March 30?

 

My grandfather is dying. On Sunday at about 6:00, my grandmother called to tell me that she'd gotten a call from his assisted living place that he was very dizzy and that they'd found him in his room on his hands and knees, unable to stand. They helped him to his feet and took his blood sugar. It was over 600. They called an ambulance. I met my grandmother over at the emergency room and after a couple minutes, he was there. I went in to see him and it seemed pretty calm, we thought he was having a weird diabetic issue. He and I spoke briefly, he was confused, as he is normally, but alert. He asked where my grandmother is. I told him she was in the waiting room, and asked if he wanted me to send her in. He said yes. I went out and got her, she went in. About 10 minutes later, she came back out and told me to go sit with him. I went in and only a minute or two later, a doctor came in, asked me a few questions, and shooed me out into the hall. I waited there as they pulled the curtain around him and doctors came swooping down from all over the place. The phone at the desk rang, and the person who answered said "Hey, Dr Whoever, it's hematology, about Angelo T". Dr Whoever takes the call. I wait a few minutes more, and they lead my Grandmother in.

Dr. Whoever introduces herself to us and she tells us that Angelo has a massive bleed somewhere, but that his belly is filled with blood. She asks us dozens of questions about his history, whether or not he has ever been treated for ulcers or acid reflux (two of the very few things he HASN'T had). She asks whether or not my grandmother has ever given thought to DNR or DNI, and that is when we know things are serious. She tells us that they're going to have to insert an ng tube and they shoo us out of the room again. They begin inserting it and he is SCREAMING, bellowing, crying out, begging them not to. I leave the ER to call my mother and my aunt to tell them they need to come.

Finally, they get the tube in, and we go back in. He is miserable. The tube is painful, and blood is flowing from it. The attending in the ER from Internal Medicine, who happened to be someone who worked in my lab for about 5 months was on call. He explains what is happening in further detail, all the while, my grandfather is begging to have the tube taken out. My lab friend AGAIN asks about advanced directives, and we know that we are well and truly fucked. My grandmother HAS actually signed DNR/DNI papers on my grandfather. Someone from GI comes down and explains that they want to do an endoscopy on him and that the easiest way to do that will be to intubate him, so that he is still, and goes on to explain that with the elderly, it is often difficult to wean them off the ventilator and that there is a risk of aspiration from the tube. My grandmother agrees that they need to find the source of the bleeding, and is convinced that the intubation will be temporary, until they identify the source of the bleeding. They hook up a bag of blood to the IV pole, and begin transfusing him.

He is wheeled up to the MICU. We follow in the elevator. The last words I say to him as he's taken into the MICU for the endoscopy are "Grampa, I love you so much". My grandmother and I go off to the family waiting room and wait. My mother shows up about 2 hours later. We continue to wait. Finally, the GI guy comes out and tells us that they've found a giant, softball sized clot of blood in Angelo's stomach. They do not know what is bleeding, and they can't move or dislodge or break the clot. He tells us that they'd like to keep him on the ventilator and do another endoscopy in the morning after flushing him with fluids. We all go into the unit to see him. It's horrible. We don't go into the room.

The next morning, I arrive at 7. I gown up and go in. He is swollen beyond recognition. His arms are bound to the bed. He is intubated, and he is draining blood from a separate tube coming out of his mouth. The nurse, an amazing woman named Kerry is taking care of him. She tells me that in total, he'd had NINE liters of blood pumped through him. The average person has between 4-6. He is agitated, fighting, not able to talk because of the ventilator and clearly unhappy.

They do the second endoscopy, and are unable to find the source of the bleeding, and from the intubation, he's developed aspiration pneumonia. He is gravely ill. Later that day, we meet with doctors to decide what to do next. It is agreed that they will pull the breathing tube and try to wean him, while giving him morphine for pain, but it's also agreed that they'll wait until my cousins arrive with their husbands. No one knows, obviously, what will happen once the tube is pulled. Will he be able to breathe on his own? We're unsure.

