Living Will

On July 3, 2008, I got the call. It was 6PM, I was in my car on my way to dinner with my friend Janice. Adi, one of my Dad's caretakers was on the phone. He had fallen and badly hurt his leg.

I got there in 15 minutes, and it was clear he had broken his hip. I knew that at 87, breaking a hip is serious, often fatal eventually. The broken hip doesn't kill directly. It's more insidious. Not being able to get up to walk makes the person a lot more susceptible to pneumonia, and that's why falls are so serious in the elderly. So, I was expecting a long lingering death.

Given that my Dad had Alzheimer's, I had to make all the decisions. That role reversal had occurred several years ago as his mind deteriorated.

After calling 911, the ambulance took him to the hospital, less than half a mile away. He was in a lot of pain, and it took too long for them to finally give him morphine, but, finally, that did the trick. He was at least comfortable. Thank God for morphine. After a painful X-ray they formally diagnosed the broken hip: it was broken in 3 places.

By 4:00AM, they finally admitted him to a regular hospital bed. My Dad was exhausted and so was I. I should have stayed through the night, since he pulled out his catheter when I was gone, but I was back by 9:00 AM with about 3 hours of sleep.

The standard treatment for a broken hip is surgery to pin the broken bones so they have a chance to heal. Given my father's advanced age I asked the doctors a frank question: is it worth it?

My Dad had made it very clear that he wanted no heroic measures when the end was inevitable. For example, when my Mother was dying of lung cancer, he committed a felony for her. He stole a prescription slip from a Doctor, forged a prescription for barbituates, and got it filled by a pharmacy, just in case she wanted to end her suffering early. She never took the pills. After she died, he kept them in his freezer, wrapped tightly, just in case he wanted to use them. Often he would bellow to my sister and I, "you know, I have the final solution in my freezer and I plan to use it when it's time!" He never did, but simply having that option seemed to give him some comfort.

Of course, he had a living will. He drafted it by himself almost 20 years earlier, though he got his lawyer to review it. He was adamant about no heroic measures if the end was inevitable. The third paragraph read:

In addition, I request that the executor of my Will refuse to pay any bill demanded from anyone who violates my wishes above. Indeed, I would hope that my executor would sue such violators; however, I leave this to his discretion.

I made certain every caregiver at the hospital read it.

With a broken hip, though, he likely was going to face exactly the kind of death he didn't want, long and tortuous. The doctors said that the surgery should reduce his pain, compared to doing nothing. If you don't set a broken hip, the bones will eventually knit together crookedly; therefore you'll never walk again, and it will be very painful. After discussing the options with my sister, we both agreed to the surgery, since it had some hope of reducing his pain, but we both believed he would never walk again. Surgery was scheduled for Saturday, July 5.

My sister and I spent July 4th with him in the hospital. Every 2 hours he got another shot of morphine to keep him comfortable. At one point, one of the attending doctors came into the room and asked my dad, "Mr. Jones, how are you doing," to which my Dad simply replied "I'm doing great!" He really was happy and comfortable. Mostly he slept a lot. Again, thank God for morphine.

The hospital had food service at any time. You could just call up and the food would arrive in 30-45 minutes. My Dad's favorite foods were salmon and chocolate. So that's what he had for dinner. Not the most balanced meal, but he ate all the food.

My sister and I arrived early the next morning for the surgery. Since it was a holiday weekend, the hospital was very, very quiet. They wheeled my dad into the empty surgical preparation area. We were the only people there. Finally we met the surgical team. There were three surgeons on the team, an older, experienced surgeon, 2 fresh residents, plus an anesthesiologist. They explained the procedure, discussed the risks, and I signed the consent form.

Then, it was time. My sister and I told My Dad that we loved him, as they wheeled him into surgery.

The surgery took a couple of hours. My sister and I waited in the waiting room reading some books, grabbing a bite in the cafeteria. Waiting like that is awful.

The surgical team finally came back. In retrospect, I realize that they don't tell you bad news directly. They don't tell you straight out that your father is dying. Instead, they said that there was a problem with the anesthesia. They couldn't keep his oxygen level up, and worried that he had gotten some blood into his lungs. So they had transferred him to intensive care.

My sister and I rushed to the ICU, but they wouldn't let us in immediately. The attending physician there spoke with us in the waiting room. He repeated what the surgeons had said and then asked, "he's 87. This will be tough. Had he discussed with us what he wanted to do in this situation?" Thank God I had the living will with me. After reading the will, the doctor almost smiled when he said, "he really thought it out, didn't he?"

Then they brought my sister and me into the ICU. My Dad was still under anesthesia, on a respirator, turned up to the max. Each time the air was pumped into him, it was like a seizure. His body jumped with every breath. There was a tube coming out of his nose, filled with blood, emptying into a large container above his head. There were several IV's, one in each arm, and a couple in his chest, if I recall correctly, with several IV bags hanging above.

It was clear it was time.

The nurse was phenomenal. Did my Dad like music? Yes, classical. Magically some sweet music started playing.

The respirator was slowly turned down and the tubes removed, one step at a time. My sister was on one side of his bed, myself on the other.

There was another patient in that ICU room. Although I never saw her through the curtain, I heard her. Another nurse was encouraging her, "you need to get out of bed and start walking." To which the old woman angrily replied, "I'm not doing any thing until I speak to Dr. Thomas." The frustrated nurse huffed, "well, he will be here shortly." While this minor drama was going on, life was flowing out of my father.

My Dad's nurse asked us about our memories of him. We told the story about the letter to the University of Michigan, the Viagra story, and amazingly, we were laughing, at least a bit, despite the fact that our father was dying in front of us.

One of the young surgeons who performed the surgery on his hip came by. Let me call him Dr. Pitt, Dr. Brad Pitt, since he was that damned handsome. He didn't realize that my father was almost gone, and apologized. He then put his hand on my shoulder, and said, "I don't know if this helps, but my father passed away a couple of months ago too. My heart goes out to you." I was able to choke out "I'm sorry for your loss."

Uncontrollable tears, laughter, and now, lust, all while my father was dying in front of me. My lizard brain was not going to be appeased until it felt every strong emotion known to man.

Then the sweet, beautiful nurse softly said, "he's gone."

I had watched my father deteriorate for years. I had thought I was prepared. You are never prepared for that moment. The pain hits you in every cell of your body. It happened so fast.

I had never seen a dead body before. His body was completely still, though still warm. His mouth was frozen open as if in a big snore, or maybe a silent scream. His color slowly became grey. I guess this is what they mean by "deathly still."

The nurse whispered, "you can stay as long as you want."

When do you leave your father after he dies?

Through continuous tears, of course I told him I loved him. I hoped he was proud of me. I knew that he was in a better place. Over and over.

Eventually, all of a sudden it hit me in the center of my soul. I needed to kiss him on his forehead, say I loved him, wish him goodbye, and then it would be time. Kissing a dead body on the forehead seemed just horrifying, but exactly the right thing to do. So that's what I did.

My sister stayed a while longer. I waited in the waiting area.

When she came out, we stayed there thinking there must be some papers for us to sign. Finally the nurse came out and said, "there's nothing more for you to do. You can go home."

Somehow we got home.

He gave us so many gifts during our life. As horrific as it was, I was glad that, as much as possible, he didn't have a long lingering death. My sister and I were able to give him something like the kind of death he wanted.