My father decided to die.
Not in the sense of suicide, not at all. But I firmly believe that he gave the matter serious, thoughtful reflection and simply decided that it was probably the best time to make an exit.
Twenty-five years earlier, he had had a seven-way CABG, a septuple bypass. I'm reasonably sure that it set a record at the time at the teaching hospital where the procedure took place. He would say, and periodically did say, that the quarter-century he enjoyed after that was a bonus. Golden time. He got to see his daughters married, his grandchildren born and grow into adulthood, or at least its cusp. He made it to almost 60 years with the love of his life, his bride.
But as recently as three years before his death, he acknowledged that he was in pain almost all the time. He was frail. He had had both hips replaced; the first one had gone beautifully, but something got pinched in the second one, and it was basically always going to hurt. He'd been living with lupus for years and with dry-eye macular degeneration as well. His atrial fibrillation was becoming more of a nuisance. His wife had been in memory care for several years and was becoming increasingly less present.
The month before, he had undergone a cardiac procedure akin to unplugging the heart and plugging it back in again. It worked really well for about forty-eight hours, and then not.
On a Saturday morning, following a sleepless night brought on by prolonged episodes of shortness of breath, he followed his cardiologist's instructions and phoned a church friend to take him to the emergency department. After a five-hour drive, I made it to his side around 3:30 in the afternoon where, after more than seven hours in a cubicle, he was being moved upstairs to the cardiac ICU.
About an hour after that, while we were watching the Kentucky Derby pre-race coverage and contemplating ordering his dinner, he said, very clinically, "My right hand feels like it belongs to someone else." I shot out of the room and flagged down a nurse. Within a minute, so many people were surrounding his bed that I had a hard time edging out of the way. He was whisked to the Neurology ICU where, after much testing and measuring, they determined that yes, he had had a stroke: not the much more common hemorrhagic stroke but an ischemic stroke in the parietal lobe.It processes sensory information, but if you have to have a portion of the brain taken out, you could do worse. Dad lost the use of, and feeling in, his right arm and leg. He retained his cognition, though, and his sense of humor, allowing me to take a photo of him in his EEG cap. He could answer most questions and knew that he had had a stroke. He did have some aphasia, though, which frustrated the hell out of him, because he had made his living as a communicator.
After three days in Neuro ICU, he was transferred to a cardiac unit, where he languished for another three days with a roommate who was startlingly cavalier about his coming surgery to remove a toe because he was diabetic and did not do what he was supposed to. It turned out he'd already lost four toes. It became a darkly comic foil to my father's last days.
That Friday -- a Friday the thirteenth, of course -- there was a care conference with representatives from neurology, cardiology, palliative care. Having lost too much time from work, I was back in Virginia and present by conference call. My two sisters were on site. I had been a nursing-home chaplain for seven years and knew -- we all knew -- that Dad would be a lousy candidate for post-stroke rehab, possibly among the world's worst. He would be hard on himself, yet tire easily. He would be impatient with himself and the therapists, and the impatience would come out as sarcasm, his words becoming weapons. He would argue -- under the guise of eliciting information -- with every guideline and instruction. It would be a nightmare.
I'm not sure whether Dad weighed the work required for post-stroke rehab. I do know that he had to have contemplated the reality that, hemiplegic, he was done with living independently at home. No more driving to choir practice, no more participating in the dance band, no more going to church, no more getting up at 3 in the morning, if he was awake, to make pastel drawings. Everything that had represented quality of life for him would be gone. He was tired, he was in pain, and, after four years of his wife in a facility, he was lonely. There must have been hours of wakefulness in which he considered his situation and his future.
He listened to the physicians during the care conference. He listened to the palliatve-care specialist, Albert Hong, who came to his room afterward and in the loveliest and most delicate manner possible conveyed that he really was not a great candidate for rehab. And he said, "I think I'm ready to be through." I can't say whether my sisters were crying, but tears were streaming down my face as I gave him my blessing. We all did. By that evening, he was in a bed in the local hospice house.
The following Thursday morning, at first light, he died in his sleep. The evening before, I had left him about 7:30. I told him I was going back to his house to feet his cat, and he smiled broadly. "I love you," I said. "I'll see you in the morning," and dropped a kiss on his cheek. The next morning, the funeral-home guy was loading him onto the stretcher.
It's taken me a year to be able to write about this. But as a lifelong writer and editor, my dad was an inimitable respecter of deadlines. He had been a college journalism educator for twenty years, and I believe it was more than happenstance that led him to wait until the semester had ended and commencement concluded before leaving the building. And he had been active in theater all his life: the man knew how and when to make an exit. Cleanly, quickly, and with grace.
I work as a hospice chaplain. I've seen patients fighting through pain to keep hanging on to life. More frequently, I've seen family members unconsciously prolonging their loved one's life by talking about how tough the person is and how much they need the person around and how they are not ready for the person's impending death. I don't know how I will feel when my time comes. But I pray that I will be able to leave as my dad did: himself to the end, and then getting offstage quickly and neatly.
