Trudy refused to be pinned down about the ventilator. In an effort to rein her in, my siblings and I resorted to communicating with her via group email. This system would make it harder for Trudy to lie, since she has to report to all of us simultaneously. Plus, even though Trudy resents direct questions, she can’t burst into tears and hang up on an email.
I wrote a message insisting that Trudy put in a standing order not to ventilate Dad in an emergency, in case no family members are present. I reminded her that we don’t want to prolong John’s suffering, and offered to instruct the doctors for her. Trudy expressed the fear that if she agreed to do that, the hospital would then stop all forms of treatment, because that is what happened to her “darling friend Jan.”
Jan was a petite, 95 year old woman who wore her gray hair in the same chin length bob she was probably given by her mother in 1923. She was an outspoken atheist, a staunch leftie, and a pragmatic intellectual. Until the day she went into the hospital for the last time, Jan continued to clip socially significant articles from the newspaper and mail them to her many friends, my father among them. She was as tough and sharp as nails throughout her entire life, but after nearly a century of service, her body finally wore out. Jan’s Advance Directive instructed the hospital not to sustain her by medical means. As was her wish, Jan spent the last few days of her life drifting toward death on a morphine drip.
Trudy’s recollection is a bit more Gothic. In her eyes, the sinister hospital staff managed to dig up an ancient, ill-conceived directive, which permitted them to leave poor, feeble Jan languishing, unattended, on the “dark and gloomy” 5th floor. One day, just after Trudy had gone home, Jan died. Trudy often wonders whether one of the hospital staff had, “slipped Jan something,” while no one was looking. She concluded by writing, “It still haunts me and I don't want to think of that happening to your Dad.”
To Trudy’s mind, Jan could not have chosen to die. Events and thoughts that don’t correspond with my mother’s wishes are inconceivable to her. Dying, i.e. leaving Trudy, is disloyal. Therefore, Jan must have been killed. Trudy will not allow John to leave her. Trudy will not let John be killed. Besides, as it stands now, John is the perfect husband. He lives at the hospital, he can make no demands, he is totally at her mercy, she gets attention from doctors, and his illness puts her at the center of attention.
Now furious, I asked Trudy to take a good look at John’s roommate and decide if that’s what she wants for Dad. I told her that John was not going to get better, ever, and begged her to take him off the feeding tube as well, so he could die in peace. I informed her that if she decided to keep John alive with a ventilator or any other life support apparatus, I wouldn’t be back to witness it.
Contrasting my hot-headed missive, my warm-hearted sister-in-law, Susan, jumped in with a long, thoughtful email, designed to assuage Trudy’s fears. She had spoken to her friend, an oncology nurse, who assured Susan that a hospital will not discontinue any treatment without specific consent from the family. She reiterated that putting John on a ventilator may prolong his current state, but without any quality of life. She added that any intubation can expose patients to additional infections and complications, and worried that a ventilator may cause John more suffering.
After visiting John, and reading the flurry of emails, Karla calmly put in her two cents as well. “Now is not the time to argue, to put things off, or to be controlling. This was the worst visit I have had with John and my feeling is that he is very close to death; his body is swollen which must mean that his organs are shutting down. He can barely open his eyes to acknowledge that he is aware of anyone’s presence. I am sure that he does not want to spend another second in this condition. He has lost any ounce of dignity that he might have had. He will never, ever improve. I am sure that if he had the ability, he would close his eyes and will himself to death. I don’t know about the rest of you but I get no pleasure from watching John in discomfort. I think he should be given the okay from all of us to let go, and be put on the morphine drip. Mom, I know that this is burdensome to you. You should relieve that burden and put John’s care in Mary’s hands. Her love for him will guide her to do what’s best for John.”
Trudy was pissed. Not because of my irate email, but because of Susan’s and Karla’s more reasonable appeals. Trudy loathes being placated. This wasn’t about John's well-being; it was about power and control. Her lengthy reply began, “How dare you…” and it only got worse. The bottom line was that she is running the show. “Never have I stated that I would use a ventilator to try and keep him alive, and it is still not my intention to use one; however, I said I don’t want to think about it right now!!!” She summed it up by telling us all she wished we understood, but if we don’t, “so be it.”
The following day, Susan and Karla both sent out emails reiterating their concern for John, and apologizing to Trudy for interfering.
Wednesday, December 12, 2007
Thursday, December 6, 2007
Kindred Spirits
Kindred Long Term Acute Care Hospital is located only a few blocks from where I grew up, in Ladera Heights. It sits on a busy street at the edge of the neighborhood, next to St. Mary's Ethiopian Orthodox Tewahedo Church.
Trudy was right. The lobby is nice. It is sunny, clean and when I arrived there was snack cart offering flavored coffee and pastries. There was also a welcoming and well-coiffed receptionist who handed me a name tag and directed me toward John’s room. It was downhill from there on out.
I walked around the corner and into a hallway where I found a nurse standing in front of her station. I asked for my father’s room and she pointed directly in front of her. John’s cramped, dingy, double-occupancy room was about 10 x 10 feet. There were tiles missing from the floor and the particleboard closet was crumbling in places. A privacy curtain was pulled back to reveal his roommate and the one television set they would share, which hung in the far corner of the room. The beds were fewer than two feet apart.
John’s roommate was unconscious and breathing with the aid of a ventilator. Various tubes and IV's invaded his body. He was lying on his side, kind of bunched up, and he looked like he’d been left that way for decades. He was basically a pile of mashed potatoes hooked up to machines that occasionally made scary alarm noises, which everyone pretty much ignored.
