Gram

Gram

Sunday, November 20, 2016

The Final Journey, Part 5

Friday October 7 (continued)

Adam called for an ambulance transport at 6:00 Friday evening. I was relieved after having made the decision to not proceed with the blood transfusion, but anxious to get Gram back to ManorCare. I had no idea how long it would take. I was emotionally exhausted; it had been a long day already, so I hoped it wouldn't take long. Gram was in a fetal position and resting mostly. I’m not sure if she was sleeping because her eyes remained half-open. She was having periods of restlessness followed by calm quietness.
We waited.
In the meantime, I called Keri from Heartland Hospice. Since we had pushed the Heartland team aside when we decided to pursue the blood transfusion, we hadn’t yet signed the papers to engage them. Keri was patient with us and she graciously agreed to meet us at the hospital while we waited for the transport. 
            Michelle and Aubrey came over, too. It was around 10:00 when Keri arrived. We all sat in the waiting area of the Emergency Room at Passavant and for the first twenty minutes, did nothing but tell stories and reminisce. No papers were signed yet. We laughed as we shared memories of Gram and times gone by. Keri seemed interested in hearing them and touched by the love we were all sharing. These moments- this experience- seemed to signal our shared acceptance of the decision and what was about to happen with Gram. 
            For those few moments, I swear we were the only people in the whole world. I was totally unaware of anything going on around us. It was like the world outside of those chairs we sat in was frozen in time. We all seemed to know now that Gram wasn’t going to surprise us this time.
I signed the papers. We would begin the hospice process as soon as Gram got back to ManorCare. Since we assumed, at that point, it would be after midnight, the agreement was effective the next day, October 8. Technically, it was in about ninety minutes.
When Keri left, I checked in with the nurse. Adam’s shift had ended and a new, not-as-friendly nurse appeared. He told us that Gram wasn’t a priority for ambulance transport and it could be a while. They had, however, contacted their service of last resort and that service was providing an arrival time of 3:30 am. “It might be earlier or later,” the nurse said. I was so frustrated. If Gram would have been just a little stronger, I would have carried her to my truck and drove her myself. My biggest fear was that she would die in that hospital. I didn’t want that to happen. I wanted her to be among familiar surroundings.
We left the hospital at 11:30 pm. I asked two nurses to call me when the transport arrived. In turn, I needed to call Keri and have her nurse, Tonya, meet me at ManorCare when Gram got back so we could begin treatment.

