Monday, January 7, 2019

Do I feel guilty about getting drunk the day my father died.

While I'm not  necessarily proud of going on the wine tour on my father's last day on this earth, I am not ashamed also.

Would I have been ashamed if in an alternate universe, he had not broken his hip but rather had had a huge myocardial infarction or stroke on that day while I was out wine touring. 

As I said, it still bothers me that he died alone but I got to see him the week he died and spent a lot of time with him during his last two years alive.  I would rather remember him as he was when he was younger because the last two years weren't really that great for him or for us for that matter.

While anaesthesia doesn't get involved in end of life very often, I did do general practice for 3 years and also anaesthesiologists get to do 6 months of internal medicine so I saw my share of death watches where the entire family assembles around the bed of a dying parent or grandparent in various stages of awareness and pain.  Overall, I didn't get the impression that anyone, patient or family got any comfort from the practice.

Friday, January 4, 2019

Thoughts on my father's death.

My father died last June 2.  He was 94 and it shouldn't have been unexpected.   As I was to find out, it was still difficult.

I go on a few medical and teaching missions nowadays.  In 2011, I went with CASIEF to Rwanda for 4 weeks (a total of 6 weeks away between pre and post-cations).  My parents were pretty old by then, so I believe  I told them, if something happened while they were away, I was not coming home.  Therefore every time I visited and left my parents it was like I was saying goodbye forever.

Between placing my parents in various levels of care over the past 2 years I have been visiting about every month, which is more than I saw them when I was attending university in Vancouver, a ferry ride away.

Anyway I was on my way to the Canadian Pain Society meeting in Montreal.  On arriving in Montreal, I turned on my phone and my brother had texted me to tell me that my father had fallen and broken his hip.  We were still in the airport.  "Do you want to fly back?" asked my wife.  No, I said, it won't make any difference.  He will have surgery in the next couple of days which he may or may not survive and whether I am there or not will not make any difference.  And besides I had said my goodbyes.  I kind of had the sense that this was it.  He was going to die within a couple of weeks or it would be the start of an inevitable downward decline.

After some consideration, I decided that after returning to Edmonton, the Friday, I would fly to Victoria on Saturday to visit Saturday and Sunday.  I had a busy next week planned.  A medicolegal in Calgary on Monday, Pain Clinic in Grande Prairie Tuesday and Wednesday , a medicolegal in Vancouver. Thursday and one in Kelowna on Friday.  Now I could have cancelled all this but really it really wouldn't have made any difference would it?  I phoned the ward regularly during the week I was in Montreal.

So I flew out to Victoria Saturday am, rented a car and went straight to the hospital.  My father had had surgery by then.  I never ever learned whether he had a hip pinning or a hemi-arthroplasty or whether it was a GA or spinal.  He was in a private room and was pretty delirious.  He did recognize me.  It was very interesting because in between bouts of delerium he actually made sense and was talking about politics which he loved doing.  He had a bundle of newspapers which he clutched tightly, not letting the nurses take from him.  I also went and visited my mother.   She kept on asking where he was and I kept on telling her he had broken his hip.

I visited again on Sunday.  The nurses said he had had a bad night and he was lying in bed but recognized me.  I spent a little time with him and then drove back to the nursing home to see my mother. I asked the staff at the nursing home if it would be okay to bring her over.   I had mixed feelings about this.   She was already not terribly able to walk even modest distances and I would have to park and walk over to the hospital with her.   The other thing that worried me was what I would do if she refused to leave my father's bedside.   Nevertheless, I took her, we walked slowly over to the hospital and up to my dad's room.  By this time the nurses had hoisted him into a chair and he was in a deep sleep.  We say there for almost half an hour, my mother and I.  At one point my father opened his eyes but didn't seem to recognize us and went back to sleep.  After half an hour, my mother said, "that's not my husband is it?" and we left, stopping for coffee and a snack at the coffee shop in the lobby.

I returned my mother to the nursing home and spend a little time before leaving.  I had a flight in the late afternoon and so had lots of time.  I could have visited my father again but I thought what difference really would it have made.  I figured he had survived the first few days of injury and surgery, the delirium would resolve and he would be eventually starting a long (and most likely futile) rehab program.

I later flew to Calgary, then to Grande Prairie, to Vancouver where my wife met me and then to Kelowna where I had a medicolegal Friday.  My son lives in Kelowna and we had planned to spend Saturday in Kelowna and leave in the evening.  My son works Saturday so we couldn't visit with him that day but took him and his girlfriend out to dinner Friday.

My wife suggested we do a wine tour Saturday and we found a taxi driver who did private tours and who would take us to the airport afterwards.  We were just on the way to our first winery when my brother phoned me.  My father was apparently now septic from at UTI with decreased blood pressure.  He gave me the pager number of the hospitalist.  I paged her and she phoned back right away.  By that time we were outside of our first winery.  She confirmed what my brother told me, I confirmed his resuscitation status and suggested that if he didn't respond to modest amounts of fluids not to do anything.

We went into my first winery.  "I hope you don't think," I said to my wife,"I am being callous by tasting wine when my father is most likely dying."  She didn't think so.

Wine tours are really just an excuse for getting drunk during the day and we did that quite happily and I am may have even forgotten about my father.  At one point our driver suggested we visit a craft brewery which we did.  Outside the tasting room, my phone went off.  It was the hospitalist.  My father's blood pressure was now worse, falling to as little as 40 systolic.  I told her that I understood and that he would probably die.  I then phoned my brother and told him, I didn't think my father would live out the day.  I am not usually good by the way at predicting deaths.

For some reason I decided to taste a flight of beers and I ordered them and took them out to table outside.  Then it hit me, my father was going to die.  I started crying.  People were looking at me.  I got myself together and then tasted my craft beer.  Why waste it. 

We finished our tour and went to the airport.  We flew to Calgary.  At the Calgary airport while waiting for my plane to Edmonton, I phoned the unit.  The nurse said my father was hanging in there.

Sometime while I was in the air between Edmonton and Calgary my father died.  My brother left a message on my phone which was on airplane mode.

It doesn't bother me that my father died.  He was 94 and had never adapted to nursing home life or my mother's dementia.  He had a great life including 33 years of retirement on a comfortable pension.  It does bother me that he died alone although I don't know that it would have made any difference or whether in his last hours he would have even noticed the company.  I don't know what goes on in peoples minds while their body is shutting down; I hope that during the hours he was unconscious before he died, he was having visions of his childhood in Sussex or meeting my mother for the first time.

My father requested that he not have a funeral.  Some people I talked to thought that it was weird and that we should have something but we didn't.  My brother got him cremated which is what he wanted.  I assume he has the ashes.

I went to visit my mother a few weeks later.  The staff had told her that he had died but of course she forgot this after getting quite upset.  She of course kept on asking me where he was.  I told her over and over he was resting.  At one point she said, "What is he resting from?".  "Arguing"  I replied because that is what he loved to do and she actually laughed.  When I went into my mother's room the book "Silk Roads" was on table in her room.   I gave that book to my father the previous Christmas.  He like to read in my mother's room.  I really enjoyed the book.  I hope he got far into it.