The Final Journey Part 3 (Confusion)

Friday October 7, 2016

I arrived Friday to find Gram’s room filled with 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 turned around, looked at me, and 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 and speaking very fast, “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 tired and 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.