Monday, December 25, 2006

Love the one you're with



Merry Christmas! Now that I'm stuffed like a pig and sitting down from the day's festivities, I've had a chance to boot up and write -- something I've not done in awhile.

I was shocked this after noon when I came to the front door of my parents' house to find my dad sobbing, literally, standing in the doorway. He hugged me so hard, and said "Merry Christmas, I love you so much." Chris, my husband, I think summed it up best that dad is now out of the woods physically, but emotionally, it's like it's all caught up with him. He talked about how sorry he is for taking my mom and the people he loves most in the world for granted, how much he appreciates every one. He told Shane, my brother-in-law, to always respect and cherish Colleen, my sister, and he sobbed while talking to my nieces, Courtney and Kristen, about how they turned into such beautiful young girls.

What a transformation! This is no longer the stoic "keep a stiff upper lip" dad I've known all my life. I have to admit, at first it caught me off guard.

But then over dinner, he hardly touched his food, and stared with a far away look in his eyes, as though he was looking through us, through the room even, into some far away place only inhabited by his own mind. I have no idea what he was thinking, but later my mom cleared it up: she said he thinks this will be his last Christmas -- that he's not going to live much longer!

This has my mom very upset. He sleeps all the time, barely eats, is distant and emotional all at once.

I don't know how to react to my dad right now. I feel kinda guilty for that. It's hard when you swap roles, when your parents become dependent on you instead of the other way around. It's overwhelming and sad and strange.

At the end of the evening, we all filed in to say good bye to dad in his bedroom, where he was lying on his side, dozing. Each of us, one by one, said good bye and gave him a kiss. Elise, my two year old, started crying and said, "papaw is sick." And then I teared up. And then my mom. But dad had that far away look in his eyes, like he was looking at us, but not seeing us. Looking through us into some place he'd visited recently. I'd give anything to know what he is thinking.

Tonight, I lived in the moment. I enjoyed my kids, my parents, my family. I laughed. I remembered to love the ones I'm with. Life is tenuous, pitifully short and sad. Enjoy the happy times, even when it rains on Christmas day.

Merry Christmas.

Tuesday, December 12, 2006

Dad is discharged!

It's true. As of today, dad is home, resting comfortably. He still has drainage tubes in place. A visiting nurse is scheduled to come out tomorrow, and Thursday he goes to an outpatient visit with his surgeon to have tubes and staples and all remaining attachments removed.

Let's hope and pray this is the end of this story. God knows he's been through enough.

Sunday, December 10, 2006

Ah, the quiet time of night. Dogs at my feet, tea in hand, time to write.

Friday morning was, very honestly, the morning from hell. Sophie was convinced there would be a snow day, so convinced that when I told her she had school, she argued with me. "Mom, there's five inches of snow out there!" she quipped. So at every turn, she stalled and struggled, staring first at her clothes, then at her cereal. Finally I became enraged. Like a mother bear, I came at her growling. She refused, as always, to brush her hair. I'm ashamed to admit, I became so angry at her fighting me to go to school, I broke the brush on the kitchen table. Elise kept saying, "mommy broke the brush, mommy broke the brush" all weekend.

The stress is getting to me, obviously.

Then, between dropping Sophie off at school and getting Elise off to daycare, my cell phone rang. It was my mom. She called to tell me there was a code called on my dad very early in the morning that morning, and the stroke team had been called in. At that moment, an NG tube was being placed down my dad's nose to drain his stomach. She was sobbing, just sobbing. I checked in at work, then dropped everything and went over to the hospital to find my mom standing at the end of the 4200 hallway, staring out the window, still sobbing. I rubbed her back, hugged her.

"I don't think he's going to pull through this time," she said through tears.

"We need to request a family meeting," I said.

"What's that?"

"It's a meeting of the treating physicians and hospital staff involved in dad's care. It's a place where we can all be present and have our questions answered," I told her.

We walked down the hall and into my dad's room. He lay, head turned away from us despondently. On the wall to his right, a vacuum suctioned bilious fluid out of his belly through the NG tube in his nose. There was quite a bit. His nurse came in, and I asked her the details of what happened last night with the code, and what was happening currently.

She said he'd been given PO (by mouth) antibiotics on top of the IV antibiotics he was already taking, and it'd made him nauseated. He sat up in the middle of the night because he felt like he was going to be sick, and suddenly his blood pressure bottomed out and he went down. A code blue was called as a precaution, but he did not code; he just passed out. The stroke team was also called as a precaution because he is at risk for a stroke, but she assured, "none of this was serious or even atypical with as much as he's been through."

