On 1/24/13, I wrote a piece about a clock and its behavior in a family event. I always intended to tell here another story about a clock, time, and dying, that will go into our family lore. Here writing in January, 2014 is that other story.
My father had the genetic curse that ran through his family -- a very low HDL (the good cholesterol) so that even though his total cholesterol or even bad cholesterol were not extremely high, his HDL was low. Even though they were not able to measure these levels in the past or provide medication to alter these bad actors, I am sure that many family members on his side of the family had this problem. His father and all of his father's 6 siblings died of heart disease in their 60s. And my great grandfather also died of heart disease as did his father my great great grandfather who died in his 50s.
My father had had a myocardial infarction, a heart attack when he was in his 60s. Then over time, there apparently was further loss of heart muscle. When he was in his mid 70s he began to really feel short of breath, and he was having angina, ie chest pain with the least bit of activity. He had a catheterization and was found to have some blood vessels blocked. Though his cardiac output was down suggesting not good muscle function, he decided to take the doctors up on their offer of a bypass. We knew that this bypass would be more risky than the usual because his cardiac function was so low. But he still wanted to try it. The alternative would be to let the arteriosclerotic process go until he had another heart attack, which would mean more damage and he probably would not survive that heart attack. Surprisingly with the help of a pump assist to the heart he survived the surgery and the bypass circulation gave him another two years of relatively good quality life.
But then gradually there was more damage, no big heart attack, but a slow deterioration in heart function. He became very short of breath, very fatigued, and unable to do much activity at all. His quality of life plummeted. Nowadays he might have been a candidate for a heart transplant but he was 78. That would not have been offered even today to a man at his age. He did receive a drug called dopamine intravenously for several days on several different occasions. This medication stimulates the heart muscle and he was able to have a few weeks each time of better quality of life. But finally he was hospitalized for the final time. He had developed complete heart block--a rhythm disturbance of the heart where the heart rate slows down so much that the heart can't do the pumping necessary to keep the brain alive. This occurred on a weekend and the cardiologist on call didn't know his case. Therefore as an emergency she had placed an external pacemaker. I headed to that hospital to provide whatever advise or decision making that would be needed.
It happened that this had occurred on July 1. My father's birthday was July 4th and that day had always been very important to him. He always loved to celebrate and he always said that the whole United States celebrated his birthday. Just like that song, Yankee Doodle Dandy, he was "the real life nephew of his Uncle Sam, born on the 4th of July." So I felt even though we would not be putting in any permanent pacemaker because of Dad's poor quality of life which the pacemaker would not improve, perhaps it was fine that the temporary one had been placed. It might let him make it to his birthday.
July 3rd came. All of the family had gathered at the hospital. But Dad had become worse. He was going in and out of consciousness. Even with the pacemaker, his heart was not functioning well at all. As the doctor daughter, I was trying to work with the nurse to regulate the morphine that he was needing for better comfort in breathing. My middle sister, herself a nurse, was basically almost collapsed in tears at his bedside. It was getting into the afternoon. I spoke with my younger sister. We decided that we better celebrate his birthday right then and there. We drove to a nearby grocery store, purchased a birthday cake, paper plates, plastic utensils, candles, and balloons. As my father opened his eyes he looked at the round clock that hung on the wall at the foot of his bed in his room. I knew he was keeping track of the time. He was trying to make it to his birthday. But he was suffering and we were suffering with him. So during one spell when he lost his lucidity, we took the clock off the wall. We put the balloons where the clock had been. We pulled the room's shade. We lit the candles on the cake and served up some pieces on the paper plates. The next time Dad came to, we told him, "Happy Birthday, Dad. You made it to your birthday." We even each ate a bite of cake and gave him a little of it also. You could see him trying to see that clock and he looked toward the window. But it wasn't long and he lost consciousness again and this time he was able to let go. He died at about 8 PM on the eve of his birthday. Yes, we faked him out. But I think he would forgive us our little fake birthday party. Maybe he thought he could have made it, but we were all suffering so much with him that it was questionable if we would have made it. That was in 1995. He would have been 78 years old on July 4th of that year. We all still miss him. But we were all there to send him off with a birthday celebration. He had begun to talk about his wishes for his funeral. He said he wanted to be carried out of the church to a John Phillip Sousa march. We arranged that. And some of the organ interludes included an organ version of "Yankee Doodle Dandy."
