<p>My dad is slipping away. On Wednesday he was taken from skilled nursing to ER unconscious and with O2 saturation in the 60s, and septic. He’s being treated for intestinal infection and that is improving a bit, but his kidneys aren’t functioning well and he has brain damage.</p>
<p>A palliative care nurse called me this afternoon, and it was comforting to know that they’re already plugging us into that. She said that in reviewing his records, she was struck not just by the number of hospitalizations – 6 or 7 in the last year, and 4 in the last 3 months – but by the fact that it was something different every time. She said that’s an end-of-life marker; his systems are shutting down.</p>
<p>Later I talked to the doctor and I asked, if they can manage to knock the infection out, what is the best case scenario? She said that physically, it would take “a very long time” for him to get back to where he was before this episode (which was poor indeed). Mentally, she said, he will probably never recover. And it would only be a matter of a very short time before something else would come up, some infection, some organ malfunction, which would finish him off. So he may die in the next few days, or it could be a few weeks, or a month or two. But we are now very near the end.</p>
<p>The doc and I decided to continue treatment for tonight, and we’ll talk again tomorrow. I have no illusions that he’s going to live much longer, but I’m trying to buy a little time. My brothers are far-flung and need time to get here. Also, if possible, I’d like him to die in skilled nursing rather than the hospital for this big reason: The SNF is next door to the AL where Mom lives, and she can look out her window and see it. She said that she wants to be able to look out and “see” him, and I want to give her that if we possibly can. </p>
<p>Some of you might remember the family drama over Dad’s bladder cancer several months back, and the brother who couldn’t/wouldn’t deal with it. That unpleasant episode turned out to be a blessing in disguise, because apparently it completely broke down the wall of denial. He has been absolutely prepared to deal with this crisis, and incredibly supportive of me. Ditto for the other brother and my precious SIL. I can’t imagine how hard this would be if we weren’t all pulling in the same direction. DH said that all my work the past 4 years at keeping the lines of communication wide open is paying off now, and I think he’s right. If I’ve done anything right, that was it.</p>
<p>The doctor did encourage us to do one thing tonight: sign a DNR. I would have signed it on the spot (I’m the DPOA), but I wanted to talk to Mom and both brothers first. Mom not only gave immediate approval, but asked if she could sign it too. Previously-in-denial brother also quickly gave the green light. “Gem” brother at first didn’t want to do it because he wanted to keep Dad alive long enough for him to get here and say good-bye. I read him the sheet that the hospital gave me about CPR for frail elderly (0-5% survival, fracture, further brain damage). As I was doing that, DH slipped me a note, which I read to Brother: “Your dad is already gone.” That one little sentence immediately changed his mind. So here it sits, that pink sheet with my mother’s shaky signature and mine below it, and my eyes fill with tears as I look at it. It’s concrete. Somehow it hits me more than anything else has so far: Dad is ready to go.</p>
<p>I also wanted to thank all of you, my vital support community. My old pastor used to use the phrase “coming alongside.” None of us can walk through this for another, but we can darn sure come alongside.</p>