The first thing I did after greeting John was to close the curtain far enough to block our view of Potatoes, while leaving it open enough so John could see the television set. Right away, John asked me for something to drink. When I buzzed the nurse for a pitcher of water, she informed me that the doctor had ordered no liquids until the occupational therapist determined whether or not John could swallow properly. This order was put in place upon my father’s arrival the day before, but no therapist had been in to see him yet. In other words, John had been denied liquids for over 24 hours. The nurse assured me that the feeding tube was providing him with adequate hydration. I complained that he was thirsty and explained he had been allowed liquids and food at USC. She carried on about procedure, and, “the way we do it here,” but I got irritated and stopped listening. Unaware of our argument, Dad turned to me and said, “How about a cup of coffee?” I remembered the beverage cart in the Nice Lobby so I grabbed a cup of hazelnut blend and brought it back to him. The nurse gave me a dirty look but, having been trained by the best in dirty looks, I was not dissuaded. I fed John sips of coffee while glaring at her until she left the room.
The nurse returned with an elderly, bearded doctor. Smiling cordially, Dr. Axelrod extended his hand and welcomed me to Kindred. He told me he had already had the pleasure of meeting my charming mother and explained that he was an associate of her physician, Dr. Mulvy. I shook his hand, told him that his hospital was filthy and asked why no one had been in to examine John in a day and a half while he lay there begging for water. Taken aback, he assured me John was getting enough fluid through his feeding tube. He boasted that the care at Kindred was among the finest in the city, assured me the hospital was clean, and blamed the appearance of the room on Federal Medicare cutbacks. Handing me his card, he withdrew.
Soon after, a jovial occupational therapist appeared. He made John repeat the phrase, “Captain Crunch!” several times and chew on ice, then he felt John’s throat when he swallowed. The therapist’s determination was that he would allow John liquids as well as food, if it were puréed.
The next day when I returned to Kindred, I saw that John had been given a haircut, a shave, and his eyebrows had been trimmed. Throughout his stay, I realized that although the place is a dump, the staff is very dedicated and mostly friendly. It became clear pretty quickly that the nurses were unaccustomed to family members hanging around, getting in their way. This is where people leave their aged and decaying relatives to die. Like poor ol’ Potatoes in the corner, for instance. They kept him in existence with machines, but no one ever visited him that I saw.
I sent out an email to Trudy, Karla and Leo, again telling them that we should make up a schedule for visiting John so that no one feels overburdened, and so that John has some contact with at least one of us every day. I wrote that he no longer wants much company, he just needs to know we are around and he is safe. I asked Trudy to please update everyone with news from the doctors, so that I would no longer be her only confidante. Karla responded immediately, offering three days that week she would come by the hospital. Leo didn’t respond to the email but he did visit.
One morning I arrived at Kindred and found my aunt Ruth sitting in the lobby, looking quite elegant in a black turtleneck and slacks, her silver hair swept into a barrette at the back of her head. She couldn’t see me waving from across the room, so I approached her and said hello. “Mary, is that you?” I came closer and told her it was. She craned her neck forward and peered at me. “I like that dress. It’s cute on you. You look good in that color. Did you dye your hair? It’s too dark. I like it lighter.” As I sat beside her, she reached into her cluttered purse, pulled out a mini dark chocolate Hershey’s bar and pressed it into my palm. I thanked her, but said I didn’t want it. “Why? Are you on a diet?? Dark chocolate is good for you.” I told her I wasn’t on a diet, but I hadn’t eaten breakfast yet. She rifled through her bag. “You want another kind? Here’s one with nuts.”
My Mormon aunt Shirley and her daughter Jenny (who had been parking the car), arrived, and we all filed into John’s room. I tried to wake him by telling him he had company. He struggled to open his eyes but they rolled back in his head. Jenny stuck some freshly cut flowers under his nose, but he just frowned and squeezed his eyes shut tightly, like a stubborn kid.
We reconvened in the lobby and all agreed that Dad was worse than ever. I told them that Trudy had allowed insertion of a feeding tube against my, Karla’s and Leo’s wishes and that I was afraid she would continue with further life support as he got closer to death. Shirley knew first hand how awful ventilators are because her 85 year-old husband Bruce had been placed on one after he drunkenly drove his car into a tree on the way to meet his young Asian mistress a couple of years ago.
(Bruce was an alcoholic, chain smoking, philandering Mormon. He was also a, “career soldier,” flying planes for the U.S. Air Force until retirement. My Dad thought he was hilarious and called him, “The General.” Throughout my childhood, Bruce arrived at our house every Christmas Eve in his mobile home, carrying 6 packs of malt liquor in a brown paper bag. Aunt Shirley followed timidly behind carrying the gifts. One year, having whipped through his supply, he hopped into the mobile home and headed to the market to buy more refreshments before dinner. (For some reason, we didn’t usually serve malt liquor at our house.) Nothing out of the ordinary there, except Bruce never returned. Eventually, John was sent to look for him. He noticed the mobile home was parked up the street and realized Bruce must have knocked on a neighbor’s door by accident. As luck would have it, Mrs. Shogrin, a fellow alcoholic, answered the bell and invited him in for cocktails. The two of them were sitting in her living room, boozing it up, when my Dad arrived to bring Bruce home. John loved that story. He would shake his head, laugh and say to himself, “Ah, The General.”)
The following morning I woke up to an email from Trudy saying that John's breathing had been labored the evening before. She said that he was given oxygen and by the time she left he was breathing easier, but she was worried. I wrote back asking her to please make sure Kindred was aware of our wish that John not be placed on a ventilator.
Within the hour, Trudy replied, "I don't want to think about that right now."
Trudy was right. The lobby is nice. It is sunny, clean and when I arrived there was snack cart offering flavored coffee and pastries. There was also a welcoming and well-coiffed receptionist who handed me a name tag and directed me toward John’s room. It was downhill from there on out.
