It reminds me of the query "what came first, the chicken or the egg." Do you become a good nurse because of your life experience, or does your life experience make you a good nurse? I just don't know. What follows is a bare rough draft of my feelings on the second anniversary of the death of my father. I share it because as a daughter and nurse, I often felt helpless and selfish when involved in his care. I say selfish because it is so painful to watch someone you love suffer horribly and there invariably comes a time when one has to acknowledge that you desire it to end because it is just too tough on you. That is a difficult thing to admit and once you do, you have to find a way to forgive yourself for feeling that way. Of course, you want the person in pain to be alleviated from pain and despair, but nurses (and sons and daughters) are only human.
When you are so personally involved with a patient or your own family, invariably the worlds of nursedom and daughterdom collide. There are difficult decisions and worlds of wonder to discover. The best advice or tip I can offer is to try not to lose yourself along the way...Thank you for allowing me to share...
I Hear Singing But There's No One There...
So it is just after one in the morning this November 21, 2007. I should be sleeping but I can't. Lately, sleep eludes me most probably because my body just has no idea how to fall asleep given my crazy night schedule. It doesn't really matter because I was always a creature of the night. There is something alluring about the solitude of night. I can't identify it but I've always felt comfortable with it. I call the night my blanket of safety. My dad felt the same way and I like to think, though I could hardly know, that I got that quirk from him.
November 17th marked the second anniversary of his death. He died at home, which was in retrospect, so much better than dying at the hospital. I say that only as someone who has attended countless hospital deaths. However one spins the experience, it just doesn't compare with being surrounded and comforted by loved ones within the confines of one's own home.
I think I knew the night before that something would happen. I wished it would. Though that is hard to admit to, it is true. Most of us would attribute that sentiment to wanting to end the suffering of the person who is sick. While that is certainly true, there is an element of significant pain of the ones left behind that just can't be ignored. It is so torturous to have to watch your loved one suffer and decline. I guess that means it is more about the ones left behind than the one who is destined to leave. I hate it when they let us humans in.
I gave my dad some morphine to help him breathe without pain. My brother told me dad had a good night after that, perhaps one of the best he had had in ages. I felt horrible about that. Why hadn't I pushed to get him some sooner? After all, who in the world cared if he became addicted? Why wasn't I more proactive in that area? Why didn't I do more? Everyone expects so much of me. I'm the nurse. I'm the daughter. I'm the one charged (even if only in my mind) of taking care of everyone. Why couldn't I help my father?
The evening before his death, dad finally spoke to his doctor about his wishes not to be revived should things turn for the worse. I knew as soon as I handed him the phone to have that talk with the doctor regarding his living will, that he was not long for the world as we know it. It wasn't that he had given up. He had given in. I was, in a weird way, glad for him. I knew how much he had fought to keep the illness at bay. I knew how much he desperately wanted to be there for my mom and their fifty year anniversary. I knew that it was nearly over. I just knew.
I didn't sleep much that night. I spent the majority of the night praying to God that I would be there when he died. I cried much of that time but not for dads passing. He was at peace with that. I had heard him say so. His words to his doctor were "I've had enough, I'm tired, I believe in God and me thank you for all you've done, but I'm through." He said it as though he were having an ordinary conversation so I knew he was at peace. When he had started calling out to his parents not long before I knew time was brief.
In the morning my mother called. She needed help to change the bed because dad had been incontinent. I felt a pain in my heart unlike any I have ever felt, but I somehow managed to at least try to nurture my mother as best I could, telling her I would be right over. In the shower, I wondered if I could be strong for her and everyone but most of all, for me.
I remember thinking, foolishly and abstractly, that the fact I had gotten my period was not only inconvenient but kind of symbolic. In all my years as a nurse, it seems that there are always signs of life when death is imminent. During the birth of my son Christopher, as his arrival was being announced to my dad upstairs from the labor room, dad had been struck by the fact that at the exact same moment, another family was sobbing in the halls over the death of a loved one. Back then I stored that tidbit in my mind but never really thought of a time when it would be such a poignant memory. Funny how that happens to us all. Stored snippets of memory that somehow jump to the surface as if we knew all along they would rise to the top.
