, now that the door was open.  In the room, I could see that his whole body was involved in his struggle to breathe. The hospice worker came by for her daily visit, and together, she and the nurse told me that his death was imminent, like four or five hours away.  They started him on a low dose of morphine, since labored breathing is a sign of discomfort, and something for the fever.

In my mind, I was thinking "this is it."  Finally, he can go.  He hardly ever spoke any more, he rarely opened his eyes, I think he had been huddled there in his mind for months, just waiting for his body to stop already.  The weekend before, we had thrown a 50th wedding anniversary party for him and Mom, and his two surviving brothers came, and four of his six kids.  He was more awake and alert and interactive for those two hours than he had been for weeks.  I knew that I had done everything I could in the past six months to bring him all the people in his life he might want to say goodbye to, so now it would just be a matter of time. But a week?

I called my siblings to let them know what was happening.  I think that at first some of them thought I was over-reacting.  One brother kept saying we would wait and see what happened.  I think that it's much easier to accept the reality of a parent's impending death when you are in the room watching it.  The nursing home brought in a cart of snacks and beverages for the family - a service they provide during the final hours for those who are keeping vigil. Every step they took in their process of preparing for a resident's passing made me feel more certain that this was actually happening.

But he didn't die that night. The morphine helped his pain, and his fever came down a bit, and by 9 or 10 that night he was sleeping relatively peacefully.  Eventually, they encouraged me to go home, saying that he would probably survive the night, but they would call the family if anything changed.

The next day, Saturday, started out with Dad looking better.  His eyes were open in the morning, and he was responding to questions, saying yes or no.  But he wouldn't drink or eat.  We kept his mouth moist with those little sponge sticks dipped in water.  I downloaded the Bible to my iPad and read to him from the Psalms, which seemed to comfort him.  I think it was Saturday afternoon that Jackie came and sat with me for a while. Mom came down from her floor and sat with me for a while. MG kept vigil with me for several hours. By afternoon, he was no longer responsive to questions, and his breathing was becoming more difficult again.  They increased his morphine slightly at my request. It was a long day with little change for Dad. When I left him that night, he seemed comfortable, although he was obviously slipping away, just not as quickly as the nurse had originally thought he would.

The next day, Dad had several visitors.  My sisters came from Albany to say goodbye, which I think was difficult for them, but really helped me a lot.  Mom spent time with them, which really helped her.  That night at around 11, I called to check on him.  Apparently they were not giving him his morphine as often as they could, because it was prescribed "as needed".  I went over to see how he was doing, and it was clear that he was agitated and having difficulty breathing.  I called Hospice to complain. I sent for the nurse manager and insisted that he receive his morphine as often as possible.  They assured me this would happen.  By midnight I was back home.  It was a rough night's sleep.  Waiting for someone to die is hard.  You feel guilty if you go home, but you have to try to take care of yourself because you don't know how long it's going to take.

Installment 2 will come later

Final Boston photo safari

We had our last class on Thursday, August 9th, and then it was time for our last data lab.  Unfortunately, our last lab was scheduled for a room in the med school library where none of the computers had a copy of SAS installed.  So I decided to head back to the Mugar library on the BU campus, which is up the street from our dorm, where I could run some last-minute sensitivity analyses and then finalize my presentation.

I decided to walk back, rather than take the BU Bus, and to use this opportunity for one last photo safari.  Rather than go my usual route through the south end and then down Mass Ave to the Fens, I decided to take a path that runs a little further to the west. This may not have been a very wise choice, for a variety of reasons. One, it was over 90 degrees out, and I started off being hungry, which I wouldn't get around to addressing until about an hour later. Two, my usual route is not only prettier, but it is probably also safer, as it turns out, something I failed to consider when I set off (perhaps because I had low blood sugar? I don't know). Three, this route would take longer than my usual route, something I had also failed to consider when I set out.

I began on Albany, then I cut up Northampton Street to Harrison Ave, passing our friends at New China (good-bye shrimp fried rice!). Then I cut down Lenox Street.  Here, I found this little community center and its cool mural:

I also found "the projects":

Just in case you were wondering if all the streets in Boston were picturesque, they are not...

I took a little detour out of the projects (this seemed like the safer choice, given how quickly my surroundings changed - and I don't have photos of this, as I thought it unwise to advertise myself as a tourist or an outsider) until I found Tremont Street, and went west on Tremont to Ruggles.  Some of the public housing projects on the outskirts of the projects looked relatively new:

Saw some pretty run-down buildings along the way... I thought it better not to take a picture of the dead, fly-covered mouse I found on the sidewalk in front of one of these buildings (you can thank me for that choice now)...

