Gram was barely conscious when I arrived at UPMC Passavant
hospital. I did not ride with her in the ambulance because I wanted to have my truck
with me and I knew it was a short ride anyway. But once I arrived, I needed to
get through those secure doors and back to her quickly. “They’ll come and get
you once they have her settled, the kind woman at the registration window said
to me when I approached. “I can’t wait for that,” I exclaimed, “I need to get
back there. She has dementia and I don’t want them making any assumptions in
how to treat her.” She gave me a sympathetic look then quickly opened the door
and told me to proceed back to room nine.
Once back there, a handsome male nurse walked in and
introduced himself to me. “I’m Adam,” he said as he leaned over and shook my
hand as I sat in the chair beside Gram’s bed. He was genuine in his approach.
He read my pain and reacted with gentleness and empathy. Under normal
circumstances, I would have been all over someone as handsome and kind as him,
but, of course, this situation was anything but normal. Tonight, all I could
think about was Gram. I immediately wanted to clarify my wishes to Adam. I
couldn’t do it without crying. “I want to be very clear. I am not trying to fix
her. I don’t want a bunch of tests and poking and prodding to try to figure out
why her Hemoglobin is low, I just
want a blood transfusion,” I sobbed, “So she feels better.” I was so nervous
they would try to convince me to start a long, drawn out process to “fix” Gram.
That wasn’t my goal. I’m sure I was
defensive. I was terrified. Adam was very kind and understanding. “It’s ok sir,
we won’t do anything you don’t want us to do. I’ll make sure I pass that on to
the doctor, too.”
“We’ll need to put an IV in her to get some blood,” the
second nurse said as she carried her caddy of blood supplies in and placed them
on Gram’s bed. “We will also use it for the transfusion.” “Okay.” I was
relieved to find that a transfusion only involved an IV and was minimally invasive.
I had no idea.
Gram didn’t respond much. She just laid there as if she
didn’t even know they were inserting the needle. By now, her eyes were glazed
over and only half open and appeared to be stuck that way from the sticky,
yellowish mucus that covered them. Before long though, she became restless,
flinging her arms and reaching and pulling back. At one point, she rolled over
in the bed toward me as I sat next to her, reached out with her right arm and
started punching me in the chest. I wondered if she was expressing anger at me
for what I was doing by bringing her here. I hope not. I know she didn’t want
to come, but I was only trying to make her feel better.
I have always been so grateful for Michelle and Jude, but on this day, more than ever. They are my voice of reason during emotional times like these. They also understand the bond that Gram and I share. Michelle was unable to come to the hospital with me right away, so I called Jude as I drove over there. “Do you want me to come over?” “Yes.” Jude always comes right away when I need her. She arrived in less than thirty minutes. I was glad to see her.
Just as ManorCare had said, the hospital did repeat the
bloodwork. Gram’s Hemoglobin, although slightly higher than the nursing home’s
test, was still at a critical level. Adam gave us the results, but said the doctor
would come to speak with us shortly.
All day, my mind had been consumed with this latest situation
with Gram – that is, placing her on hospice again. My heart sunk when I first spoke
with the hospice liaison, Keri, on Thursday. This time was different; real. I
remember thinking as I arrived at work this morning; I go through my day to day life, doing my thing, then all sudden it
occurs to me: This is really bad. She’s been losing weight. That’s what’s been
happening. I’ve been visiting and not really noticing or allowing myself to
notice. Then, two days ago I look at her and suddenly think, oh my God, this is
bad.
For the last several weeks Gram had gradually slowed her intake of food. Despite my efforts to
bring fast food and milkshakes, she continued to lose weight. Just in the last
couple weeks, it became harder and harder to get her to eat anything at all. She’d
take a few bites here and there. Even the milkshakes became less desirable to
her. She also became angry about food. Unlike those times in the past when she
refused food, her recent anger was a new response. On a couple of occasions,
she even threw food at me. “I don’t want it!” She yelled once when I tried to
feed her a french fry and she tossed it at me. This time was definitely
different.
But Friday, at the hospital, she would not even drink
water from a straw. She emphatically pushed my hand away when I held the straw
near her mouth. When I dipped my finger in the water and tried to dab some
water on her lips just to moisten them, again, she angrily pushed my hand away.
I really liked the doctor who came into room nine to talk
to me and Jude. He was realistic and candid, with good bedside manner and
deeply empathetic. “I’ll do whatever you want me to do,” he said as he came to
give us the results of the full blood workup he ordered. “But I want you to
understand the whole picture.” I noticed his tears as he continued, “Your
grandmother is dying. Her organs are shutting down – her kidneys are currently
functioning at 15-20%, she is severely dehydrated and anemic. A transfusion will
not make her eat or drink and that is one of her biggest issues.” He went on to
say that swallowing had become a big issue, too, and was responsible for her not
eating or drinking. I knew he was right because even when she drank water early
yesterday, she seemed to choke on it. “Is there a risk of her dying during the
procedure?” I asked. “Yes, there’s a high
risk. She needs so much blood that it could get into her lungs and that would
be a painful death.”
When I heard “painful death,” I immediately said, “We’re
not doing this.” He repeated his earlier statement, “I’ll do whatever you want
me to do.” This time, though, he added, “But I think you’re making the best
decision for your grandmother.” As I sobbed, I told the doctor how adamant and
even angry Gram had been about not letting me put food or water near her mouth.
He told me that was very typical of patients in her condition. I was now
convinced that Gram was ready. She made her decision. She wanted out.
I was immediately oddly calm and breathed a sigh of
relief. Now I just wanted to get her
back to her own bed, engage hospice for comfort care, and let her succumb
naturally and peacefully to whatever her body is telling her. The doctor left
and sent Adam back in and told us he would contact the ambulance to get Gram
back to ManorCare.
I needed to hear what that doctor said tonight. And hearing
it made the whole trip to the ER worthwhile and even necessary, at least for
me. I needed the perspective this doctor gave me. I needed to make the best
decision for Gram. It allowed me to do so. And it allowed me to be at peace
with that decision.
I texted Heather and Tara and talked to Mom on the phone.
I suggested they come in to see Gram. I had no idea how much time we had left,
but I knew it couldn’t be much. My family has always been keenly aware of my
relationship with Gram and how, when this time came it might affect me.
Everyone’s response was the same. Once they expressed their sadness for Gram, “Are
you ok?” They asked. I was very
touched by their concern and support. I really needed it now.
I was heartbroken but very much a peace with the decision. I believe Gram
had made her wishes clear - something she's never been a stranger to doing -
and I will respect that.
I hoped and prayed that this final leg of Gram's journey would go quickly.
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