Dad's Decline

After my dad was admitted to the hospital where they do VAD procedures, I came and stayed near him with my brother. Dad was admitted the Wednesday before Labor Day and was scheduled for the operation the day after labor day. He was hooked up to about a dozen different medications as they tried to stabilize him before the procedure. The result was a fairly quick decline. Over the 5 days before the surgery I saw him gradually slip away. When I arrived he was lucid but could only talk in a whisper. He would tire after a few minutes. Still when I could hear and understand him he still was mentally alert. As time progressed however, the deteriorated. While his voice improved with the help of a speech therapist, he gradually became less lucid. First he was unable to hang on to the flow of a conversation. By the third day he was unable to follow much and responded only in small sentences. As I explained the operation and the possible positive and negative results the best he could muster is "get'r done" By the fourth day he was having difficulty distinguishing reality from illusion. He dreamed his partner had left him to join the FBI (not really a possibility). He would lose track of what he was saying in the middle of a sentence. He tried to draw a clock for the occupational therapist. He drew the circle and then the 12 and the numbers down the left side. By the time he got to six he had lost track of what he was doing and began writing numbers all the way back up. The clock ended up with 14 right next to 12. The day of his surgery he believed he was in a clinic in Tijuana and refused to have the operation. My brother and I, alerted by his partner that he was refusing the operation raced to the hospital at 5 in the morning where we talked him down. We reassured him he was not in Tijuana, but a top notch medical facility in the US. As he slept he would occasionally wake up muttering about taxes and business regulations. We would reassure him all these would be taken care of and he drifted off to sleep. Later he asked the operation be postponed until he was stronger. We told him he was declining and that he would not get stronger with out the operation. The operation had been delayed from 7 am to noon because of a heart transplant. But by the time the anesthesiologists arrived to get him to sign the release he did so without objection. There were other signs as well. Dad's breathing became more difficult and shallow. By the last day when he was sleeping he looked like he was struggling for breath. His arms were swollen in spite of the lasix they were using to try to get rid of the fluid. And he still was not eating. He had no interest in food, and even when we were able to get him to swallow something, he would complain that he was nauseous. He was physically weaker, an attempt to actually sit on the side of the bed was unsuccessful and exhausted him. I believe in retrospect this was an attempt to try to show that he was improving and should therefore put off the surgery, but if that was his intention it failed miserably. He was near the point of death and he was miserable. But my father clung to life, he may have been unhappy, but he never dispaired. While he was afraid of the surgery and the possibility of death (he said to the surgeon when he came by to see how he was doing the morning before the surgery, "Don't kill me." The surgeon answered "I understand" -- perfect doctor non-committal speak) it was the very fear that showed he was not ready to die. The doctors told us that the current medication regime would keep him alive for a week or two at best, without the medication he had a day or two. The VAD offered a way to get back possibly years with better quality of life. Despite his fear, we pushed on toward the surgery Around noon he was wheeled into the operating room and thus began a long wait for us.