Wednesday, November 30, 2011

Farewell...A Tribute

It’s never easy losing someone you love. And even though I’m so often surrounded by death and the families left behind, I realized, no matter how much you try to rationalize, it doesn’t make saying goodbye to someone I love any easier. I got the phone call on a Saturday morning that my grandmother had gone to the hospital for the last time and was sent back home on hospice and not doing well. I was at work and obviously pretty shaken up. I had friends help me find tickets while I tried, in vain, to finish my cases. My attending, seeing how visibly upset I was, said, “Go, go, do what you need to do.” Who said surgeons were heartless? By the time I got home, a friend was already at my door.
“What do you need?” he asked.
“A good cry, and a bowl of queso,” I said.
I got a ticket to Kansas City for 6am the next morning and spent the rest of the afternoon with some incredible friends willing to do anything they needed to help support me.

The next morning I went straight from the airport to my grandmother’s assisted living home. Traditionally, as one gets sicker, he or she must go from an “assisted-living” community to a “nursing home” for higher level of care. But, because my grandmother agreed to hospice, she was able to stay in what had been her home for the last six years, while an outside company came in and helped with anything of greater acuity than for what the community was equipped.

I walked into her room and could immediately see she had hours to days, at best. She looked exhausted. She refused any morphine or ativan because wanted to be fully awake when she saw her family for the last time. When she saw me, her eyes lit up, she flashed a huge smile, and said, “Oh Alexandra! Get over here!” I went over and gave her the tightest hug I’d given anyone in a long time, something I think I needed as much as she did. Some of my relatives were sitting around her bed, and my uncle said, “Oh good. We could use a doctor around.”
“No no,” I said, still working on holding back tears. “I’m not a doctor today, just a granddaughter.”

Nanny was sharp as ever, every faculty intact. She made jokes. She fretted over the hairnet keeping her hair in place. She was always pristine in appearance and refused to wear the same blouse (with matching necklace) within a one week time frame. She fussed over everyone, making sure they had somewhere to sit, got enough food, thought the temperature of the room was ok. Streams of friends and family members came in and out of the room all day long, and nanny recognized and greeted every single one. Nanny always maintained a tough exterior, but on the inside, she had unconditional love for every person in her life.

Later in the evening, my mom and her sister got in, the last of nanny’s children to arrive. Each time someone came into the room, the shock of seeing how sick Nanny looked brought on a new wave of grief. I found that as long as I was eating, I wouldn’t cry. So, every time I started to get upset, I’d just start eating whatever happened to be around me. My mom asked me after she got in, if I had gotten anything to eat yet that day. My uncle, who overheard, said, “Eat yet? She hasn’t stopped eating! Fried chicken, potato soup, trail mix, snickers, sodas…”
“Thanks for calling me out on being a fat ass,” I replied. But I guess he’s not the first to comment on my ability to consume large quantities of food. Hey, everyone deals with grief in their own, special way.

After nanny saw the last of her children arrive, she finally relented to sleep. She slept though the night and we were at her bedside the next morning. However, she never fully ever woke back up. Her heart dropped down to the 40’s and her breathing started to slow until it came to a point she took a breath and then no more. She was never uncomfortable, just appeared to slowly drift into the infamous eternal slumber. I ended up having to pronounce my grandmother because there was no licensed MD or RN on site. Even though I have pronounced people before, it is much different when you reach for your own grandmother’s wrist. I knew full well there would not be a pulse, but still felt a wave of overwhelming grief run through me when I palpated nothing.

This experience is so different from some of the final moments I have witnessed working in the SICU over the last several months of other people’s loved ones. My grandmother died in her room, peacefully, surrounded by people who loved her. I realize hospice isn’t applicable in every situation, but this is my first personal experience with it, and I am becoming a huge proponent of it henceforth. I have had several patients who, despite the fact we know the odds of them surviving are slim to none, continue to be full code. They have a different machine functioning for every major organ system. They have inexperienced residents (yes, I reluctantly mean myself) stabbing needles into their jugulars. They are in horrible pain but we cannot give them too much pain medication because their blood pressure is too low. And, then they die in the company of strangers, pounding on their chest, sending electrical volts through their hearts, with the family pushed out of the room.

My grandmother could have been put in an ICU, started on dialysis for her failing kidneys and drugs for her failing heart, but that would have given her days maybe a month at best? And, odds are, she would have died in that ICU bed, with the nightshift team around her, and no family member in sight. Nanny made it clear she did not want that, so that was not even an option or a decision her children ever had to make.

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