One of my cousins arrives the next day at about 4:00. The other is stuck at O'Hare with her husband, waiting for their delayed flight to arrive. It's decided that we have to have another family meeting, with two of the micu doctors and a social worker, to make sure we're all in agreement about the next stages of his care.

I feel like I'm sounding very cold about all of this, but you have to understand that since Sunday, I have had about 2 hours sleep. My grandmother and I keep going over and over how we went out with him on Saturday and how he seemed okay and how of all the things we expected to be wrong with him, a massive GI bleed was never even on the radar. I've cried and cried and cried and cried. I've been positive and hopeless all in the same minute. I am devastated. I mean, how else can I describe how I'm feeling? You've read what I write about my grandparents. You know how I spent most of my growing up with them. I am who I am because of my grandparents, and a great deal of my personality is directly because of my grandfather's influence. When he had the brain surgery and he changed so rapidly, I was upset. I managed to mostly keep it in check because my grandmother needed me to be strong for her, because she was having such a hard time with him. All the times he wandered away. All the phone calls I got from him, me trying to explain to him who my grandmother was.

Then, when he went into assisted living, I was relieved. He found a place where he could be happy doing the little things he was able to do. Arts and crafts. Go on little trips. Talk with the nurses (who adore him). I mean, sure, it's never what I would have chosen for him, but you don't get to pick how you age and I was okay and never heartsick about it because I knew that he was unaware that he was in any way debilitated and that he was truly satisfied with his life.

He always knew who I was. There was never any of the confusion with names and faces he seemed to have with my other family members. Even through his dementia, he would sometimes talk to me about the things he and I used to do, and the last time he was in the hospital, week before last, he said "You are my favorite".

Anyhow, I won't go into details about how the past few days have been. They took him off the vent yesterday and gave him an oxygen mask and morphine and he stopped struggling. On the vent, he was wild eyed and restless. The vent was incredibly painful, and if you factor in the brain of an old man who is demented, in a strange and frightening place, he fought constantly, pulling at the arm restraints, trying to get out of bed. His eyes would fly open and lock with mine and he was begging me to get it out. Off the vent, he was mostly stable. Not at all lucid, but stable. My mother and I stayed with him until about 12:30

This morning, I went to work because I was very far behind on some projects. At about 10:30, I got a call from the MICU nurse telling me to get over there as quickly as I could because there was a change in his breathing. I ran from my building and was able to spend 15 minutes alone with him, and during those 15 minutes I told him everything that I hoped he already knew. That I loved him more fiercely than he could imagine, that there was nothing in the world I wouldn't do for him, that I was proud to have been his granddaughter and that he was the best grandfather anyone could ever hope to have. I told him that he was my favorite, too.

My family showed up. We sat, staring at the monitor. After an hour, I couldn't be there anymore. I went back to work. Sometime in the afternoon, my cousin called and told me his breathing was changing again. Again, I ran back over. We sat around his bed, she, her husband and I, and watched the numbers on his monitor change. His breathing grew more shallow. His heart rate dropped. Everyone else showed up, and as we were standing around his bed, his heart rate went below 30, his pulse stopped and he stopped breathing. Suddenly, just as quickly as everything stopped, everything started again.

The end of this is that it's not over yet. I mean, he is still alive, but barely. He will not recover this time and the thing I am holding most dearly to me right now is that the last words I spoke to him while he was still able to understand me were I love you.

 

i carry your heart with me

ee cummings

i carry your heart with me (i carry it in
my heart) i am never without it (anywhere
i go you go, my dear; and whatever is done
by only me is your doing, my darling)
i fear
no fate(for you are my fate, my sweet) i want
no world (for beautiful you are my world, my true)
and it's you are whatever a moon has always meant
and whatever a sun will always sing is you

here is the deepest secret nobody knows
(here is the root of the root and the bud of the bud
and the sky of the sky of a tree called life; which grows
higher than the soul can hope or mind can hide)
and this is the wonder that's keeping the stars apart

i carry your heart (i carry it in my heart)

 

 

the other day - home - email - soon