March 6, 2007
3:47 a.m. – The phone rings, pulling me out of a half-slumber. I had moved the phone closer to my pillow just in case it rang in the middle of the night. This was unusual, but somehow I expected it tonight.
I have a three-minute conversation with Alonzo, the night nurse at Piedmont Hospital. “Your father has asked for you twice,” he tells me. “He’s having a rough night. His pulse ox is about 65 and he’s having trouble breathing. I don’t usually call in the middle of the night, but…”
“Do you think he might die before morning?” I interrupt. He pauses.
“I couldn’t say.” But I hear him say it in the pause. My father is dying and needs me now. I sigh deeply. This is not what I want to do in the middle of the cold night. I have spent almost every day of the last 20 days going to and from the hospital to be with my dad, and I am exhausted.
“All right,” I hear myself say. “I’ll be there in a little bit.” He hangs up quickly, and I can tell that he is relieved I am coming.
I take my time getting ready to leave. I really don’t know what to do. “I can’t do it,” I hear myself saying. I get dressed. I call my sister repeatedly but there is strangely no answer or voice mail. Later she tells me that I called 16 times, but there was a problem with their new computer phone system. It logged my calls but never rang the phone.
Finally, I call my brother’s house. My niece Amanda answers and I tell her I am going to the hospital. But she only says she loves me and to call them when I know something. That’s not what I wanted to hear. She is young and doesn’t realize that I am really asking for help, which for some reason, I can’t do. So, I’m on my own in the middle of the night, on my way to my father’s death bed.
4:10 a.m. I finally leave the house. When I get to the hospital, I just sit in the parking deck paralyzed with fear. “I can’t do it,” I keep repeating out loud even as I leave my car and enter the hospital. I honestly do not believe that I can do this by myself.
4:20 a.m. I walk into Rm. 350 – Dad is clearly in distress and says to me, “I can’t breathe!” He is alone in the room. But then a respiratory therapist appears and attaches a different breathing mask. The therapist is trying to get dad to leave the mask on but he is convinced it is smothering him. He yells “Take it off. I can’t breathe. Oh lord, I can’t breathe!” He is desperate. I can’t stand it.
I walk into the hallway and dial my brother’s house again on my cell phone, my new constant companion. This time my sister-in-law Sharon answers and not my sleepy niece. I say, “I think he is dying.” Instantly, she says “I’ll be right there.” I am so grateful. Later she tells me that I actually said, “If anyone is in the area, it would be nice if they could drop by.” It was the closest I could come to asking for help. I’m not good at it. I am so relieved when she says she will come.
I go back into dad’s room. “I’m seeing two of you,” he says as he looks up at me. “I wish there were two of me,” I say. One could have stayed at home, I think.
Alonzo walks in. I have never met him but I know immediately who he is. Dad had told me he was a great big black man. Dad liked him a lot, trusted him to take care of his decaying body. Alonzo and I never introduced ourselves that night; we just ministered to dad.
Alonzo gives dad some medicine through the IV. He tells me what is happening. Oxygen, blah blah blah. He tells me that he gave dad lasix earlier. I know about lasix (a powerful diuretic) from my friend, Scott, who suffered a massive heart attack recently. It should help. “How long ago,” I ask. He tells me it’s been several hours. It hasn’t helped. Alonzo picks up the urine bag hanging from the side of the bed which, for the first time, is nearly empty. He shakes his head. Dad’s kidneys have shut down. Even with lasix on board – the fluid isn’t leaving daddy’s body. He is drowning before our eyes, lying in a hospital bed in Atlanta.
Alonzo shakes his head a lot that night. I didn’t quite get the message, but he was trying to tell me that it was over.
Dad talks a lot, constantly, terrified. “Put me up!” he orders. Then moments later, “Put me down!” I press the button to raise and lower the bed, over and over. It’s all I can do. “Okay, daddy,” I keep saying, trying to calm him. He is mumbling. I struggle to understand. He won’t keep the oxygen mask on although Alonzo and I repeatedly tell him it will help. Would it? Probably not. Father knows best. Alonzo says, “Mr. Cole, I think you’re deprived of oxygen which is making you anxious.” Mr. Cole. Such respect.
Finally, we leave the mask off. But then the pulse ox machine beeps constantly, alerting us that dad’s oxygen level is dropping. “Are we done with this?” I ask Alonzo, pointing to the annoying beeping machine. He nods and turns off the pulse ox machine; the constant, loud, beeping finally stops. There is no need for blood pressure readings, steadily dropping, or oxygen measurements anymore. We won’t try and torture dad to wear the thing that he is convinced is smothering him. Dad keeps ordering us to take the mask off even when it is gone. “It’s gone, daddy,” I say. He reaches up to feel for the mask, unconvinced, because he still can’t breathe. It’s not there. He finally stops asking us to take it off.
