Showing posts with label congestive heart failure. Show all posts
Showing posts with label congestive heart failure. Show all posts

Tuesday, August 28, 2012

It's a mix of sadness, humor, my grieving son, my anxious Dad, black-suited mortician with no sense of humor and the ethereal event on the mirror.

Say Goodbye to Grandma

(Mom (Jo) and me.) 

As I turned away from the mirror, something caught my eye.  

I snapped back to see what it was. There, returning my gaze, was a familiar face.  It was more of an image, actually:  an expression, a tilt of the head, a flash of the eyes.  Not my face, but my mother's face, translucently superimposed, for lack of a better description, over my own.  Like a hologram.  No alarm, no sense of foreboding, no feeling that seeing two faces in the mirror was the slightest bit unusual.

The hour, I would remember later, was shortly after noon. I exited the ladies' room and returned to my desk.  It's 1991.

My telephone rang at about three o'clock, and at first I didn't recognize the voice on the other end, but then I realized it was Jeff.  My college senior son, whom I thought had headed back to Penn State for a week-end of beer, women and general rowdiness, called.  His voice sounded strange until it suddenly occurred to me that he was choking back tears.

His Grandma, my mother, he related through spastic sobs, had suffered either a heart attack or a stroke. He and Dad had been with her.  Death tried its best strike instantaneously, but following a call to 911 the paramedics appeared, dutifully wielding drug-filling syringes, shock paddles, and an artificial air supply.  They quickly transported her to the hospital, only a few minutes away.  Unfortunately, between the time Dad found her and the time help arrived, her brain had been without oxygen for nearly ten minutes.  But even so, in the emergency room, with my father and son pacing about the waiting room, resuscitative measures persisted on this seventy-four-year old woman, an insulin-dependent diabetic with a history of congestive heart failure and aortic aneurysm.

An ER doctor appeared.  Success.  They had a pulse.  Sort of.  She was on her way to Intensive Care.

So, on that sunny midsummer afternoon, my octogenarian father had found his wife sitting before the television in her favorite chair.  Her head was flung backward.  Her mouth and eyes popped wide open, no doubt in astonishment at her own sudden death.  He had witnessed the paramedics' furtive work, and followed her ambulance to to the hospital, where he paced and hoped.  And now,  his mate of fifty years was being rolled to Intensive Care.  She was unresponsive to pain stimulus, her pupils were fixed and non-reactive, and she had little or no blood pressure, but the doctors had done their job, and her heart was pumping, more or less, with the fragile, thready, non-rhythm of an electrically-induced pulse.  She was breathing with the aid of a ventilator, and clinically, they said, alive.  Another miracle of modern medicine.
My Dad, Charlie.

My family lived in the Pittsburgh area, six hours away by car.  I could drive, or I could spend two hours getting to Metro airport on a Friday night, sit on a runaway for an hour, fly for an hour, and have Jeff picked me up the airport for the hours drive to my small home town.  Simple math, coupled with my abject terror of airplanes, convinced me I should drive.  But first, I had to pack.
Mom always said she wanted to be cremated with no viewing.   She insisted she did not want to subject her family to the weeping, wailing. and general circus atmosphere of a three-day post-mortem ritual, but I've always suspected she simply cringed at the prospect of being mourned over by an odd assortment of people for 72 hours, in a situation where a stranger had taken posthumous control of her hair and make-up, possibly using frosted blue eye shadow.  I lean toward cremation for much the same reason.  That, and my paralyzing claustrophobia.

But I wasn't sure how my dad would feel about cremation.  We'd never discussed it as a family.  I hung some suits and dresses in the back of my car, just in case I was called upon to host a wake.

Before I left home, I contacted my mother's treating physician, not to be confused with the miracle-worker in the emergency room.  He confirmed my fears:  oxygen-deprived, unresponsive, not breathing on her own, likely to fail during the night.  He gentle but firm, offering sympathy without false hope.  I appreciated his candor.  He also suggested that should she have another "cardiac episode" the kindest thing to do would be to let her go.  I agreed.  Then I drove east.

