One Last Duty to Perform

The leaf appears frozen about ten feet in the air, yellow against the gray and brown of sky and trees. Of course it is not really frozen in space, but is attached a branch by a slender stem. It is unique because it is the only leaf remaining on this particular maple on this particular residential street. Even the apple trees are bare. Beyond the trees up the stone steps and through the screen door, my father also hangs on, the last survivor of his family of origin. Convinced his time has come, he has refused all medical treatment and waits.

His hands are cold, laying atop a fleece blanket. Quietly, she asks "Are your hands cold?" She gently slides his hands back under the polartec. He turns to face her with gratitude, but says nothing. Perhaps he fears an onslaught of aphasia, or perhaps he is simply tired.

Months ago diagnosed with kidney disease, my Dad's life plunged into a repetition of dialysis and monitoring. In the summer, he and my stepmother trained to do dialysis at home which was more frequent, but less invasive than the highly difficult hemo-dialysis.

Hemo-dialysis was not only inconvenient, requiring half a day at a clinic several times a week, it was surprisingly dangerous. Because the process directly integrates into the circulatory system it has the disturbing side effect of sometimes dramtically reducing blood pressure. More problematic was its psychological impact. It confined my dad to an alien environment for four hours at a time, during which he really couldn't move around. Dad hated it and I should not have been surprised when he refused to do dialysis after many weeks in the hospital. Nevertheless I was angry with his decision and felt again abandoned in a time of need. But it is his life, and I feel silly about begrudging him choices.

At the beginning of autumn, he was diagnosed with a "brain cloud" For weeks, no one in the family was able to pry to depth of the truth from the doctors. At last, they admitted that there was no cure, my father had about 6 months left, 6 months that would be dominated by some kind of dialysis and possibly a parade of medical interventions.

The weeks at the hospital were fabulously unpleasant, moments of growing ambiguity punctuated by terrifying complications, internal bleeding and abdominal surgery. Finally, it seemed that he was recovering. Two days before his 68 th birthday, Dad was released. He had his birthday at home and was gradually regaining the ability to walk.

An infection set in around my dad's dialysis exchange ports. After another week back in the hospital it was apparent that home dialysis would no longer be an option. By the time the infection was addressed, they decided to remove the implanted exchange which would consign him back to the hemo machines.

After the surgery, they put him back on hemo-dialysis. Afterward, he was so incensed that he refused further treatment. I would like to believe that had I been there, I could have reasoned with my father. But in the quiet spaces of my irrational mind, I know that I wouldn't have been able to mount a reasonable defense. While it may be that any of his immediate family might have convinced him to undergo one or two more treatments, it is certain that he would have eventually refused. The doctors thought he had only a few days without dialysis.

It has been two weeks since he started his journey home. I have seen him several times and sometimes believe that he will regain his strength that through some miracle undetected by medicine, his organs would recover and the cancer would recede. But my father has become like the ocean at low tide. Although the waves sometimes seem to run all the way up the beach, they are, in fact, farther out to sea. Even though Dad is ocasionally alert and articulate, he is farther away from me.

He raises his face to the ceiling as if recalling some memory or stretching his neck. He looks around as if just waking up, notes his wife and one of his sons. We hurry to ask him if he needs anything or is any pain, as if we had been in another room instead of sitting and watching him for the last three hours. He forms a surprisingly complete and articulate sentence, "Everything is fine."

It is dark outside, home for me is three hours away through an intensifying storm. As I have done for many days, I tell my dad goodbye, as if it's the last time. He nods as if he expects to see me again. Hugs and silent condolences are exchanged. I step out into the darkness between the trees. Standing by the car, I notice that the leaf is still there, still frozen against a nearly black background. I close the car door. The rain begins to fall.