My father had the genetic curse that ran through his family -- a very low HDL (the good cholesterol) so that even though his total cholesterol or even bad cholesterol were not extremely high, his HDL was low. Even though they were not able to measure these levels in the past or provide medication to alter these bad actors, I am sure that many family members on his side of the family had this problem. His father and all of his father's 6 siblings died of heart disease in their 60s. And my great grandfather also died of heart disease as did his father my great great grandfather who died in his 50s.
My father had had a myocardial infarction, a heart attack when he was in his 60s. Then over time, there apparently was further loss of heart muscle. When he was in his mid 70s he began to really feel short of breath, and he was having angina, ie chest pain with the least bit of activity. He had a catheterization and was found to have some blood vessels blocked. Though his cardiac output was down suggesting not good muscle function, he decided to take the doctors up on their offer of a bypass. We knew that this bypass would be more risky than the usual because his cardiac function was so low. But he still wanted to try it. The alternative would be to let the arteriosclerotic process go until he had another heart attack, which would mean more damage and he probably would not survive that heart attack. Surprisingly with the help of a pump assist to the heart he survived the surgery and the bypass circulation gave him another two years of relatively good quality life.
But then gradually there was more damage, no big heart attack, but a slow deterioration in heart function. He became very short of breath, very fatigued, and unable to do much activity at all. His quality of life plummeted. Nowadays he might have been a candidate for a heart transplant but he was 78. That would not have been offered even today to a man at his age. He did receive a drug called dopamine intravenously for several days on several different occasions. This medication stimulates the heart muscle and he was able to have a few weeks each time of better quality of life. But finally he was hospitalized for the final time. He had developed complete heart block--a rhythm disturbance of the heart where the heart rate slows down so much that the heart can't do the pumping necessary to keep the brain alive. This occurred on a weekend and the cardiologist on call didn't know his case. Therefore as an emergency she had placed an external pacemaker. I headed to that hospital to provide whatever advise or decision making that would be needed.
It happened that this had occurred on July 1. My father's birthday was July 4th and that day had always been very important to him. He always loved to celebrate and he always said that the whole United States celebrated his birthday. Just like that song, Yankee Doodle Dandy, he was "the real life nephew of his Uncle Sam, born on the 4th of July." So I felt even though we would not be putting in any permanent pacemaker because of Dad's poor quality of life which the pacemaker would not improve, perhaps it was fine that the temporary one had been placed. It might let him make it to his birthday.
July 3rd came. All of the family had gathered at the hospital. But Dad had become worse. He was going in and out of consciousness. Even with the pacemaker, his heart was not functioning well at all. As the doctor daughter, I was trying to work with the nurse to regulate the morphine that he was needing for better comfort in breathing. My middle sister, herself a nurse, was basically almost collapsed in tears at his bedside. It was getting into the afternoon. I spoke with my younger sister. We decided that we better celebrate his birthday right then and there. We drove to a nearby grocery store, purchased a birthday cake, paper plates, plastic utensils, candles, and balloons. As my father opened his eyes he looked at the round clock that hung on the wall at the foot of his bed in his room. I knew he was keeping track of the time. He was trying to make it to his birthday. But he was suffering and we were suffering with him. So during one spell when he lost his lucidity, we took the clock off the wall. We put the balloons where the clock had been. We pulled the room's shade. We lit the candles on the cake and served up some pieces on the paper plates. The next time Dad came to, we told him, "Happy Birthday, Dad. You made it to your birthday." We even each ate a bite of cake and gave him a little of it also. You could see him trying to see that clock and he looked toward the window. But it wasn't long and he lost consciousness again and this time he was able to let go. He died at about 8 PM on the eve of his birthday. Yes, we faked him out. But I think he would forgive us our little fake birthday party. Maybe he thought he could have made it, but we were all suffering so much with him that it was questionable if we would have made it. That was in 1995. He would have been 78 years old on July 4th of that year. We all still miss him. But we were all there to send him off with a birthday celebration. He had begun to talk about his wishes for his funeral. He said he wanted to be carried out of the church to a John Phillip Sousa march. We arranged that. And some of the organ interludes included an organ version of "Yankee Doodle Dandy."
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