There is no greener grass

But the "grass is greener" game is a popular one, isn't it?

What if...

I could give anything for....

If I would have just....

I have tried really hard not to play these games over the past three weeks.  Especially lately, however, one stands out in my mind:

If it just hadn't happened so fast.

Sure, I say that now.  But if it had been a long road?  Well, it was that, too, wasn't it?  My dad was sick for a very long time.  Very sick.  But this particular incident- the one that ended his life- well it happened relatively quickly.

I'll back up even further in case I've lost you.  (Warning: medical jargon ahead.  I'll probably butcher most of it, but if you don't have a med background you won't notice.  For those that do, sorry.  And why the details?  Because this is therapy, people.  Skip ahead if you please.)

My dad was diagnosed with COPD (Chronic obstructive pulmonary disease) in 2007.  COPD is basically the combination of chronic bronchitis and emphysema- two diseases that are usually but not always brought on by cigarette smoking.  In my dad's case, it was absolutely smoking but also likely a genetic component as well, since his father died of the same thing (though much later in life.)  Anyway, in 2007 his COPD was already pretty severe.  He was admitted to the hospital in late April of that year, right before my college graduation.  I think it was finals week, in fact.  We thought (wrongly- due to poor information from an extended family member) that he was going to die then.  He didn't, obviously.

Two years later, in January of 2009, he was taken by ambulance to the hospital again- this time he was intubated (put on a ventilator) and sedated for 3 full weeks.  His blood oxygen levels went up and down, and finally we were able to completely wean him from the ventilator with the help of a tracheotomy.  It was quite a roller coaster of emotions- I was 8 months pregnant with Owen and feared that my father- with whom I had a rocky relationship with for the year prior (well, my whole life, really, but it really culminated in a huge argument before my wedding, after which I didn't speak to him for almost an entire year- right up until his hospitalization) wouldn't meet my child.  This made me unspeakably sad, but not as sad as the thought that my father was going to die thinking that I hated him.  While we thought- based on what his pulmonologist expected- that he was going to die (this was 2 weeks in to the 3 week sedation/4 month hospitalization), I vowed that if he lived I was going to mend my relationship with him.  He was going to know that I love him and that I forgive him.

I did just that.

Thankfully, he was weaned from the vent and transferred to the ICU stepdown unit, and then to the nursing home with his trach, and finally the trach was removed (!!!)  and he was sent home (!!!!!!!!!) to live a relatively normal life.  He lived alone, and that made us (my sister and I) nervous but we knew he had all his meds, his oxygen if needed, and his CPAP machine for nighttime.  Not that he was really all that great about following doc's orders, but we hoped for the best.

Even the best, though, meant that he wouldn't live for much longer.

COPD is a really awful disease, and unfortunately there is no cure and there is no way to make it better.  It only gets worse.  There are flare-ups or "exacerbations" of the disease, like a respiratory illness, for instance, that then require medical action.  Over time, these exacerbations get worse and worse.  For instance, my dad's first hospitalization in 2007 was only a week-ish stay.  No intubation.  In 2009, he was on the vent for a long time, needed a trach, and was then to use his oxygen fairly regularly at home. We knew the next exacerbation would be worse than in 2009 so we knew two things:  he would be hospitalized for a very long time, and he would be intubated.  Each time he was put on the vent, it would be more difficult to get him back off of it.  His lung functioning was deteriorating quickly and there was nothing we could do to stop that process.

I think you can imagine how stressful it was when he'd get a cold or cough.  At least for me, I always thought "Oh no, he's going to have to go to the hospital, and then what?"  And each time he'd get over a little infection I'd be so thankful.  Last winter (2010) he got sick a couple of times but always got better.  He was able to come to Cleveland to visit us for Christmas, he was at Owen's baptism, and he came up for Owen's birthday party.  Those are all such sweet memories I have with my father.  I am so thankful for that time that I spent with him and could watch him with my son whom he loved so, so very much.

This winter, he got sick again and immediately I told him to go to urgent care if he couldn't breathe.  He joked with me about it, but he seemed to really feel lousy.  He told me as much.  I talked to him everyday and the first day that he mentioned he was ill was Saturday January 22nd.  Over the next two days I'd check in with him to see how he felt and it seemed to me that he was sick but was going to feel better soon.

Tuesday the 25th I got a voicemail from the Ambulatory Care Center in Ottawa.  I called the nurse back and she let me know that he was intubated and taken to the hospital in Lima.  I was worried but didn't panic because, well, he made it through the last time.  Even against all odds, he had made it.  He would do it again.  (Intellectually, I should have known.  We knew he didn't have too much longer to live, we knew it was going to be worse this time... we knew.  I guess this was denial protecting me.)

I called my sister and mom to let them know.  I didn't have much information from his ICU nurse but what she could tell me seemed worse than last time, and she seemed much more urgent.  It was one of his regular nurses from 2009, which I was thankful for.  She was my favorite nurse, and it was nice to have a familiar voice to talk to, and a familiar nurse taking care of my dad.  I know that she loves her patients and I am so grateful for her care.  But that familiarity with her also allowed me to notice those stark differences between the last time and this time.

Still- denial.

He's going to be fine.  We just need to get through the woods.  It's going to be fine.