My home town hadn't changed much in the years since I'd escaped:  the same old bank high on a hill, presiding over Main Street from its corner lookout, the same  monument standing sentry in the middle of town, wreaking havoc on out-of-town drivers who huddled around it defensively, never sure who had the right-of-way (nobody did), the same guys I'd slapped at the drive-in back in high school, perched on the same bar stools they claimed the year I left for college.  Now though, they had lower bellies and higher hair lines.  But as I turned down Washington Street at one A.M., the peeling paint of my parents' house was barely visible in the darkness.  My mother had always left the porch light burning for me, no matter how late I got it.  So I guess something had changed after all.

The Intensive Care nurses had been alerted that I would be arriving well after midnight, and that I should admitted.  Dad I rang the requisite buzzer well  and then proceeded down the dark, narrow hall to Mom's cubicle.  The monitoring equipment flashed like the cockpit of some futuristic space craft.  The withering bedridden body tethered by plastic tubing, swollen, purple tongue displaced by a hose forcing what were most probably unwanted breaths, was not the mother who drew the blinds and read to me during thunderstorms so that (and she) wouldn't be afraid.  That person was gone.

I spoke in hushed tones with the ICU nurse, about the massively distended abdomen (internal hemorrhage?), about the blood in the urine, about lines on the monitor becoming flatter with each heart beat.  Dad, in the meantime, was balanced on the edge of a chair, hair uncombed, hands folded between his knees, listening to our words and alternating worried glances between his wife and the numbers flashing on the digital gauges.

"So, how's her blood pressure?" he asked, looking up hopefully.

On the blood pressure monitor, where numbers should have been, there was a digital question mark.  He either did not see this, or did not wish to.  It was time to take him home.  I told the nurses I would be back shortly to spend the night.

Dad spoke very softly on the way to the elevator.  He shuffled across the cold tile in a pair of old terry cloth slippers.  He had forgotten to change into his shoes.  "She's gone, isn't she?"  he asked.

I put my arm across his rounded shoulders.  He is barely as tall as I am, which is practically elfin, but his hunched posture and his hung head diminished him even further.  "She wants to be,"  I said.  "And if she isn't by tomorrow," I continued, "I think we have to help her."

When Dad and I returned from the hospital, I settled him onto the couch with a cup of warm milk, which he fortified with a hefty splash of Jack Daniels.  I coaxed him to try and sleep a little.  There was nothing he could do.  Jeff was in the living room, waiting for us.

"So how's Grandma?"

"Not good," I replied.  "I'm going back up to spend the night.  Do you want to come?"

He did, and we returned to Intensive Care.  The blips on monitor were slightly flatter.  There was still a question mark where the blood pressure reading should have been.  Mum was gasping for ragged breaths, as if to say, "Okay, if you want me to try, I'll try."  With each failed attempt, a yellow warning light on the ventilator announced a mechanical breath instead of a natural one.  The yellow flashed were becoming more frequent and closer together.  The nurse offered us chairs.  We accepted.  Jeffrey was in tears and inconsolable.  His Grandma had been like a mother to him.  More like a mother, I had to admit, for most of life, than his own mother.

"You should have seen her,"  he said.  "I knew she was dead.  They knew she was dead.  Why didn't they just leave her alone?  Look at her!  She's hate this!"

I agreed that she would.  I also promised my grieving child that if she didn't leave us during the night, all this equipment would be disconnected as soon as we could reach her doctor.

"I just never though Grandma would die,"  he said, sniffling.  "She's always been there."

Everyone handles grief differently, I suppose, and Jeff's way was to blurt.  So he blurted.  Never raising his eyes from the floor, he related how, if it weren't for Grandma, he'd probably be in prison, or at the very least a drug rehab center.  He reminded me how I, when he was 14, left him in the custody of the father and moved to Texas with Husband #2, (recently divorced also).  He pointed out that while he was growing up I spent untold hours pursuing a pointless career which had ultimately resulted in my being laid off from an unrewarding automotive job in Detroit in the dead of winter.  But through it all, there was always Grandma.

I listened and said nothing.  The ventilator whooshed.  The monitors blipped.  He continued.

"You know how I'm always telling you how I want to run a corporation and buy a BMW?  You know how important money is to me, right?"

Unfortunately, I did.

"Well, " he continued, wiping away tears, "I'd give all that up if I could just bring her back.  You know, I never ever told her that I loved her."

