In early December of last year we lost my wife’s father. By nearly every measure, Frank had had a extraordinarily long and interesting life, and we viewed his passing as cause for the celebration of a life rather than the mourning of a death. I’m sure he would feel the same way. I thought I would share here a few of my personal thoughts regarding our relationship and his passing.
For as long as I knew him, Frank did not believe in God, at least not in a traditional sense. Born in January 1912 to Polish immigrant parents, Frank was baptized and raised Roman Catholic. He attended a Catholic school in St. Paul, Minnesota through the eighth grade, his final year of formal education. But whatever faith he may have had early in life had faded by the time he and I met. It was not that he was militant about his beliefs, though he might have had some pointed criticisms regarding organized religion. It was that religion simply played no significant role in his life. I don’t think this was the result of some sort of intellectual anti-epiphany, such as I experienced. It was more a matter of loss by disuse.
While Frank did not believe in a personal God, he had an enduring belief in Godot. Years before, he had seen a production of Samuel Beckett’s absurdist play, Waiting for Godot, and it obviously had had a major impact on him. While many authorities have considered the (never seen) character of Godot to be a representation of God, Frank saw Godot as a metaphor for death. He remarked frequently that he had once again eluded Godot or talked about Godot lurking around the corner.
Frank had lost his wife in 1998 and his son in 2009, leaving my wife as his only surviving child. For a variety of reasons, he asked me to act as his health care agent, and he and I had a number of serious discussions during his final decade as we witnessed his physical health slowly but inexorably decline. In his last year, particularly, Frank experienced a number of increasingly serious health issues, as his various systems simply began to wear out. In February and again in October he spent a week in the hospital and then two or three weeks in a transitional care facility coping with an unreliable heart that led to lung congestion and an accompanying shortness of breath, physical weakness, and occasional confusion.
Frank hated the institutional experience and after the October episode declared that he did not want to go through it again. Years earlier I had worked with Frank to fill out the standard “Do Not Resuscitate” directive, but this was more serious than that. While he was still in the transitional care facility, he and I had the Conversation. I had pulled up a chair facing him so that our knees were almost touching, looked him in the eye, and asked what he really wanted if he should get sick again. “Just let me go,” he said. Did he really mean that, or was he just expressing frustration? Carefully, I explained to him that we could change the directive to provide that, should he get sick again, he should not be given medication or other procedures intended to make him well again. Instead, he could state that he only wanted whatever medication or procedures would make him comfortable. Was that what he wanted, I asked. Yes, he said. So we made those changes to his directive.
That was in the first week of November. On November 30, a Wednesday, I got another call from the retirement home. Frank was again experiencing shortness of breath, and they were recommending sending him to the ER so that he could be given supplemental oxygen, something that the retirement home could not provide. I reminded them that Frank had made it clear that he didn't want to go to the hospital again. They told me that the oxygen would be palliative only and that once his oxygenation levels were returned to normal, he could be brought back to the retirement home. Meanwhile, I could be arranging for hospice support, who could provide oxygen as needed upon his return. I asked Frank if that would be OK, and he said yes, so long as they took him to his choice of hospitals. And that’s what we agreed on. That, it turned out, was the last conversation that Frank and I had.
Frank knew that there was no afterlife, that this was the one life that we had. Frank also told me that he had no fear of death. It was just nothingness, he said. What he feared was the process of dying. He argued that he knew that the dying process would be extremely painful and that he didn’t know whether he would be able to handle it. I’m not sure where he got that notion, though his son’s death from lung cancer seven years earlier had been a difficult one. I assured him that he was wrong, that the dying process did not have to be painful, that modern medical advances had changed all that. I don’t think he believed me, but I was determined to prove him wrong.
My wife and I live in suburban Milwaukee. Frank lived in the Twin Cities, and it was a five to six hour drive between the two locations. I spent much of that Wednesday arranging for hospice care, as well as for 24/7 companion care because Frank was considered a “fall risk,” a potential liability issue that the retirement home didn’t want exposure to. It turned out that the hospital had not been able to stabilize Frank’s oxygenation level and were keeping him overnight, despite our wishes. We drove up Thursday morning with the plan of helping Frank get settled back in his assisted living apartment that afternoon, along with helping to set up hospice and companion care.
When we arrived at Frank’s apartment early Thursday afternoon, the transformation was shocking. Frank had been brought back to his apartment and was lying in his bed. He appeared to be sleeping but, in fact, was unresponsive and no longer communicative, and we were told that he had had neither food nor liquids since Tuesday evening. We understood, then, that his situation was hopeless and it was simply a matter of when.
A hospice nurse had come to oversee the administration of oxygen, as well as of comfort medication, basically morphine and diazepam. From time to time Frank seemed to be struggling and I pointed this out to the nurse. She was quick to instruct staff to administer medication liberally and on an as-needed basis. Thereafter, Frank seemed to be comfortable, only indicating any distress on those occasions when staff needed to reposition him in his bed. I interpreted that as a good thing, since it meant that he could still signal discomfort if he was experiencing it and nearly all of the time he was not. For my part, I felt that I had kept my promise to Frank that the process of dying did not need to be a painful one.
Hospice staff reminded us that timing was unpredictable. Occasionally, we spoke to Frank, held his hand, and assured him that we were there and that everything was OK. The end came on Sunday afternoon. His breathing had become more and more labored and then stopped as he quietly slipped away. I think that is how Frank wanted it to be.
© 2017 John M. Phillips