Dad was calm and poised in his black tuxedo, and each of our wedding albums contain a similar photograph of him. Except in this one, behind his tan-skinned smile, hung the painting of a ship sailing through stormy seas, foreboding clouds overhead. I looked at Dad, and then the ship, and saw a paradox: each of the two beautiful vessels navigated a unique storm.
The hospice director reviewed Dad’s charts and presented two options: to continue medications while vital organs failed in spite or as a result of them, or allow nature to take its course, ensuring his comfort while his body did what it was doing anyway.
My sister, Catherine, and Ralph discussed this juncture with Dad in advance of this event, and said that they were prepared to care for him at home, so that was now in question.
“(Aside from the list of vital organ malfunctions and the infectious C Diff) Is there any reason that you’d recommend against Dad's return home to receive comfort care?” I asked.
“I'd never recommend a transport for a patient who I didn’t believe would survive the trip.”
Her mouth moved and so did my sister’s, but the sound receded as I withdrew like a turtle inside its shell for an internal debate:
Oh gawd! That puts another spin on things. Settles it. He cannot go home.
That’s a no-brainer. He will not survive the ride!
So what? According to the medical charts, he will not survive this hospital either.
I bet he’d rather take the risk than stay here. Besides, it’s a very John Wayne option.
I joined the conversation, pretending that I‘d been listening all along.
"I will do whatever it is that the patient and the family wishes."
“Will there be a morphine drip?”
“That’s not done at home,” the director said. “It would require a pump and -- let me look into that,” she said.
It was evident that there were additional relief options available in the hospital than at home, then again, there were more microorganisms to kill you, too.
Dad received an injection of morphine and then declined future doses. He did not want to become addicted.
“At our age, Dad, we don’t have to worry about addiction,” my brother said.
“Nope.” Addiction was less of a problem than getting home.
Dad’s doctor met a few of us siblings near the elevator as we spoke about the situation.
“I don’t believe your father is going to make it through the day,” he said. Then, like the fifty-fifty chance of sun in the painting, he smiled. “Then again, your father might be playing games with God.”
Even the doctor knew Dad. The man who made crucial decisions in blazing fires as chief in the New York City Fire Department and through the perils of World War II, Dad's prayers were about hope, light breaking through storm clouds.
Aware of the risk, Dad chose the transport.
The Death Ride
The tall, dark-dressed EMT workers approached. Dad was prepared to leave the hospital, and, according to all sources, that would be capital “H” in home.
“I bet you can’t wait to get out of here,” the nurse said.
Before he finds out what can be added to C diff, you mean?
“Nah, it was all right here,” Dad said. “You guys were great.”
“Awe, thank you. I’ll just get that IV out for you.”
Dad looked at his arm.
“I don’t know what I’ll do without it,” he said.
She smiled and swept her hand up and down his arm.
“Ah, that? It was just for decoration anyway.”
She hugged him and wished him well. And as his stretcher was rolled down the hall, social workers, nurses and techs lined up wishing Dad well as he passed.
The EMT driver offered me a ride in the front seat of the ambulance, which afforded me several advantages. I'd felt each bump in the road firsthand (and wondered how it was that an ambulance had zero shock absorption.) I’d analyze the physical effects, like a jarring meter as I juggled conversation about the young driver’s career choice and his life upstate. It was easy, like explaining innovative products at work with a knife in my heart.
The second EMT worker was seated behind Dad’s head, so there was no advantage to his proximity for my purpose, which was to scream after every pebble in the road: He is fine!
When the twenty-minute ride ended, we pulled into the driveway. Still no sound from Dad, I jumped out and head to the back, suppressing a scream:
PLEASE OPEN THE FRIGGIN DOORS FAST!
They were opened to reveal Dad, wide awake, a slight flip of the hand.
“Hi,” he said, “that wasn’t so bad.”
Greg and I slept in the living room that night next to Dad’s bedroom. I had not slept in four nights, but I was in full fix-it mode and would amend for every crisis I’d missed in two years within six hours.
“Let me take the intercom so you can sleep," I said.
“Are you sure?” Catherine asked.
“Of course. It doesn’t make sense for you to have the intercom if we’re on watch.”
“Okay, knock if you need me.”
On Fix-it Detail when the heart is involved, I was not one to ask for help, but rather showed symptoms of needing it, for instance mental vapor lock, accompanied by blank stares. Occasional bouts of reality occurred as well, at which time I sobbed. (Note: This issue should not be confused with incompetency. I am handy during other crisises. For instance, I once developed super-human strength when a friend passed out on the curb, drunk in Brooklyn. I carried her to her parents... thus got even and relieved myself of the responsibility at once.)
Dad was awake and restless for the remainder of the night. Perhaps the final injection of morphine was working its way out? He was confused and red in the cheeks, his forehead hot. Then again, mine was, too. The oxygen machine churned out furnace-like air, so the sole way to distinguish fever was through the professional in-the-ear thermometer. It had two buttons. I tried both. Nothing. After sufficient alarm, staring into his red eyes and cheeks and fear that he suffered, I received a career revelation that I felt compelled to open a window and shout.
Instead, I bolted up the stairs and knocked on Catherine’s door.
"What's going on?" she asked, pulling the door closed behind.
“It just occurred to me that I am a retail manager, not a nurse. I am unqualified to judge whether or not Dad is suffering. I don’t know what the hell I am doing. We need another professional for the overnight shift."