Friday, June 27, 2008
Thank You For Smoking (Update 5)
It’s Friday, nearly midnight and we have just returned from an entire day at the hospital that began with the same sort of visit with dad that has become a routine over the last few days. He appeared more sedated and agitated than he had in the days prior. His eyes remained closed for most of the time I spent with him in the morning.
I should go back to the beginning of the day. As I sit at the end of it, I am realizing how I spent nearly the entire day avoiding. Avoiding facing the reality of the day as I woke up, avoiding going into my dad’s room initially, and avoiding the emotion that was natural and critical to navigating through something like this. Midway through the day, I caught myself doing this and instead of changing course and drawing near to the people with which I feel most connected and identified, I turned on my iPod and added a soundtrack to my seclusion.
Like it or not, this day started with the knowledge that this would be the day that we – as a family would remove the ventilator and allow my dad to die on his own terms. Of course these ‘terms’ go back generations in the planning since he is a lifelong smoker.
As we ate breakfast together and chatted about the sports page and gas prices we for the most part avoided the topic that dragged us out of bed in the first place. We all knew it and were well aware and in agreement that today would be the beginning of the end.
We met the doctor and the social worker in the same meeting room that I met them in a few days prior. This time we filled the room, all the chairs and were standing along the back wall. Sons, siblings, nieces and nephews, in-laws and spouses of every sort. My dad would be proud to know that his ‘sentencing hearing’ was standing room only.
The doctor started with his same wit and awkward style. While I had grown comfortable with it and him, and had developed a pretty good working relationship with him, the rest of the family seemed skeptical and guarded with him. He discussed the nuts and bolts and the chemistry and physiology involved with removing the ventilation tube from dad’s throat. We discussed everything from what sort of oxygen mask he would use to how much morphine would be appropriate to comfort levels. The theme quickly and clearly emerged. Our function – the doctor’s function was shifting to managing his comfort instead of managing his condition.
We had established 5:30pm as the transition time. The staff would prepare the machine needed as well as clean my father up. All the medications prescribed to treat the infections and heart issues and everything else that had begun failing him was also being stopped. The only medications that would be used going forward would be to treat his pain and discomfort and facilitate his comfort. As the meeting ended, we splintered in several directions. Some went to lunch while others returned to the waiting room for conversation and a good cry. I took off downstairs to the patio of the cafeteria. All I wanted at that moment was to be alone. I challenged why this would be during something like this with many of my favorite people around me, and all I could manage to assume was that I have just grown accustomed to handling everything on my own over the last couple years. Who knows? No matter what it was, I found little comfort in my isolation, but it’s all I was prepared to handle at the moment. There is an absence of emotional accountability to which I have grown dependent. It has been both depressing and comforting over the last couple years. Plans of growth and progress through dark times are hatched in it, but thoughts of immeasurable pain and suicide visit too.
I sat alone until 5:30pm and then walked into the hall in front of the ICU where most of the family had begun to gather again. I waited a respectful few minutes and walked back to the room. The doctor and nurses were finishing his preparation. Again I avoided site of my father and the happenings in the room. I could hear that the doctor was having a disagreement with one of the nurses about the name of one of the masks. When they were clearly finished, I went in where my brother and two cousins were already. Dad looked fresher; his hair was combed and his face had been wiped off. The external ventilator mask was large and cumbersome. My dad seemed to seizing and gasping for air as he breathed. While the large, intrusive tube was gone, it had been replaced by full view of his struggle to breathe through a clear oxygen mask. His mouth was open as he struggled to suck in every molecule of oxygen being pumped into the mask.
Every few seconds, he would grab into the air as if there were some life raft afloat in it. His hands then slammed into the bed’s surface and he grabbed a handful of bed sheets, pulling this into his chest. This transition was supposed to be painless and comforting. It looked awful and painful.
It seemed as though it would not be long now. This reality had finally caught up to me and bit firmly into my ass. After a short stint in the room with my father, I walked back into the hall and stood alone again. I had come to realize that getting too close to any one of the family members in my midst would certainly push me over the emotional edge, and I just didn’t want to do that. I had claimed my role as the ‘strong and practical’ one.
When my uncle (my dad’s older brother) came out a minute after me, he walked up to me and wrapped me in a huge hug and said, “I love you, brother.” Everything that I had built in defense of the emotions gave way in an instant. I grasped him close and sobbed into his chest. He held on as long as I needed him to. As held tighter, so did he. I was so happy he didn’t say anything in that moment. There was nothing to say. A cliché or Hallmark quote would have cheapened the authenticity of the moment. I needed exactly what he gave me.
For the next few hours we all sat vigil outside of the ICU, taking turns going into his room, rubbing his legs and holding his hands. As time passed and his vital signs remained stable, it became clear that dad was going to hang on through the nights. By 10:00pm we had all decided to go home for the night to sleep and refuel.
The prominent thought and emotion for me is that my dad is already gone. The doctor adjusted his medication to assist him with the clear discomfort he was feeling. The tradeoff is that it put him into what amounts to the deepest of deep sleeps. So no matter when he finally takes his last breath, my dad will never wake up and make eye contact with me again. I feel like I said goodbye today in the arms of his brother.
