Blindsided on an Idle Thursday

I think that most, if not all, of the extraordinary days I have experienced have started out as very ordinary days. Last Thursday was one of those days.


What was it that Baz Luhrmann said in that song to the graduating class of 1999?

“The real troubles in your life are apt to be things that never crossed your worried mind; the kind that blindside you at 4pm on some idle Tuesday.”


Thursday was just one of those ordinary, idle days - all the way through, pretty much. We were tired because Spud is keeping me up at night, so we oven roasted some ribs, ate, set aside half a rack for the Fella to take over to his mother (she’s 80 and she lives close by so we often make extra when we are cooking to drop off to her) and by 10:15pm we were in bed, lights out, congratulating ourselves on getting to bed early for a good night’s sleep.


At 10:30pm, on the dot, came the blindsiding. The phone rang. The Fella answered and I could hear his mother’s panicked voice, “I don’t feel well. Can you come?” My husband was already rolling out of bed and reaching for his trousers, “I’ll leave right now.” I stayed in bed to keep out of his way while he grabbed the rest of his clothes and he headed out the door, saying, “It’s probably nothing, you try to get some sleep and I’ll be back in a little while”.


I lay there in the dark wondering whether or not I should really stay put or get dressed. As I lay there in the dark, I heard 1...then 2...then 3 sirens. It was about 10:42pm. My heart sank like a stone – it could have been coincidence but we live in a quiet part of Vancouver and the Fella’s mother only lives about 2 blocks up and 1 block over.




The phone rang. It was the Fella. He was in tears, “It’s bad - about as bad as it gets. The paramedics are here, working on my mother. I cannot get through to my brother on his cell phone. Can you find another number and ring him?” I said, “Ok. Stay with your mother and I will come find you - either at her house or at the hospital.” He said, “I am not sure if they’ll be taking her to a hospital.”



By sheer luck, I had stuck my BIL’s (Brother in Law) house phone number to the fridge recently. So I got up, phoned and luckily, he was in. I explained. He said, “I’ll leave now.” Then added, sounding a bit perplexed, “But I spent all afternoon with her. I left her at 6pm and she was fine.”



It was 10:50pm. I drove over to my MIL’s (Mother in Law’s) house. I wasn’t sure whether anyone would still be there but as I turned into her street I could see a fire truck and two ambulances parked outside her house. The Fella was standing on the lawn talking to one of the ambulance crew and my MIL was on a gurney, being wheeled across her front lawn towards an ambulance. Her face and shoulders were so pale that they almost appeared to glow in the dark.



The ambulance left with my MIL for the hospital and we waited to lock up her house while the crew from the other ambulance cleared away all of their equipment and discarded medical supplies from her hallway. While this was happening, the Fella explained that when he got there, he found that his mother had left the front door open for him. She was waiting for him, sitting in a chair in her hallway - coat and shoes on, handbag over her shoulder and her house keys in her hand – ready to go. He thinks that she tried to say something as he walked in through the door but then her eyes rolled upwards, she lost consciousness and was struggling to breathe. He dialled 9-1-1 straight away. The time on his cell phone was 10:40pm. He said that the firemen arrived first and helped his mother until the paramedics arrived.


When the crew had tidied up, I drove us to the ER where we completed his mother’s registration at the front desk and were shown to a Family Room by a social worker who told us that my MIL’s heart had stopped twice on the way to the hospital but that they had got it going again and were working on her now to stabilise her. It was about 11:20pm.



The family room was a blue-grey carpeted box with two sofas, two coffee tables, a spare hospital bed and a very small, lonely looking box of tissues. The social worker bought us both a plastic cup of water and we waited. The Fella was in pieces – in shock at finding his mother, the trauma of seeing the emergency crews work on her at her house and knowing that the situation was pretty bad. My BIL phoned us twice to update us on his ETA and we explained where he would find us.


Just before he arrived, two ER doctors came in to see us looking very glum. They explained very carefully that the situation was very serious and that they were trying to stabilise my MIL but they were not certain what was causing the problem. They warned that she seemed decided to go, rather than to stay and they said that without the assistance of the paramedics, she would not have made it this far. In a little while they said that they would take us in to see her. They left. My BIL arrived. We waited some more.



Eventually, the social worker came back, warned us that my MIL was hooked up to a breathing machine and then we were ushered through the ER to see her. We walked into a brightly lit, busy area with 4 work areas, separated by dividers. It was just like walking into a hospital television drama set. I looked at the floor as there were other people being worked on when we walked in. The medical staff looking after my MIL had stepped back to allow us through to see her. She was almost unrecognisable - chalky white, naked (partially covered up by some kind of blue rubber pad), surrounded by machinery, intubated and her chest was heaving up and down mechanically with the rasping of the breathing machine.




