by Barbara Ebel
“I am feeling a bit guilty,” Bob said, “wondering if we missed any tell-tale signs.” He scraped gravy off the meat loaf he’d bought and took a bite.
“I’m sorting all of that out too,” Annabel said.
“What, like he was clinically depressed and shouldn’t have been discharged?” Stuart asked.
She nodded and tugged at the lopsided stethoscope around her neck.
“We recently took psychiatry,” Bob said. “We were sure he showed no signs or symptoms of a real clinical depression. He was rational about his age and his medical problems and the fact that he was only getting worse.”
“He lived a good life,” Annabel said, “and didn’t want to be caged in a facility without the ability to take care of his own needs. The situation was deplorable to his dignity and pride. He tried his damnedest to prevent further medical problems, but the odds and circumstances living there were stacked against him. How many of us would feel the same way? Would we make the same decision?”
“Unless I was exactly in his shoes,” Jordan said, “you pose a hypothetical question I don’t think I can answer.”
“My opinion,” Stuart said, “is that most geriatric patients would not think about the issue as deeply as Mr. Harty did. They are passengers along for the ride and are not responsible for what can and does happen to them.”
“Do you empathize with Mr. Harty’s thought process and not negatively judge him for what he did?” Annabel asked and waited for an answer.
“Yes, I felt strongly for the issues he spoke about and I can’t fault him for what he did. Society doesn’t condone taking one’s life, but the public tide of approval for tricky subjects sometimes takes time. Look at Dr. Kevorkian. There is more acceptance of his philosophy now than before.”
“Patients used to seek him out,” Bob said. “They used to leave their home state and travel great distances to be put under his care; his terminal care.”
Bob turned to Annabel. “Would you do what Mr. Harty did?”
“It is too difficult a question to answer with certainty. But, I believe I would. I also think what he wanted us to understand was that, in the end, his quality of life mattered more to him than extending the duration. Of course, at that age, it takes foresight to prepare the way he did and, most likely, the circumstances might not always work out. I, however, could not commit suicide with some kind of drastic measure.”
“Like what?” Jordan asked.
“Any kind of violence. Such as a knife or a gun.”
“But what if you were desperate? Maybe the only possibility would be to slit a wrist.”
Annabel took a heavy sigh. “So true,” she said. “Goes to show …”
“What?” Bob asked.
“If we’re having this much trouble figuring it out at our age, imagine how difficult it would be fifty or sixty years from now.”
“Let’s change the subject,” Bob said, “and silently say a prayer for Mr. Harty. If there is a God, I hope Mr. Harty is in his graces and found a spot at the pearly gate.”
“However, that’s another part of the discussion,” Stuart said. “The religious and spiritual aspect of what he did.”
“My goodness,” Annabel said. “I didn’t know this topic would become so involved.”
“We owe it to you,” Bob said. “We’re having this conversation because we’re becoming thoughtful medical thinkers and not just students cramming stuff into our brains and spitting it back out.”
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Gloria Pratt gathered all her mother’s discharge papers into her bag and then went to the pharmacy to fill the new prescriptions. Meanwhile, a nursing assistant wheeled Darlene to the front door of the hospital. With new medications in tow, Gloria brought her car to the front of the building, and with assistance also from the doorman, they loaded Darlene into the front seat of the SUV. Her help left and she struggled with the wind at her back to fasten the seatbelt past her mother’s bulky winter coat.
“Mama, we’re going home,” Gloria said as she left the secondary roads and proceeded onto I-75. “Back to the surroundings you’re familiar with. Your own bed, your own house, and special food prepared for you. I’ll even put on your favorite show.”
Darlene stared with an empty expression out the front window while Gloria turned the wipers on slow-speed for the slushy precipitation that had just begun.
“I don’t mean a TV show that is your favorite now,” Gloria said, “because we both don’t have a clue what that would be. We’ll stick with what you loved before Parkinson’s changed you into a different human being … as if you were dropped off from outer space. I don’t mean that to sound nasty, Mama. You were dealt a nasty card and it’s not your fault.”
