Passing

So my father died on March 6, 2015. He was 86 years old.
He was in a beautiful hospice room overlooking an artificial lagoon.
By the time he arrived there on March 3rd, he had no idea where he was.
My mother, sister and I enjoyed the view.
The lagoon had an assortment of life circulating around, mullet, manatee’s and dolphins.
It was a wondrous distraction from the Inevitable death that was playing out before us.
My father was a lover of nature. He would have enjoyed the view from the room too.
His last months were a torture that pained me greatly to see.
He had one or more strokes years before that had robbed him of long term memory access.
The names of plants and birds that would have flowed off of his tongue had become inaccessible. He knew friends and family. There were just missing pieces.
He seemed to take this in stride, as his general heath was ok. He had a gentle sense of humor about it, rather than letting the frustration get the best of him.
He and my mother kept up the activities that had become their lives in retirement on Sanibel.
Some of the activities had to be pared back, but he kept busy.
October 28, 2014 he had another stroke while out roving at the J.N. ‘Ding ‘ Darling National Wildlife Refuge.
My parents have volunteered at Ding Darling for many years, helping visitors identify birds, plants, and guide visitors through a Calusa indian shell mound trail.
He was hospitalized and given treatment for the stroke clot.
I spoke to him on the telephone from his hospital room that night.
He was aware of what was going on and seemed to be in good spirits.
The next day he was to have surgery to implant a pacemaker. A cardiologist had decided that this was necessary.
The story now changes. After the surgery my father became combative. He had to be restrained to prevent him from removing IV’s and bandages.
He was declared a fall hazard and kept in bed.
After a couple of day recovery, he was moved to the memory care wing of a rehabilitation facility.
He wandered the halls looking for a way out.
My mother knew that this was not a situation she could deal with on her own, much less at home. She visited every day and brought touches of home to him.
His waking hours flipped. He was up all night and slept during the day.
I was able to visit. He seemed to recognize me. We walked around and tried to talk.
He had trouble feeding himself.  I tried to help and it made him cry.
That is when I realized that he was there, but unable to make things work for himself.
On subsequent days his ability to communicate and even walk, changed.
A big part of this I attribute to a cocktail of anti-psychotic drugs that were being used to make the patients more manageable.
After a couple of weeks he was moved to another facility, specializing in memory care.
He moved in on his 86th birthday.
Memory care is a catch all for a variety of dementia diagnosis. Alzheimer’s, senility, or in my fathers case vascular dementia. Stroke related brain damage.
My mother and sister worked very hard to make my fathers room as nice as they could.
He was not infirm, so the furniture was normal. Not hospital grade.
He could go outside when he wanted to. His sleep patterns were still reversed so he spent the night roaming. Mom had to hire ‘sitters’ to watch him all night and follow him around and keep him company.
I visited again in January at the new facility. Clean and open. The staff seemed nice and watched over their residents. They had more work than they could handle.
Some of the residents had full time attendants, hired by their families.
Mom visited every day for a few hours.
The commute was shorter than the first rehab facility, but it still took about 45 minutes to drive from their house. Snow Bird traffic.
He did not communicate as much, but still seemed to recognize me.
His health was not as good. He seemed to be in pain.
The last day I was there we found blood on the bathroom floor.
No obvious wounds. It was thought he had a UTI and should go to the hospital.
One big downside to the care facility was that they could dispense drugs and had nurses and a doctor on staff, but they could not render medical care of anything other than a superficial nature. A nursing home could do that, but Dad was not ready for that level of care.
Any doctors appointments had to be scheduled by my mother, and transportation to and from the appointment had to be managed by her also.
So dad went to the hospital. They determined that he had a UTI, and kidney stones.
The urologist determined that doing anything about the stones would be worse.
He went back to the facility.
A week or so later, my sister called me to ask where Mom might be. The facility had called her to say my Dad had cut his hand and needed to go to the hospital.
The blood thinners he was prescribed present a problem.
So back he went.
He was there for a couple of days. At the time of his discharge Mom was approached by staff that told her that Dad should transition to hospice care.
The Hope Hospice is just across the street from the memory care facility. They could send  a nurse to care for Dad in his room, rather than moving his to a new location. This was near the last week of February.
I had set up another visit for the 3rd of March.
I arrived at 1:45 and went to the facility with Mom.
We were greeted by the hospice nurse at my dads door. She asked that we wait a minute while she changed him.
According to Mom, he had eaten some breakfast that morning, but only with some coaxing.
The hospice nurse told us that she was consulting with the attending hospice doctor about moving Dad to their facility. His condition had deteriorated since morning.
We went in to see him. He lay on his back with his hands grasping at the air. His eyes opened, but the pupils were very small and they did not track motion. His face grimaced and relaxed.
We called my sister and told her it was time to come down as soon as she could.
The hospice nurse told us that she would find a bed for Dad at their facility.
We stayed with Dad and held his hand.
Eventually we found out that there were no beds available across the street, but that there was one at their Shell Point facility. Much closer to the house. They would transport him later.
First we heard 8:30pm but then 7:30pm for the transport.
At 7:00pm his sitter arrived for her night shift. A nice young woman. She was taken aback by the news that Dad was leaving.
The transport arrived at 7:10, and the driver had Dad loaded up in no time and was on the road.
Mom and I headed out and got something to eat. Neither of us had eaten since morning.
We heard from my Sister, she would arrive the next day.
We headed back to the house.
The next morning Mom received a call from the hospice to let her know that Dad was alive and what room he was in.
We headed over after breakfast.
Dad was in a big room, with big windows looking over the lagoon.
His eyes were not open, but his hands sometimes moved around in the air.
He was not grimacing as he had been.
The hospice nurse introduced herself and made us welcome.
A very un-hospital like environment. Low lighting and quiet. Peaceful.
We stayed with Dad until it was time to get my Sister from the airport
We brought her back from the airport and stayed with Dad for a few hours.
Not much change is his condition. We watched the dolphins catch mullet in the lagoon.
(edit, I left out a day. Cold medicine can do that to you)
Thursday morning we headed back to the hospice in the van
Dad was still with us, not much change. We took turns holding his hand.
Sometimes it was cool, but then it would warm up.
At lunch time we went back to the memory care facility to clear out Dad’s room.
He was not coming back, and the billing does not pause.
The memory care facility is almost all out of pocket expense. His meds were covered by insurance, but not anything else.
His long term care policy will reimburse us for a large portion, but it will take time for the paperwork and claims to process.
Thank goodness they had the foresight and means to have that policy.
It did not take long to clean things up and say goodbye to the staff.
We headed back to hospice for the afternoon.
More hand holding and staring out of the windows.
Friday morning brought us back. The nurses told us that his temperature was down and had very low blood pressure.
We stayed and held his hand. The hospice staff asked my Mom if she had made any arrangements with funeral homes. She had not. They gave her a list of local places.
She started calling around for rates. Prices for cremation are all over the place.
She decided on one.
We went to lunch.
When we returned the nurse caught us in the hallway. Soon, she said.
His hand seemed cooler. His breathing was shallower.
Over time his breathing slowed somewhat.
At about 4:50 I noticed that his breathing had stopped. I went to get the nurse.
She quietly hustled in and verified.
Tears and hugs.
I looked down at dad and saw a vein on his neck pulsing. I tapped the nurse on the shoulder and pointed.
A look of surprise and another hustle. I mentioned that he had a pacemaker. She went to get a magnet device that shut it off. I am so glad that he did not have a implanted defibrillator.
That would have been an unpleasant scene.
It takes a special kind of person to work in a hospice. I am pretty sure it is nothing I could handle for long.