I walked around the corner and into a hallway where I found a nurse standing in front of her station. I asked for my father’s room and she pointed directly in front of her. John’s cramped, dingy, double-occupancy room was about 10 x 10 feet. There were tiles missing from the floor and the particleboard closet was crumbling in places. A privacy curtain was pulled back to reveal his roommate and the one television set they would share, which hung in the far corner of the room. The beds were fewer than two feet apart.
John’s roommate was unconscious and breathing with the aid of a ventilator. Various tubes and IV's invaded his body. He was lying on his side, kind of bunched up, and he looked like he’d been left that way for decades. He was basically a pile of mashed potatoes hooked up to machines that occasionally made scary alarm noises, which everyone pretty much ignored.
The first thing I did after greeting John was to close the curtain far enough to block our view of Potatoes, while leaving it open enough so John could see the television set. Right away, John asked me for something to drink. When I buzzed the nurse for a pitcher of water, she informed me that the doctor had ordered no liquids until the occupational therapist determined whether or not John could swallow properly. This order was put in place upon my father’s arrival the day before, but no therapist had been in to see him yet. In other words, John had been denied liquids for over 24 hours. The nurse assured me that the feeding tube was providing him with adequate hydration. I complained that he was thirsty and explained he had been allowed liquids and food at USC. She carried on about procedure, and, “the way we do it here,” but I got irritated and stopped listening. Unaware of our argument, Dad turned to me and said, “How about a cup of coffee?” I remembered the beverage cart in the Nice Lobby so I grabbed a cup of hazelnut blend and brought it back to him. The nurse gave me a dirty look but, having been trained by the best in dirty looks, I was not dissuaded. I fed John sips of coffee while glaring at her until she left the room.
The nurse returned with an elderly, bearded doctor. Smiling cordially, Dr. Axelrod extended his hand and welcomed me to Kindred. He told me he had already had the pleasure of meeting my charming mother and explained that he was an associate of her physician, Dr. Mulvy. I shook his hand, told him that his hospital was filthy and asked why no one had been in to examine John in a day and a half while he lay there begging for water. Taken aback, he assured me John was getting enough fluid through his feeding tube. He boasted that the care at Kindred was among the finest in the city, assured me the hospital was clean, and blamed the appearance of the room on Federal Medicare cutbacks. Handing me his card, he withdrew.
Soon after, a jovial occupational therapist appeared. He made John repeat the phrase, “Captain Crunch!” several times and chew on ice, then he felt John’s throat when he swallowed. The therapist’s determination was that he would allow John liquids as well as food, if it were puréed.
The next day when I returned to Kindred, I saw that John had been given a haircut, a shave, and his eyebrows had been trimmed. Throughout his stay, I realized that although the place is a dump, the staff is very dedicated and mostly friendly. It became clear pretty quickly that the nurses were unaccustomed to family members hanging around, getting in their way. This is where people leave their aged and decaying relatives to die. Like poor ol’ Potatoes in the corner, for instance. They kept him in existence with machines, but no one ever visited him that I saw.
I sent out an email to Trudy, Karla and Leo, again telling them that we should make up a schedule for visiting John so that no one feels overburdened, and so that John has some contact with at least one of us every day. I wrote that he no longer wants much company, he just needs to know we are around and he is safe. I asked Trudy to please update everyone with news from the doctors, so that I would no longer be her only confidante. Karla responded immediately, offering three days that week she would come by the hospital. Leo didn’t respond to the email but he did visit.
One morning I arrived at Kindred and found my aunt Ruth sitting in the lobby, looking quite elegant in a black turtleneck and slacks, her silver hair swept into a barrette at the back of her head. She couldn’t see me waving from across the room, so I approached her and said hello. “Mary, is that you?” I came closer and told her it was. She craned her neck forward and peered at me. “I like that dress. It’s cute on you. You look good in that color. Did you dye your hair? It’s too dark. I like it lighter.” As I sat beside her, she reached into her cluttered purse, pulled out a mini dark chocolate Hershey’s bar and pressed it into my palm. I thanked her, but said I didn’t want it. “Why? Are you on a diet?? Dark chocolate is good for you.” I told her I wasn’t on a diet, but I hadn’t eaten breakfast yet. She rifled through her bag. “You want another kind? Here’s one with nuts.”
My Mormon aunt Shirley and her daughter Jenny (who had been parking the car), arrived, and we all filed into John’s room. I tried to wake him by telling him he had company. He struggled to open his eyes but they rolled back in his head. Jenny stuck some freshly cut flowers under his nose, but he just frowned and squeezed his eyes shut tightly, like a stubborn kid.
We reconvened in the lobby and all agreed that Dad was worse than ever. I told them that Trudy had allowed insertion of a feeding tube against my, Karla’s and Leo’s wishes and that I was afraid she would continue with further life support as he got closer to death. Shirley knew first hand how awful ventilators are because her 85 year-old husband Bruce had been placed on one after he drunkenly drove his car into a tree on the way to meet his young Asian mistress a couple of years ago.
(Bruce was an alcoholic, chain smoking, philandering Mormon. He was also a, “career soldier,” flying planes for the U.S. Air Force until retirement. My Dad thought he was hilarious and called him, “The General.” Throughout my childhood, Bruce arrived at our house every Christmas Eve in his mobile home, carrying 6 packs of malt liquor in a brown paper bag. Aunt Shirley followed timidly behind carrying the gifts. One year, having whipped through his supply, he hopped into the mobile home and headed to the market to buy more refreshments before dinner. (For some reason, we didn’t usually serve malt liquor at our house.) Nothing out of the ordinary there, except Bruce never returned. Eventually, John was sent to look for him. He noticed the mobile home was parked up the street and realized Bruce must have knocked on a neighbor’s door by accident. As luck would have it, Mrs. Shogrin, a fellow alcoholic, answered the bell and invited him in for cocktails. The two of them were sitting in her living room, boozing it up, when my Dad arrived to bring Bruce home. John loved that story. He would shake his head, laugh and say to himself, “Ah, The General.”)