Gloria hummed for the rest of the trip home as if to keep company with herself. She pulled the vehicle into the garage of the small two-story home and twice plodded back and forth into the house to unload her mother’s things. Lastly, she began the arduous task of getting Darlene into the house and getting her situated into bed for a midday nap.
Having worked up a sweat, Gloria put the guard rails up on her mother’s bed and massaged hand sanitizer into the palm of her hands alongside the bed. She’d neglected her own needs for hours and then ran to the bathroom because she thought her bladder would burst.
CHAPTER 13
Gloria woke up and, in her normal fashion, listened for any sounds coming from her mother downstairs. All was quiet. She grabbed clean clothes, went to the window, and noticed the frost on the trees and the grass outside before hurrying to the bathroom. It took only a few minutes to wash her face, brush her teeth, and change. She grasped the handrail and swiftly went down the staircase.
Gloria first eyed her mother in bed, her chest rising, her mouth making smacking noises. She prepared a pan of warm water and a washcloth and placed it where she needed it.
“Mama,” Gloria said, putting her hands on Darlene’s shoulders. The woman sleepily glared at her daughter and pushed one of her hands away. Gloria raised the back of the bed, and with efficiency, slinked her mother to the edge of the mattress and got her up. With one arm around her waist and the other holding Darlene’s arm around her own shoulder, she grappled with walking her a few steps and setting her on the portable toilet chair. She always sat her on it once or twice a day. It got her blood moving and it made it easier to discard her overnight adult diaper and then apply a fresh one.
Not too much urine trickled into the pot. Gloria swished the cloth into the pan of water and, while holding Darlene up, washed her private parts as best she could. She applied a fresh diaper, propped her up in the wide nearby chair and fought to pull up a pair of loose pants with an elastic waistband and a flannel shirt with wide buttons.
On the kitchen counter, first Gloria rubbed a handful of hand sanitizer into her skin. She proceeded to line up all of her mother’s medicine bottles and opened the lids of a blue pill container labelled from Sunday to Saturday. Starting with the most important one, carbidopa/levodopa, she counted out each medicine seven times and dropped them into the plastic slots. With the drugs ready for the next week, she took the morning pills over to Darlene and spent five minutes making sure the woman swallowed each one with a teaspoon of apple sauce, which Gloria craftily sneaked into her mouth.
Gloria fed Darlene oatmeal with honey over the next hour, started laundry, and turned on the TV as she folded the wash and sipped her first cup of coffee. Then it was already time to situate Darlene back in bed. Usually, she would fall asleep for a nap.
After she trudged over to the kitchen counter, Gloria fixed another cup of coffee, and spooned oatmeal into a bowl for herself. As she ate at the round kitchen table, she intermittently peered over at Darlene. Her mother had done an excellent job of continuing to raise her in her teen years after her father had died early from a heart attack. She had been a clerical worker in the very hospital she just came from, having continued the tradition of her husband - to work somehow for the men and women who had serve
d in the military.
She thought back to the day her mother received the news of her diagnosis. Darlene read the literature she received from the doctor in one afternoon, continued to study about the disease, and finally sat down with Gloria a month later to express her concerns.
“I’m going to do everything I can to beat this disease,” Darlene said. “However, I hope to never, ever become a burden to anyone, especially to you.”
“Mom, please don’t say that,” Gloria had said. “A mother can never be a burden.”
“I’ll put it another way. If I can’t maintain caring for my home, my loving relationships and roles, and my own self-care such as eating and dressing, I don’t want to exist.”
“Stop talking like that.”
“No. I must finish. I am entitled to go downhill mentally; however, if the situation becomes deplorable, if I can’t communicate sensibly, if I don’t understand half of what’s going on, and I can barely function in a few daily activities, then I don’t want to be alive. I don’t know what it’ll take, because at that stage, I don’t think I’ll be capable enough to smother myself with my own pillow.”
