Life in Death - Part 1 of 3

This is the first in a series of three entries about my father's last few days. At the time of this writing, Friday 8/2, I did not know that he was going to die. 

I have to warn you that these entries will be painful to read, as they were to write, but there is beauty in this story. Although Dad was 93 years old and had faced many health issues, his passing still took us by surprise. I think that we don't talk about death enough, probably because we don't like to think about our own mortality. If you choose to read about Dad's courageous battle, I and my family will be honored. 

On the morning of Wednesday, July 31, my father woke up with chest pain, pain in his right arm, and severe nausea. After consulting with my brother Rick and me, Mom called his doctor and then headed to the emergency room. 

Within a few hours, he was diagnosed with an ischemic heart attack. We learned that he had a blood clot in his heart, and his heart function was at 30 percent (50 percent is normal). At that point, he was in stable condition but feeling terrible due to the nausea. However, the medications he received made him much more comfortable by that evening, and it seemed that the heart attack might have been a mild one. They started him on IV heparin to clear the clot, and we settled in to wait for the results of his cardiology consult. 

I wanted to be with Dad, but my sister Amy was staying with me, and I couldn't leave her alone. It would have been difficult to take her with me, and only two people were allowed in the E.R. room, so we said a prayer for him and went to bed, thankful that the attack had been mild and that Rick could stay with him through the evening.

Dad Looks So Strong in this Photo Taken by Rick at 9:05 p.m. on Day 1 of Hospitalization

Tough Decisions

The next morning while I was preparing breakfast, my phone rang. 

"Are you the daughter of Richard D-?" asked a heavily accented, male voice.

My heart started hammering. "Yes, I am."

He introduced himself as the cardiologist and then cut straight to the bad news. Lots of it. Dad's heart attack had been a major one, and he was now having unstable heart rhythms. He had a heart blockage with only 20 percent heart function, and his lungs were full of fluid. 

"Your father needs to decide whether he wants to proceed with a cardiac catheterization. I've explained the risks and told him there is a strong chance that he would not tolerate even taking the pictures. He would have to lie flat for the procedure, and he's having trouble breathing. There is almost a 50 percent chance that he would not survive it, so I think managing his condition with medication is a safer option." 

He said that Dad wanted to try medication and then do a procedure if it wasn't effective, but he explained that it didn't work that way. There was already damage to the cardiac muscle, and the longer he waited to do anything, the lower the possibility of success. We had to make the decision now. 

He then went over five risk factors that made Dad a poor candidate for any surgical procedure. My heart sank.

"He wanted to talk to his son... Rick? But we couldn't reach him." 

Wiping my sweaty palms on my shorts, I swallowed hard. I'm no good at making decisions! I closed my eyes and prayed silently but fervently, "Lord, please give me wisdom."

But wait, there was more! 

"We have been talking about whether your father wants to be resuscitated. He told me he does not want any resuscitation efforts other than medication, and he does not want to be intubated. We wanted to talk with his family about this. Do you have medical power of attorney?"

"No, I don't. I think that Rick does." 

"Could you conference him in on this call?" 

We were unable to make the connection, so the tough decisions fell to me. I took a deep breath and pressed my palm to my chest. "It sounds to me like doing a procedure is too risky, and we don't want to put Dad through more trauma. And... if Dad says he doesn't want to be resuscitated, then I think we should honor his wishes." 

It felt surreal to say those words. I'd been with Dad several times in various emergency rooms over the last few years, and always his answer to those same questions had been yes, he did want to be resuscitated. 

As soon as we'd hung up, I handed Amy her morning meds and hastily delivered all the bad news I'd just received. Then I fired off a text in the group thread that Rick had started the day before with all my siblings. 

Next, I sent a message to my son Ethan, his wife Sumer, and my daughter Allyson. Allyson immediately asked if Mom needed a ride to the hospital and was soon on her way to pick her up. Meanwhile, Rick had arrived at the hospital and said Dad was doing okay. His chest pain had resolved, and he was no longer nauseated. The medications seemed to be working. 

My relief was short-lived because Allyson sent this message just a few minutes later: 

"He's having some more heart abnormalities, they had to give him another medication, he said he's having bad chest pain, I would get down to see him whenever y'all can. He looks super worn out, he's back on oxygen."