The following morning I woke up to an email from Trudy saying that John's breathing had been labored the evening before. She said that he was given oxygen and by the time she left he was breathing easier, but she was worried. I wrote back asking her to please make sure Kindred was aware of our wish that John not be placed on a ventilator.
Within the hour, Trudy replied, "I don't want to think about that right now."
Wednesday, December 5, 2007
Unsettled
The day my father was transferred to his new nursing home I was almost killed.
That morning I had gone to USC University Hospital to see that John made it safely into the ambulance that would whisk him across town to where my mother was waiting at Kindred Long Term Acute Care. Later, I met my friend Jeff for lunch at a tedious hipster-themed diner in my neighborhood called Fred’s 62. (They do make a pretty decent tuna melt, I have to admit.)
I ordered a sandwich and my phone rang. It was Trudy and she sounded apprehensive. “Your father wants to know where you are.” I told her I thought we’d agreed I would see him off at USC in the morning and then go visit him at the nursing home the next day. “Oh…. OK... Well, he wants to talk to you.” She held the phone to his ear and he asked me when I was coming. I reminded him that I’d be there tomorrow and asked him how the place was. “Raunchy.” If John noticed his surroundings, they had to be bad. “Put Mom on.” Trudy admitted the place was, “a little dirty.” I reminded her that she had visited Kindred and deemed it, “very nice.” She replied, “Well… the lobby is nice.” “Didn’t you look at the rooms when you checked the place out?” “I can't talk now. I’ll have to call you later.”
I choked down my meal and absentmindedly carried on a conversation while I stewed over this one. After lunch, Jeff and I decided to walk to the bookstore a few doors down. As we were crossing the street to put money in his meter, an SUV stopped to let us pass. We continued walking when suddenly there was a loud squealing of tires. Jeff and I grabbed each other and did that geeky move where you lift one knee up to your chest, hunch up your shoulders and squint. Inches away from where we cowered mid-crosswalk was a teenage boy in a sports car, talking animatedly on his cell phone. He didn’t stop conversing, nor did he look over at us, as he lifted the one hand he had on the steering wheel to give an unconcerned wave, like, “It’s cool. I see you.”
That was all I needed. “You fucking piece of shit!! Get off your mother fucking cell phone, you fucking asshole!!! Fuck you!!!!” I was becoming redundant, so Jeff pulled me onto the opposite curb. He hugged me, asked me if I was OK, and said something about how scary that was. I answered with, “I could have killed that asshole!” (I also may have, regrettably, made a disparaging remark about young Armenian hoodlums and their reckless driving. Mea Culpa.) Jeff reminded me that I could not have killed him; he could have killed us, by hurtling a ton of metal in our direction at 60 miles an hour. Just then two lanky, effete looking men outfitted in black denim, accented with heavy chains, walked by us. I couldn’t tell whether his voice was sympathetic or mocking when one of them slowly shook his scraggly raven locks and cooed softly, “He was on his cell phone.”
In retrospect, my guess is mocking.
That morning I had gone to USC University Hospital to see that John made it safely into the ambulance that would whisk him across town to where my mother was waiting at Kindred Long Term Acute Care. Later, I met my friend Jeff for lunch at a tedious hipster-themed diner in my neighborhood called Fred’s 62. (They do make a pretty decent tuna melt, I have to admit.)
I ordered a sandwich and my phone rang. It was Trudy and she sounded apprehensive. “Your father wants to know where you are.” I told her I thought we’d agreed I would see him off at USC in the morning and then go visit him at the nursing home the next day. “Oh…. OK... Well, he wants to talk to you.” She held the phone to his ear and he asked me when I was coming. I reminded him that I’d be there tomorrow and asked him how the place was. “Raunchy.” If John noticed his surroundings, they had to be bad. “Put Mom on.” Trudy admitted the place was, “a little dirty.” I reminded her that she had visited Kindred and deemed it, “very nice.” She replied, “Well… the lobby is nice.” “Didn’t you look at the rooms when you checked the place out?” “I can't talk now. I’ll have to call you later.”
I choked down my meal and absentmindedly carried on a conversation while I stewed over this one. After lunch, Jeff and I decided to walk to the bookstore a few doors down. As we were crossing the street to put money in his meter, an SUV stopped to let us pass. We continued walking when suddenly there was a loud squealing of tires. Jeff and I grabbed each other and did that geeky move where you lift one knee up to your chest, hunch up your shoulders and squint. Inches away from where we cowered mid-crosswalk was a teenage boy in a sports car, talking animatedly on his cell phone. He didn’t stop conversing, nor did he look over at us, as he lifted the one hand he had on the steering wheel to give an unconcerned wave, like, “It’s cool. I see you.”
That was all I needed. “You fucking piece of shit!! Get off your mother fucking cell phone, you fucking asshole!!! Fuck you!!!!” I was becoming redundant, so Jeff pulled me onto the opposite curb. He hugged me, asked me if I was OK, and said something about how scary that was. I answered with, “I could have killed that asshole!” (I also may have, regrettably, made a disparaging remark about young Armenian hoodlums and their reckless driving. Mea Culpa.) Jeff reminded me that I could not have killed him; he could have killed us, by hurtling a ton of metal in our direction at 60 miles an hour. Just then two lanky, effete looking men outfitted in black denim, accented with heavy chains, walked by us. I couldn’t tell whether his voice was sympathetic or mocking when one of them slowly shook his scraggly raven locks and cooed softly, “He was on his cell phone.”