“Can’t you give me something for the pain?” he asks repeatedly. He is in pain even though he is on a low dosage of dilaudid. “I can’t breathe. Water.” He asks for water. But he can’t sip through the straw…he doesn’t have the strength or the air. I ask Alonzo if we can spoon some water into his mouth…I see the spoon on the tray. I have gotten used to improvising ways to try and feed dad. He hasn’t been able to eat or keep anything down for 20 days now. But Alonzo is afraid he will choke if we try to use the spoon, so we don’t.
“Water!” dad cries out. Repeatedly, I try the straw. Alonzo and I both encourage him to suck hard, which he does, but he cannot get water up the straw. He used his last breaths trying to suck water through a straw. He tried hard. Stupid! This is one of many things I regret about that night. We give him lemon swabs to put in his mouth. I dip them in water.
Nurses, respiratory therapists, technicians are in and out. They all want to help. They all know he is dying. They ask if I need anything. I have never seen so many medical staff in his room before. It is crowded, frantic. Nothing can be done.
“Oh lord. Can you give me something for pain? Oh lord!” With every gasping breath, he speaks. I can’t understand all of it, but I try. Exasperated, he repeats himself as loudly as he can. “Water!!”
Finally, Alonzo says maybe we can try the spoon. “There’s one right there,” I say pointing. Alonzo grabs it and rinses it off—unnecessarily, but as a good nurse. I hurriedly grab the nearest cup of water instead of asking Alonzo for a fresh cup (another regret). I use the cup I have dipped the lemon swabs in, so it must have tasted of lemons. I sit the bed up and spoon one, two spoons of water into his mouth. He laps greedily. It is enough. That’s all he wants. “Put me down.”
“I don’t like his color,” Alonzo says.
Dad’s breathing is louder, more labored and raspy. “I can’t breathe! Put me up. Put me down. Put me up. Put me down.” I press the buttons on the side of the hospital bed. Up and down he goes, over and over. “Okay, daddy.” It is all that brings him relief. Later I realized it was shifting the fluid in his lungs.
5:15-5:30 a.m. My sister-in-law shows up like an angel. I’m not sure what time. I didn’t see her walk in, I was so focused on daddy. “Pammy,” someone says and I look up and she is there. I am so glad. “Sharon,” dad says clearly, curiously. He knows she is there. She tries to be calm, upbeat. “Hey darlin,” she says to him and rubs his forehead. He likes it. I step back for a moment’s rest as she is with him.
Alonzo comes in with a shot for pain. It is a small amount of dilaudid, which dad has been getting around the clock. It is not enough and we know it is not enough. But it will give him a few minutes of comfort. He calms after the shot, lies back. His head falls to the left side awkwardly. It has been doing that for 20 days. He can’t hold his head up straight; he no longer has the strength. A broken neck suffered in the coal mines in Japan as a POW 60 years ago is now finally bothering him terribly. It is his biggest complaint, and the doctors ignore it. It’s not life threatening. But it’s why they give him the meager amounts of dilaudid—the pain in his neck. He kept pointing out the knot on the back of his neck to every doctor that walked in the room. After days in bed, it was too sore to touch but each one looked at it, noted it, ignored it.
As I kept vigil at dad’s bedside for 20 days, we spoke of many things. It was a treasure to have this time with him, while he was still lucid and hopeful of going home. “If I could just get out of here and get back into my old recliner, I’d be okay,” he lamented daily.
Once he said, “I was just thinking about a poem I had to learn in school.” He had only gone through the 8th grade in school, but he remembered the teacher’s name and the poem. He recited it perfectly for me. It was about a dozen lines long and he never faltered. I could tell he really liked the poem; he recited it quite clearly and dramatically. It was a poem about the beauty of Gilmer County, he said. “I just thought I ought to say it.” I wish I had written down the name of the poem, but I didn’t. I was too startled. He was reciting poetry learned in grade school from his deathbed.
Two days before he died, he asked if I had any fingernail clippers, and I told him they were in the car and I would bring them the next day. Dad was always fastidious about his nails, keeping them clipped short. Now, he was too weak to clip his own nails.
I walked in and he was uncomfortable. His neck was “killing him” and he hadn’t slept—again. He hadn’t slept or eaten in almost 20 days, despite the massive amounts of medication being piped into his veins and his TPI. The first thing he asked me was “Did you bring the fingernail clippers?” Proudly I pulled them from my purse, grateful that I had remembered them; it seemed to make him so happy.
