My Earthly Rock…. Part Two

This is the hard part… it’s hard to write these memories, that are so fresh.

Dad was transferred to the rehab hospital on March 24, 2016,  three weeks after being admitted to the hospital.   He was very nervous about the rehab hospital not wanting to take him because of various symptoms associated with the spinal cord pressure from the lesion that was still not identified after several biopsies (the spinal cord lesions, bone marrow biopsy- nothing was ever identified as cancer).  I reassured him (or tried to) that those issues were why they were in business.   Dad was willing to give it all he had.  He was weak after three weeks in bed.  During his time in acute care, all transfers were done with lifts or passive movement (mostly to avoid the hospital staff getting back injuries).  He hadn’t been up on his feet for those three weeks.  For each day in bed, %3 of muscle strength is lost.  That’s why it’s so important to be up as much as possible when someone is sick and/or in the hospital.  But sometimes, it’s unavoidable.

The first day dad had physical therapy at the rehab  hospital,  I wanted to be there to get an idea of how he was starting out.   With two therapy staff, putting their shoes in front and back of dad’s shoed feet, and him pushing up from the elevated therapy mat, he was able to stand up absolutely perfectly… but he couldn’t tell he was vertical, and he felt like he was falling.  He knew he was up, but had no idea where he was in space (proprioception issue).   He had a look of terror in his eyes, but he was doing everything they asked him to do.  Everything.   I was actually very encouraged by what I saw, and it brought tears to my eyes.  It really looked like he had a good chance at getting strong enough to go home.  He had to be able to transfer with one assist (one person) in order to go home, and if the first day had him ‘up’, I was thinking that a few weeks would have him that much stronger.  I  kept telling him “you’re doing SO good!”.  And I meant it.

During the initial acute care hospitalization, and continuing in varying degrees, dad had been having stomach pain (he’d also been hospitalized in Florida for stomach issues that were thought to be food poisoning).  It was thought to be from the way the nerves worked coming from the area of the spinal cord with the most pressure on it.   I questioned why nobody was trying to figure out how to help that, and I was sort of dismissed as just not understanding that it was from the spinal cord pressure.   I had worked neuro when I got out of nursing school, as well as various types of rehab during the 20 years I was able to work as an RN.  I understood the obvious symptoms, but knowing my DAD, I also knew that nobody was even considering that something else could be causing a problem.   Being out of an acute hospital sort of narrows focus.  Nobody was looking for any other problem.   And that was a huge omission.  I don’t know if anything could have been done, but nobody was looking.

The stomach pain continued to be a problem in regards to general comfort (progressing to suffering), ability to eat, and his general feeling of not going to be OK.   Come to find out, dad was right.  There was something going on that nobody knew about.  He’d been telling me specific things he wanted done if he died.  He had me write them down.  There were four things he wanted done specifically with three paintings and a  small Steiff teddy bear.  I wrote them down, but never thought that he was not going to get through rehab.

On April 3, at 5:20  that Sunday morning, I got a call from the rehab hospital to tell me that dad was having more intense abdominal pain, and his blood pressure had dropped when they got him up to use the bedside commode; he needed to go to the ER.  I jumped out of bed and grabbed what I might need (my medications) for the day, and took off to try to catch the ambulance to make sure we got to the hospital where dad had been prior to rehab.  I understood that they HAVE to go to the closest one if someone’s vital signs are too unstable, but thankfully they went to the hospital with his more current records about the current situation.  I wasn’t prepared for what I saw when I got back to the room to see dad.

He was delirious from pain as well as sepsis (which was discovered through the ER blood testing).   He was unable to give the right year, and wasn’t cooperating with the nurses as they tried to get an IV in to give him pain medications.   Normally, dad would joke around with those trying to help him, but he kept telling us all to “shut up” (not a phrase he used), “get my overcoat”, and “goodnight, goodnight, goodnight”  (wanted to be left alone). He was also doing these weird biting gestures towards his female friend when she got there.  I got  up near his head to talk to him (and wiping his mouth after he vomited), and explaining that everything that was going on was to help him.  He’d acknowledge that he’d heard me, but was still erratic and ‘not right’.  Eventually, the nurses got an IV in to give him pain meds (and nausea meds), which did help him settle down.   I’d never seen dad like he was that morning, and it scared me, but I had to stay in ‘nurse mode’.   I knew that I’d just become responsible for decisions regarding his care.  He was no longer capable of making rational decisions about his health.  The POAH (Power of Attorney for Healthcare) had just kicked in.  That made me so sad.  Dad had always been able to make good decisions, and his mind had always been so sharp, with a great sense of humor.