In retrospect, my guess is mocking.
Tuesday, December 4, 2007
If It's Not One Tube, It's Another
The morning after the feeding tube was placed in his abdomen, John seemed even more listless and disoriented. The doctors attributed his weakness to the lingering effects of anesthesia and assured me he would gain strength once his intake of calories increased.
Since nutrition couldn’t be delivered through the tube for 24 hours after surgery, I tried to con John into eating some lunch. Feeding him had become especially difficult because he had lost so much weight that his gums were receding and his false teeth were constantly sliding out of place. The upper denture would hang half way out of his mouth, but he wouldn’t let me remove it, so I had to keep pushing it back in. I finally got him to open up long enough for me to quickly slip in some rice, but he refused to chew it. He just left the food sitting on his tongue and stored in his cheeks. I managed to sneak in some chocolate pudding to moisten it, and then he sneezed out the whole mouthful all over himself. And me.
When I arrived at the hospital the following day, John’s breathing was uneven. He started coughing and I thought I saw an obstruction in his throat, so I pulled on a blue latex glove, stuck my fingers in his mouth, and pulled out something dark grey and squishy, but kind of dense. I thought maybe in his demented state he’d started chewing on the L.A. Times. (I still brought him one most days, even after he couldn’t read it anymore. He liked to hold it and pretend.) I dangled the dark wad way out in front of me, between my thumb and forefinger, squinting and grimacing at it, but also trying to figure out what it was. The nurse changing John’s IV bag stared at me, unconcerned. “It’s just phlegm, baby.”
Trudy called on my cell phone to see how John was doing. (Trudy usually visited John at night so she could be there for dinnertime. She’d stay and watch television with him, usually until the 11:00 news started. I stopped working a few months ago, so I normally arrived around 11:00am. I’d try to feed him lunch, then I’d put on a movie, or read while he slept. I’d leave around 3:00 or 4:00.) I told Trudy that John was ok, but that he had some congestion and wasn’t eating. She gave a relieved sigh and followed it up with, “Oh, good. When I left the hospital last night he was having a really hard time breathing. I thought he was a goner.”
One of John’s doctors, a young intern named Dr. Lopez, came in to examine him. After filling me in on the terrific Muse concert he and his wife had attended the night before, he informed me that John was running a fever, most likely because of the feeding tube placement. After listening to John’s lungs, the doctor asked me whether I would give permission to ventilate if it became necessary. I refused to discuss it standing right beside my father, so we moved to an unoccupied room.
I had heard being on a ventilator felt like trying to breathe through a straw. Dr. Lopez didn’t refute the claim. In fact, he said that a patient on a ventilator is usually sedated to prevent discomfort, and so that he or she won’t yank out the tube in frustration. He then explained that if John’s difficulty breathing worsened, and we chose not to intervene with a ventilator, we would enter, “a hospice situation.” The doctors would simply put him on a morphine drip to alleviate any pain, and let nature take its course.
My father had not drawn up an Advance Directive. I don’t know why. But I do know that if he could have imagined himself in this predicament, he never would have submitted to lingering in a hospital bed, immobile, barely conscious, false-toothless, shitting himself, with a tube in his stomach delivering protein shakes and a tube down his throat forcing air in and out of his lungs. Never.
I called Karla. She and my brother-in-law agreed: No ventilator. I called Leo: No ventilator. I called Trudy. She, of course, had the final say. I would try to persuade her, and even beg her if we disagreed, but I would not fight her on this. John is her husband and he dedicated his entire life to appeasing her. He wouldn’t want to live like this, but he would suffer it, if that’s what Trudy wanted.
Trudy sounded like a terrified child on the phone. I gave her my opinion and feared her response. For the first time throughout John’s decline, she asked what Karla and Leo thought. And then, she tearfully agreed. No ventilator.
The next morning, John’s temperature was down and he was breathing easier. The folks at USC University Hospital were eager to get him moved back into a nursing home, I assume before he caught something else and died there. He wasn’t going back to the place in Santa Monica, where he may or may not have contracted scabies. Besides, his condition now called for a higher level of care than they offer. The social worker on staff at USC suggested a critical care nursing facility called Kindred, which is very close to my parents’ old house and not far from their condo. Trudy checked it out and was pleased. “It’s very nice. And the administrator's name is Trudy. Can you believe it? There are a lot of black people there, but I don’t care about that.”
Since nutrition couldn’t be delivered through the tube for 24 hours after surgery, I tried to con John into eating some lunch. Feeding him had become especially difficult because he had lost so much weight that his gums were receding and his false teeth were constantly sliding out of place. The upper denture would hang half way out of his mouth, but he wouldn’t let me remove it, so I had to keep pushing it back in. I finally got him to open up long enough for me to quickly slip in some rice, but he refused to chew it. He just left the food sitting on his tongue and stored in his cheeks. I managed to sneak in some chocolate pudding to moisten it, and then he sneezed out the whole mouthful all over himself. And me.
When I arrived at the hospital the following day, John’s breathing was uneven. He started coughing and I thought I saw an obstruction in his throat, so I pulled on a blue latex glove, stuck my fingers in his mouth, and pulled out something dark grey and squishy, but kind of dense. I thought maybe in his demented state he’d started chewing on the L.A. Times. (I still brought him one most days, even after he couldn’t read it anymore. He liked to hold it and pretend.) I dangled the dark wad way out in front of me, between my thumb and forefinger, squinting and grimacing at it, but also trying to figure out what it was. The nurse changing John’s IV bag stared at me, unconcerned. “It’s just phlegm, baby.”