He rolled toward me, held out his hand, and asked me to clip his nails. I had never clipped anyone else’s nails and I hesitated. Plus, he had no nails. They were down to the quick already. But he thought they needed clipping. He became irritated with me, demanding that I clip his nails. So I tried, but there just wasn’t any nail to clip and I was afraid I would hurt him. He grabbed the clippers from me impatiently and tried to clip them himself, but he didn’t have the strength. “I can’t do it,” he said tiredly, falling back in the bed. So I tried again, and finally he was happy with the result.
Yesterday, I was in dad’s hospital room, watching as his condition deteriorated before my eyes. We had thought he was improving and the social worker had found a nursing home that would take him with his TPI and other problems. Dad was looking forward to being in a nursing home near me and away from mother. I should have known something was going on when the social worker came to tell me, after conferring with the doctor, that I didn’t need to run out and see the nursing home. She was so kind, so diligent. (We were planning to move dad the next day and I wanted to visit the nursing home first.) I should have known then that the end was coming.
But tonight, dad is actively dying and the hospital must follow a fine line between relieving his pain and killing him. A dance. A legal dance. He has a living will on record.
Somehow, I am dead calm. I know what is happening and what I must do. I just do it. I speak to daddy and to nurses. I am in constant motion trying to make him comfortable. It is the hardest thing I have ever done, or will ever do, and I must do it. It is the middle of the night, but the room is grossly bright as staff are in and out, taking blood, pushing medicine. Trying to beat back death still after 20 days in hospital.
Sharon and I talk while dad rests after the pain shot. “Good,” I say, “This is good.” This is what I have wanted since I walked in the door. Peace for my dad. This is what I have been praying for the last two years—a peaceful death for my dad. But it doesn’t happen. I don’t remember what else I say, but for a second I slump against Sharon’s chest and let a few sobs burst out. They just burst out, I don’t expect them, and I quickly cap them. “Pammy” she says, “go ahead and cry. You need a good cry.”
“I can cry later,” I say, standing up, shaking off emotion. Dad rouses again. His ten minutes of relief are over. “Water!” he cries out.
My father had always drunk copious amounts of water. “It takes water to make my mo-chine run,” he used to say light-heartedly with a big grin. But I knew where that sentiment came from; from the nine days on the Bataan death march that he survived by taking water from the Philipinos on the side of the road. My whole life, dad kept a full jug of water in the fridge, chilled and ready to drink.
“Ice chips,” Sharon says. It never occurred to me. I hurriedly ask one of the nurses for ice chips. They are so kind, so good. They ask Sharon and I if we want anything for ourselves. What? They minister to us as well as dad. It was such a good place to die.
Finally, a doctor shows up. One I’ve never seen before, a woman, African, young. I’ve seen dozens of doctors in 20 days. There’s a different one for every shift, every day, every organ. Kidney doctor, heart doctor, stomach doctor, lung doctor—all the organs my father has problems with. So many doctors written in a tiny spiral notebook I kept. Some of them try to help, to explain to an elderly, hard-of-hearing man what they can do. Some of them just leave politely, convinced there is nothing they can do. I have never seen this doctor. She is the middle-of-the-night intern. I don’t know her specialty and she doesn’t know my father’s case. She’s just on call.
“How are you feeling Mr. Cole?” she asks. What a stupid question! The man’s in death throes! “I can’t breathe!” “Are you in pain?” “Yes!” “What hurts?” “Everything,” he says. She stares at him a moment, listens to his chest. She starts to talk and then motions me into the hallway.
She says this and that, and then “…we’re going to move him into the ICU and intubate him.”
But I stop her. “We’ve been here 20 days,” I say clearly. “Everything that could be done for him has been done. Now I just want him to be comfortable.” Because we’re just prolonging this.
“You don’t want him moved to the ICU?” she asks legally. I just want him to be comfortable, I say again. I am telling her that nothing else can be done. I am asking her to put my father to sleep, like we did with my 16-year-old dog Mel last winter.
“Okay,” she says nodding, understanding. She confers with Alonzo. She says goodbye. Alonzo tells me he made sure she wrote the order for dilaudid every 15 minutes prn – as needed. “I don’t want to have to chase her all over the hospital every half hour,” he says.
“He shouldn’t have to suffer like this,” Alonzo says as he gives dad the first shot—and as it turns out, the last shot. No, I say loudly, he shouldn’t.
Sharon asks, “Should we call the family?” “Yes, this would be the time,” Alonzo says.
“This can take a long time,” she says to me. “This can take hours,” she says, remembering her own father’s death. She is so kind to me. I could not have done it without her.
