Orphaned

However you choose to define the Millenium, my dad didn’t live to see it. Through the ‘90s my parents would occasionally visit me in California but each time they were a little more feeble. While modern medicine could deal with most of his problems, they weren’t able to get the blood flowing properly into and, just as importantly, out of one of his legs. They tried a variety of procedures but he could still only walk about half a block before he had to stop due to pain in his leg. Finally he had to give up playing golf, which had always been such a huge part of his life, and with that he started coming to terms with dying. I only saw them at Christmas, now, so I didn’t really notice what was going on and my mother didn’t want to see it.

In March of 1999 he celebrated his 79th birthday and that night went into congestive heart failure... again. He had made it clear that he didn’t want to go into the hospital again, apparently being revived from congestive heart failure isn’t a lot of fun, and anyway, he was ready to go. So he should have died in his bed that night. Had that been the end, it would have been much better for him, but not, strangely, for me.

My mother did what people normally do in a situation like that, she called 9-1-1. My dad never forgave her for the remaining four days of his life, spent in the hospital, and my mother was very much aware of that. But this gave me time to fly in and be there as he was dying. I would like to say that I “eased his suffering” at the end but the truth is that, while I did my best, I didn’t know what I was doing and mostly made things a little worse. It was especially bad for him at night so I was there over-night, doing what I could and trying to help the overworked nurses. The last night, he was on a good deal of morphine and mostly slept. I was sitting only a few feet from him in an unusually silent hospital (it was probably around 2am) when he stopped breathing. It’s a strange thing to notice. I think there were two or possibly three exhales over the next minute or so, as the body relaxed, and then he was completely still.

After a few moments, I went out and found the nurse who came in and adjusted him in bed (for reasons I won’t go into) while I went home to tell my mother. The hospital really was as still as death. The only people in the lobby were a family crashed on the sofas in the midst of their own personal tragedy. Even the streets were empty as I drove home -- the same route I had taken at 16 when my dad was in the same hospital for his heart attack. My mother didn’t want to “view the body” so she stayed home while I went back and saw to everything there.

The strangest thing about the next day was that we ended up sitting in the living room -- a room we almost never used. I guess it had fewer associations for her. Honestly, the worst part of the whole process was getting rid of all my dad’s stuff. The man was a clothes horse. Here's something I wrote at the time:

A Death -- 21 March 1999

"This is bad."
heart pumping so fast
lungs overwhelmed
again
and again
a festival of indignities as hospital days pass
enough food
enough discomfort
enough

finally resting
lungs morphine cleared
sleeping
breathing
sleeping in a sleeping hospital
breathing more or less regularly
sleeping just barely into another day
breathing
silence
an exhale
silence
an exhale
finally at rest

in the lobby a family felled by sleep like they were gassed

Burnsville

One of the things I became aware of as I was taking care of my father was how immobile my mother was. My dad’s health problems had been so pronounced that her’s had been cast in the shadow. Various things happened to make me question her ability to take care of the house and herself without assistance -- and she was stubbornly resistant to accepting help from the neighbors. At length I convinced her to sell the house and move to the same Independent Living facility where her sister, F__, had been living for some years. So in September of 1999 we sold the Scottsdale house, packed up the family Saturn with a few bags and the cat and made our last cross country road trip to Minnesota.

The Saturn turned out to be the ideal car for a trip like this. The rear seat-back was divided into a larger and smaller section, either or both of which could be laid flat opening up the car to the trunk. We laid the smaller side flat and left Bogie’s carrier open in the trunk so he could come and go as he pleased. We kept to the family tradition of covering as much ground as possible, keeping my mother’s lack of endurance in mind. I made reservations in advance in Albuquerque, Colorado Springs, and Lincoln.

This time I did all the driving and even discovered that I would have to do all the navigating as well, as my mother got confused trying to read a map as we passed through Denver. We arrived in Minnesota the 1st of October along with a spectacular storm sweeping up from Iowa. As we approached the state border, the sky to the north, where we were headed, was purple and dramatic -- the kind of thing you would run away from rather than drive into. Just over the state border, in Albert Lea, we got clobbered by snow and ice along with thunder and lightning -- windshield wipers aren’t that effective when your windshield is covered with globs of fast-frozen ice. I had to pull off the Interstate until the ice melted so I could see. (On this trip, we drove Interstates all the way, usually at 80 mph, and the only road problem we encountered were in Nebraska where the old paving was either in the process of being replaced or in desperate need of work.)

Burnsville is the last outer suburb of the Twin Cities before you cross the Minnesota River and hit Bloomington. I pulled off the Interstate there to get a local map to plan my final approach to a place I’d never been before. Then we drove the final few miles to Gideon Pond, the independent living complex where my aunt lived.

My mother’s place at Gideon Pond was nicer than anyplace I’ve ever lived. She had a bedroom, a small kitchen, and a big bathroom. There were pull cords so if you fell, you could summon help from the always occupied front desk -- she would eventually need this feature. Since he had moved in with my parents, Bogie had never been an outdoor cat, so he was generally content in the apartment though he was also doggishly outgoing and would occasionally escape into the hallway to visit with strangers. We arranged for her groceries to be brought to her, and there was a little shuttle bus to take her to doctor’s appointments. (After the trip, I was convinced her driving in a strange city was a bad idea, so we gave her car to my cousin’s daughter). My mother never socialized with the other residents, but she did make friends with some of the staff. And my cousins were around to look in on both of our mothers.