Well, Wednesday I got a call from his nurse that his sats (oxygen saturation) were dropping into the low-mid 80's (upper 90's is good.  It's on a 100-point scale) and that they were actively bagging him.  I started to panic, and the nurse started crying.  Oye.  This was bad.  I was at the zoo with Kraig and Owen and had to stop and finish talking to the nurse while I sobbed in the middle of the zoo.  I called my sister and my uncle to let them know to get to the hospital as soon as possible.  We'd keep each other updated, but this was not looking good.  His pulmonologist (again, the same doc as last time) "didn't know what else to do"- he was maxed out on his meds, they were already at 100% on the vent, they couldn't do anything else.

They stopped bagging him, adjusted a few meds, moved him back to a regular bed, and his sats started to slowly improve.  By then my sister had arrived and a nephrologist came to speak with her.  My dad had renal cancer in 2010 and had a kidney removed.  The nephrologist said that dad had sterile sepsis and that had caused fluid buildup in his lungs which lead to the respiratory distress that afternoon.  The doc was certain (yes, certain) that if we started dialysis, we could do the work that the kidney wasn't doing (filtering his blood) and that would reverse all of the edema and fluid.

I went to bed Wednesday night thinking that my dad had so many lives- we thought he was on his last one, but no.  He had tricks up his sleeve and he was going to make it out again this time.  We were so hopeful.

There were a few other issues- suspected pneumonia, premature ventricular contractions, and acidosis- that were cause for some concern, but we thought the dialysis was going to fix all of that on Thursday.

Well, the dialysis wasn't doing a thing on Thursday morning.  Four hours in there was no improvement. They flushed and restarted it, but his pulmonologist came in to let my sister know that he did not think the dialysis would work the second time, and that he didn't see any ray of hope.  He was out of treatment options.  We were going to have to fly in to Ohio as soon as possible to say our goodbyes and let him go because at this point, all measures to keep him alive were artificial.

They did try the dialysis again on Thursday evening, but it did nothing.  Over the course of Thursday night as we packed our bags and tried to rest before our early Friday morning flight, my dad deteriorated to the point where we suspect there was little-to-no brain function.  He was still sedated, of course, but it seemed his body was definitely shutting down.  All of that is irreversible, and while it was difficult to know that information as we flew 8 hours to Ohio and drove 3 hours across the state to see him, it was also comforting in that I had a peace about what we had to do.  My dad was no longer there in spirit anymore- we were just keeping his body alive as much as we could so that I could say goodbye.  There was literally nothing that any doctor could do to bring him back.  We did all that we could.  That was tremendously comforting to know, though the decision to pull a loved one from life support is never easy.  There were no choices left; there was no question about what to do.  I'm thankful for that.

So, we got to the hospital at 7:30pm on Friday night.  Kraig said goodbye to his father-in-law, and then my sister and I had some alone time with my dad.  We prayed, we talked to him, we joked, and we wept.    We said everything we felt that we needed to say, and we let him know that we did everything we could and that we were sorry, but we'd have to let him go.  And it was okay to go- we were there with him and we love him.

As difficult as that was, I am thankful for the peace I had.  As I looked over his body- attached to the dialysis, ventilator, and umpteen (literally, in the teens) different medication bags, I knew he was just hanging on by a thread.  His sats were dropping, his vitals were tentative at best, and even as I stood there for 10 minutes things were slowly declining.  The decision of when to let him go was easy- do it now, and do it as quickly as you can.  That may seem callous, but I choose to believe that he was just waiting for me to come say goodbye.  We were also teetering on the brink of respiratory or cardiac failure and I didn't want him to go that way.  I wanted it to be peaceful, and for that to happen things needed to remain in our control.  He wasn't going to hang on much longer, so it was better to do it now, at least in my mind.

So, they unhooked him from everything, extubated him, and made sure he was comfortable (ie. very sedated) as he took his last breaths.  My sister and I were both there, and while it was difficult to witness, I am glad that he died with his lovely daughters holding his hands.  He wouldn't have had it any other way.  He passed away at 8:30pm on Friday January 28th.

But that's only the beginning, isn't it?  At least for me and my sister, our suffering is only just beginning.  Our story is far from over yet, and while those that love us like to say things like "he's in a better place", we are not in that place.  We are not better at all, actually.  This is a loss that is so deep, so profound, we can hardly find our way through it.  Heck, it's three weeks later and I am still struggling to convince myself that this is real.  He's really gone.  It just doesn't make sense to me.   I knew for years that my time with him would be cut drastically short, but that doesn't make it easier.  In fact, the wonderful two years that I had with him just leave me yearning for more time.  It's unfair.

That's where I am at.  I am bouncing back and forth between denial, sadness, and anger.  I miss my father so very much, I can hardly express how his absence makes me feel.  Like I said, we talked all day, everyday, so already it feels like forever since I have talked to him.  He was my best friend.  I stay at home with Owen and he couldn't work due to his condition, so we were each other's pals day in and day out.  Every morning I'd wake up to a text from him.  I talked to him more than I talk to anyone else except Owen and Kraig- he was my number 3 guy.  And in his death, I can imagine no more painful a loss except if I lost my husband or son.  My dad was so special to me.

I know that one day I will read back over these entries and I will be thankful that I am finally able to smile instead of weep when I think of my dad.  I'll be thankful for the time I had with him instead of feeling like I've been robbed.  I'll be happy that he is no longer suffering instead of just wishing he was still here with us.  I'll still miss him, but it won't hurt so very, very much.  Until then, I am in the middle of this indescribable pain and sadness.  But when you are "going through hell, keep going." (Churchill)  That's what I intend to do.  Please help me keep going.