Sunday, November 6, 2016

The Final Journey, Part 3

Friday October 7, 2016

I arrived Friday to find Gram’s room full of people. I was taken aback. I was here only to meet Keri from Heartland Hospice and sign the paperwork. I knew Michelle was going to be there because I had told her, but I didn’t expect the others.
Gram was sitting in her wheelchair near the window. She looked so weak and only half awake. Michelle was sitting in front of her. Sarah, one of the ManorCare nurses was standing behind Gram’s wheelchair and Paula, another ManorCare nurse, was sitting on the bed next to Gram. Keri and a hospice nurse were standing against the wall. Paula immediately blurted out, “Mike, her Hemoglobin is down to four. She needs a transfusion. She needs to go to the ER.” I almost fell against the wall. And before I could even process what I had just heard, Michelle chimed in and said, “Mike, you should listen to this before you sign the hospice papers.” She was thinking, and rightfully so, that once I signed, I wouldn’t have been able to get her a transfusion.” (We found out later that hospice would have permitted it.) Sarah concurred with Paula. I could feel the panic and anger well up inside me as I realized the seriousness of the situation. Defensively, I said, “Whoa, whoa, wait a minute, I’m here to put her on hospice, I’m not trying to save her life. I don’t even know what Hemoglobin is or what it means!” I paused, and then continued, trying to remain calm, “I mean, what’s causing it? Something has to be causing it. And I’m not going to run a bunch of tests to find out. Won’t we just have to do it again?” I could feel myself beginning to tremble as I tried to retain composure. I was so confused and words and questions filled my head. In some way, I resented them planting a seed of doubt in my mind. I also had to remind myself that Gram had documented her advance directives when she had her will done several years ago. I needed to do right by her. I was worried about what she would have to endure by going to the hospital. “Think about the experience for her,” I said, “Possibly having to sit at that hospital for hours, shitting and pissing herself. Will they keep her? Will they let me be with her? If not, I won’t do it. I don’t want her to die in a strange place and without me.” It seemed like I had no control over the words that were coming out of my mouth.
I calmed down a little and as we discussed the situation, I learned that low Hemoglobin could be caused by internal bleeding or diet. A normal, healthy level would be twelve. Gram’s previous level stayed around nine. Clearly, four was dangerously low. “Everything I’m seeing with her right now is exactly what someone with low Hemoglobin experiences,” Sarah said, still standing behind Gram’s wheelchair and welling up with tears. “A transfusion will perk her up. I’ve seen it before.”
I’ve always respected and appreciated the opinion of those who took care of Gram, especially those like Sarah and Paula who had been there since Gram arrived. These people took care of Gram every day and, as in the case with these two, often thought of Gram as their own family.
Sarah was in tears as we continued to discuss Gram’s situation and she was pleading with me to consider the transfusion. I would find out later that Sarah was reprimanded by the hospice nurse for crying and being “unprofessional.” Sarah apologized to Michelle and me, but I found it unfortunate that she was reprimanded and unnecessary for her to apologize. I was grateful for her input and I know Michelle was, too.
By now, I knew I was probably going to allow the transfusion because the seed of doubt was planted. I knew that if I didn’t, I’d always wonder if I could have made Gram feel better. Until now, even though I was engaging hospice, I didn’t think her death was imminent. As I had said before, I did think this time was different – that she wasn’t going to bounce back. However, I thought she had a month or so left. “Perking” her up, I thought, would make her feel better for her last weeks or months.
Before making a final decision, I had to make sure that this transfusion was the right thing to do. I asked for a doctor. The ManorCare nurses contacted a nurse practitioner who was on site. She immediately came down to talk to us. She reiterated the possible causes of Gram’s blood condition and also outlined the risks of the transfusion, mainly that she may not survive. She needed so much blood that it could kill her. At the same time as the ManorCare nurse practitioner was discussing the procedure, the hospice nurse reminded me about the poking and prodding Gram would undergo at the hospital. “Is it invasive?” I asked the nurse practitioner. I had no idea how a transfusion took place. I envisioned holes all over her body and tubes of blood flowing everywhere. “It’s an IV,” she responded. “Will it make her eat again?” “It might improve her appetite a little.” She also informed me that the ManorCare test could actually be wrong. “The hospital will do another blood test,” she reassured me.
I walked over and sat down in front of Gram. Opening her eyes seemed like a huge effort for her. She did, though, and she looked at me. Her eyes were long and droopy and looked sad. “Do you want to take a ride?” I said, softly. Gram shook her head and mouthed, “No.” “Do you want to go to the ER?” Her response was the same. My heart hurt for her at that moment. But despite her response, I decided to send her to the ER for the transfusion. I felt like I had to. Again, I was only thinking of making her feel better as she lived out her last weeks or months.
As I walked to the nurse’s station to arrange for the transport, the hospice nurse, who had earlier left Gram’s room, said, “What would your Gram be saying to you right now?” She’d say, “Leave me the hell alone,” I replied. “But I think I could talk her into this,” I said, “One time. I think she’d do it for me.” I directed attention to the ManorCare nurse then and said, “Once we get there, I reserve the right to stop this at any time if I feel it’s too invasive.” “Of course, she replied.” We put hospice on hold and the nurse summoned the ambulance transport.
As the medics wheeled Gram out on the gurney, Michelle and I followed. We were both in tears. A male patient grabbed Michelle’s hand as she walked by, held it tightly, and said a prayer. Another patient, Kevin, quickly wheeled toward us, looking deeply concerned. “What’s going on with Gram?” Once we explained, his eyes welled up with big tears and he said, “We love Gram.” He grabbed Michelle and gave her a big hug.
          What an awful day.