Wednesday, January 27, 2010

Preparing the way--Thursday, February 15, 2007

An excerpt....
The phone rang at one 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. I am not sure why they would do this. Surely it would be better to leave him in peace, sleeping? He was unresponsive at this time. They thought I should know. They were not sure if I should go in or not. They were not sure how quickly he might leave us. They agreed to call me back at 3:30 a.m. and keep me updated. They did not call back, and I fell asleep at around three. I woke at seven a.m., hurriedly got dressed, had some coffee, and packed up a blanket, a thermos, and some other things.
            I had gone into the LTC at around eight-thirty a.m.; I saw the nurse 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 got into his lungs as he sucked in the air. Dad was mouth breathing, with some rattling in his chest. There was paraphernalia on the table beside him; large Q-tips, a container of Vaseline; another of something like mouthwash. I had no idea what it was for. His eyes were one-quarter open, and he was unresponsive.

            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 couldn’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 his office later. Were we not entitled to health care and visits by a doctor? How enervating this was! The RNs had no control without the authority of a doctor who did not even bother coming in to see my father. Finally, at ten 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 and it would be easier if I could use his private bathroom toilet rather than going down the hall. The custodial staff needed a nurse’s order to remove the booster seat. 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 collided with a staff member when I came out of the door a couple of times.
            Audrey, from the front desk, came up to the room and told me that the Director of Care would be in to see me before long. This was good news. The PSW said to hit the call 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, but did not otherwise disturb him. 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 us two chairs, and we settled in for a chat. She explained many details to me: outlining what I could expect in the next few days. She gave me some information I had not heard on mouth care, signs of death (see the final section of this book) and what they would be able to do for us. 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 was far better to err on the side of comfort, rather than not enough. He had been aphasic (uncommunicative) for days. She explained about the oxygen. If they don’t have oxygen patients could panic because they cannot breathe. It was a comfort measure. She explained that the body could go three minutes without air, three days without water, and three weeks without food. Dad was two days without water at this point. Food was a distant memory.
            The DOC explained the symptoms of approaching death, all of which Dad had demonstrated in the past few days. His breathing softened and came and went over time. We could expect apnea (periodic cessation of breathing), Cheyne-Stokes respiration, cyanosis, and other symptoms.
            A Web site entitled, “As Death Approaches” says: “The fear of the unknown was always greater than the fear of the known,” and that was true. It was comforting to know what to expect, not that all of this had 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. (I was still not giving up my day job!) Staff came in and helped 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 five p.m. the clouds began rolling in, and we were having snow squalls. I told Brian to come home. I had put a phone call in to my brother to tell him what was going on. He was out in his camp at the mine and hard to reach.
            I made it back to the hospital for five-thirty p.m. after picking up a Sub sandwich, a couple of juices, and potato chips--to hell with the weight management. At 5:50, the doctor arrived--he had decided to pop in and see if I needed anything. Not now, thanks! The RN came in at 6:50 and every hour from then until she left. She checked Dad and asked if I thought he needed more morphine. In hindsight, I wish I had given him some. I did not see evidence that he was in pain, but felt that he had no way of letting me know. He was comatose. He was still blinking; his forehead and hands were red. He was breathing five 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, a form of white noise that cancelled out all the noises in the hall: people chatting, pages for various staff members, residents wandering the halls. I had brought my computer with family photos on it and was sorting the photos, travelling down memory lane and remembering all of the wonderful things Dad was and had been for me and for many others: father, husband, chorister, churchgoer, and volunteer. At eight p.m., he was breathing six breaths every ten seconds. By ten p.m. I had inhaled my food, had one of my juice boxes, and watched four CSI’s[1] in a row! It was bizarre and most surreal sitting there checking him every so often. It was comforting to watch TV and remove 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 did not appear in pain. When Dad’s 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; there appeared to be nothing left of him.
            At 11:00 p.m. I did mouth care for him, just as Diana had done. I made a mess and got Vaseline on his beard, but did not worry about it. I knew he would forgive me. I held his hand and watched more TV.

[1] An American TV show about crime scene investigations--CSI’s.

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