The Final Journey Part 4 (Turning Point)

Friday October 7, 2016 (cont.)

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 up 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. It was a gut-wrenching decision.
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 blood work. 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 as 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 retracted. “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 was 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 dose of 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 would respect that.

I hoped and prayed that this final leg of Gram's journey would go quickly.