Terminal Agitation

February 26, 2012 at 3:52 am (By Rodjean, Uncategorized)

Months have passed since I posted here. Now I have something to share.

Two weeks ago my father died. He was a professional violinist, an avid sports fan, a strong man and a strong personality. He put down his worn tuxedo at 90, after playing professionally for78 years. Congestive heart failure eroded him till he could not walk ten steps without stopping to catch his breath. He declined aggressive treatment, deciding instead on hospice care.

He was chipper on the morning of his last day on Earth. The about Noon he took a turn for the worse. His passing would be brief, but not easy. He started groaning and gasping for air, complaining that he could not get comfortable as the nurse and I rolled him onto one side, then another. I held his hand and recited a couple of prayers with him. I looked into his eyes, my face a foot away from his, and told him that I loved him. I talked about the good old days and how he had performed for Presidents and played with Frank Sinatra, Tony Bennet, Sammy Davis Jr., and other stars. He listened and spoke occasionally, but he was still uncomfortable. He looked at me with anxiety in his eyes and grabbed my arm with a strength he had not shown in years.

The nurses gave him a combination of Ativan, Morphine, and Haldol. His speech started to slur, but he restlessness and discomfort continued. He cried out for Jesus. At times he was unintelligible. At one point, after about four hours, he lifted his arms towards the ceiling, gazed upwards, and in a breathy voice, he whispered, "I'm dying, I'm dying," as if it had just occurred to him. The nurses gave him more Ativan. At five hours, a new pattern appeared. He started to doze, not breathing for about 30 or 40 seconds, then he suddenly awoke with a start and with a wild look in his eyes, he started gasping for breath. This lasted for about two minutes, then he stopped breathing and appeared to doze again for another 30 or 40 seconds, followed by more gasping. (I have since looked it up and learned that this has a name. It is "Cheyne-Stokes" breathing. The literature claims the dying look more uncomfortable that they are, but who knows?) I just held him and talked to him. At six hours he wasn't saying much, but he gestured and said he had pain in his throat. I looked at the nurse and said, "Isn't there anything you can do to make him comfortable?" She gave him more morphine. Finally, a few minutes later he fell asleep and began to snore. I stepped out of the room and asked for a drink of water. I returned two or three minutes later, and he had stopped breathing.

Some of you may have been present through a "hard passing" death. I had never been with someone in the hour of death before. It was harrowing and disturbing. It left me spent and a bit numb. The nurse told me it was quite common. If you Google "death – agitation" you will see that this is how many people die. I had no idea. The movies portray the dying as very collected, saying things like asking Knute Rockne to tell the team to "win one for the Gipper" some day, or trying to give a cop a description of a criminal. That may be true for a few, but not for most of us. We are never quite in harmony with this world. Rudely shoved out, we enter this world, and many of us will be rudely shoved into eternity.

PS There was one funny moment. After switching my dad every few minutes onto one side or the other, at one point he was on his back, with his head elevated. He mumbled that he wanted to be moved again. I said, "Dad, which way do you want to go?" He just pointed up.

Months have passed since I posted here. Now I have something to share.

Two weeks ago my father died. He was a professional violinist, an avid sports fan, a strong man and a strong personality. He put down his worn tuxedo at 90, after playing professionally for78 years. Congestive heart failure eroded him till he could not walk ten steps without stopping to catch his breath. He declined aggressive treatment, deciding instead on hospice care.

He was chipper on the morning of his last day on Earth. The about Noon he took a turn for the worse. His passing would be brief, but not easy. He started groaning and gasping for air, complaining that he could not get comfortable as the nurse and I rolled him onto one side, then another. I held his hand and recited a couple of prayers with him. I looked into his eyes, my face a foot away from his, and told him that I loved him. I talked about the good old days and how he had performed for Presidents and played with Frank Sinatra, Tony Bennet, Sammy Davis Jr., and other stars. He listened and spoke occasionally, but he was still uncomfortable. He looked at me with anxiety in his eyes and grabbed my arm with a strength he had not shown in years.

The nurses gave him a combination of Ativan, Morphine, and Haldol. His speech started to slur, but he restlessness and discomfort continued. He cried out for Jesus. At times he was unintelligible. At one point, after about four hours, he lifted his arms towards the ceiling, gazed upwards, and in a breathy voice, he whispered, "I'm dying, I'm dying," as if it had just occurred to him. The nurses gave him more Ativan. At five hours, a new pattern appeared. He started to doze, not breathing for about 30 or 40 seconds, then he suddenly awoke with a start and with a wild look in his eyes, he started gasping for breath. This lasted for about two minutes, then he stopped breathing and appeared to doze again for another 30 or 40 seconds, followed by more gasping. (I have since looked it up and learned that this has a name. It is "Cheyne-Stokes" breathing. The literature claims the dying look more uncomfortable that they are, but who knows?) I just held him and talked to him. At six hours he wasn't saying much, but he gestured and said he had pain in his throat. I looked at the nurse and said, "Isn't there anything you can do to make him comfortable?" She gave him more morphine. Finally, a few minutes later he fell asleep and began to snore. I stepped out of the room and asked for a drink of water. I returned two or three minutes later, and he had stopped breathing.

Some of you may have been present through a "hard passing" death. I had never been with someone in the hour of death before. It was harrowing and disturbing. It left me spent and a bit numb. The nurse told me it was quite common. If you Google "death – agitation" you will see that this is how many people die. I had no idea. The movies portray the dying as very collected, saying things like asking Knute Rockne to tell the team to "win one for the Gipper" some day, or trying to give a cop a description of a criminal. That may be true for a few, but not for most of us. We are never quite in harmony with this world. Rudely shoved out, we enter this world, and many of us will be rudely shoved into eternity.

PS There was one funny moment. After switching my dad every few minutes onto one side or the other, at one point he was on his back, with his head elevated. He mumbled that he wanted to be moved again. I said, "Dad, which way do you want to go?" He just pointed up.