"I never did either, Jeff."

"Well, you should have!  I should have!  And now it's too late."

The nurse tiptoed in and related that the patient's "complexes were changing."  That translated to flatter lines on the monitors.  Big surprise.

"Do you want us to push IV meds.?"  she asked.

I shook my head.

"If she goes into arrest, do you want us to try to convert her?"

"No,"  I said.  "Just let her go."

"Please,"  said Jeff.

"Do you want stay with her now?"  the nurse said.  "Some families do, but some would rather not be there when..."  She trailed off.

Nobody would say the word "death."  But nobody had to.  It was all around us and long overdue.

She slipped away when we least expected it.  The conversation had grown lighter, regressing to a discussion of football, a subject of which I know nothing, and wish to know even less.  Jeff was relating how an individual named Bubby Brister had bought him a beer in a local bar.

"Who's he?"

My son shook his head, amazed at my ignorance, and blew his nose.

"It's the Steelers' quarterback, Ma."

"No kidding?"  I retorted.  "Wow.  How long has Bradshaw been gone?"

He groaned.

A figure appeared behind us, hands folded and resting on the front of her white uniform in a very proper and professional manner, waited until we noticed her.

"She's gone." the figure said softly.

Sure enough, she was.  Flat lines were everywhere.  The yellow light flashed in vain.

I had been holding her hand as best I could throughout the night, in spite of the tape and tubing and the needles in her veins.  I stood beside her now and brushed the hair back from her forehead.  Even at 74, Mom had the softest, smoothest skin.  She had always attributed this to daily use of Noxema, which she foisted on me as a teenager.  I think Mom just had good genes.  I gently kissed her cheek, and moved away from the bed.

"Say goodbye to Grandma," I said to my son.

He did, through many tears, and a final peck on the forehead.  We left the hospital.

Jeff said, "I can't believe she's gone. She's really gone." Yes, rice with milk, (Jeff loved that.), soothing lullabies, (Born to Lose, by Ray Charles, weird lullabies) and Mom's favorite chair from morning till night; she slept in that chair, sitcom after sitcom.

"Everybody dies, Jeffrey." Absolutely everybody. News flash.

Let me give you some advice:  Never, under any circumstances, go see anybody lying on a slab in the preparation of a morgue.  Especially if it's someone you wish to remember in a context not associated with the House of Usher.  I speak from experience.

Dad not only agreed with cremation, he was adamant about granting her that last wish.  We were seated in the conference area of the local mortuary, attending to details and reciting information for the endless paper trail required before any departed person is permitted by the bureaucracy to be legally dead.  A somber young woman in a black suit and a Rolex wrote in fluid black lines with a fountain pen.

"A mass?"  No, just a simple memorial service.

"Embalming?"  No, just cremation.

"Flowers?"  No flowers.  Memorial contributions to the Humane Society.

"Excuse me?" said the black suit.

The Humane Society.  You know?  Animals.

My mother had lovingly fed every stray that wandered into town, and her bread-and-seed-strewn backyard was legendary among the local bird population.

"An urn?"  No.  She wanted her ashes scattered.

"Scattered?  Where, exactly?"

We weren't sure.  Somewhere in the mountains.  Actually, she had wanted them scattered from an airplane, a small aircraft.  Her brother, an aircraft mechanic, would be at the funeral.  I planned on asking him to enlist one of his pilot buddies to do this.

"I'm afraid you'll need special permission to do that," said the black suit, temporarily resting its pen.  "You see, it would constitute pollution."

I've always had a talent for laughing hysterically at inappropriate times.  I did not disappoint myself.  When I calmed down, I continued.

"Let me get this straight.  The federal government permits...even encourages...mammoth corporations to spew toxic waste into the water and air on a daily basis, annihilating entire ecosystems in the name of profit, and the remains of one tiny little white-haired lady constitutes pollution?  Give me a break."

The black suit responded with an icy, vacuous glare.  She glanced at her Rolex and finalized the paperwork with minimal comment.  The cremation would take place on the morning of the memorial service.  She would personally deliver the remains in a cardboard box, and that would be the end of her involvement.

There was still one more thing to do.