Trudy called on my cell phone to see how John was doing. (Trudy usually visited John at night so she could be there for dinnertime. She’d stay and watch television with him, usually until the 11:00 news started. I stopped working a few months ago, so I normally arrived around 11:00am. I’d try to feed him lunch, then I’d put on a movie, or read while he slept. I’d leave around 3:00 or 4:00.) I told Trudy that John was ok, but that he had some congestion and wasn’t eating. She gave a relieved sigh and followed it up with, “Oh, good. When I left the hospital last night he was having a really hard time breathing. I thought he was a goner.”
One of John’s doctors, a young intern named Dr. Lopez, came in to examine him. After filling me in on the terrific Muse concert he and his wife had attended the night before, he informed me that John was running a fever, most likely because of the feeding tube placement. After listening to John’s lungs, the doctor asked me whether I would give permission to ventilate if it became necessary. I refused to discuss it standing right beside my father, so we moved to an unoccupied room.
I had heard being on a ventilator felt like trying to breathe through a straw. Dr. Lopez didn’t refute the claim. In fact, he said that a patient on a ventilator is usually sedated to prevent discomfort, and so that he or she won’t yank out the tube in frustration. He then explained that if John’s difficulty breathing worsened, and we chose not to intervene with a ventilator, we would enter, “a hospice situation.” The doctors would simply put him on a morphine drip to alleviate any pain, and let nature take its course.
My father had not drawn up an Advance Directive. I don’t know why. But I do know that if he could have imagined himself in this predicament, he never would have submitted to lingering in a hospital bed, immobile, barely conscious, false-toothless, shitting himself, with a tube in his stomach delivering protein shakes and a tube down his throat forcing air in and out of his lungs. Never.
I called Karla. She and my brother-in-law agreed: No ventilator. I called Leo: No ventilator. I called Trudy. She, of course, had the final say. I would try to persuade her, and even beg her if we disagreed, but I would not fight her on this. John is her husband and he dedicated his entire life to appeasing her. He wouldn’t want to live like this, but he would suffer it, if that’s what Trudy wanted.
Trudy sounded like a terrified child on the phone. I gave her my opinion and feared her response. For the first time throughout John’s decline, she asked what Karla and Leo thought. And then, she tearfully agreed. No ventilator.
The next morning, John’s temperature was down and he was breathing easier. The folks at USC University Hospital were eager to get him moved back into a nursing home, I assume before he caught something else and died there. He wasn’t going back to the place in Santa Monica, where he may or may not have contracted scabies. Besides, his condition now called for a higher level of care than they offer. The social worker on staff at USC suggested a critical care nursing facility called Kindred, which is very close to my parents’ old house and not far from their condo. Trudy checked it out and was pleased. “It’s very nice. And the administrator's name is Trudy. Can you believe it? There are a lot of black people there, but I don’t care about that.”
Tuesday, November 27, 2007
Like Mother, Like Daughter
A psychic approached Trudy at Dupar’s coffee shop the night before John’s feeding tube surgery and informed her that she had a Bad Aura. It was sometime after midnight. Trudy and Ruth had stopped in for eggs on the way home from visiting John at the hospital because Trudy had a craving.
Ruth is legally blind and, whether she admits it or not, Trudy is very hard of hearing. I imagine that when the psychic approached the table, Ruth was shouting inquiries while Trudy read the menu aloud. The psychic, who Trudy described as, “very well dressed,” introduced herself and told Trudy that she could sense she was burdened by health problems. She then asked if Trudy’s health was bad. Trudy was astonished by her insight. “How could she know that?” I shared her excitement. “I know! How on earth could this woman divine that two older-” Trudy interrupted, “OLDER?” “Yes, Mom. Older. Elderly.” “ELDERLY? Well!” “Yes, how could she walk over to two ELDERLY women sitting in a diner late at night, no doubt conversing loudly about hospitals and doctors, and ascertain that at least one of them has medical issues?” Trudy pronounced her amazing and planned to visit the psychic at her home in Diamond Bar for a reading.
That reminded me of the time JB insisted I drive all the way out to Orange County for a consultation with his psychic when I was about 21 or 22. Her name was Dolly and she was a middle-aged woman living in the middle of the suburbs in a small house cluttered with stuffed unicorns, rainbow prism stickers and religious knickknacks. She had a really high-pitched voice like that spooky little woman in “Poltergeist.” Reluctantly, she allowed me to make an audiocassette of our session, which I later chopped up for interstices in a mixed tape.
First, Dolly read my aura, which she saw was mostly white. This told her I would soon have dental work on two teeth, take a trip to the snow, and participate in a wedding. The fact that there were no blacks, greys, browns or maroons in my aura told her that I wasn’t going to die in the near future, or go to jail, and that I wasn’t hooked on drugs.
Next, she asked for a piece of my jewelry and dealt out some Tarot cards, while calling forth her spirit guides, “Timothy, Stan, and Dr. Frank Vigiano.” They apparently relayed some urgent information to her so she looked up from her cards and asked whether I knew anyone who raised goats. I told her, “No, I live in New York. There are no goat herders in Manhattan.” Unfazed, she flipped more cards, tapped an acrylic fingernail on one, and assured me that I wouldn’t be killed in a car accident. Then, she stared at me long and hard before finally asking, “Mary, do you know a man whose name starts with a D? Doug?… David?... Donald?... No…wait… Oh! Mary!... I see a Dick in your future!” After that, she wrapped it up by warning me to be careful in the sun because I burn easily. I’ll bet Dr. Vigiano told her to say that.
And he was right. I do. Amazing.