Dad was sent for an abdominal CT scan, to find a source for the pain.   When the ER doc pulled me out of the room to tell me what was going on, I was completely caught off guard.  Even the ER docs and radiologist weren’t expecting what they found on that scan. There was a ‘diverticula’ (small pocket that extends from the intestinal wall) that had ruptured.  Dad had never been diagnosed with diverticulosis (the outpouchings) or diverticulitis (inflammation of the outpouchings).  The contents of dad’s bowel had been spilling into his abdominal cavity, causing extreme infection to the point that his system wasn’t able to fight it off (peritonitis with sepsis/septic shock).  The bacteria had also spilled into his bloodstream causing the sepsis and septic shock (what  made his blood pressure drop).  The sepsis was so severe that it was producing gas in his abdominal cavity and bladder.   Four specialists that were contacted, and nobody could fix it. Only one came in to see him (urology guy), and he said that the catheter was the only fix for gas in the bladder (which had already been inserted when he got there).  A general surgeon, urologist, infectious disease doc, and internal medicine doc- and the ER folks- all said that dad was going to die, more by what they didn’t do than what they said.   I knew what they were saying, and yet it didn’t seem possible that this vibrant man who had driven home from south Florida just weeks earlier was going to die very soon.  And that I was responsible for any decisions until that happened.

Dad and I had discussed end of life care many times, and I knew what he wanted.  He didn’t want anything heroic or that would prolong the inevitable.  The disease process was making all of the decisions for him for the most part, I just had to sign off on not doing anything active, other than whatever it took for comfort.   I knew that he didn’t want to be a full code- he had made himself a “no code” when he was initially hospitalized in March.  But signing that “Do Not Resuscitate” paper broke my heart.  I felt like I was giving up on him, and yet I knew that keeping him in a state of intense suffering would have been cruel and selfish. The ER doctor and nurse practitioner made sure I understood what was going on, as well as the inability to offer any hope besides comfort care.  When  I told them that I’d been an RN since 1985,  they sort of relaxed a bit.

I had gone back in to talk to dad, telling him that they knew why he was so sick, and that they couldn’t fix it.  He nodded enough to let me know that he heard me.  When I asked him if he was ready for comfort care only, he nodded (not that we really had a choice).  When I asked if he was ready to see mom, he nodded again.   I had promised him that first day he was in the hospital (March 3) that I’d be honest with him about anything I knew, and I felt that I needed to keep my end of things regarding what the CT scan had shown.  That was one of the hardest things I’ve ever had to do.  He had a right to know.  He almost seemed relieved.  He’d been in so much pain, and was facing dependency in a nursing home if he couldn’t transfer with only one person.  That wasn’t my dad.  My dad was the guy who got up at 7:00 a.m. to go stand in line at estate sales, or drive crazy distances while traveling.  He wanted to live as long as possible, so when he nodded that he was ‘ready’, I knew that he needed the ultimate relief of being healed by the Great Physician.  He was ready to see God.

They offered a bed in ICU, which would have driven dad nuts with all of the bells and alarms, and it wouldn’t have fixed anything.  Dad hated any extraneous noises, so I knew he just wanted a private room where it was quiet.  With any admission, he’d beg me (literally) to make sure he got a private room.  I had to tell him those times that I’d do what I could, but hospitals have to reserve some private rooms for people who are admitted with infections that would put others at risk.  But with palliative care (end of life), private rooms are generally available.  So that’s where we went… to a room on the cancer floor where they were used to handling patients who were there for comfort care only, until the inevitable happened.

I had called one of dad’s close friends earlier that day while dad was in the ER, and let him know what was going on.  He had been able to get to dad’s Sunday School class and let them know  en masse, which was incredibly helpful (one of dad’s lifelong friends was also in that class, and he came up when dad was still in the ER).  Those two friends were able to come and visit, and another friend had dad’s brother’s phone number (he was in Florida) so I could let him know as soon as I got it.  My uncle called dad’s local cousins, who were able to see dad later that afternoon, after dad had lost consciousness.  But they were there, and able to spend time with dad once he got to the room.  I firmly believe that it’s important to let people know that they aren’t alone, even if they can’t respond.  It was important that those friends and family be able to see dad before he died.   The friend that I first called (I had his phone number, as he was my ‘go to’ guy while dad was in Florida) arrived after dad was in the room, and I went out to tell him that dad was dying… I’ll never forget the look on his face. Nobody was expecting things to change so drastically.  Both of those friends had seen dad the day before, when he seemed to be doing better.  Looking back, it’s likely that the diverticula had already ruptured, and the pressure was relieved, so he felt better- but that started the cascade of toxins in his system, that ultimately caused the septic shock which is what killed him.