"So this is not serious?" I asked for the sake of my mom, who moments before was sobbing and thinking of my dad being on death's door.

"No," she reassured. "None of this is serious." I could see the relief in my mom's face as her eyes softened. So, no family meeting was needed. But....

How did it go from being routine medical care to my mom planning a funeral?

Simple: lack of communication.

When the NG tube was being placed, nothing was explained to my mother. She stood watching, helpless, afraid to ask questions for fear of getting in the way. She heard a nurse say, "he's been through so much," but wasn't offered an explanation of what was happening and why. So, what she heard, in this unfamiliar, intimidating world of tubes and monitors and medications, was "this must be serious; he must be near death."

Because of the medication he is taking for pain, he jumps slightly, fidgeting with the blankets, his gown, etc. My mom told me later this was what my grandmother did before she died. Because of this association, my mom also drew the conclusion that my dad must be near death as well.

It doesn't take much to go from 0-60 when your loved one is lying helpless in a hospital room. Medical professionals forget this, forget what it's like to be on the other side. We need to remember, to advocate for families, to encourage them to speak up and ask questions. Because that fear and anxiety lead to unnecessary stress -- stress that can be alleviated by simple communication.

Oh yeah, and my dad? He may be discharged this week. :0)

Wednesday, December 6, 2006

Fourth Surgery Report

Tonight, I went to visit my dad again in the surgical ICU at General. He'd just been given a strong pain killer, and was dozing in and out of consciousness, mouth open, tubes once again poking out from every direction. He woke briefly, long enough to recognize that we were standing at his bedside, and then dozed off again.

Suddenly, his green eyes flipped open, and he said, "guess what!"

Stunned, we replied, "what?"

He said, "guess what was on in the operating room?" He didn't wait for us to answer, before he said "Meatloaf!" And smiled weakly. "Who would ever have thought they would be playing Meatloaf in the operating room!"

"What song?" my mom asked.

At this point, he dozed back into sleep.

At 67, he is probably an unlikely candidate for being a Meatloaf fan. But fan he is. For his 60th birthday, I bought him and my mom tickets to see them live. I think it was one of the most memorable moments of my dad's life.

So, that Meatloaf was playing when my dad went in for his fourth (and hopefully final) surgery to repair his lung, to him, this was a sign from God. That God was near, keeping an eye on him.

Tonight, dad rested comfortably in the SICU when we left him. My mom is exhausted. She called me sobbing tonight at 7:30. The only thing I could make out was that she needed me. So I rushed to the hospital.

After waiting 12 hours to see my dad post-op, the SICU secretary refused to allow my mom to see him until precisely the 8 p.m. visiting hour. Not only this, she spoke very tersely to my mom. It was just enough to send her over the edge. That's when she called me sobbing.

We reported her to the charge nurse in surgical services.

What happened to "family centered care?"

Sophie's Prayer


Last night, as I tucked the girls in bed, Sophie said this:

"Dear Lord,
Please let my papaw come out of the hospital before Christmas, and keep Kahlua and my four fish comfortable and safe up there in Heaven.

Without you, we wouldn't be here, so thank you for letting us be here.

God bless America and everybody in my family. Amen."

Monday, December 4, 2006

This morning, my mom called me from the hospital quietly crying to tell me my dad has to have yet another surgery, this time with tissue taken from his abdomen to make a patch to repair the hole in his lung. I can't even recall how many weeks he's been in the hospital consecutively. I know it's over five.

The vet's office called to tell me Kahlua's ashes are in and I can pick them up anytime. It's done. The last two months with her, it killed me to think of her beautiful fur burning. I can't think about it too much.

Sometimes, when the other dogs are being rowdy in the living room, they'll bump the Christmas tree, and I'll hear the bell that was on her collar jingle. Just for a second, I'll expect to see her coming toward me. Likewise, when I came home from work tonight, I half expected to find her waiting for me at the door.

She's gone.

I am pensive and quiet tonight. It's cold outside, finally winter, and I'm enjoying it. But I'm tired.

Friday, December 1, 2006

It's been awhile since I've wanted to sit down and write, so much has gone on just in the last week, leaving my head spinning. But right now, every thing is quiet and it's lovely. All the dogs are at my feet, dreaming their doggie dreams, paws twitching in slumber scenes of chasing rabbits or squirrels. The Christmas tree is lit up, its blue lights and white shining star glowing off the hardwood. Occasionally the sound of the wind whipping around the house breaks the silence. But otherwise, this moment is perfect bliss. And so, the perfect time to write.