Ruth is legally blind and, whether she admits it or not, Trudy is very hard of hearing. I imagine that when the psychic approached the table, Ruth was shouting inquiries while Trudy read the menu aloud. The psychic, who Trudy described as, “very well dressed,” introduced herself and told Trudy that she could sense she was burdened by health problems. She then asked if Trudy’s health was bad. Trudy was astonished by her insight. “How could she know that?” I shared her excitement. “I know! How on earth could this woman divine that two older-” Trudy interrupted, “OLDER?” “Yes, Mom. Older. Elderly.” “ELDERLY? Well!” “Yes, how could she walk over to two ELDERLY women sitting in a diner late at night, no doubt conversing loudly about hospitals and doctors, and ascertain that at least one of them has medical issues?” Trudy pronounced her amazing and planned to visit the psychic at her home in Diamond Bar for a reading.
That reminded me of the time JB insisted I drive all the way out to Orange County for a consultation with his psychic when I was about 21 or 22. Her name was Dolly and she was a middle-aged woman living in the middle of the suburbs in a small house cluttered with stuffed unicorns, rainbow prism stickers and religious knickknacks. She had a really high-pitched voice like that spooky little woman in “Poltergeist.” Reluctantly, she allowed me to make an audiocassette of our session, which I later chopped up for interstices in a mixed tape.
First, Dolly read my aura, which she saw was mostly white. This told her I would soon have dental work on two teeth, take a trip to the snow, and participate in a wedding. The fact that there were no blacks, greys, browns or maroons in my aura told her that I wasn’t going to die in the near future, or go to jail, and that I wasn’t hooked on drugs.
Next, she asked for a piece of my jewelry and dealt out some Tarot cards, while calling forth her spirit guides, “Timothy, Stan, and Dr. Frank Vigiano.” They apparently relayed some urgent information to her so she looked up from her cards and asked whether I knew anyone who raised goats. I told her, “No, I live in New York. There are no goat herders in Manhattan.” Unfazed, she flipped more cards, tapped an acrylic fingernail on one, and assured me that I wouldn’t be killed in a car accident. Then, she stared at me long and hard before finally asking, “Mary, do you know a man whose name starts with a D? Doug?… David?... Donald?... No…wait… Oh! Mary!... I see a Dick in your future!” After that, she wrapped it up by warning me to be careful in the sun because I burn easily. I’ll bet Dr. Vigiano told her to say that.
And he was right. I do. Amazing.
Monday, November 26, 2007
The Most Important Meal of the Day
I was about to leave for the hospital when Trudy called to tell me the doctor was postponing John’s final arm surgery. “Your dad has pneumonia. And, his nurse - I really like her; she looks just like Geena Davis, but not as attractive, and shorter – she told me that they will probably have to put in a feeding tube.”
Later that day, John’s internist, Dr. Pacino, informed me that my father was no longer taking in enough calories to survive. He had lost about 60 pounds over the course of the year, and as he became weaker and more delirious, he ate less and less. The doctor explained that the only course of action, if we chose to act, would be to insert a feeding tube through John’s abdomen, which would deliver protein drink directly into his stomach. I asked Dr. Pacino if the feeding tube would help my father become healthier or improve his quality of life. He said that a tube would prevent John from dying of starvation, but that sooner than later he would be back in the hospital, probably with another infection, and then another, until one of them finally overtook him. Also, he informed me that even with nutrition from a feeding tube, John’s life would not be extended for very long, and he would only feel as well as he did on his best day within the last three months. I told the doctor that ultimately the decision was Trudy’s, but I was against prolonging my father’s life with a feeding tube, or any other life support measures.
By the time I arrived at his room, John’s lunch had been served and laid untouched at his bedside. I was trying to persuade him to take a few bites of pasta when he looked up at no one in particular and asked, “So, this guy who broke his bones. Is he gonna be OK?” Until then, I had been able to maintain a pretty upbeat, “Isn’t this hospital bit a kick?” attitude in front of John. But when he threw that out, I burst into tears. At the sound of my sobbing, he suddenly focused on me, widened his eyes and smiled. “What? What’s the matter? I’m all right. Everything’s all right. It’s ok.” Waving a spoonful of Penne Bolognese in the air, I started bawling, “Dadd-hy, you have to eat someth-hing or the doctor will shove a fee-heeding t-hube in you. And, and, and …that won’t be very comfortable.” Laughing weakly, he answered, “Alright. You don’t have to be so tragic about it.” And then he let me feed him the entire plateful of food.
A few days later, John was cleared for his last surgery, which was a moderate success. Immediately following the procedure, Dr. Stanovich proudly shuffled through the vivid digital photographs he had taken, which illustrated that although it was impossible to use John’s frail skin to graft, he was able to sew most of the wound closed. The small section that remained exposed was expected to heal on it’s own.
After wolfing down that one bowl of pasta, John went back to refusing food and continued to lose weight. He was scheduled for release to a critical care nursing home soon, so the internist pressed me for an answer about whether or not we wanted John to have a feeding tube inserted. I explained that my siblings and I were against life support, but our mother was undecided.
After a few tortured phone conversations and IM’s on the subject, Trudy seemed to begrudgingly agree that a feeding tube would do little but prolong John’s suffering. Or so I thought, until one morning when I walked into my father’s room to find him crying out in pain while an impatient intern clumsily jammed a tube up his nose. I grabbed John’s hand and politely asked her what in the fuck she was doing. Sighing loudly she complained, “Well, I’m TRYING to get this tube down his throat so we can get him to surgery. PLEASE RELAX, SIR.” A nurse nearby volunteered that the night before Trudy had given her consent. The purpose of the tube presently being driven up John’s nose and down his throat, she explained, was to expand his stomach in order to ease placement of the permanent tube that would be implanted directly into his abdomen.