Since Dad was at home when Mom passed, he hadn't had the opportunity to say goodbye.  He wanted to go down to the prep room and do this now.  I wanted nothing less than to accompany him.  I also didn't want him to go down there alone and pass out.  Or worse.  I went.

As we approached her, I felt only calm, clinical detachment, observing how quickly the human body, lacking prompt infusion of man-made preservatives, begins to deteriorate when the soul leaves it.  She was covered with a sheet up to her chin.  Her head was supported from behind and held upright by some sort of U-shaped brace.  Her mouth had been sealed shut and her hair brushed back from her face.  She appeared to have shrunken considerably in the last several hours.  Her skin had the color and texture of cement beginning to dry:  mottled gray and dirty white.  I didn't want to touch her, but I had to.  The skin felt as it appeared.

Dad leaned over and kissed her, and then, for the first time, broke down and cried.  I took his arm and led him back up the stairs.  That was the only time I had ever seen my father kiss my mother.

The black suit walked us out to the front porch and said goodbye, but not before pointing out the benefits of my father's pre-planning his own cremation, making the arrangements now, and locking in the cost to hedge against inflation.  I wondered how much the price of matches could go up.

The arrangements were made on Saturday, and service wasn't to be held until Monday morning.  We spent Sunday accepting condolences from friends and relatives, looking through old photos and generally cleaning up the house, which had deteriorated badly in the past few years, partly because of Mom's failing health and partly, I think, because of apathy.  So I filled a bucket with hot, soapy water and Murphy's and went to work.  I remembered when I was a tot, our small apartment virtually shone.  I used to follow Mom around with a dust cloth every day to help her clean. and when she thought I wasn't looking, she would go back and re-do what I had done.

Over the years, I've tried to use that early negative experience to justify my being the worst housekeeper who ever hid pizza crumbs and enormous tufts of cat hair behind the couch until some far-off cleaning day.  But I think the truth lies a little closer to the surface.  I concur wholeheartedly with sentiment expressed by my second husband.  Quite possibly the most astute thing he ever said, was spoken as he flung a wet dishtowel into a basket containing my best silk blouses.  "This domestic crud really sucks," he declared.  That was, I think, the only thing we ever agreed on.

From Sunday morning, until Andy Rooney closed Sixty Minutes, I scrubbed and Windexed.  Dad did laundry.  Jeff carried garbage bags out to the fence.  Somehow, we got through the day.

The morning of the service dawned sunny and hot.  I arrived at the mortuary slightly ahead of everyone else, as I wanted to place a small vase of rosebuds; three red ones, one from each of us, and a photograph.  While ferreting through desk drawers on Sunday afternoon, we had found a picture of Mother taken when she was about 19 years old.  She was wearing spike heels and a slim skirt and sweater, dark. curly hair tumbling around her face, leaning against the porch of an old ramshackle house that was home to her family and the previous generation as well.  She looked gorgeous.  I knew at once that was how she would like to be remembered.  I also wished for a moment that I had been born with my mother's looks instead of my father's brainy mind.

Although open to the public, the service was sparsely attended.  Long-lost relatives drifted in.  Mom had very few friends.  She had been agoraphobic before anybody had a name for it, barely leaving the house except for medical reasons, for at least 15 years prior to the death.  She wore dark sunglasses and closed blinds.  Those at the funeral who were not family, were, for the most part, business acquaintances of my Dad, who had been the town plumber for 30 years.

Jeffrey had been dating the same girl for nearly five years.  Becky sprang from an enormous, excruciatingly Catholic family, which had produced eight offspring.  I finally had the opportunity to meet some of her siblings at the funeral, as well as her mother, who had been raising children while I had been raising hell. Becky introduced me to two brothers and two sisters, impeccably groomed, poised and polite.  I extended a welcoming hand to the mother, an ex-cheerleader and homecoming queen who had married her high school sweetheart and then began to reproduce with alarming frequency.  My son was clearly comfortable surrounded by the manner of family of which, he felt, he had been deprived. (Uncle Bill)

As the small crowd milled, I sought out Uncle Bill, my mother's baby brother, wiry, white-haired, bearded and fifty, although he could subtract at least ten years from his age and no one would question him.  I asked him if he would take Mom for a final plane ride over the mountains.  He said nothing would make him happier, and we agreed to confine our plans to no one in the Environmental Protection Agency.  Dad and I would deliver the remains the next evening.

