Saving my grandfather

You were supposed to die of cardiac arrest as you circled toward home plate. Or of a brain aneurysm in the summer during one of your countless hikes through the mountains.

You weren’t supposed to die here. Not in a hospital bed, inhabiting this fragile new body, with an oxygen tube in your nose and tumors in your lungs.

Two days before you left us, I traveled home to visit you. I’d last seen you six months before, shortly after your eighty-eighth birthday. You were a lifelong athlete and adventurer, but you seemed just a little less spry than I remembered.

Now, you were slumped in an old office chair in your bedroom, eating milkshakes to calm your inflamed throat. You choked with every spoonful, and your cough was so weak.

“I just want to ride my bike around the block,” you told me. And then, “I wish I could sing again. I miss that a lot.”

You had sung as a tenor in the local opera chorus for years. Now you punctuated every third word with a rattling breath. This cancer had taken your strength, your stamina, even your voice.

That night, you were confused. The morphine that the hospice nurse had delivered was fogging up your brain–the same one that had taught math and woodshop decades ago and that had devoured the physics, nature and astronomy books lining the walls of your room.

You were jumpy and restless, so I spoke softly. I asked if you’d like to go to bed. You asked me to turn the thermostat to quarter past three. Eventually you fell asleep in your chair.

The next afternoon, you couldn’t catch your breath. You’d never been afraid to scale mountains, sail the ocean or trek across foreign continents alone, but now you were scared. When we asked if you wanted to go to the hospital, you said yes.

I remember grabbing your coat in a hurry. My uncle rushed you out the door in a wheelchair and helped you into the passenger seat of your purple car. My mom and I followed behind.

As we all sped to the VA hospital emergency room, I could see your hand sticking out the passenger-side window up ahead, riding the breeze of fifty mph. It was the first time you’d been outside in days.

In the lobby of the ER you became listless. You crumpled deep into your wheelchair. Desperate little bird sounds escaped your lips with every breath. Graying and sick old men surrounded us. Veterans of Korea, Vietnam and, like you, World War II.

Someone in blue scrubs appeared from behind a set of double doors and spirited you away into a white corridor. Moments later, they asked for my mother — your daughter and healthcare proxy, who knew that you’d signed do not resuscitate/intubate paperwork.

I followed, not quickly enough, and the double doors eased shut.

I demanded to be let in, before they could insert tubes, lines and medicines into your dying body.

I tried to reason with the front-desk clerks.

“My mom needs me! She’s alone, and I’ve got to help her! I have to make sure they don’t do anything drastic!”

I was met with silence as the veterans looked on.

“I can help … I’m a doctor,” I uttered, hopelessly.

“The ER physician says no more visitors until your grandfather is stabilized,” someone said.

Desperately, I dialed my mother. There was a ring, then her hysterical voice. “They’re going to intubate him!”

The call disconnected. I began to plot a way in when a nurse finally appeared beyond the doors, calling my name.

I ran through the corridor, past my mother sobbing outside your room and into the melee. People swarmed around you, directed by a man with a stethoscope standing at the head of your bed.

I stepped forward.

“You can’t intubate him, he’s DNR/DNI!”

“He’s going to die. I’m not going to let him die.”

“If you intubate him, you’ll never extubate him.”

“DNR doesn’t mean do nothing.”

“He doesn’t want this.”

“He says that he does.”

I thought of all the people I’d cared for in the ICU. Terminally ill, poked, prodded and bled dry. Surrounded by endlessly beeping machines and blinking lights. And in the end, dead anyway.

“Who are you?” the man asked.

“I’m his granddaughter. I’m a second-year resident in internal medicine.”

“A second-year resident,” he parroted scornfully.

“He wants intubation,” he said.

Hours later, I would imagine myself clocking him in the jaw. But in that moment, I pushed past him and laid my hands on your shoulders.

“Do you want a tube down your throat?” I asked.

“Yeah.”

“Or do you want medicine that will make you comfortable?”

“Yeah.”

Your eyes were foggy. You stared past the chaos into some distant nothingness.

You aimlessly pulled at the large checkered hospital gown they’d slipped over your wasted frame, and I held your hands to stop you. You were still so strong.

My uncle — a pediatrician — finally appeared. Between us, we convinced the ER physician to relent.

He turned the lights down, and one of the nurses let us know that there was fresh coffee.

Someone injected a sedative into your IV, and you went still. More family arrived as the doctor admitted you to comfort care.

Eventually we followed you upstairs, to a large room on a quiet floor with a view of the Sierra Nevada mountains.

We sat with you for a long time. As the hours passed, some people said goodbye, but I remained with my mother and my aunt. We huddled around your bed as darkness descended.

The three of us stayed up all night, curled into uncomfortable armchairs with starchy blankets. We told stories, and I recalled the day you clumsily, proudly placed the green hood over my shoulders when I graduated from medical school. We remembered your pranks, and laughed hard and loud as your favorite showtunes played on my iPhone. Sometimes, we’d fall into long stretches of silence, watching you with puffy, bloodshot eyes.

We listened as your breathing deteriorated into something strange and staccato, like a metronome.