Once she forced the tube in place, the effervescent intern left the room. John then turned to me and pleaded, “What are they doing to me?” Averting my eyes, I mumbled a vague explanation that they were giving him something to help him with his appetite. And then my cell phone rang. It was Trudy.
She spoke in the frightened little girl voice she puts on when she knows that I know she’s done something wicked. She admitted that even after we, as a family, had agreed not to do it, she ordered the feeding tube. “But,” she assured me, “they can always remove it. It’s easy.” When I said I thought it wouldn’t be easy for us emotionally to take away John’s life support, she replied, “Emotionally? I don’t get it.” When I asked her why she hadn’t told any of us that she had ordered a feeding tube, and why she hadn’t shown up for the operation herself, we got disconnected.
In a few minutes an orderly arrived with a gurney. Staring down at his clipboard he asked, “Is this John B?” My father frowned and answered, “I used to be.”
Later that day, John’s internist, Dr. Pacino, informed me that my father was no longer taking in enough calories to survive. He had lost about 60 pounds over the course of the year, and as he became weaker and more delirious, he ate less and less. The doctor explained that the only course of action, if we chose to act, would be to insert a feeding tube through John’s abdomen, which would deliver protein drink directly into his stomach. I asked Dr. Pacino if the feeding tube would help my father become healthier or improve his quality of life. He said that a tube would prevent John from dying of starvation, but that sooner than later he would be back in the hospital, probably with another infection, and then another, until one of them finally overtook him. Also, he informed me that even with nutrition from a feeding tube, John’s life would not be extended for very long, and he would only feel as well as he did on his best day within the last three months. I told the doctor that ultimately the decision was Trudy’s, but I was against prolonging my father’s life with a feeding tube, or any other life support measures.
By the time I arrived at his room, John’s lunch had been served and laid untouched at his bedside. I was trying to persuade him to take a few bites of pasta when he looked up at no one in particular and asked, “So, this guy who broke his bones. Is he gonna be OK?” Until then, I had been able to maintain a pretty upbeat, “Isn’t this hospital bit a kick?” attitude in front of John. But when he threw that out, I burst into tears. At the sound of my sobbing, he suddenly focused on me, widened his eyes and smiled. “What? What’s the matter? I’m all right. Everything’s all right. It’s ok.” Waving a spoonful of Penne Bolognese in the air, I started bawling, “Dadd-hy, you have to eat someth-hing or the doctor will shove a fee-heeding t-hube in you. And, and, and …that won’t be very comfortable.” Laughing weakly, he answered, “Alright. You don’t have to be so tragic about it.” And then he let me feed him the entire plateful of food.
A few days later, John was cleared for his last surgery, which was a moderate success. Immediately following the procedure, Dr. Stanovich proudly shuffled through the vivid digital photographs he had taken, which illustrated that although it was impossible to use John’s frail skin to graft, he was able to sew most of the wound closed. The small section that remained exposed was expected to heal on it’s own.
After wolfing down that one bowl of pasta, John went back to refusing food and continued to lose weight. He was scheduled for release to a critical care nursing home soon, so the internist pressed me for an answer about whether or not we wanted John to have a feeding tube inserted. I explained that my siblings and I were against life support, but our mother was undecided.
After a few tortured phone conversations and IM’s on the subject, Trudy seemed to begrudgingly agree that a feeding tube would do little but prolong John’s suffering. Or so I thought, until one morning when I walked into my father’s room to find him crying out in pain while an impatient intern clumsily jammed a tube up his nose. I grabbed John’s hand and politely asked her what in the fuck she was doing. Sighing loudly she complained, “Well, I’m TRYING to get this tube down his throat so we can get him to surgery. PLEASE RELAX, SIR.” A nurse nearby volunteered that the night before Trudy had given her consent. The purpose of the tube presently being driven up John’s nose and down his throat, she explained, was to expand his stomach in order to ease placement of the permanent tube that would be implanted directly into his abdomen.
Once she forced the tube in place, the effervescent intern left the room. John then turned to me and pleaded, “What are they doing to me?” Averting my eyes, I mumbled a vague explanation that they were giving him something to help him with his appetite. And then my cell phone rang. It was Trudy.
She spoke in the frightened little girl voice she puts on when she knows that I know she’s done something wicked. She admitted that even after we, as a family, had agreed not to do it, she ordered the feeding tube. “But,” she assured me, “they can always remove it. It’s easy.” When I said I thought it wouldn’t be easy for us emotionally to take away John’s life support, she replied, “Emotionally? I don’t get it.” When I asked her why she hadn’t told any of us that she had ordered a feeding tube, and why she hadn’t shown up for the operation herself, we got disconnected.
In a few minutes an orderly arrived with a gurney. Staring down at his clipboard he asked, “Is this John B?” My father frowned and answered, “I used to be.”
Saturday, October 27, 2007
October 16, 1920 - October 26, 2007
In the movie It's a Mad Mad Mad Mad World, Tyler Fitzgerald (Jim Backus) downs three cocktails while piloting his airplane. Leaving his seat to mix a fourth, he puts Benjy (Buddy Hackett) in charge of flying the plane. Panicked, Benjy asks "What if something happens?" to which Mr. Fitzgerald replies, "What could happen to an Old Fashioned?"
Old Fashioned:
Muddle a teaspoon of sugar in a splash of water and 2 dashes of bitters.
Add ice and 2 fingers of Bourbon.
Top with a maraschino cherry.
Cheers, Daddy
xoxoxoxo
Old Fashioned:
Muddle a teaspoon of sugar in a splash of water and 2 dashes of bitters.
Add ice and 2 fingers of Bourbon.
Top with a maraschino cherry.
Cheers, Daddy
xoxoxoxo
Subscribe to:
Posts (Atom)