The Hardest Prayer

After a flurry of text messages, Amy and I set out for the hospital, as did Ethan and Sumer. As we neared the hospital, I asked Amy if she would pray. "Pray whatever God puts in your heart," I said, "but especially for him to be at peace if it's his time to go be with Jesus." 

Amy poured out her heart to our Father as I tried not to speed. "Lord, you know we want to keep Dad with us longer if we can, but we know you know what is best. It's hard for me to pray this, but Lord, we just want your will for him." She choked on a sob, and tears rolled down my cheeks. "Dad's heart is in your hands. Lord, we ask that you give him life, even in death. If this is his time to pass, we ask that you would help him go to you with joy." 

Although they'd come from across town, Ethan and Sumer pulled in right behind us at the valet stand. It was about 1:30 p.m. at that point. I hugged them and sent them on ahead; Amy and I walked as fast as her hemi-walker could take her through the warren of long corridors. 

In the waiting room, we were surprised to find my nephew Jacob, a handsome young Marine whom I initially didn't even recognize, home on leave from California. He hugged us warmly, and then we all sat down to wait. Jacob and his stepsister Hillary (my niece) went back to see Dad as soon as Mom and Allyson came out. Next were Ethan and Sumer. 

Allyson gave me a long, tight hug. As we swayed together, I thanked her profusely for driving her grandma to the hospital and keeping us all updated on her grandpa's condition. Then, since only two people could go back at a time and there were so many of us gathered, she decided to head home. 

Death's Door

A "code blue" sounded on the intercom, and Amy said, "I sure hope that isn't Dad." 

I started to reassure her that it surely wasn't Dad, but just then, Sumer rushed through the double doors and beckoned to me. "There's a problem with Grandpa, and they want to talk to you." I hurried through the doors, accompanied by the front desk attendant through a maze of hallways lined with sick people on gurneys. 

I found Ethan standing outside Dad's room, which was completely packed with emergency personnel. Red lights flashed on the cardiac monitor and a blaring alarm was quickly silenced by one of the nurses.

I pressed my way in and stood at the foot of the bed. "I'm his daughter," I said in a shaky voice. I grasped an ice-cold ankle and looked for Dad's eyes, barely visible above his oxygen mask. "I'm here, Daddy. I love you." 

He murmured something inaudible, and the hint of a smile curved his lips.

A woman smiled at me kindly. "You can come stand next to him," she said, stepping back to make a place for me. 

"Do you have medical power of attorney?" asked a nurse standing in front of a computer on a cart.

"No, but my brother and sister do."

"Could you call one of them?" she asked. "We need to verify your father's wishes about resuscitation." 

With trembling fingers, I scrolled through my maddeningly slow phone and found Rick's name in the contacts list. Just as it had a few hours before, his phone went straight to voicemail. Then I tried Emily, but her phone went to voicemail, too. 

I added a text in the family thread asking Rick or Emily to phone me immediately. 

While we waited, I held Dad's hand and quoted my favorite Psalm (139), though I was so rattled that I couldn't remember some of the verses. "You hem Dad in, behind and before. You have laid your hand upon him," I half shouted into his hearing aid. "Where can he go from your presence? Where can he flee from your Spirit? If he goes up to the heavens, you are there." My voice broke. Maybe Dad was going up to the heavens right now. 

Emily's daughter Hillary brought in her phone, and I heard Emily on the phone's speaker. With such a pandemonium all around me, I couldn't catch much of the conversation, just something about no chest compressions and saying goodbyes. 

Another staff member reached around me to access Dad's IV. I started to back away, but she said gently, "You're fine. But could you please step over this cord?" And then, "Lidocaine."

I looked around and realized that all of our family members who were present had gathered in the tiny room. It was literally like a clown car in there, and when I say "literally," I'm not using it in that peculiar figurative sense that people like to use. There were maybe 10 emergency personnel from every medical specialty plus our seven family members, including Hillary's three-week old baby, Penny Jayne. 

