Archive for December, 2009

My father

Posted in Light on December 28, 2009 by cgeary

My father, Rudy Stock, passed away a week ago (December 20) — almost to the hour that I write this. Though he had been in declining health for the past few years, his death so soon after entering the hospital for what we thought would be a routine admission was unexpected.

This post is much longer than what I usually write…I realize I am writing for the most part for myself…to help me think through and remember the events of the past week.

The nurse’s aid from Daddy’s assisted living facility called me the morning of the 16th to tell me that she was calling the rescue squad because of Daddy’s high fever. Though I think he had been sent in needlessly in the past, this seemed reasonable. Throughout the day I kept in touch with the hospital, the assisted living facility, Joyce, who helps Mother and Daddy in many different ways, my brother, Greg and daughter, Emily. Things seemed routine. The infection was more serious than sometimes; they admitted him and I went to visit after work. He was having trouble communicating and was very agitated. I have to admit it was difficult to be with him, but I assumed he would be fine once the antibiotics kicked in later in the evening. I left at 9pm. His doctor called me at 2:30am, though telling me that he’d had some problems and they’d called in the ICU team — wanted to verify the DNR orders — and suggested I come in. I did — not knowing what I would find — I was impressed by the team that was there with him. I had not been able to find copies of the living will or the health POA…called the assisted living facility to see if they had a copy….called my brother in Colorado and asked him to confirm for me that that was the right thing to do. The doctors were not concerned about the paperwork…told me I seemed like a reasonable person and they would do what I asked. His BP had fallen and they wanted to know how aggressively I wanted to intervene to bring it back up….whether to use pressors or not…they explained the risks and also that they might just need to do something less aggressive to get a better reading…so I opted for that and luckily didn’t have to make any other decisions because the BP increased and he seemed better. They moved him to a ward with a higher level of care and I left at 5am to get more sleep. I emailed my supervisor and my brother and then had the deepest 3 hours of sleep I could remember. I only stayed a few hours at work…went to pick up some additional clothes for my father to go home in when he did get to go home. The rescue squad had taken my father to the ER in only his underwear. My mother, Norma, who has dementia and had forgotten exactly why Daddy was gone, had nevertheless laid out a set of clothes even though I had not told her I was coming for them. I went back to the hospital…Daddy was not doing great…having a hard time breathing and very very agitated. They told me he had pneumonia in addition to his other infection. He had a nurses aid with him all day to watch and make sure he didn’t pull out his tubes. It was impossible to understand anything he was saying. I stayed for a bit but decided to go home but skip the dinner party I had been invited to and go home and fix myself a good meal and rest. My husband Ron was driving home from Baltimore in a terrible snowstorm. I started watching Body of Lies and taking phone calls from my brother, my mother and my husband. At 8pm the hospital called and told me to come in…things were not good. From some tests they found out that Daddy had had a small heart attack…he was breathing hard. I should come in. I called my brother who was getting ready for a Christmas party. He said he’d go home and find a flight out the next day.

Again, we talked about how aggressively to treat Daddy’s problems. Again, it seemed like gray area that I didn’t really understand. I knew Daddy didn’t want us to use extraordinary means, but the technology is so nuanced now for assisting someone to breathe and what about antibiotics?? I decided to have a B-pap mask put on him to increase his chances of hanging around until my brother could get here the next day…I kept him on the antibiotics also…and decided Greg and I would make a joint decision when he got in…his flight was scheduled to get in by 1pm on Saturday.

I decided to stay the night, believing that my husband Ron would get in by midnight and be there with me. The traffic and the snowstorm were so bad he didn’t get in til 4am…I had slept sporadically by the time he called. I asked him to go home and get some sleep and then go pick up my mother. I went ahead and got up at 5am…drank the coffee they had on Daddy’s breakfast plate (he couldn’t eat the whole time he was there but they kept bringing his meals) and watched three episodes of Law and Order before I turned the TV off. Emily and her husband Aonghus were able to come by before work…I woke Ron up at 8am to go get my mother and Greg’s plane was delayed a bit so he didn’t get in til later in the afternoon. The B-pap machine had quieted Daddy down the evening before but on Saturday morning he was hating it. Though he was not communicating very well, it was clear he wanted it off. I had been talking to him the whole time telling him Greg was coming, so I asked him to just hold on a few more hours.

Mother sat there and held Daddy’s hand and talked to him, but we weren’t sure she realized how serious things were getting. She said she wanted to spend the night but we didn’t think she was really up to it, and it didn’t take to much to persuade her that she should go home.

When Greg got there, Greg, Ron and I met with the doctor of the day (Ronny) to discuss our options and we all agreed palliative care was what was needed. There is a palliative care team at UNC Hospitals who the doctor said could give us more information but we weren’t sure when they were available. So we decided to take of the B-pap machine and just put on an oxygen mask and to start giving Daddy morphine to make him more comfortable. It was interesting that no one ever really uses the word “die” when talking about end of life issues..but I think at one point Ronny said Daddy’s organs were failing and I think that helped me quite a bit.

At that point everything seemed serious but I couldn’t tell how imminent Daddy’s death would be. I was exhausted but thought I should stay. Greg and Ron persuaded me to go home for at least a few hours for some rest. When I told the nurse, however, she seemed concerned. I told her I lived 10 minutes away so she said she would call. Over dinner I talked about my guilt about leaving Daddy there for the evening and Greg and Ron assured me it would be ok. So, thankfully, I went home and got a few hours of solid sleep.

