The Paradox

The Paradox

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.

Dad: Father of the BrideThe 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.”

Whoa!

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.

     Why not?

     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.         

     True.

     I bet he’d rather take the risk than stay here. Besides, it’s a very John Wayne option.

     Agreed.

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.”

     Career Revelation

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."

Developing...

The Paradox
Dad was sharp and handsome in his black tuxedo, and each of our wedding albums contain a similar photograph of him. In this one, behind his tan-skinned smile and crisp, white collar hung the painting of a large ship that sailed across choppy seas. I looked at Dad, and then the ship, and saw a paradox.

The hospice director reviewed Dad’s charts. We had two options: to continue medications while vital organs began failing, or allow nature to take its course, ensuring his comfort among his loved ones: Beautiful ship, ghastly storm.
     “Is there any reason you’d recommend against his return home to receive comfort care?” I asked.
     “I would never recommend a transport for a patient that I didn’t believe would survive the ride.”
The fog thickened and I watched her mouth move, my sister’s, but an internal banter ensued:
     Oh gawd! That puts another spin on things. Settles it. He cannot go home.
     Who said he can’t?
     It’s a no brainer. He will not survive the ride.
     According to the medical charts, he will not survive this hospital either.
     True.
     I’ll bet he’d rather take the risk of trying than stay here. It’s a very John Wayne option.
   Agreed.
I pretend I‘d been listening all along.    
     “Will he have a morphine drip?”
     “That’s not done at home,” the director said. “It would require a pump and -- I don‘t know. I will look into it,” she said.
It became evident that there were more relief options available in the hospital than at home.
Meantime, in his hospital room, Dad did two things, he’d just been given his last dose and said no more morphine injections. He did not want to become addicted. Then he asked what time he was going home.
     “At our age, Dad, we don’t have to worry about addiction,” my brother said.
     “Nope.” Going home was another matter.
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 weatherman reporting a fifty-fifty chance of rain, he smiled. “But your father might be playing games with God.”
The doctor knew Dad, and so did we… the man who confronted fires and war, prayed to God to survive his choice.  
Knowing the risk, Dad chose to the transport.
The Death Ride
As the dark-dressed EMS workers approached, it felt like the grim reapers approached. Dad was going home, yeehaa! On the other hand, that would be capital “H” in home.
     “I bet you can’t wait to get out of here,” the nurse said.
     “Nah, it was all right here,” Dad said. “You guys were great.”
     “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.
The nurse smiled.
     “It was just for decoration anyway.”
She hugged him and wished him well. And as his stretcher was rolled down the hall, many people gathered, a sort of heroes goodbye.
The EMS guy offered me to ride in the front seat of the ambulance. This afforded me three multitask advantages. I was able to feel each bump in the road instead of just wondering whether he’d hit any. I’d analyzed each, like a jarring meter, all as I juggled conversation about the driver’s life upstate. It was easy, like selling innovative products at work with a knife in my heart.
Since the second EMS worker was seated behind Dad’s head, there was no advantage to his proximity for my purpose, which was to scream every two minutes: He is fine!
When the twenty-minute ride ended, we pulled into the driveway. Still no sound from Dad, I jumped out and ran to the back of the ambulance, suppressing the internal scream:
OPEN THE DAMNED DOORS!
The doors were opened to reveal Dad, wide awake, who flipped his hand in greeting.
     “Hi,” he said, “that wasn’t so bad.”
I Am Not A Nurse!
Greg and I slept in the living room, which was right next to Dad’s room. It was about four nights since I’d slept, but that was not enough. Dad was home now, and I was in full
H-E-L-P mode. I was going to make up for every crisis I’d missed in six years within six hours.
     “Let me take the intercom so you can sleep I said.”
     “Are you sure?” Catherine asked.
     “Sure. It doesn’t make sense for you to have the intercom if we’re on watch.”
     “Okay, call me if you need me.”
I was up the rest of the night, perhaps the last injection of morphine that they’d given him was working its way out. He was not in pain, just confused and hot as the fires of hell and damnation. Then again, I was, too. The oxygen machine was churning out some furnace-like air. I was unsure whether Dad had fever or not. I was not given the crash course on how to use the in-the-ear thermometer, but it had two buttons. I tried both. Nothing. After fifteen minutes of looking at his red cheeks, and fearing fever, unable to sooth him back to sleep with my calm voice, I had a revelation.
I bolted up the stairs and knocked on my sister’s door.
     “Be right there,” she said.
She opened the door and saw me pacing.
     “Something just occurred to me as I tried to figure out how the thermometer functioned,” I said.
     “What’s that?” Catherine asked.
     “I am a retail manager, and not a nurse! I don’t know what the hell I am doing. We need a nurse from twelve to six.”




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I was sixteen when he’d shared his vision of family life. His hand flattened the air, as though he smoothed wrinkles on a bedspread.
     “I like for life to be as smooth as glass,” he said.
You’ve got nine kids. That’s not going to happen, I thought.
How could it when I did not open my eyes in the morning before my sister asked me where her blouse went? She needed to peel back the blanket back to find out, because I was not going to admit that I’d passed out in it. Instead I pretended I was too groggy to process her question and therefore abdicated of the responsibility of a truthful answer. That counted for about three lies for which I now make a literal blanket apology.
My need for autonomy, sense of uniqueness, and the futile exercise of it was overpowering.


 fifteen and in between everything. I knew more than my parents but lacked the independence to prove it. Still waters was not my goal. I preferred sounds of laughter, music, chit-chat -- anything that either made sense of, diffused or drowned out my deepest fear, sense of doom and conflict between loved ones.