That is when I truly realized that Dad's condition was dire. I knew that they had been very strict about the two-visitor maximum, and if they wanted us all there, it meant... I didn't want to think about it. I picked my phone up off the floor, where I'd somehow dropped it, to add another text to our family thread: "Anyone who can come should come. They do not think he has long. He is alert and comfortable."

One by one, the medical team slipped out. I didn't know if that was a bad sign or a good one. 

A Beautiful Avalanche

Next came a flurry of FaceTime calls from Dad's children and grandchildren. At one point three phone screens were held up in front of him. His eyes darted from one person to the next as voices called out to him in a beautiful avalanche of loving words.

I served almost as an interpreter, repeating the words of each caller and repeating his replies, which were muffled by his oxygen mask and his weakness. 

We love you, Dad. We're here with you.¹

I wish I could be there, Dad. My heart is with you. I love you.²

She's blowing you a kiss, Dad.¹

Dad's hand squeezed closed, and then he puckered his lips inside his oxygen mask.

He caught it! He's blowing you a kiss.¹

I caught it, Dad!²

Rick is on his way back. He's coming, Dad.¹  

We wish we could be with you, Grandpa. We love you.³

I wuv you!⁴

I could never have chosen a better father (sobbing). I'm so blessed that you're my daddy.⁵

[I'm blessed that you're my daughter.]

Keep fighting.... Behave, Grandpa!⁶ 

[You behave.]

Knox, do you want to talk to Grandpa? He's on the phone.⁵ 

Knox, age 4, shook his head and looked away, feigning shyness or perhaps needing a nap after hours in the car. 

I love you Grandpa. How are you feeling?⁷  

[I'm doing okay. At 93, what can you expect?] 

You've always been so strong.⁷

[I'm not strong now.]

I just can't believe that, Grandpa. You always just keep trucking.⁷ 

Grandpa, I love you so much! (sobbing)⁸

I wuv you, Gampa.⁹

That was Vivi, Dad. She says she loves you.¹ 

[Aww]

You're the strongest man I know, Grandpa. I wish I could be as strong as you. You're an inspiration to our whole family.... You have to get better, Grandpa. Who else would I vent to about the Cowboys?¹⁰

Daddy, are you ready to see Jesus?¹¹

[Yes, I am.]

Thank you for loving me, Grandpa.¹²

[Thank you for loving me.]

Do you have any life advice you'd like to give?¹³

[Trust the Lord.]

This was my best attempt at transcribing some of the rapid-fire, loving words that filled the tiny room. I'm sure Mom probably said something, but what I recall is her pale, anguished face as she stood mutely at the foot of the bed, leaning on her walker. Refer to the footnotes at the end of this entry if you would like to know who said what. 

Life in Death

As I looked across all the tearful faces, both in the room and on the phones, my eyes stopped on my daughter-in-law rocking and cooing to her niece, Penny. She looked so serene, so right with a baby in her arms that my eyes filled with tears and my heart cramped with the pain of imagining my own grandchild there, and Daddy never seeing that beautiful scene. 

Sweet Penny Jayne

My next thought was to recall Amy's prayer about life in death. My gaze shifted back and forth between our family's youngest member and the oldest. This was the circle of life exemplified, with one tiny girl just on this side of the door to eternity and one frail man poised at the threshold to the other side.

Reluctantly, all the callers signed off, and the rest of us waited, but nothing happened. Dad's heart rate was very high at nearly 130, but steady. His oxygen saturation was close to normal. His breathing was shallow, but regular. 

I realized then that, despite relaying so many loving words across the miles, I hadn't imparted any last words of my own except, "I love you, Daddy." But that felt like enough. Everything had been said.

When the crisis had passed, Jacob held Mom while she sobbed. We all hugged and cried a little, and then Jacob, Ethan, and Sumer left. Rick, who'd gone home a couple of hours earlier when Dad seemed perfectly stable, returned. No one told us we had to leave, so we leaned against walls and sat in chairs and watched Dad breathing. 

After a while, the electrophysiology physician's assistant came in and explained what had happened. Dad's damaged heart muscle had been unable to pump efficiently, and his heart sort of panicked. The heart rate rose so high that his ventricles were almost quivering rather than pumping blood. He'd had a couple of short episodes of this ventricular tachycardia earlier, and this last one had been sustained enough that normally they would have shocked his heart to restore normal rhythm. Due to the DNR order (do not resuscitate), they'd only been able to give him antiarrhythmic drugs and blood thinners.