“Ma!” Gloria shouted.
“Oh, hush.”
In the next few weeks, Darlene visited an attorney and had him draw up her will, power of attorney, and medical directives. All monies as well as all decisions would go to Gloria. She directed the attorney to make a non-standard “do not resuscitate” order if her Parkinson’s was in its advanced stage and asked for no life saving measures under any medical emergency. If they could even let her wither away and die, she would prefer it.
After that, her life turned into the key components of Parkinson’s management: education, physical therapy, and eventually speech therapy and occupational therapy, and her signs and symptoms progressed eventually to her present state.
Gloria looked over at her mother, who still hadn’t closed her eyes. Her hand beat up and down on the blanket and she sputtered out the first sensible word of the day. Gloria poured part of a nutrition drink into a cup and assisted Darlene in drinking one sip.
She finished her own oatmeal, grateful that her mother would soon close her eyes. Gloria glanced at the time. Her hired help would be at the house in an hour to fill in for her because of a job interview at the same government hospital. She wanted the job badly; she’d make a little bit more money. It was important, however, to still keep her schedule at three ten-hour shifts.
She began packing her purse with her CV and other essentials but couldn’t shake the feeling that had been growing in her the last several months. The guilt was worse now since the doctors at the hospital had confirmed her mother’s condition and godforsaken prognosis. Her mother never wanted to get to the stage she was in now, let alone get worse. Gloria would do anything to care for her, however, the very things she was doing were in contrast to the care her mother wanted. Her mother didn’t want any care!
Darlene Pratt, if she could make sense right now, would smother herself with her own pillow or reprimand Gloria for going against her wishes and not letting her go. Gloria swallowed hard, doused her hands with hand cleaner, and prepared for her job interview.
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“You’re all sprung for the weekend,” Dr. Schott said to the students after rounds the next morning. “You all lucked out with a quiet night. Go study this weekend and the residents and I will do rounds on Sunday morning and then check our patients out to the call team.”
Annabel, Bob, Stuart, and Jordan glanced at each other with surprise, turned before Donn changed his mind, and echoed their thanks.
With the ringer still off, Annabel felt the vibration of her cell phone on her waist as they headed to the call rooms. “A family member is calling from home,” she said with concern, glancing at Bob.
“Hello,” she said.
“Annabel, it’s Mom. Can we talk a moment?”
“Sure,” she said, picking up on Sara’s anguished tone.
“We didn’t tell you something because we’ve been handling the situation and didn’t want to upset you, but now we’re at cross roads and need to make a family decision.”
Annabel slowed her pace as she kept her head down, focused on the tile floor. She gave Bob a tentative wave to go ahead, but he hung by her side.
“What’s going on there? Tell me what?”
Her mother, Sara, breathed a heavy sigh. “After you visited us during your surgery rotation, Dakota had a stroke.”
Annabel’s eyes widened and the words “Dakota” and “stroke” echoed in her brain. Dakota was their one and only pet, a Chesapeake Bay retriever, with intelligence that, in her mind, surpassed at least half the human beings on the planet.
“A stroke? What does that mean? He’s like incapacitated or something and you didn’t tell me?”
“Sweetheart, for three days, we all took turns at his side 24/7 and we made some progress. He had no control with his housetraining, slept almost the whole time, and didn’t eat. We managed to keep him hydrated and then the next two weeks things perked up … a little bit. We took turns figuring out what he would and could eat and finally he started eating half cans of chicken with rice.” Sara gulped a sigh and stopped.
“I’m listening, Mom.” Annabel finally glanced at Bob with a frown and shook her head.
“Anyway, his situation improved, he had no adverse mental sequela, but his GI tract took a toll. We have been taking him out basically every three hours ever since then, even during the night. And he’s so good not to have an accident in the house; he breaks our hearts when he sincerely nudges us in the middle of the night to go out. It hasn’t been easy on us, but it’s worse for Dakota. Your father put him on Pedialyte to replenish his electrolytes because of all the diarrhea.