I should go back to the beginning of the day. As I sit at the end of it, I am realizing how I spent nearly the entire day avoiding. Avoiding facing the reality of the day as I woke up, avoiding going into my dad’s room initially, and avoiding the emotion that was natural and critical to navigating through something like this. Midway through the day, I caught myself doing this and instead of changing course and drawing near to the people with which I feel most connected and identified, I turned on my iPod and added a soundtrack to my seclusion.
Like it or not, this day started with the knowledge that this would be the day that we – as a family would remove the ventilator and allow my dad to die on his own terms. Of course these ‘terms’ go back generations in the planning since he is a lifelong smoker.
As we ate breakfast together and chatted about the sports page and gas prices we for the most part avoided the topic that dragged us out of bed in the first place. We all knew it and were well aware and in agreement that today would be the beginning of the end.
We met the doctor and the social worker in the same meeting room that I met them in a few days prior. This time we filled the room, all the chairs and were standing along the back wall. Sons, siblings, nieces and nephews, in-laws and spouses of every sort. My dad would be proud to know that his ‘sentencing hearing’ was standing room only.
The doctor started with his same wit and awkward style. While I had grown comfortable with it and him, and had developed a pretty good working relationship with him, the rest of the family seemed skeptical and guarded with him. He discussed the nuts and bolts and the chemistry and physiology involved with removing the ventilation tube from dad’s throat. We discussed everything from what sort of oxygen mask he would use to how much morphine would be appropriate to comfort levels. The theme quickly and clearly emerged. Our function – the doctor’s function was shifting to managing his comfort instead of managing his condition.
We had established 5:30pm as the transition time. The staff would prepare the machine needed as well as clean my father up. All the medications prescribed to treat the infections and heart issues and everything else that had begun failing him was also being stopped. The only medications that would be used going forward would be to treat his pain and discomfort and facilitate his comfort. As the meeting ended, we splintered in several directions. Some went to lunch while others returned to the waiting room for conversation and a good cry. I took off downstairs to the patio of the cafeteria. All I wanted at that moment was to be alone. I challenged why this would be during something like this with many of my favorite people around me, and all I could manage to assume was that I have just grown accustomed to handling everything on my own over the last couple years. Who knows? No matter what it was, I found little comfort in my isolation, but it’s all I was prepared to handle at the moment. There is an absence of emotional accountability to which I have grown dependent. It has been both depressing and comforting over the last couple years. Plans of growth and progress through dark times are hatched in it, but thoughts of immeasurable pain and suicide visit too.
I sat alone until 5:30pm and then walked into the hall in front of the ICU where most of the family had begun to gather again. I waited a respectful few minutes and walked back to the room. The doctor and nurses were finishing his preparation. Again I avoided site of my father and the happenings in the room. I could hear that the doctor was having a disagreement with one of the nurses about the name of one of the masks. When they were clearly finished, I went in where my brother and two cousins were already. Dad looked fresher; his hair was combed and his face had been wiped off. The external ventilator mask was large and cumbersome. My dad seemed to seizing and gasping for air as he breathed. While the large, intrusive tube was gone, it had been replaced by full view of his struggle to breathe through a clear oxygen mask. His mouth was open as he struggled to suck in every molecule of oxygen being pumped into the mask.
Every few seconds, he would grab into the air as if there were some life raft afloat in it. His hands then slammed into the bed’s surface and he grabbed a handful of bed sheets, pulling this into his chest. This transition was supposed to be painless and comforting. It looked awful and painful.
It seemed as though it would not be long now. This reality had finally caught up to me and bit firmly into my ass. After a short stint in the room with my father, I walked back into the hall and stood alone again. I had come to realize that getting too close to any one of the family members in my midst would certainly push me over the emotional edge, and I just didn’t want to do that. I had claimed my role as the ‘strong and practical’ one.
When my uncle (my dad’s older brother) came out a minute after me, he walked up to me and wrapped me in a huge hug and said, “I love you, brother.” Everything that I had built in defense of the emotions gave way in an instant. I grasped him close and sobbed into his chest. He held on as long as I needed him to. As held tighter, so did he. I was so happy he didn’t say anything in that moment. There was nothing to say. A cliché or Hallmark quote would have cheapened the authenticity of the moment. I needed exactly what he gave me.
For the next few hours we all sat vigil outside of the ICU, taking turns going into his room, rubbing his legs and holding his hands. As time passed and his vital signs remained stable, it became clear that dad was going to hang on through the nights. By 10:00pm we had all decided to go home for the night to sleep and refuel.
The prominent thought and emotion for me is that my dad is already gone. The doctor adjusted his medication to assist him with the clear discomfort he was feeling. The tradeoff is that it put him into what amounts to the deepest of deep sleeps. So no matter when he finally takes his last breath, my dad will never wake up and make eye contact with me again. I feel like I said goodbye today in the arms of his brother.
Posts