The next morning, the others trickled back in.

I left. I needed sleep. My whole body ached, and my eyes burned with salt and fatigue.

I had just slipped into blessed unconsciousness when the phone rang. It was 10:05. You’d stopped breathing.

You were still lying in bed when I returned. You were cold, waxy and discolored. It didn’t matter.

Two hours later a group of volunteers placed you in a box, draped you in an American flag and escorted you to the morgue.

We accompanied you as long as we could. Before they wheeled you away forever, my grandmother, mother and I placed our hands atop the box you lay in.

When you finally left us, the sky was blue, and sunlight had crested the mountains.

You weren’t supposed to die like this, but maybe this way wasn’t so bad.

I got to say goodbye.

Alia Moore is an internal medicine resident. This piece was originally published in Pulse — voices from the heart of medicine, and is reprinted with permission.

Comments are moderated before they are published. Please read the comment policy.

  • http://www.amerechristian.com/ Ron Smith

    Hi, Alia.

    Laura, my daughter, passed April 24th, 2012 after a severe brain bleed into the brainstem area.

    Its hard…death that is…to watch. We were all standing around her when they extubated her, but we knew what was going to happen. There was no nystagmus with the warm or cold water in the ears and no respiratory effort without the ventilator driving it.

    You know it was rightly said that the worst part of death is the shame of it. That of course is true if you see life through the lens of someone who believes in a good God.

    But time in Laura’s case was not only the nail in the coffin, but the evidence of that good God. I wrote about her in Forever And A Day For Laura Michelle (free on iTunes). You see, unlike Him we are entangled in the time’s sticky threads. Who could read my poem about Laura which was written twenty years to the day before her death, and think that timing was accidental? And the promise he kept, and someday I’ll see.

    “Forever and A Day For Laura Michelle

    …now being confident of this, that he who began a good work in you will carry it on to completion until the day of Christ Jesus.—Philippians 1:6

    I started praying for a little child the other day.
    ‘Cause I was sure that was God’s way
    To heal that little one and make her whole.
    I was sure of this royal goal.

    Her little body was twisted and turned.
    Oh, how in my heart the desire burned,
    For her wholeness all at once to see,
    And then to be all that she could be.

    As I prayed, the Holy One spoke quietly
    To my inner man on bended knee.
    How long will you wait, how long will you believe
    For this miracle that in your heart I’ve conceived?

    I thought only momentarily, and said,
    God, I’m your servant, I wait in your stead
    If it be a day, a month, a year or three,
    I’ll wait, I’ll wait, I’ll wait, this miracle to see!

    Days, months, years passed by,
    And it seemed the Lord waited, I don’t know why,
    To heal my little girl, such a precious sight,
    “So small and frail, sometimes I would just cry.

    But His words to me would echo,
    And in my spirit man, I knew it would be so.
    How long will I wait, how long will I believe,
    For this miracle that in my heart you’ve conceived?

    Forever And A Day,
    That’s the only way
    To stand in faith, for this my child.
    Though it seems her healing hides, it will only be a little while.

    By Ron Smith, MD

    April 24, 1992”

    Excerpt From: Ron Smith. “Forever and a Day.” iBooks. https://itun.es/us/USEjG.ll

    Ron Smith, MD
    www (adot) amerechristian (adot) com

  • medicontheedge

    Before my lovely mother in law died, I made her promises about her care if she became incapacitated. I promised her I would throw myself physically in front of anyone who wanted to do something she did not want. And I would have if I had to.

  • Lisa

    I am glad you were there for your grandfather.

    One thing I do not understand is why you family would have taken him to the ER, if he was under hospice care. I would have called hospice; I wouldn’t expect to have ‘good’ death in a hospital.

  • Lisa

    Alia, my mother and mother in law both died of cancer. They both had hospice care and the one thing I learned from their deaths is that the hospice nurses were the ones who were best equipped to guide them through the dying process.

    I think your story illustrates something that I have heard recently and that is people may change their minds about how they want to die when their death becomes more imminent. While we can discuss our wishes before hand, I think the discussion needs to be on going and needs to be engaged in with both family and medical professionals.

  • http://batman-news.com Rebecca Berger

    Thank you for sharing your story. This story also brings up the important question about revisiting code status when a patient is in extremis. In an ideal world, resuscitation status should be discussed is in the office of a primary care physician, oncologist, or other physician who knows the patient well, providing information about likely outcomes of resuscitations and giving the opoportunity to ask questions about the meaning of being “full code” or DNR/DNI. It seems this so rarely happens, and yet we believe we will respect these explcitly stated wishes. Yet then, when a patient presents to the ED in respiratory distress, we again offer them “the tube.” Sure, there are times when this conversation is not well documented (a case for intercompatible EMRs and standardized documentation of code status like allergies). Is it fair, to ask a patient who has clearly declined intubation whether they do want this life support?Does every patient has a right to change their mind, and are we really giving them all of the available options? It is a challenging question. If I was not the physician who discussed and documented the code status initially, do I know how the conversation occurred, who was involved, and how strongly the patient felt about their end of life wishes? This remains an unanswered ethical question for me.