“Besides this situation, his joints are degenerating by the day. His arthritis is so painful, we hate to watch him follow us around. He wants to be by our side because he loves us, but we agonize when he has to reposition himself with difficulty and lay down again.”
“You should have told me,” Annabel said sternly. “I would have made a quick visit to help and offer him my comfort. But this is just the preliminary set-up, isn’t it?” Annabel tried to keep her heart from thumping in her chest. “What’s the caveat, Mom?”
“The last few days, Dakota developed stridor; your father and Casey told us that’s the official name for it.”
Annabel thought of the combined medical knowledge between her father being a neurosurgeon and his best friend and brother-in-law, Casey, who was a paramedic. They would know what to call practically anything medical related. She thought of the word and only now knew its meaning because of her medicine rotation. Dakota must be breathing noisily with a harsh vibrating sound which occurs during inspiration. Besides a possible obstruction in the respiratory tract or upper airway, there were many other potential causes.
“Do they know why?” Annabel said.
“Since there is no obvious obstruction and Dakota has no respiratory disease, your father thinks it’s central in origin. In other words, like his stroke, a neurologic insult is the key factor. Perhaps a tiny mini-stroke in the brain or brainstem. And by the way, Dakota’s been on a baby aspirin as a stroke preventative, but there is only so much we can do.”
“So are you all imminently worried?”
“Yes, sweetheart. As of yesterday the breathing problem which affects his jowls is making it difficult for him to eat and you know how much he loves to eat. This morning, he could hardly scarf anything down, and the little he did had to be choked down.”
Annabel fought the emotion welling in her eyes and her throat and her heart. A silence engulfed both of them.
“We are making a family decision today. We believe the time has come to put him to sleep. As difficult as it would be to euthanize him, the next week or two may be hell for him and purgatory for us to watch. The whole problem with all of this is that he hasn’t lost his spirit, still wags his tail, and is following us around with all hi
s usual loyalty. We feel you must voice your opinion. It may be impossible because of your schedule, but you may be able to come say hello or good-bye to him. However, we may absolutely need to put him to sleep today. Dakota’s regular doctor is the vet on-call tonight, so we would spare Dakota another night and day of all these complications.”
Annabel now couldn’t hold back the tear hanging off the inside of her eye. It rolled over her cheek and spun away as Bob walked much slower with her. With a slight touch, he directed her closer along the wall to leave room for a medical student coming the other way.
“I’m coming down,” Annabel said. “I’m wrapping up a night on call and I’ll be there as soon as I can. Don’t do anything without me, Mom.”
“Besides everyone else, I’ll tell Dakota you’re coming.”
Annabel ended the call, shoved the phone in her pocket, and immediately looked at Bob. “Our family dog is really sick, Bob. I have to go to Nashville because they may put him to sleep today. I have a say in the matter, but I can’t not see him or say good-bye. God, how I love that dog.”
“I’m sorry, Annabel,” he said, trying to further examine her features and her sorrow. “Don’t get mad at me for saying so, but I don’t think you should take the drive yourself, especially if you lose him and drive home. Plus, the weather has made for less desirable road conditions in the last few days. Why don’t I take you? Do your folks have an extra couch I can crash on?”
“I would hate for you to do that,” she said but nodded at the same time.
“Then it’s settled. Let me go home first to repack and cancel an appointment and I’ll be right back over to your place. I’ll wait on you if need be.”
“You won’t have to wait on me.”
After grabbing their books and overnight bags, both of them left to prepare for a weekend emergency trip to the Music City.
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Bob rapped on Annabel’s door and when she opened it, she shoved a small cooler at him. She turned and grabbed her scantily packed bag and one textbook. “I doubt if we’re going to do any reading, but I’m bringing this along just in case.” She frowned as she turned and locked the door. “The problem is, we’re bound to a six-hour drive each way.”