The morning of the seventeenth was beautiful. It was sunny and not too cold. Only later did I realize that I had put on a red sweatshirt. Red was dad's favorite color. I wonder if I somehow just did it for that reason. I don't know. I hope so.
I don't remember much of the ride over. How do you prepare for your father's death? I do remember wondering if anyone was going to be strong for me. How is that for selfishness? Always having to be the strong one is not an easy role to play. There are times when you wonder who is going to be there for you. You have to be sensitive to the needs of certain family members but it feels as though no one has to be sensitive to you. No one understands or really even has an expectation that you are suffering too. They think because you are the strong one that you will sail through. They think because everyone expects them to be less strong or more affected in some way that you will understand. That is such a hard place to be. To have to try and weed through all the sensitivities and nuances of everyone but not to have them have the same expectation for you.
Dad was confused. His feet were purple. Just to turn him caused him immense pain and when he cried out my heart ached for him. I wished that he would die because it was so hard to see him in that kind of pain. I wished I had figured out a way to talk with him at length, knowing that he understood how much I loved him. I was never able to have the in-depth conversations with him my brothers had. As he gasped for breath after we finished changing his bed, I knew the mere fact that he had allowed me to assist my mother meant that he had truly surrendered to God. He had not given up; he had just accepted that it was his time. It was such an awful scene. I stroked his face and tried not to cry. I cried. Almost as difficult as watching my dad try to breathe was the sight of my mother in tears muttering over and over again, "It's OK Bobby, it's OK." I could see the years flash in my mind and could only imagine what was going through her mind. Was it the time her sailor Bobby had his necktie bitten by a horse? Was it that first meeting? Was it the birth of their children? Was it the difficult times? I imagine it was most likely a split second synopsis of their life together.
I gave dad some of his medicine to help him breathe. It took a few minutes but his breaths became much less labored and he even looked peaceful. I don't know if he knew I was there. Mom took his hand and lay her head down on his chest, still moaning "It's OK Bobby, it's OK." For reasons yet unknown to me, as I stood at the door of the bedroom taking in the scene of my mother's farewell to my dad, I started singing a song he taught to me as a young child. "I hear singing and there's no one there, I smell blossoms and the trees are bare, all day long I seem to walk on air, I wonder why, I wonder why. There are times when I can't sleep at night. And what's more, I've lost my appetite. Stars that used to twinkle in the sky now a twinkle in my eye, I wonder why" I wonder why I sang that song, but now I am glad that I did. I like to think it soothed both of us.
It occurred to me as I was singing that I had to let my mother know that she had to give dad permission to die. So, I told her she had to give him permission. "Permission for what?" she angrily spat my way..."Permission to die," I quietly replied in tears.
"Bobby, it's time to go home." "We've been together for fifty years and I loved all the time we had." "It's time to go and stop suffering." At that moment I called my husband and asked him to come over. There had been so many occasions when we had thought the time had come only to have dad make a reprieve but this time I just knew.
Dad was for once, breathing peacefully. He seemed calmer with mom...I left the room to call my estranged brother to tell him that dad was dying. I don't know if he believed me because he was short with me on the phone. Given our estrangement, I imagine that was to be expected. I was angry with him for not realizing the gravity of the situation. Dad had tried so hard to hang on for everyone and not show them the depth of his pain and deterioration. But, a nurse sees the truth. A daughter sees the suffering.
Dad took his last breath when I was out of the room talking to my brother and I have to believe he knew that I wasn't there. People can and do choose the time and circumstances of their deaths. I have seen it hundreds of times in my career as a nurse. I have held the hand of people who had no one else to be there. I have hugged and held strangers who at the moment of their passing were closer to me than my closest friends or family. But, I wasn't there when my dad passed. I was talking to a brother who hates me. For some time that colored my thoughts and wreaked havoc with my emotions but then I realized that in an odd way, it was dad's way of at least bringing us a little bit together. And, it was his way of saving me from the pain of witnessing that ultimate moment from life to death. I know he was at peace. I know that in my heart and soul, so I accept that it might have been his last attempt at keeping some control in an uncontrollable situation.