And a community garden, which looks like it was built right on top of this abandoned factory:

This is the big Boston Police station at the corner of Tremont and Ruggles (and yes, I am cheating by looking on the maps app on my iPhone as I write this blog entry):

One of my favorite ad campaigns in downtown Boston, to promote animal adoption:

I swear, I couldn't walk anywhere in Boston without seeing church steeples... I kinda liked that about the city:

Something struck me as important about this intersection, but for the life of me I can't remember what it was...

Then I found this alleyway that had all this cool graffiti... clearly, the artist is watching us right now:

I'm sure this young lady broke their heart at some point...

This has GOT to be Heath Ledger's Joker:

Eventually, Ruggles Street becomes Fenway, and I find myself behind the Museum of Fine Art, walking along the Fens... one of my favorite parts of Boston...

This is actually the courtyard of an apartment building on Park Drive

And then I'm walking up Brookline toward Commonwealth, and I find myself at the Landmark Mall, which is the second place MG and I went the day we moved me into the dorm (the first being Chipotle for lunch).  That little old lady in the lower right corner actually offered to take my picture for me, but by this time, I was pretty sweaty, so I decided against it.

Two blocks, and I'm at the Chipotle, where I finally have some lunch, and then it's off to Mugar for the rest of the afternoon. And that ends my final photo safari of Boston.  Mixed feelings about that.  I do have some shots from my last night down at Copley Square with MG, which I will post another time.

In a VAN down by the RIVER

I don't have a lot of time, so I'll try to be quick.

I'm supposed to be working on my presentation for Friday afternoon - the last day of the Summer Institute.  I'll be glad to be going home, but I'm also starting to feel sentimental...

Here are some HDR images I shot on the river tonight at sunset. The river and the close proximity to the ocean are two things I will definitely miss about Boston. The pollution and garbage and smells I will NOT miss.

It's impossible to get the whole skyline in my 17-55 lens, so I took it in pieces...

I liked this shot so much, I solarized it, too:

 

Last week, I walked from the BU medical library over to Fenway health, and I took the opportunity to take a photo safari:

 

In the historic south end of Boston, sometimes you find little fountains in the middle of the street

I'm pretty sure that when these guys were adopted as watchdogs, the homeowner imagined this as a more active role...

 Just one of the fabulous views as you stroll around the south end.

 I did find an HIV prevention center... good to know... I love this poster

 Appropriately named :-)

So many little beautiful details in the architecture here

I have walked through the Fens multiple times, and I never get tired of it.  I really appreciate that there are big green spaces here, but I especially love the water

 ANOTHER picturesque street... enough already!

And finally I arrive at my destination, the mother ship of LGBT health :-)

I beg your pardon...

...but I came across a rose garden - actually, it was the Kelleher Rose Garden, which is in the fens, and I found it on my way to the Museum of Fine Arts on Sunday.  I've never seen such a collection of roses, it was really beautiful.  All of these shots were taken with my iPhone, and it was a super-sunny day, so they aren't very good, but I had to share.

The fens are marshes, I guess, here in the middle of Boston. They must be part of the watershed for the Charles River.  I saw this bird in the fens, which I am not familiar with, but it must be some kind of water fowl.  Unfortunately, I did not have my Rebel with me, or my Olympus, just my iPhone, so I couldn't really zoom in and get a clear shot of him.  I don't know if you can tell from this picture, but he's pretty big.  He almost looks like a black heron... definitely bigger than any of the geese that were hanging around that day.

I have so many other photos, I can't keep up with them.  Here are some pictures from inside the old South Church on Boylston Street, where I went last night for an AA meeting:

We don't meet in the main chapel, but I had to peak in... I love all the stained glass.  And here are some buildings I noticed along the mile and half walk between my dorm and the church:

This is a long row of apartment buildings, I think. I just love the repetition.  You see this all over town.

The traffic at the intersection of Massachusetts Avenue and Commonwealth Avenue - but I took the picture for that brick building on the corner.  I love all the chimneys.

The balcony is like a little sunroom, and I love the medallions over the third-story windiws and the ornate trim around the doors and windows...

That's all for now.  I still have some pictures from my afternoon with Paul and Cristiano on Saturday, which I will have to upload tomorrow.  I'm sorry I'm not being vigilant about chronology, but there are just so many pictures and so little time to share them with all three of you that read this! :-)

A serious moment...

Here's a sign that gives me pause every time I pass it, mostly because it is constantly being updated:

This digital counter is situated on the back of Fenway Park. There are several billboards to the left of it listing facts about gun violence and children, such as the fact that a child is killed by a gun every 3 hours in America. This is what the sign said as I was walking by it on Sunday afternoon, on my way to the Museum of Fine Arts.  I thought it must include the children who were killed in Aurora, Colorado that week...

But then this is what it said as I was walking home later that afternoon...

Here is what it said this morning, as I was walking over to Fenway Health for our meeting...

And this is what it said this afternoon... If you're counting, that's 32 kids killed by guns since some time last week... that is an unbearable reality.