On December 17th, 2008, my father succumbed to kidney failure while under the stress of a malignant brain tumor. Clinically, it was the kidney failure that killed him, but it was the brain tumor which sapped him of the will to live. Would it have been better to endure the pain of ongoing hemo-dialysis knowing that eventually his mind would fail? Probably not. Despite observing this inevitable parade of events for several weeks, Dad's death was and remains a stunning loss.
My mother died when I was 3. From the age of about 3 to 10, my grandparents raised me.When my grandfather died, I was quite stoic, “I’ve been through death before, after the initial shock and rage, it will become a fact.” This at the ripe old age of 16. But the fact was, every death is different. The greatest impact of my Grandfather’s death was not so much his absence from day to day life, but that the potential to see him at all was just gone. And it wasn’t so much that there was any great conversation that I hope to have, it was that all conversations were no longer possible.
About 16 years later, my Grandma’s death was hard to reconcile because she always seemed so bulletproof. She wasn’t a towering “in your face” presence, but she was so stubborn, it just didn’t seem possible that she would die. Although she was getting forgetful, she just didn’t seem unhealthy.
Uncle John’s death was the most surreal to me. I hadn’t seen him for years, when I went to the service, they had a picture of him from many years ago and again it just didn’t seem that he could die due to his defiant nature. My uncle and I always butted heads, even when I was younger. I guess there’s still some bad feelings there, that really are pointless now.
The hardest death to take, at least in the short term was our dog. Elsa was just a dog and she was only my dog for about five years when she died. She wasn’t particularly well-behaved, she didn’t save anyone from a fire or drowning. In fact, we had to take her to a dog shrink to figure out why she was snapping at Benj, then only a year old. She was clearly miserable in her last few days, her kidneys failing due to a poisoning incident as a puppy. In her prime she would ferret out loaves of bread, devour the bread, then leave the bag in the middle of the kitchen. As soon as we came home, she would start circling the bag as if confessing some sin. In the end, she wouldn’t eat bread at all and only grudgingly gnaw at a hamburger. She perked up on the day we put her down, apparently to say good bye. After we buried her I just broke down. A few weeks later, Grandma died, and while it was devastating and seemed to last a lot longer, Elsa’s death just seemed harder.
For a long time, I was really embarrassed about the difference in grief I felt between the death of a dog and the death of the woman who raised me. At last I came to realize that Elsa’s death meant not only the loss of a pack member, but the reinforcement of my fear of deep unexpected change. An always present fixture in my world was suddenly gone. For days I thought I could hear her in the kitchen. One day I thought she was wrapped up in a blanket on the floor. For several weeks it took me a few minutes to re-orient. Elsa was a presence that was gone, a part of my environment no longer available. It made her loss jarringly immediate every day.
I guess the good news is that now I rarely think of Elsa’s death. We still watch videos of her now and then, but these are more simple memories was than poignant vignettes of loss.
On the other hand, I still often think about Grandma and Granddad. Aside from an array of historical questions I never asked, I miss their well-grounded advice. They were a window to way of living and thinking about life that I still miss very much.
Dad’s death really hasn’t sunk in. I can feel I am still in denial about it. Intellectually I know he’s gone, I felt the weight of casket, I saw the flag and felt the emptiness in the house. I feel a certain need to assess my own life and legacy, to perform the strange calculation of “I’m only x years younger than my Dad, what can I accomplish in that time?” Yet, I can’t get over the thought that I’ll see him again. Often these fantasies relate to fishing. But sometimes I think that I’ll see him at the big oak table, bent over a notebook and a genealogy book, intently copying facts in his elegant longhand.
Sometimes the realization that he’s gone ambushes me in some moment when I’m not worrying about a job and not paying attention to what I’m doing. Typically, these occasions are on the drive to work through a long straight valley that I should avoid. It’s such a beautiful and undemanding stretch of road, I can’t stay away from it. It’s also the shortest way to Microsoft. But I’ll be driving along looking out over the fields, and I’ll think of the deer or the hawks and of being outside and I’ll remember how Dad once said he wanted to be a fishing guide, or how he wanted to go back to Georgetown. Then I’ll realize, these things can never happen, and then I realize he’s really gone.
Friday, January 9, 2009
Monday, November 24, 2008
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.
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.
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