Friday, January 28, 2011

1/28/2011, Later

Both Dr. Kissell and Dr. Bagarry came by. Both looked concerned. Dr. Bagarry said that we had some options. They could treat Tank with antibiotics (assuming an infection), and attempt to get more information by doing an MRI and a lumbar puncture. Dr. Bagarry said, though, that at this point he was certain that Tank would not walk again. He said that he could treat the infection, and other things that popped up, but that it was a bad sign that the seizures had "pushed through" the seizure medication, and that they would probably continue to be a problem. He said that at the very best we could expect Tank to live for another few weeks, lying in bed, and perhaps talking some, and perhaps recognizing people, but probably not. The other option was giving Tank extra anti-seizure medication which would serve to keep him in a very relaxed and seizure-free state. Morphine would be given if he seemed to be in pain (but it probably wouldn't be necessary). Doing this, he would probably live for another day or two, and pass peacefully. He would seem to be sleeping, and--at the end--would experience "agonal breathing" (sp?), which is a sudden and more-labored breathing, that starts and stops fairly quickly.

Kelly wasn't there, and Terry was opting for the "comfort care." I didn't see the harm in antibiotics, an MRI, and a lumbar puncture (Dr. Bagarry said that they were all routine, and could be easily accomplished). Dr. Bagarry left briefly, and Terry and I spoke with Dr. Kissell. Terry asked him what he would do if it were his wife, and he took a deep breath and said, "I'd let her pass." I appreciated his frankness, and maybe I was overly influenced by his words, but I changed my mind, and voted for "comfort care." When Dr. Bagarry returned, he quickly accepted our decision. He told us that he had been Tank's doctor for a long time, and had been with him during the lymphoma/stomach/stent ordeal of several months ago. He said that most patients would not have survived that, and that he hadn't expected Tank to survive, but that Tank had been very strong, and very motivated. I asked him if the time since then felt to him like an unexpected gift, like something extra, and he said yes.

All the medical professionals left for a while, and Terry and I were tearful. I'm fairly sure Kelly wasn't there. Up until that moment, it seemed like maybe Tank would get better. Not all the way better, but somewhat better. Suddenly, it seemed like his home-visit with Mike and Peggy was in the distant past.

I called Kelly and told him to return to the hospital, and I called Sally and Peggy and gave them the news. All three readily agreed with the decision made by me and Terry. I didn't encourage Peggy and Sally to join us, but rather to remember Tank the way he was the last time they'd seen him. Of course, it was up to them.

I'm sitting here at the Motel 6 with Sally right now. We went to The Whale's Tail for dinner, and had fish and chips. It's right next to the Morro Bay Theater where True Grit is playing. About a month ago, Tank said he really wanted to see True Grit when it came out (he was at Bayside). Sally said that it had already come out, and he said that maybe he'd be able to catch it while it was still in theaters, or see it later on video. I think Sally and I are going to the matinee tomorrow, after the Farmers' Market, after lunch in Guadalupe. We're honoring Tank. :) Really.

Today, I grabbed something from Tank's home office and brought it to the motel with us. It's a cute sign that we've got propped up next to me. It's a little piece of old wood...maybe a chunk of fence post, about 15 inches by 4 inches, and 3/4 inch thick. It's sawed at one end, and jagged at the other end. He probably found it on a walk. He's written "Laugh lots!" on it, with a Sharpie.

Peggy is good at making me laugh, and one of the times we were talking that day, she accused me of wanting to be alone with Tank when he died, like I was alone with Grandma Fern. She called me a Death Hog. :) I told her I wanted a prettier name, like Death Princess...a name that sounded a little less fat. She said no: Death Hog.

The nurses started the Atavan (sp?) drip that would keep Tank from having seizures and would keep him nice and relaxed and comfy. The doctor described it as over-riding the fight-or-flight response, so the body didn't produce epinephrine (which would keep it in an agitated state). I didn't know how quickly things would proceed, so I asked Terry for a moment alone with Tank, to talk.

Soon, they moved us to another room, so that we would have more privacy. It was a room with two beds, but the other bed was empty. Kelly, Terry, and I sat with him.