Sophie is at her first slumber party tonight. Ten giggly girls all under the age of eight in pajamas eating pizza and popcorn, watching "Grease" and gossiping about boys and teachers and school. She's growing up so fast. For Christmas, she emphatically told me not to get her any Barbies or any other dolls because she's too old for them. She wants her bangs to grow out. She listens to "radio Disney" and shakes her booty in a wild sort of dance in the living room. She is seven years old. Growing up so fast.

My dad is still in the hospital. Apparently when he'd had his sternal rewire, infection was already in the bone, and the pressure of the rewire broke two of his ribs, puncturing his lung. When he called his physician, the doc dismissed him, calling in a script of vicodin. Now, that puncture won't heal, weeks later. His chest blows up with air from crepitis depending on the position he lays in. I've not actually seen it, but my mom says it looks like a football under the skin. He's depressed, unable to even walk to the bathroom in his hospital room because he has to be attached to drainage tubes and a vacuum connected to the wall every second of the day and night, or his chest blows up with air.

I have prayed harder for him than I've ever prayed for anything in my life.

Today, I put a picture of Kahlua in an ornament on our tree. And I took Marley for his first puppy exam at the same vet where Kahlua died not a week earlier. I found pictures of Kahlua as a puppy recently. I'm at peace with her death and my decision. She lived a long, happy life, and died in my lap. I might not have been there with her at the moment of her birth, but I was with her all her life until the moment of her death, and that's all I wanted. The cycle is complete.

It's late. I think, like the dogs, I might lay down now during this quiet night and go to sleep. It's getting colder outside. I hope it snows.

Namaste.

Saturday, November 25, 2006

This Want of You

What physically remains of you
I keep finding throughout my house:
under the sofa, in the corners of the bedroom, on my coat.
Your fur, your beautiful coat, gray and white plume of soft fur, now
nothing more than dust bunnies rolling
like small tumbleweeds throughout obscure places in my house.

But what remains of you is within me.

We put the Christmas tree up tonight,
took the bell off your collar and put it
front and center
among the sweet smelling boughs.
And with that, I picture you running through Douglas furs in Wyoming,
chasing chipmunks,
sniffing out fox or squirrel.

You live in my memory.
So vivid, now, I see your tail waving at me
As you trot in front, lead dog,
smart girl.
I can reach down and pet your soft head,
smell the earthy want of you
see you digging a nest in the flowerbed to lie in the sun.
I miss you. God, how I miss you now.

And I'm sorry. I would trade so many, so much
to have you back here with me
just for tonight
under this tree.

Friday, November 24, 2006

In Memory: Kahlua, 7/1/1994 - 11/24/2006





11 Years, 4 months, 23 days

Wednesday, November 22, 2006

Pretty Lucky Life

Dad's lung collapsed the night after surgery. Pneumothorax, the medical term for collapsed lung, is rectified fairly easily by inserting a chest tube on the side of the body where the lung is collapsed. But for my dad, this is just one more point of entry for various bacteria.

My dad has always been stoic and strong, proud of his eight year stint in the Marines. Although only five foot ten inches tall, I would marvel at his strength when I was young, watching him pick our 19 foot boat up by the trailer hitch and walk it to the hitch on our truck.

He's always been so proud of his chest and the hair on it, as if it's some hallmark of masculinity. Now, because of the total sternal resection, his chest is sunken in, hairless and covered with scars and suture lines. He shakes from pain, then becomes suspicious and acts oddly after a morphine injection.

My poor dad. I want to do something, would do anything I could to help him or heal him, but there's nothing I can do but watch from the sidelines, helpless.

Similarly, there's nothing I can do for Kahlua, who vomited up blood again last night. I think the time has come to put her down, but it kills me to think of this. But I cannot think of myself. She is suffering.

This year, I am thankful for my parents. I am thankful for finding a part of myself again in my dogs; I am thankful for my dogs, who make me so happy -- they have truly been a joyful distraction from all the stress of life. I am thankful for my marriage, my kids and my husband. I am thankful for my house, however much work it needs! I am thankful for having worked at the hospital almost six years; I am thankful for my job.

And every one of these things, at one point or another, has made me completely crazy! There are days I ask myself "why FIVE dogs?" or "why did I have another child?" or "did I really mean it when I said 'for better or worse?'"