During the time in the room, the nurses were fantastic about watching dad’s comfort level. Even when someone can’t verbalize how they feel, it’s easy to watch restlessness, picking at blankets or clothing (dad kept trying to remove his gown, so I just took it off and kept him covered with the sheet and blanket),  moans, etc.   I was there from the time he got to the ER that morning, and  alone with him after 9:00 p.m. or so, when the others went home.   I wanted that time alone with him, knowing that those were going to be the last hours I’d ever have with my dad.

The nurses would come in periodically, and ask if I wanted certain things done (blood pressure, blood sugar, catheter, etc).  I agreed to anything that was for comfort (the catheter helped decompress the gas that had built up in his bladder, but there was already no urine being produced).  Nothing was going to be fixed by having his arm squeezed for a blood pressure reading (but I did agree to them doing it if they needed it for paperwork; they didn’t).  His blood sugar wasn’t going to get better (he’d been on steroids for the spinal cord pressure, which are known to elevate blood sugar, as can infection).   I’d had to make the same decisions when my mom died.  Dad had deferred to me once he knew that mom wasn’t going to recover from her sepsis caused by a urinary tract infection that was blown off at a hospital in Sun City West, AZ (not Mayo).  It was a horrible repeat of her death in many ways.

For almost four hours, I was alone with dad.  I’d sort of flip flop between ‘daughter’ and ‘nurse’ mode.   Sometimes, I’d sit in the recliner by his bed and just listen to his breathing, never wanting it to stop, but knowing that he needed to get some perfect peace.  Other times, I’d  sit on the bed, and hold his hand or stroke his cheek with the back of my hand, telling him how lucky I’d been to have him for a dad.   I reassured him that I’d be OK, but that I’d miss him.  I let him know that I knew he’d been working so hard to go home, but if he was ready to rest, it was OK  (it’s important to let people know that if they die, loved ones will be OK).  The nurse medicated him a couple of times when his breathing indicated that he was likely uncomfortable.  And, I’d  cry, knowing that ‘it’ was going to ‘happen’ soon.  Those hours were both precious and excruciating.

Finally, his breathing eased into a gentle rhythm.  There was no struggle.  He just slowed somewhat, and then his breathing gradually and gently slowed to a stop.  I was sitting on the bed with him when he went to be with the Lord.  There was a single facial ‘contortion’, and then ultimate peace and healing.  He was reunited with mom (they’d been together for 46 years), and his love after mom had died (Marilyn- 8 years).  He got to see his two sons who had died as newborns, within a couple of weeks after their separate births.  He was reunited with many friends and family.  And, most importantly, he was finally free of the pain and fear that had gripped him for many weeks.

It’s only been a little over a month since dad left this earth.  I will always be so thankful for the 52 years I had him.  He was my biggest ‘cheerleader’, and always had my best interests in mind.   I miss him.  A lot.  But with hope in the promises of the God I believe in, I know I’ll see him again.

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My Earthly Rock… Part One

The last couple of months have been heart wrenching.  My dad died.  He was 83 years young, and until the end, he was very active.  A couple of weeks before he went to the hospital, he drove from south Florida to northern Illinois in two days, covering the distance from south Georgia to home in one day to outrun a snow/ice storm.   He had always been my biggest ‘cheerleader’ from the time he and mom got me at 10 days old until he died.  But let me back up a bit.

My dad had always been pretty healthy.  He had the standard appendectomy and gallbladder surgeries.  He did have a bout with thyroid cancer a few years ago, that required surgery and radiation, but he was considered to be cancer free with the scans monitoring his situation.   This is a guy who didn’t even own a bottle of Tylenol for a long time, and when he started having some unexplained back pain several months ago, he finally gave in and got some Aleve.   When he called his primary doc about the back pain in November 2015, the doc ordered muscle relaxants over the phone- for a guy who had no history of chronic back pain, and did have a history of cancer.  I wasn’t (and still am not) very happy about that.  I feel he should have been seen in person.  Just as a matter of good care for something that wasn’t part of dad’s history.  Dad just sucked it up and dealt with it.

He felt good enough to go to Florida after Christmas with his female acquaintance, whose daughter and son-in-law have a condo overlooking the ocean.  During his time there, he had what was felt to be food poisoning, and did a two night stint in the hospital down there, staying an extra night when he got too dizzy in the elevator when leaving the first time for them to actually let him go.  He felt bad enough after that to want to get home as soon as possible,  to see his own doctor who finally ordered an x-ray when he got back.  X-rays really aren’t that great for back pain unless there is a fracture of some sort, or the discs are showing degenerative changes (which is the very basic place to start with diagnostic testing).  The x-ray didn’t show much besides some normal aging changes.  The doc also gave dad some pain meds, which did help a bit.  But dad got worse.

