Anatomy Of A Loss

This past week marked two years since my father's death in a hospice facility in my hometown. Mom and I marked the occasion by meeting at the cemetery to pay our respects.

I've been replaying dad's final hours in my mind intermittently for the past two years.

He'd lost his oxygen supply when the tubing caught on a corner of the bed on his walk to use the restroom in the middle of the night. Mom found him standing pale and disoriented, just in time to ease him to the ground and call 911. A long night spent in the ED, followed by a lucky break with a rare opening in a highly regarded hospice facility. He was discharged directly from the ED to the hospice facility, something I've witnessed perhaps once in my nearly two decade career.

 My early arrival at the hospice facility to find him awake, lucid and in surprisingly good spirits. His assenting to remain in the hospice facility going forward, a tremendous relief to the entire family but especially my mother (who had reached the limits of her caregiving abilities).

A visit from the palliative care physician, a caring man dad had come to know and respect, who agreed to continue seeing dad after he enrolled in hospice.

I called my three siblings and told them that dad seemed fine, that this was probably just the next step in his disease process - no, they did not need to get on a plane.

His demise began with something so unremarkable as to seem benign. We suggested he try drinking a protein shake because he hadn't eaten during his ordeal in the ED.

He aspirated the shake (it went down the wrong passage, entering his windpipe and lungs instead of his esophagus and stomach). He received nebulizer treatments of the type that asthmatics get to relax open his airways, and his oxygen flow was increased.

For the first time in years of decline, his air hunger reached a threshold where he requested morphine - something I'd discussed with him previously, but that he'd always been too fearful to try. After repeated doses of morphine and ativan spaced out over time, he appeared restful, even though his breathing remained rapid and somewhat labored.

I called each of my siblings back - two on the east coast, one in another country, and told them that he'd deteriorated significantly since we'd spoken, and that they should get on a plane as soon as they were able.

My mom and I sat at the bedside reminiscing, and were eventually joined by my uncle mid-afternoon. I held dad's left hand throughout. At one point, I noticed my father's arms briefly straighten and extend awkwardly, and recognized it as decerebrate posturing, which in his case most likely indicated brain damage due to his lungs being unable to properly take up oxygen.

I pointed out my observation to my mom and uncle, explaining what it meant and that  dad could pass within hours. We sat in the room with him, and as he continued breathing peacefully our conversation resumed.

Just after sunset I noticed that his chest had ceased rising. Without drawing attention from the others in the room, I felt for a pulse, and there was none. I let my mom and uncle know that he was gone.

My uncle was in a state of disbelief. This was his younger brother, his charge, now gone. My mother was in tears but with visible relief. She had borne witness to his suffering for so long, cared for him exclusively for so long, this was a reprieve from his greatest fears of being incapacitated even further.

I was exhausted, awash in a mess of emotions that came in waves: devastated to lose my dad;  grateful to have been present and served my parents in their time of need; distracted by the logistics of the coming days, which I readily immersed myself in arranging since my mother was not in a position manage funeral arrangements and invitations and selecting a casket.

I was extremely grateful that, over the prior year and only after my strong insistence, dad had completed an In Case of Emergency binder with all his pertinent financial information, a downloadable pdf I'd purchased from a blogger acquaintance (Chelsea Brennan) back in 2018. This made all the difference between chaos and order in the following weeks and months of settling mom's affairs.

For the first year and change after his death, my father visited me in dreams that felt real. I'd awaken in the middle of the night to realize that he was gone and the tears and feelings of irretrievable loss would return all over again.

By the second year, the dreams continued but the framing had changed. Each visit was a gift instead of a marker of loss. The depth of my grief was a sign of his impact on me, and my love for him. I continued to awaken in the middle of the night, but with a sense of gratitude and even joy that he continued to keep stop by while making his rounds.

There is such a thing as a good death.

There can be such a thing as a positive experience with loss.