But ultimately, when I look at my life, it's a pretty lucky life. I am fortunate. I might forget it sometimes...but I know I am.

Namaste

Monday, November 20, 2006

interesting

Interesting finding tonight that even my dad's sternal wound infection is related to smoking....

"Numerous studies were performed to identify causative factors of sternal wound dehiscence and subsequent infection. Factors identified include hypertension, smoking,...."
"Sternal necrosis" (breastbone tissue death)"and osteomyelitis" (bone infection)" occur in patients with profound sepsis, with gram-positive infections, and on whom inadequate debridement is performed. Debridement is the cornerstone in healing these wounds; d├ębride viable, bleeding bone. Some advocate resection of the entire sternum and costal cartilages to reduce the chance of recurrent infection. Regardless, perform bone biopsies at the farthest margin of debridement. If dehiscence is observed early, 1-stage debridement followed by immediate flap transposition can be performed.

Contraindications: diabetes and tobacco using patients!

Nov 20

Today, my dad had his entire sternum removed in a three and a half hour surgery, the bone completely eaten away by infection.

Today, Elise spent the day in sick child care at the hospital with pneumonia and a temperature of 101.

Tonight, Kahlua lays across my lap, laboring to breathe, coughing violently every so often.

Tomorrow, my dad turns 67. Pieces of his body have been rerouted and rewired and removed since his birth 67 years ago. A slice of his abdominal muscle now protects his vital organs in his chest where his breastplate once sat.

That's what's going on.

At times, out of no where, I burst into tears. Kahlua will look up at me, wheezing, with her brown eyes fixed on me, or Elise will cry for me to rock her, or I'll see my dad intubated yet again. And I'll think of how short life is, and what life will be like without Kahlua, and someday, without my dad. Hearing my dog groaning in the night, seeing my dad drift into and out of consciousness, seeing my child's tears, I realize how vulnerable we all are.

Years ago, in cadaver lab, I remember thinking this too. That whole summer, it freaked me out how our skin is really so easily sliced, how the superficial fascia just tears away from the muscle like linen ripping, how it's absolutely amazing we go through all we do in a lifetime and still remain intact.

Life is beautiful and short. We are born perfect. We are beautiful and perfect.

Sunday, November 19, 2006

November 19

Tonight I saw my dad in the hospital. He has a PICC line in now, and is scheduled for surgery tomorrow morning. The plan is for debridement of the infected tissue inside his sternum. Tonight, as he talked, the air exchange was audible in his sternum. While we were visiting, a male nurse came to fill the hole in his sternum with gauze. It's bloody, pus-filled and foul smelling.

Tuesday, my dad will be 67. Sophie and I took him cards we'd made, one "Get Well" card and two "birthday" cards, along with a gift. He seemed like he was holding back tears reading them. What a birthday.

My poor dad. As he ate his dinner tonight, he said, "well, this might be my last supper." He is very down, frustrated, and understandably so. He says he doesn't know what he is living for.

As Sophie and I walked down the hall toward my dad's room, we looked up to see he and my mom 20 feet up the hall in front of us, then slip out the emergency exit door. We found them down on the patio, in the dark, smoking. Hiding in the dark, like criminals or closet lovers. Hiding from the rain, in shame, in the dark, smoking.


ALL of this could have been alleviated or made better by quitting smoking: the heart disease, the breaking of the wires that held his sternum in place (which broke from coughing from emphysema), the lack of wound healing, ALL of it. And yet, this addiction is so strong, he stands outside in the rain with a staph infection, suture line visible through his hospital gown and jacket, smoking.

I wish my parents could see the sad irony of this.

On top of all this, Kahlua vomited a pool of bright red blood this morning. The time is coming very near. And Thanksgiving is Thursday.

Thank you for my voice, and not being afraid to use it.
Thank you for my sense of justice, and trying to make sense of the world.
Thank you for my family.
Thank you courage, grace, compassion.
Thank you Sophie, Elise.
Thank you Foxy, Mandy, Jack, Marley.
Thank you Kahlua.
Thank you reality check and karma.
Thank you balance.
Thank you, God, for this moment, and for every moment of my tiny little life.
Thank you grief.
Thank you hurt.

Saturday, November 18, 2006

self mutilation



For some reason, when I came home and found this on our breezeway last evening, it struck me as completely hilarious. A glamorized image of the ideal husky, this toy, now matted with slobber, missing an ear and most of its face met me on the floor of our porch, a gift left by our huskies. Chris said it looks like it has a cleft palate. Imagining three huskies ripping the face off of a stuffed replica of themselves reminded me of how I used to give my Barbies mohawks when I was a kid, mutilating idealic images of the "perfect" person. My dogs probably look at that stuffed replica of the idealic husky and want to vomit.