He said they would continue to monitor and adjust his medications, and hopefully Dad's heart rhythm would stabilize.  

Ethan's Quick Action

I didn't hear Ethan's perspective on the story until the next day. He and Sumer had been talking calmly with Dad when suddenly alarms started beeping, all of the lights on his heart monitor began flashing red, and his heart rate increased to over 190 beats per minute. They waited about 10 seconds, but no one came in, so Ethan ran to the nurses' station and told them something was wrong with his grandpa. The nurse glanced at the flashing computer screen and made an announcement over the intercom. Then a team of emergency personnel crowded into his room, and that's when they asked for an immediate family member to come in. 

I thanked him for acting quickly and told him he just might have saved Grandpa's life. I'm sure the team would have come in at some point, but surely every second counts in a situation like that.

Mom wanted to spend the night with Dad, but Rick and I argued that it would not be good for her to sit up in a chair all night. Also, the halls were packed with COVID-19 patients, and we didn't want her to get sick. She said she didn't want dad left alone in case.... She just didn't want him alone. I convinced her to go home with Hillary and Amy by promising to spend the night myself. 

Dad's pulse remained close to 130 for about four hours. When he was finally moved to an ICU bed, with only Rick and me left in the room, his eyes quickly grew heavy, and he dropped off to sleep. His pulse then fell into the 70s and stayed there. At this point, he'd been awake for about 48 hours. We figured sleep was probably the best medicine for his exhausted body. 

A Precious Reprieve

After Rick left the hospital for the second time in a day, I sat quietly next to Dad and held his hand. Again, I pondered what words I might want to say to him, but all I wanted to do was squeeze his hand. He reminded me of the last time he'd been hospitalized. "Do you remember how you held my hand when I had to be still in that machine for a whole hour?" he asked.

I smiled. "Oh, I'd forgotten that, Dad."

"If you hadn't been with me, I don't know if I could have stood it."

"I'm glad I was with you," I said.

"We've always been very close, haven't we?" he asked. 

"Yes, always."

"Remember how I used to come home from work and lay next to the [heat] register to take a nap? And you would lay down in front of me and nap with me?"

"I don't remember it, but I do remember seeing a picture of us on the floor." 

1972

I reveled in the quiet, clutching Dad's hand until it went slack with sleep. Around midnight, his kind nurse Trevor brought in a recliner and a blanket for me and dimmed the lights. I was surprised to feel myself falling right to sleep, just like Dad. 

Since that time, Dad has remained stable and continues to improve. He has been weaned off all of his IV medications is no longer taking any blood thinners. He has a mild case of pneumonia and will remain in the ICU until the cardiologist clears him. Today [Friday 8/2/24] he did very well on his physical therapy evaluation. He was able to sit and stand without adverse effects on his blood pressure. 

We don't know what the future holds for Dad, but we're grateful he is still with us.

Oh, how I wish this were the end of the story! 

=============================================================

List of Speakers from Conversations in the Emergency Room

1. Me (Sarah, daughter)
2. Melody (daughter); she and her extended family were just beginning a vacation many hours away, in Galveston
3. Erin (granddaughter, Melody's daughter); she was driving to Galveston with her family
4. Jace (great-grandson, Erin's son, age 2)
5. Emily (daughter); she and her family were driving to a vacation in Tennessee
6. Chad (grandson-in-law, Erin's husband)
7. Greg (grandson, Melody's son); he and his family were driving to Galveston
8. Savannah (granddaughter, Emily's daughter); she and her two children had just been picked up at the Nashville airport by Emily and Paul when she received this devastating news
9. Vivianne "Vivi" (great-granddaughter, Savannah's daughter, age 3)
10. Sam (grandson, Emily's son); on active military duty in California
11. Amy (daughter); in emergency room with us
12. Jacob (step-grandson, Emily's stepson); in emergency room with us
13. Sean (grandson, Melody's son); either in Galveston or enroute there