Kelly fetched drinks and snacks, as required. I didn't want to leave, so if I needed something, Kelly would get it for me. Terry paid him the supreme compliment (perhaps unintentionally) when she said to me, "He's doing EXACTLY what Tank would do in this situation."

(Right now, Sally--in PJs--is getting drinks for us from the motel vending machine. Nice.)

Tank was resting comfortably. In fact, Tank spent the next three days resting comfortably. He seemed to be asleep, but could not be awakened. He was wearing a hospital gown, and his large bald head was warm and friendly. His right hand was the hand I wanted to hold, because the left hand had lost some feeling after the seizures. Well, it had lost some strength; I only assumed it had lost some feeling. I was usually able to score the chair by the right hand, and just sit there holding it.

I think that was the night Kelly found a BBQ joint nearby and brought us huge sandwiches and huge portions of fries. He always brought me diet Dr. Pepper on ice. He fetched endless frappuccinos for Terry. He told us stories about people he met outside the hospital.

That night, we watched NCIS. I don't remember actually watching it, but I was aware that it was on, and glad. Tank recently told me that when he got out of Bayside he wanted to buy a new car: a Dodge Charger. That surprised me, since Tank's always been a Ford F-150 guy. When I told Kelly about the Dodge Charger, he laughed merrily, and said that Jethro Gibbs from NCIS drives a Dodge Charger. :)

After NCIS, we watched The Big Bang Theory, not because Tank liked it, but because it was amusing. Tank liked TV in general, so it seemed okay to leave it on.

I think Kelly drove home that night. Terry slept in a chair, and I slept for a few hours on the other bed. It was comfortable. I could hear Tank breathing. The nursing staff was wonderful. The new shift nurse always introduced herself (they were always women, usually middle aged) and every three or four hours she and a CNA would take Tank's vital signs, adjust his medication, clean him up, and change his gown and bedding. When they left, he always smelled like baby powder. He was always fresh and sweet-smelling and shiny clean.

I woke refreshed, and moved to Tank's side again. I think all of us were surprised that Tank survived the night. One nurse offered that she thought he would "go" at about 1 or 2 a.m., but he sailed on past. That morning, I think we had a visit from a social worker and a hospice volunteer, but Terry dismissed them both, even though Kelly pointed out that the social worker looked like Chuck Conners. Stephanie visited occasionally, offering hugs to all.

The days get mixed up in my mind, but one day Stephanie brought her little dog to visit. I had to walk to the courtyard to see Lucy the dog, and I left Tank alone to do so. Lucy recently suffered her own tragedy, and is healing, and is probably ready to "laugh lots" in her own little shi zhu (sp?) way.

I spent the day holding Tank's hand (and touching his face and head when no one was looking). It just seemed okay to touch him as much as I wanted to. I noticed that my hands look like his hands, but 25 years younger. The more I held his hands, the less I disliked my large, spotted, ruddy, wrinkled hands. How could I love his hands, but dislike my own? I decided to love mine.

Doctors came and went, always loving and encouraging, always sincere and serious, with plenty of eye contact and shoulder patting. Everyone agreed that things were proceeding as expected and that Tank was particularly strong. They were watching for signs such as a weaker pulse and a loss of color in the extremities, but those things hadn't happened yet. Tank's pulse was still irregular, and it was very interesting to me to monitor his pulse. :) I usually monitor Dan's pulse when I hold his hand. I've never hand my fingers on an irregular pulse. Tank's was strong, so it was easy to detect the irregularity. It was also fast (about 124, if they'd all been there), but it seemed to miss one occasionally, like maybe 1 out of every 6. I couldn't get enough of it.

Kelly brought huge amounts of food from the same good BBQ place. He brought biscuits from McDonalds every day. He brought diet Dr. Pepper from the cafeteria. Wednesday night, Kelly prepared to drive to Terry and Tank's to sleep but, before he left, he took a fistful of pooled coins and one-dollar bills and went to the cafeteria vending machines. He brought back a dozen items: chips, granola bars, candy bars, drinks.

That evening, they moved us to a new room. It was a private room with a shower, and more room for chairs. They brought in a cot. There was a big window, and lots of good light the following morning. The view was beautiful, with eucalyptus and magnolia trees.