Dad is no longer in pain but he still can’t breathe. He rests for a few moments. His head falls to the left side again. Alonzo says “I’m going to straighten you up in bed Mr. Cole.” Dad says nothing. Alonzo picks him up like a rag doll and pulls him up in the bed. He might weigh 90 pounds now. Alonzo looks concerned. “Mr. Cole?”
Again, Dad’s head drops over toward me and saliva drips from the corner of his mouth. This isn’t unusual, and he hates it when this happens (he is embarrassed) so I hurriedly grab a tissue and wipe his mouth. Then, his face contorts into a strange grimace, his mouth opens wide and he sticks his tongue out. His tongue has black spots. I have never seen him do this, and I worry he is in pain. Now, looking back, I think this is when he died. I move his head upright on the pillow again. Alonzo shakes his head. Sharon says “Oh.”
“Mr. Cole? Mr. Cole?” Alonzo pulls the sheet up tight around daddy’s neck. That’s nice I think, he must be cold. Alonzo tucks the sheet neatly. Then he says to me, “He doesn’t appear to be breathing anymore.” Surprised, I look and notice that he isn’t. I hadn’t realized. I’m not upset. It’s just another in the endless stream of facts about daddy’s health that I have kept track of for 20 days. He’s not breathing anymore.
Sharon disappears to start calling the family to the hospital. Alonzo briefs me about what will happen next. They will call a chemical code. They will give dad a shot of atripine to try and restart his heart, but no shocks. “What’s atripine?” I ask, still taking mental notes about the many medications my father is on.
“I’m going to give you a moment with him now,” Alonzo says. “I am right outside.” He leaves and it is just dad and me. I rub his forehead and say “Good job. Good job.” But that is all. I don’t want to be alone in the room with this corpse. My daddy is gone. So I go outside and tell Alonzo it is ok. I tell Sharon (still on the phone) that no one needs to come to the hospital now. I hear her relay the message to someone on the phone. Alonzo pushes the code button.
Instantly, 20 medical staff converge on dad’s room from somewhere on the floor. A man rushes to bring in the crash cart before I am out of the door. I step aside, but he backs up and kindly motions me out. In two minutes, no more, Rm. 350 is crammed with nurses, interns, physicians, everyone interested in the process of saving a life. But then the charge nurse announces that this is a chemical code and everyone knows that it is too late. They relax. They invite me into the room, but it is crowded and I know he is dead. I don’t want to see anymore. I start into the room and then back out into the hallway, dazed.
The African doctor, who just half an hour earlier decided dad could die, comes to me and extends her hand. “I am so sorry for your loss.” Two nurses that I know, who cared for dad for the last 20 days, come to me and put their hands on me. I am so sorry, they say. Do you want a chair. One grabs a chair. They want me to sit down. They are afraid I will fall down. One by one, each staff person who was in the room when dad was pronounced comes to me and offers condolences. I am the patient now. Many of them knew dad, cared for him, understood what a loss this was for me. 20 days is a long time to be in the hospital.
Alonzo was busy, talking to other nurses who had been involved. I touch him on the arm and he turns to me. He has tears in his eyes. I hug him. “Thank you for taking such good care of him,” I say. He hugs me.
“We spent a lot of time talking,” said Alonzo. “I got to know him, I took care of him all last week.” Earlier in the day, Dad had said, “I hope Alonzo is on tonight.” He was afraid, and he knew Alonzo could take care of him.
Alonzo went on. “Before I called you I said to him, you know your daughter is probably asleep. Are you sure you want me to call her? He was very clear about making his needs known. I believe that when a patient asks you to do something clearly, you should do it.”
Shock. Must have been. Sharon and I go and sit in chairs at the end of the hallway. We watch them go in and out of daddy’s room. Doctors come to us and offer condolences. I don’t know any of them. Such a good place to die. Occasionally, I break down and cry. Not hysterically, but unexpectedly, great gulps of grief. I see one of his nurses go into a room. She is very young and pregnant and busy. She looks at me with concern, but I never speak to her. I think daddy liked her. I think she was upset.
Sharon works the phone like a professional. She calls my sister, whom I never got a hold of, who is supposed to have the 10 am shift with dad at the hospital today. “Clyde’s gone,” she tells her. “Don’t come to the hospital today.” She calls my brother, who volunteers to go to my mother’s house and tell her that her husband of over 50 years is dead. She calls her son-in-law Aaron who is in Korea. He is a solider and was on military funeral duty when he was stationed in the states. He calls someone in the army. Within minutes I have decided to have a military funeral, and Aaron has arranged it from Korea.