What does Disney know about sleddogs anyway? Sleddogs are not glamorous AKC beautified show dogs. They're down-and-dirty, "git-r-done" working dogs who are often stinky; usually voracious in their appetite for food, exercise and companionship; sometimes timid; almost always vocal; sometimes downright ugly, floppy-eared beasts who appear more suited to work in a junkyard than on a trail hooked to a gangline.

My daughters recently wanted to rent Iron Will, a Disney rendition of a boy who runs a sleddog team to victory to honor the memory of his dead father and preserve his family's farm. Typical glamorized Disney images of what people think of when they think of sleddogs: 70 pound Malamutes, with steel-blue eyes and glossy black and white coats thick as blankets.

My dogs seemed to give their opinion of Disney and the "traditional" husky by chewing the face off this one, leaving only the blank empty expresion of steel blue eyes and a big hole where the rest of its mouth would have been.

Go get 'em, kids!

Friday, November 3, 2006

Cold, clear skies

Tonight, under clear cold skies, I hooked the huskies up and we ran in the dark. I love it when it's so cold everything seems crispy. Now, the dogs are curled up, sleeping contentedly with their big tails wrapped around themselves while I sit pricing mid-distance sleds, praying for snow and dreaming.

I'm also praying for my dad. He underwent surgery this a.m. to repair broken wires that held his sternum together after open-heart surgery in June. All wires connecting his sternum were broken except for one at the very top. The cardiologist rewired everything back together. He came out after surgery and gave mom the broken wires, cleaned and sealed in a little clear specimen container. The Cardiologist said a portion of one of my dad's lungs was lodged in his rib.

Tonight, in the ICU, he was in a lot of pain. He is extubated and his numbers looked good, blood pressure, sats, respirations, etc all holding, like him: strong and steady. Tomorrow, remove chest tube and move him to the floor. He was very visibly in a lot of pain tonight.

Nothing has ever struck me quite the same as seeing him both times in the ICU. He looks so old, so frail and helpless. Watching my parents age is odd. Logically, I know (obviously) that my parents are aging and will die someday. Emotionally, however, I still think of them as eternal, ever-present....I still picture my dad as this invincible heroic-like figure of my childhood, who could do no wrong and who nothing would ever topple. It takes some getting used to, this thing of watching your parents' age and realizing their mortality. Tonight, when I walked into the ICU to find my dad lying there, seeming so small in that big bed, mouth hung open, skin pale and cold, drifting in and out of consciousness, I was reminded instantly of my grandmother, dying in a hospital bed last January. I could see my dad, dead. No more, spirit gone, could feel what it would feel like to lose him and miss him. And instantly, the familial ties lept up, rallying, as I offered him an extra blanket, ice, water, an extra pillow, to massage his feet, anything to make him feel more human and more alive.

Is it selfish that I offer these things to him? I want to help him because I love him, because he is my dad, but I also want to help him because I want to ...I want, I want, I want...because of me...because I want to reassure myself that he is not in a critical state of disrepair. That I will not lose him. Not yet.

It is quiet now. Dogs snore at my feet, lounging on the couch. Dreaming, their feet jump and move, as if they're running. Over fields of snow they run, under stars and cold, clear skies...

Wednesday, November 1, 2006

Kahlua's Last Stand

Kahlua is refusing food again. When she goes outside, she just lays in my flowerbed. She is weak and so, so skinny, bones jutting out in all directions. She looks at me often with such a look of deep sadness and confusion in her eyes, as if trying to understand why she feels like crap, why she can't run around with the other dogs without coughing.

But then, she'll perk up, wolf down a whole plate of pancakes (her favorite) jump around, and bark excitedly at me. Dying is such an up and down process.

A friend of mine and I were talking today about how similar it is watching an animal die as it is watching a person going through the stages of dying. It's up, then down, good days and bad. Two days ago, Kahlua devoured pancakes, bacon, and eggs left over from breakfast. Today, she hardly ate half a hot dog, turning her nose up at the last couple bites distastefully.

Last night, 3:12 a.m., I awoke to horrible hacking cough out in the hallway. The cough is increasing in frequency and severity. And she can't weigh more than 25 pounds now -- every calorie she takes in going to feed the tumors.

11 years, 4 months, 17 days....