Thursday, February 15, 2007

Dad's last few hours

Thursday, February 15, 2007 Prepare the Way
The phone rang at 1:00 a.m. The PSW had gone in to visit dad, which they did hourly, and he seemed to be very badly off. They would touch his arm and speak his name. He was unresponsive. They thought I should know. They were not sure if I should come in or not. They were not sure how imminent or how quickly he might leave us. They agreed to call me back at 3:30 and keep me updated. They didn’t call back and I fell asleep around 3:00. I woke at 7:00 a.m. and hurriedly got dressed, had some coffee and packed up a blanket, a thermos and some other things.

I had gone into the Leisureworld around 8:30; I saw Denise in the hall and asked if she could tell me about the rest of his night. She hadn’t had time to read his file but promised to get back to me. I went into his room. He was lying on his back with an oxygen tube in his nose. Apparently, even when mouth breathing enough oxygen gets into his lungs as he sucks in the air. Dad was mouth breathing, with some rattling in his chest. There was paraphernalia on the table beside him. I had no idea what it all was for. His eyes were one quarter open and unresponsive. Large half Q-tips, a container of Vaseline, another of mouthwash, I thought.

I had brought in a big comforter, which was washed and returned later, along with several pillows and pillowcases. They proved invaluable later on. The PSW asked if I wanted him to go to breakfast or if I wanted them to bring in a tray. I knew he couldn’t eat. I had tried giving him some water on Tuesday and he could not suck from the straw. At this point he hadn’t had anything to eat or drink in twenty-four hours. He can’t eat or he would choke. From time to time he would hiccup. I thought he might have had a slight convulsion. He kept on blinking, but did not say anything. I dug under the covers and found a hand to hold. Surprisingly it was warm. His feet, remarkably, were not so swollen anymore. This was peculiar as this condition had begun in the summer and had not gone away despite diuretics and his special socks.

There was a call in to the doctor, who did not work on Wednesdays but would be in to his office later. The staff was kind. Finally, at 10:00 a.m., we got an order for dad to have injections of morphine, 2-5 mg every two hours, as needed. It was such a relief. They gave him 2 mg and he seemed more comfortable. Some workers thought he was not in pain, but I knew better. I knew him so well by now. He was in a hospital gown. I asked about the toilet seat, which had been changed for a higher one. He hadn’t been on the toilet for months. I asked if they could put a regular one on now, as I knew it would be a long few days. The custodial staff needed a nurse’s order to do so. We made it so! The only public washroom that I knew of was on the main floor. This would make it very handy for me, as long as no one walked in on me! In fact, I nearly took out a couple of staff members when I came out of the door a couple of times.

Audrey came up to the room and told me that the Director of Care would be in to see me before long. The PSW said to hit the button if anything changed or if I needed anything. They looked after me. They had put a radio in the room and they were playing some old songs. It was comforting. They shifted him at 10:30. I decided to go and get something to eat. Brian had poured me a coffee in his travel mug and I knew I was getting light-headed. I was scolded affectionately for not staying out and having a relaxed breakfast, but I wanted to get back to dad. I had my second cup of coffee and breakfast sandwich in dad’s room.

I phoned Brian. He said he would come in around noon. Then the Director of Care (DOC) came in. She found me a good chair, found herself one, and we settled in for a chat. She explained many details to me; outlining what I could expect in the next few days. She said he could have his morphine injections until the end. It was a judgment call when he needed another injection, but I was the one in the best position to make that decision. It is far better to err on the side of comfort, rather than too much. He had been aphasic for days. She explained about the oxygen. If they don’t have it they panic because they cannot breathe. It is a comfort measure. She explained that the body could go 3 minutes without air, 3 days without water and 3 weeks without food. Dad was 2 days without water at this point.

The DOC explained the symptoms of approaching death; sleepiness, confusion, decreased appetite, decreased urine output, lack of response to calling their name. His breathing vacillated from regular breathing to irregular. With cranial involvement we can expect apnea. She explained Cheynes-Stokes respiration. This is the gradual increasingly quick intake of breath, followed by an episode of apnea, stopping breathing, for 15 – 45 seconds. As the body shuts down, it stops sending oxygen to the extremities. She said to look for cyanosis, which is the discolouration of the skin due to deoxygenated hemoglobin in blood vessels. Sometimes the organs shut down or the body sends oxygen to organs rather than the extremities. There is mottling in the hands or feet. Once this occurs, death is imminent - within 72 hours.

A web site entitled, “As Death Approaches” says: “The fear of the unknown is always greater than the fear of the known” and that is true. It was comforting to know what to expect, not that all of this has to occur. She reminded me to look after myself, to take regular breaks. She said to talk to him and let him know I was there. She felt for his heartbeat, which was weakening. She showed me how to do mouth care and told me that the mouth care he had received so far was excellent. Staff came in and helped them check his position. Dad was moaning and he was twitching. He could have been having more seizures. His forehead, where the tumour was growing, was a brighter red than elsewhere.

Brian arrived to spell me off and I went home for a break. He phoned on his cell phone every few hours, while I supervised the roofers and chatted with them. At 5:00 the clouds began rolling in and we were having snow squalls. I told Brian to come home. I had put a phone call into my brother and was waiting to tell him what was going on.

I made it back to the hospital for 5:30 p.m. after picking up a Sub sandwich and a couple of juices and potato chips – to hell with the weight management. At 5:50 the doctor arrived, he decided to pop in and see if I needed anything. The RN, came in at 6:50 and every hour until she left. She checked him and asked if I thought he needed more morphine. In hindsight, I wish I had given him some. I didn’t see evidence that he was in pain, but felt that he had no way of letting me know. He was still blinking; his forehead and hands were red. He was breathing 5 times every ten seconds. I don’t know why I measured it. It was good to have something to do, other than the mouth care.

I rearranged the big easy chair twice, eventually pulling it out and putting the comforter and three pillows on top. It was comfortable. The oxygen tank pulsed all night. That in and out was a form of white noise that canceled out all the noises in the hall, people, and pages for various staff members, residents wandering the halls. I had brought my computer with family photos on it and was sorting the photos, traveling down memory lane and remembering all of the wonderful things dad was and had been for me and for many others: father, husband and volunteer. At 8:00 p.m., he was breathing six breaths every ten seconds. By ten p.m. I had inhaled my food, had one of my juices and watched four CSIs in a row! It was bizarre and most surreal sitting there checking him every so often. It was comforting watch the TV and removing myself from the situation from time to time. It was a breather of sorts.

I went closer to dad, for the umpteenth time looking for signs. The RN had checked his feet for cyanosis, but I found it in his hands. I looked at one eye and a tear was starting to fall from it. For some peculiar reason I hesitated – do I ask for more meds? He was otherwise quiet and didn’t appear in pain. When the other eye began to tear I pushed the buzzer and asked for morphine. It was 10:45 p.m., I looked at dad’s ribs sticking out, his organs were so small and there appeared to be nothing left of him.

At 11:00 I did mouth care for him, just as Diana had done. I made a mess and got Vaseline on his beard, but didn’t worry about it. I knew he would forgive me.

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