The only call I make is to Madie, who is at work in Ohio. “Just wanted to tell you that daddy died this morning.” Oh, she says, I’m so sorry. It was short. That’s all I remember.
So many details. A man, a patient advocate I have seen before, comes and kindly asks us about the body. He will call the funeral home. I have the information in my purse. It’s been there for 20 days, along with a copy of daddy’s living will. The advocate calls the funeral home who says they will be there within an hour. Dad had made sure I had the card from the funeral home with this information. “You just call this number and they’ll handle everything. It’s all been paid for,” he reassured me proudly. He then sat and recounted a list of all his finances, making me write them down. He was leaving a little over $100,000 including the house, to my mother and he wanted to make sure I had a list of his assets.
His health had declined as anyone’s his age would—he had just spent his 89th birthday in the hospital. It was a wonder that he was still at home, caring for my mother when he had his last “spell.” He had gone to the grocery store, to the pharmacy for mother’s medicine, and taken his taxes to H&R Block. When he got home and started putting away the groceries, he didn’t feel well and argued with mother. Apparently, it was a bad argument. Their last interaction was not unlike many of their interactions, angry and ugly. It ended with mother calling 911 and dad going to the hospital with chest pains.
Strangely, he barely talked to my mother the last 20 days. She was home, too infirm and weak to make the trip to Atlanta to see him, and he was too sick to spend much time on the phone. But he didn’t seem to mind. Perhaps it was like a vacation for him, a break from being the constant caretaker to an ungrateful wife. He was a good husband, and he had 20 days of rest at the end, a time when all attention was on him.
7:00 a.m. The nursing shift changes and Alonzo walks toward us on his way out. I stand and hug him again. “Stay strong,” he says. He is my black angel and he gives me strength, as he gave daddy strength.
A doctor comes and asks about my father’s pacemaker. They have to disconnect it. On the monitor in the nurse’s station, my father’s heart still beats because of it. Don’t they have this information, I wonder? It’s in my purse on a card in daddy’s wallet, which I have also been carrying for 20 days, at dad’s request. He didn’t want his wallet to get stolen in the hospital.
The patient advocate says they will clean up the body and then we can go back in but I don’t want to. Clean up the body – disconnect the pacemaker, remove the TPI line he has been fed through for ten days, take out the hated catheter, bandage up the open wounds he has from the days of shots and IVs in his 89-year-old skin. And the rest…
The patient advocate brings out all dad’s belonging in two big plastic bags. We have accumulated a lot in 20 days. Clothes, cards, books, magazines, presents. Grape juice and pudding, granola bars, chewing gum. Things we tried to get daddy to eat over the last 20 days. He could keep nothing down. His digestive system quit long before he did. I had also forgotten my coat in the room.
We could leave now, but I’m not ready. Sharon says we can stay as long as I like. Lots more phone calls. I never spoke to mother, in fact never spoke to hear throughout making the funeral arrangements or the funeral. It was as if we didn’t want anything more to do with each other, now that dad was dead. He was our only real connection.
My brother Richard calls and says that mother was very upset when he told her dad had died, but then she got right into “what am I going to wear to the funeral” mode. We have a 2 p.m. appointment at the funeral home somehow, to discuss the funeral. I understand that I have to be there. Sharon wants me to come home with her to Villa Rica, but I want to go home for a while…take a shower, see my dog. Shock. Nothing else will matter today.
Finally, we leave the hospital. There is nothing else to do here.
My father has died. A once in a lifetime event. Nothing will ever be the same again. The person who loved me more than anyone will ever love me is gone. It was not easy or graceful or peaceful as I had prayed it would be for years. And it makes me wonder if there is a god, when even Jesus was left to suffer and die a horrible death on the cross, as he cried out for help. What kind of god, or father, would allow such a thing to happen? He must not exist.
I had finally turned to my granny for help. My grandmother has been dead for 25 years. But as I went to sleep the night before dad died, I asked her to come and take dad, to end the suffering of her son. I was too angry to ask God for help anymore. “Come and get your boy,” I desperately begged my granny’s spirit…and she did. She did.
About 6 a.m. on March 6, 2007, after 20 days in Piedmont Hospital when no one knew if he would live or not, my father died. He had spent Valentine’s day and his 89th birthday in the cardiac care unit. We celebrated both events.
I was able to spend almost every day of the last 20 days of his life with him, and he was able to talk to me up until the last few minutes of his life. It was me he asked for as he lay dying, and I somehow found the courage to honor his request as his daughter. But it has left me traumatized and faithless, and I still struggle with the loss. The death of a parent is incomparable and leaves scars under the best circumstances.