The black suit, true to her word, appeared at our door shortly after noon the following day, carrying a white cardboard box about the size of a half-gallon of milk.  We placed on the dining room table, where she spent the rest of the afternoon while I grocery shopped, wrote thank-you notes and, finally, showered and changed for the trip to see her brother.  Jeff popped in on the way to his summer pizza-delivery job.

"What's in the box?" he asked absently-mindedly.

"Grandma," I said.  "We're taking her to Uncle Bill's.  Do you want to go?"

Jeff rolls his eyes and then he declined.  He had to work, probably grateful that the pizza-delivery with fast-food to rude people with big dogs; this, compared to a deceased grandma packaged in a corrugated container, was probably downright refreshing.

We were ready to leave.  Dad was clearly uncomfortable.

"Where should we put it...her?" he asked.

"Oh for Pete's sake," I groused.  "Put her on your lap."

He did.

Uncle Bill still lived in the house where he was born, in a minuscule town inhabited almost exclusively by Polish Catholics.  It was also the the town where my mother grew up.  We took her for one last ride down Main Street.  We crossed the Everson Bridge, traversing the railroad gorge which still supported the splintered remains of the house where she was born, teetering on a creek bank; the house in the picture I had taken to the funeral.  The family had had moved uptown to Maple Street just a few years before Mom and Dad got married.

We passed the Polish Club, where, every Friday night, my grandpap would send her home from the dance at 10:00 PM sharp. "Go home, Jo" he would order.  "Nice girls are home by now!"  She would obediently hike up the hill to the rhythm of polka-band music in the background.

We passed the market where my grandmother had shopped on the last Saturday morning of her life.  She was only 63; far too young.  After carrying stuffed, paper grocery bags up the steep incline to her home, she had simply sat down in a chair and succumbed to a massive stroke.  The date was April 12, 1958 and she was obese.  The family doctor, some 30 years ago, appeared with his little black bag, and quietly pronounced her dead in the family parlor.  This was decades before anyone in the medical community had discovered the direct relationship between false hopes and huge profits.  Hers, like her daughter's, was an abrupt departure, but my grandma passed quickly, with peace and with dignity.

On the final leg of the trip to Maple Street, we circled the cemetery where Grandma and Grandpap had been laid to rest.  They died of stroke.

Uncle Bill was waiting for us.  We left his sister in his care. He assured us she would spend the night on the dresser beside him, comfortable for one last time in her family home, and that he would telephone us when the ashes had been dispersed.

The call came at about 7:00 AM the following morning, as I was packing for the trip back to Michigan.

"She's gone," he said.

Uncle Bill and pilot friend, both with an apparent wanton disregard for the environment, had honored the last wish of a fine lady.

The sun had just begun to rise over the mountains, he related, the moist mist of dawn still covered the lush, rolling land, and everything was absolutely quiet, save for the invasive whine of their engine.  They flew to a mountain ridge which remained. amazingly, uninhabited by anything but wildlife, without so much as a utility pole to mar the pristine landscape.  Then he slid aside the window of the compact Cessna, opened the box, and let her go.

Dad helped me with my luggage and walked me to my car.  We chattered about superficial things, safe things, but the conversation soon came back to Mother; more practical items this time, like insurance, legalities, and death certificates.  He said he knew that the time of was officially listed at 3:12 AM, July 13, 1991, when she expired in the hospital, but in his mind he knew she had actually left us the previous afternoon, in her living room, when he found her a few minutes after noon.

A few minutes in afternoon?  The time I saw the face in the mirror.  I suddenly realized she had said goodbye to me.

My father and I said our goodbyes, too.  I gave him a hug, and not wanting to make the same mistake with both parents, I said, for the first time in the life, "I love you, Dad."  He considered it, and shuffled off toward the house to spend his first night alone in more than fifty tears.

I started my car.  I glanced in my rear view mirror, and saw that the sun was now high in the sky, radiant over the mountain range to the east.  She was out there, somewhere, free and at peace, and scattered among the birds and animals she had loved so much.