On March 1 (a Tuesday), dad asked me to go to see his doctor with him (being the family RN, dad liked it when I could explain things to him after appointments in language that made more sense to someone not in the medical field).  He was able to walk into the office and perform all of the tests with no difficulty aside from some pain with specific movements.  The pain was mostly to the left of his spinal column in the chest portion of his spine (in the back).   The doc ordered an MRI, which dad did NOT like, because of claustrophobia, but it was the best thing he could have ordered…. and would have been much more useful a few months earlier.

The next day, dad called me to say that he woke up with his legs feeling weird, like he couldn’t feel them very well, but it had eased over the course of the day.  He chalked it up to the muscle relaxant he’d taken before bed the night before, and decided not to take any more of them.  The next day, Thursday March 3, dad called me at 8:00 a.m.  Anybody who knows me knows that I’m a night owl normally, and getting up around noon was my usual routine.  Dad always respected that, so I knew that if he was calling, something was really wrong.   He said he couldn’t walk right.  He’d gotten to the bathroom, but needed me to get over there as soon as I could.  I asked him if I had time for a shower, and he said yes.  I had already figured that going to the ER was the only logical thing to do at that point, and was getting ready for a day at the hospital, minimum.  When I got there, dad was sitting on the bed.  He stood up, and it was like watching someone try to stand on an inner tube in a swimming pool.   I told him to sit down, and just let me know what he needed to get ready to go to the ER via 911- it was going to be the safest way to transport him, as well as avoid the waiting room.   After he shaved and had a bowl of cereal, we got a few things put into a bag in case they kept him (I couldn’t imagine them not keeping him since he lived alone, I’m disabled enough that caring for him would be not very logical no matter how much I wanted to, and he needed to know why this was all happening… he needed tests).  Then EMS came for him, and I followed the ambulance to the hospital.

The usual ER things were done (IV, labs, x-rays), and then they ordered an MRI.  Dad was not amused, and was very anxious about the whole thing.  He’d gotten some pain meds, anxiety meds, and nausea meds, along with a washcloth over his eyes, and by the time he went to the MRI I don’t think he would have cared if they put him in a coal mine shaft.  He said it wasn’t so bad.  The results weren’t so good.  They’d only done the lower spine in the ER, as they can only test for emergent problems- and there were some ‘suspicious’ lesions in his lower spine.  It was enough to admit him.   And enough to scare him.

His oncologist (he requested) has been a family friend for decades, as well as my mom’s and my oncologist at times (mom died in 2003 after 17 years cancer free).   The good doc came up that evening, and suspected that dad had multiple myeloma based on the type of tumor he’d had in his thyroid gland a few years earlier, and the looks of the initial MRI.  He also said that they needed to get an MRI of the rest of his spine, since the area where dad had the most pain was higher up.  Dad has always been terrified of hearing ‘multiple myeloma’ since his mom died from that (with amyloidosis complicating things the most) in 1979.  SO much has changed in treating MM since then, and “Bob” (oncologist- not real name) said that if it was MM, that dad could have a good quality of life with chemotherapy pills.   But first,  more testing with the MRI being the one dad was most nervous about.

It took a couple of days to get dad through the MRI, but when they got it, they saw a lesion pressing ON dad’s spinal cord at T-7, causing the pain, as well as inability to feel where his feet were when he was trying to walk.  He could move his legs, and had good strength when pressing or pulling against the doc’s (or my) hands.  The pain at this point was the worst, but only really bad if he had to move.  I’d never seen him in so much pain, and in 20 years of working as an RN, I don’t know if I’d seen too many other people with that level of pain.  Even my chronic pain (which is a different beast altogether) paled in comparison (and I don’t condone comparing pain, as everybody feels it differently in accordance with their own very personal frame of reference).  But dad turned pale, and grimaced to the point of not recognizing him if I hadn’t been there when it happened.  He was immediately scheduled to start radiation to shrink the mass within a couple of hours of the MRI being done and read.   Biopsies were done of various areas in the spine and bone marrow, and the hope was still that dad was going to be able to go to the rehab hospital, and eventually return home.   At least that was what we were aiming for, and “Bob” was optimistic at that point.

Dad was in the hospital for about three weeks before being sent to the rehab hospital (NOT a nursing home with physical and occupational therapy, which are fine for many things, but not intensive rehab).   He was still very understandably terrified, but gave it his all once he knew that the rehab hospital would  only work with him if he could do three hours of therapy a day (broken up into four sessions between PT and OT).   He didn’t believe he’d be OK, but knew he had to work as if he believed if he wanted any chance at going home (with help if needed), and not a nursing home.   So, he worked as hard as he could, and was transferred to Van Matre Rehab Hospital for the next stage in his excruciating journey.

…. on to Part Two.