Terry and I decided to spend the night again. She suggested that I go home, and I suggested she go home. She chose to sleep in a comfy chair, so I took the cot. I slept for about four hours, half awake and listening to Tank breathe. It was more gurgly than it had been earlier. You know that sound of coffee perking? A humid, bubbly noise? It sounded like that. Inhale, exhale, gurgle, repeat. He continued to be turned frequently, with lots of pillows tucked on one side, then the other. I used a pink swab to moisten his mouth occasionally, and applied lip balm. I kept the room neat.

Kelly had plans to drive back to Utah the next morning (Thursday). Terry hadn't left the hospital Tuesday or Wednesday, so she drove home to shower. I was alone with Tank, and it was quiet and peaceful. I'd been calling Sally and Peggy a couple times a day. Also, Sally was now on her way from Utah, and would arrive by early evening. I pulled a chair close, and held his hand. I noticed a slightly funky smell, and thought it was Tank, but then realized it was me. I was savoring my filthiness, though, and was unwilling to go home, or even to use the shower in the bathroom.

I think it was the previous day, Tank was occasionally making a slightly louder breathing noise. It seemed a little distressful, and the nurse showed us how to press a yellow button that would give him a little burst of Atavan to calm him. We'd done that a couple of times. The same nurse observed the little cries of distress, and said something that probably violated hospital protocol. She said that she didn't know what our spiritual beliefs were, but that some people thought that those sudden disruptions in an otherwise-peaceful sleep indicate that a patient is kind of standing on the brink between this world and the next, and that he's reaching out to someone he loves on the other side. :)

Terry was in touch with the crematorium during this time, making arrangements.

While Terry was home, I noticed the same erratic eye movement that had preceded the earlier focal seizures. Then, his whole body seized, to a degree somewhere between the grand mal seizure and the focal seizure. I pressed the yellow button to give the extra Atavan (turns out I pressed it nine times, although it gave only one dose...apparently my actions were recorded for the nurse to see). The nurse came in, and I think she gave him some morphine. They sometimes gave him a little morphine before they turned him, just in case it caused him pain.

Oh! Right after Terry left to go home to shower, Kelly arrived with breakfast for me, and to say good-bye. We chatted for a while. It was really a treat spending time with him, and it broke my heart to see him go. While here, he repaired the threshold at Tank and Terry's house, making it safer and more attractive. He'd spent a lot of time locating the correct grab bar for their bathroom, but then it became clear that it wasn't necessary to install it, so he put it in Terry's backseat, with the receipt. While trying to find Home Depot, he stumbled upon Carlock's Bakery, which seemed to me like a sign, and I encouraged him to buy treats for us. They were delicious. He hasn't spent time in San Luis Obispo County, but he got to know it quickly, and was able to find anything, even Rite Aid late at night, when Terry needed a prescription filled.

Terry got back right after the morphine injection, and we got her up to speed. We each settled in on each side of Tank, and I held his hand. I tried to stay present, and not get distracted, and to memorize each second of this time. His pulse was weaker, and still irregular. When Terry was out of the room, I peaked under the sheet to see his thighs, and noticed a new sallowness. Maybe I mentioned this earlier, but Dr. Lewis said that we should expect a slow "winding down." Terry and I continued to sit with him, and I kept holding his hand, appreciating its warmth.

It was very quiet in the room. I noticed Tank's breathing change slightly. Before, his lips were parted about 1/2 inch as he breathed, but now his lips were closed. The sound changed slightly, with a bit less gurgle. "I think this is the winding down," I said. "What?" said Terry. "I think this is the winding down." And sure enough...

It was very quiet in the room, and I had a chance to hug him and kiss him and touch his face and hands some more. So did Terry. Death came swiftly, and everything seemed to shut down in unison. He was there, and then he wasn't. I thought--not for the first time--of that final scene in "Gladiator" when Maximus dies, and he walks through the fields, and his fingertips graze the tips of the tall grass, as he moves toward his beautiful wife and child.

Soon, I called Sally, who was en route. In what seemed like a happy coincidence, she and Kelly were together in Bakersfield having lunch. Then, I called Peggy.

It was a pleasure being with Tank at the end. It was a pleasure being with Tank always.

1 comment:

  1. Thank you, my dear cousin, for such a beautiful account of the final moments of a wonderful life. I will miss Tank. But I am so fond of the precious time and memories.