I got Ron up early on Sunday morning to take me in before he and Greg went to get Mother. Daddy was breathing hard but not so agitated. I told Ronny I had been expecting a call in the middle of the night and he said that they didn’t really expect him to have hung on so long. I had a few hours mostly alone with Daddy that morning and that was what I needed. I had woken up knowing what I needed to tell him and so I had time to tell him those things. I have no idea what he really understood but I’m convinced he understood at least some of it. I was very emotional and I needed the time to fall apart a bit before everyone got there. One of the doctors from the palliative care team — who was not on duty — called me that morning and talked to me about the antibiotics and asked if I had questions and was very very gentle over the phone. He told me he would come by after he went to church, but then he came by before church and listened to me talk about Daddy. He thought Daddy was working too hard to breathe and so ordered more morphine. He was there when Mother and Greg and Ron came in but then disappeared. He was truly my angel of the morning.

Mother had decided not to come in that morning so Ron and Greg had had to spend some extra time with her to get her there. Greg was worried that she didn’t really understand that Daddy was dying and wanted to make sure she knew before it happened. Around noon when it was just Mother, Greg, Daddy and myself in the room, I asked her if she knew what was happening and she started crying and said she didn’t think that she would ever talk to Daddy again. I told her I thought she probably wouldn’t but that she was with him then and she keep holding his hand and that I thought he knew she was there. She held up pretty well through the afternoon…crying hard every once in awhile and then stopping for awhile.

I wanted very much to just be experiencing what was going on with Daddy the whole time but there were also people to call and email so that it wouldn’t be a total shock and so that Mother and all of us would have some support over the next few days. My son Max missed a plane from NY in the morning, so the drama of his getting a plane and then getting him to the hospital played out through the day as well. My daughter got off work a few hours early so she was able to have a bit more time with Daddy and my mother.

The staff at the hospital was great. Over the four day period there were many many different people working with my dad and with us but the continuity was almost flawless. Even though Daddy was mostly unresponsive, they were very respective to him, talking to him throughout, telling him everything they were doing. They were kind to my family…helping us to understand what was happening.

By 5:30 that evening we noticed that Daddy was breathing the way they told us he would when he was close to death…holding his breath for 20-30 seconds and then fast exhalation….we got quiet and just stayed with him and then called the nurse when he stopped. She came in just to verify and then got the doctors and the chaplain. It was very sad, though his death was very peaceful. The whole day had been sort of surreal to me. I was there, but I was standing outside of it watching as well. It is a scene we’ve all seen on TV and in the movies, but it is not one I’ve experienced myself. My fear was that I wouldn’t feel anything….or that I would hold back so that I could take care of things that needed to be taken care of, but my fear was not realized. I did feel everything, and I was able to feel that and then continue to do what needed to be done.

Mother wanted to go back to her the assisted living facility (rather than come home with us) because that is her home. My son got there after my dad died but before they had moved his body so he was able to spend some time with him after he got there. Emily and her husband, and Max, Greg, Ron and I went back to my place to be together for a moment and eat dinner.

My father was not a religious man and I don’t know what he believed about the afterlife. I do not know what I believe exactly either. Death is the great mystery. I do believe that consciousness is not completely tied to our physical bodies, however, so that opens up a lot of possibilities. I know that he was not in good health the past few years – he had Parkinsons and other mobility problems — he was very uncomfortable a lot of the time — often in pain — and though his death saddens me and I miss him — I have missed him as his happier, healthier self for quite some time. I think how we die is important and I believe that he had a relatively peaceful death and am glad he is not suffering now.

Back home…

Posted in Travel on December 9, 2009 by cgeary

It was a short trip…just a week. Very intense…very busy. I was meeting all the people working on the various aspects of the project and getting myself acquainted with all the usual implementation issues. The weather was lovely except for the one huge thunderstorm earlier in the week. My next trip will be sometime around February….travel to the Copperbelt and working with a smaller team. I look forward to it in a way that I have not looked forward to this kind of travel in a long time.

The trip home was long..over 16 hours in a 3 across window seat (I was unable to get an aisle seat and I am pretty claustrophobic)…but it really wasn’t too bad, which makes me think that if you are doing something you feel is important and get your mind wrapped around something…the difference between contentment and unhappiness is often in your head.

Enough said….here are a few more photos from the week.

The rains came…

Posted in Travel on December 2, 2009 by cgeary

Heavy showers

On my second day in Lusaka (yesterday) the rains that just threatened on the first day actually came. Just after we got back to the hotel it started raining with a vengenance…hard and for a long time…lots of thunder and lightening. We were all glad to be inside, though it was still raining when we left for dinner….the traffic was still a mess…it took us nearly an hour to drive to the restaurant…normally a 15 minute ride.

We got out a bit yesterday…saw a clinic..met with stakeholders….a hot day til it started raining….I’m adding a few photographs below…the cart you see was pointed out to us as an ambulance. The beautiful mango tree was in the clinic compound as well.

mango tree

Today was a good day. The weather had coooled down after the rain. We got out a bit to go shopping but did most of the work in the hotel. I did manage to go swimming in the beautiful pool here, in spite of the cooler air. Tonight I had dinner with a couple of friends who I have worked in Zambia with before. It will be nice to be able to visit them periodically as I return here for my work over the next couple of years.

We’ve been watching Christmas decorations go up in the hotel and hearing the Christmas muszak pumped in through the speakers. And today at the Shop-Rite we saw ladies looking through the Christmas decorations. I know it is December but it seems a bit incongruent with the warm weather and the tropical vegetation all around. I’m hoping it will seem a bit more like time to start my Christmas shopping when I get home this weekend.