I visited more frequently and gradually got to know the neighborhood (Bloomington and Edina, mostly). Since my mother mostly read, played solitare, worked crossword puzzles, and watched TV, I convinced her to upgrade her terrible, old TV one Christmas. This meant I then had to drive all over in a furious snow storm with walls of ice and snow bordering every road, shopping for that TV. I had never had to drive in snow before but I learned and came to love “boating” through icy parking lots.

Early summer of 2003, my mother ended up in the hospital with pneumonia. By the time I could get there, she was already out of the hospital but into a Transitional Care facility several miles away. She was not doing well and seemed to be having a bad reaction to the antibiotics she was taking. I had rented a car through Priceline and couldn’t extend the contract. As she continued to have setbacks, I would have to drive the car back to the airport every few days and exchange it for another, identical, vehicle. I stayed with her most of the time, even eating my meals in the surreal dining room (most of the people were there for rehabilitation after a stroke or something, or just to re-build their strength after being in the hospital.) When I would take off to do my laundry I would inevitably get an emergency call and have to return, so that I eventually got really nervous just being in the laundry room.

Finally, she got better and I got her back home and then returned to San Francisco. But in August her lung problems returned and so did I. I did everything I could to keep her out of the hospital. After her previous experience, she had no interest in fighting a prolonged battle against death -- she was, like my dad four years before, ready to check-out. But it really is hard to stay out of the system until everyone agrees that there is nothing else medicine can do, and her doctors still thought they were treating her, though for what exactly, was not clear. I reluctantly took her into the hospital in Burnsville on a Monday morning and everything went about as badly as it could. Within a day, in addition to her lung problem she now had a bonus, raging urinary track infection (the details of which I will spare you).

On Thursday, her lung doctor decided that maybe the problem wasn’t pneumonia after all, and switched her to steroids -- and scheduled an appointment to see her in a couple weeks. Meanwhile, I called her favorite niece (B__) and told her she needed to come in soon if she wanted to say goodbye. I also reminded everyone on the floor of my mother’s Do Not Resuscitate request. Two good things happened that final day: The first sensible doctor I had seen was working when my mother started having heart attack symptoms (her breathing was very labored by this time). The good doctor and our favorite nurse worked together to get her diagnosed with an EKG and then sent down to CCU after receiving some morphine for the pain.

At that moment, I was quite bummed, not because my mother was dying, that seemed to be inevitable -- even desirable -- by this point (the previous night she had joked about hopping a plane for Oregon where assisted suicide was an option), what was upsetting was that she was going back to CCU which she had really hated on Monday and now she was in even worse shape for the ordeal. I rode down in the elevator with my mother -- she on a gurney with the two nurses on either end. Our favorite nurse was by me at her head while the helper was at the foot of the gurney and they were chatting as I was praying for a power failure or something. What I noticed as we rolled into the CCU, was the appalled look on the faces of the people at the front desk. They could see what none of us could (or had noticed in the case of the nurse at the foot of the gurney) that my mother appeared to be dead -- there is a characteristic expression having mostly to do with the mouth. The CCU staff hustled her into a room and shooed me away. Did they try to revive her? I think they probably did, but if so they were not successful and she got the peace she was ready for. The only unfortunate thing, from my point of view, was that B__ had had trouble getting away from work and didn’t get a chance to say goodbye.

Again, the worst part of the aftermath of this death was dealing with the stuff. There were some things I wanted to keep so I hired movers to transport them to San Francisco. Other items we gave away or sold. Lots went to B__. I then had to clean out the apartment and hop on a plane with the cremains in time to meet the movers. Just to make things interesting, after I checked my bag containing the cremains and went to the gate I was called back (past security) to the check-in area because they couldn't clear my bag because of the cremains. The plane was due to leave in minutes and I was stumped as to how I could deal with this before I missed my flight, but then they decided I could carry the cremains as a carry-on. So I rushed through security and to the gate just in time to catch my flight. If you can explain to me how it's safer to have a suspect bag in the cabin rather than in the baggage compartment I would be appreciative.

Epilog: As I was closing my mother’s estate I noticed that I had bills for all the medical stuff in Burnsville except for the hospital itself. Normally, they bill you for every bedpan and every meal so I was anticipating a daunting bill. Finally, I called the hospital’s Accounts Receivable department to ask where the bill was. The accountant put me on hold for a while and then told me there was no bill outstanding. This is speculation, but here’s what I think happened: My mother had very difficult veins, it took multiple tries for them to get the IV in. When they were giving her morphine during her heart attack, she said it wasn’t working and they gave her more. I think they may have assumed they missed when they actually hadn’t and double dosed her. They inadvertently did what she would have wanted had it been legal. But the hospital was probably concerned about liability so they didn’t charge us at all. I’ll never know, but from our point of view this was a case of all’s well that ends well. Finally, something else I wrote at the time:

A Death -- 21 August 2003

parched
ice chips, fed by spoon like to an infant
cold, wet, crunching between teeth
no control
pain, wetness, discomfort
helpless
oxygen tube at nose, cool, dry
"Does anyone have a hammer?"

swallows swoop outside the window
parched
ice
pain across mid-back
lean forward
fighting for breath
pain in upper arms
EKG
pain in chest
IV fails
finding a vein
more pain
finally a vein, relief?
still hurting
parched, ice -- the last as it turns out

rolling to CCU
nurses chatting in elevator
privacy of a sort, a chance to slip away unnoticed
passing out, passing over
body breathing somewhat
heart beating somewhat
slowing
stopping
an adventure over
next adventure?