Since then, I have been preoccupied with my own mortality or lack thereof. When I think of how quickly the last twenty years have passed and how I may not perhaps, have much more than that time in the world, I am stymied. Life is short. I'm saddened that I no longer have a relationship with the brother I spoke of. I'm saddened at the loss of my youth. I'm amazed at the way time flies away when you are planning other things. There isn't any time to waste.
I wanted to be an archaeologist or an oceanographer. I wanted to write stories. I wanted to experience so many things that I was never brave enough to try. Why? If one single second of my life had been different I wouldn't have what I have now but still, I wonder.
Lately, when I am having a difficult time at work I have to laugh because I will always find a penny on the floor of the lounge or in my patient's room. Walking into chaos is always difficult and on the nights I just feel it can't get worse, there will be a penny on the floor. Dad used to always tell us when we found pennies that they were pennies from heaven. That's why we place them on his grave...
I play silly games with myself such as saying, "Dad, if you can hear me, let me hear a crow." And then, of course, I hear one caw at the moment in question. Real or imagined circumstance, it makes me feel better.
When I was a young nurse, I was an attendant at the death of a well-beloved person. I say well beloved because his family was all there and the death was both expected and accepted. We, nurses, were just there for support. At the moment of his death, another nurse and I witnessed a luminescent cloud of something leave his body and curl slowly up to the ceiling. I don't know if anyone in the family witnessed that. If so, they never spoke of it, but the other nurse and I looked at each other in both shock and amazement. We didn't really talk about it other than to wonder if that had been his soul. I will never know, but I have to believe my dad is in a better place, as cliche as that must sound.
I have another brother whom I deeply love and respect. He is brilliant in so many ways. He contends there is no God, that afterlife is simply some sort of manifestation of energy. His explanation comforted my mother and really, it is all a matter of semantics because something happens which is beyond explanation. In my view, it doesn't really matter who is wrong or who is right, or even if there is a Heaven or not. If what we believe is strong enough to sustain us through life, that's OK with me.
I'm not going rewrite this. This is my rough draft. This is how I feel. On this November seventeenth, I thought of all my brothers and mother and children. Although my husband doesn't talk much about it, he also dearly loved my dad and was there at his passing. Dad loved him as he did his own sons and told him so. Who comforts him? People don't have to say anything. I know when my husband holds me or pats my shoulder, he is saying so much more than he could ever say with words.
Not long ago I worked two difficult night shifts. The first involved a patient who had gone to a routine doctor's visit only to discover that her baby had no heartbeat. She was to be my patient for twelve hours. She was in severe pain of cramping and contractions we had to induce so she could expel her dead fetus. She was still in the throes of doing that when I left in the morning. The next night, I had a labor patient who had lost her mother during the pregnancy. Her due date was November seventeenth. I was quiet that night but didn't speak of my own personal memories of that particular anniversary. She didn't talk much about her mother and I didn't press her, but at the moment of delivery, when she saw her baby, she burst into tears. I understood. Later, when all the equipment had been cleared away, she grasped my hand and burst into tears, with heaving, heart-wrenching sobs..." I want my mom!" she cried with enough anguish to hurt my heart. "Will you be my mom today?" Fighting to hold back my tears, I told her, of course, I would.
Later that morning when I returned home and helped get everyone ready for school, in the middle of a conversation (or gripe session) with my husband, I was suddenly overwhelmed with emotion, and burst into tears..."I want my dad", I cried every bit as sad as my patient had cried out for her mother. I wasn't prepared for it. I never am. As my shoulders heaved with gut-wrenching sobs, and the tears fell, I remember saying to my husband, "I hate it when this happens." I guess being a nurse doesn't always guarantee one can control their own emotions. But, it was a good thing that it happened. That morning I finally slept.
I miss you, dad. I want you to be here with us but not at the expense of you feeling the way you did. I honor you and I love you. I still daily review your voice in my mind so I won't forget it. And as much as you always said I needed to have the last word, I would give my life and everything I have for the privilege of YOU being the one to have the last word. I love you, dad...Night night...