I stood back to give the Fella and my BIL some space but they appeared as bewildered and disorientated as I felt. It didn’t look possible to get close enough to touch her through all of the machinery, so all they could do was stand and look at her from about 6ft away. The medical team ushered us back out to the Family Room so that they could continue working. The social worker said that they were preparing her to go up to the Cath Lab. We waited.


Two new people came to see us in the Family Room. One of them, a man, introduced himself as the Cardiologist. He asked who had found my MIL and asked the Fella some very specific questions,
‘Was she breathing when you arrived at her house?’


‘She was trying to.’

‘Was she breathing – yes or no?’


‘She was trying to, yes.’

‘What time did she ring you at your house?’


’10:30.’

‘What time did you call the paramedics?’


’10:40.’

‘What was her health like before today?’


‘She was on high blood pressure medication but she was very able and independent. She lived alone, still drove a car and ran her own business, working at weekends.’



The cardiologist outlined two options, saying that the Fella and my BIL needed to decide how to proceed.


The first option was to intervene further. It was thought that my MIL had a clot, a blockage, in her heart. They could take her up to the Cath Lab right away, prepare her for surgery and perform an angioplasty. The surgery would take about 15 minutes and the hoped outcome would be that her blood pressure would stabilise. However, he warned that her condition was considered critical, that there was a high risk that she could die on the operating table and it was not 100% guaranteed it would resolve the problem.


The second option was not to intervene further. He would instruct the ER team to step back and adopt a palliative care strategy. They would make my MIL comfortable and we could spend her remaining time with her. He confirmed that without surgery, there was no possibility of recovery at all.


As you can imagine, there was a lot of discussion at this point. I kept quiet except to ask clarification questions and follow up questions to elicit more information from the doctor. The penny dropped for the Fella and my BIL that the reason the cardiologist was asking all those pointed questions about breathing, timings and previous state of health was that he was trying to rule in or out whether she might have sustained some kind of brain trauma from lack of oxygen and whether she would be fit enough to recover from the surgery/the entire experience.


When they asked about this, the cardiologist could not offer any guarantees. My BIL asked whether they could check brain function before surgery, he said that they could but that would delay the heart surgery by a further 30 plus minutes. If they decided to proceed, then they needed to do the procedure straight away. He did say that he thought it was a positive sign that she’d been coherent on the phone to the Fella at 10:30pm, that the emergency services had got there very shortly after 10:40pm and that she had fought the intubation in the ER. Apparently, you have to be pretty much a vegetable if you choke that down without any resistance. Although, I think that the phrase the doctor was much more politically correct. He said something like, ‘they worry about whether someone has sustained neurological damage if they don’t fight the intubation.’


At the end of this part of the discussion, it was not clear that proceeding with surgery was the right thing to do or not. It might/might not help to stabilise her, she might/might not survive the procedure and she might/might not be okay afterwards.


So, the discussion turned to what my MIL would want if she was there and able to speak for herself. I can vouch for the fact that she’s a fiercely independent woman with a very strong set of views and a very particular outlook on life. As it happens, she had retired from working at this hospital some 20 years earlier as a Social Worker. According to her two sons, she wasn’t very fond of sick or infirm people and she certainly wouldn’t want to be one herself.


I think that the big worry for the Fella and my BIL (not for them but for her) was that she would survive surgery only to face a long recovery, be physically or mentally disabled in some way, be unable to live her life on her own terms and have the rest of her life overshadowed by the fear of having to go through something awful like this again. Very upset, they concluded that if she had been there in the room to speak for herself, she would not have wanted the surgery.


So they opted for palliative care. The cardiologist left to speak to the ER team. The social worker came by and said that she would take us through to see my MIL again before they took her off the breathing machine. This time, I opted not to go – I thought that her sons should be have some time with her on her own and I did not need to see her in the way that I had seen her before. When they came back, the social worker said that after they had taken her off the breathing machine, they would move her to a private room and we could spend as much time with her as we wanted. We waited again. What was the time at this point? I knew but I have forgotten already.


You know, in my naiveté and from watching too much ER, I thought that when they switched off her breathing machine, that would be it. I guess that I was preparing myself to spend time in a room with a dead body for us all to say goodbye to my MIL after she had died.


So it was with some surprise that I walked into the ER ward cubicle and found that my MIL was still alive - unconscious, intubated and hooked up to two drips and oxygen but still very much alive. She looked like she was having a rough night’s sleep but it certainly didn’t look like she was about to gasp her last.


The nurse explained that she was breathing on her own and was medicated so that she wasn’t in any pain. He said that we could stay with her for as long as we wanted. If she was still with us at the 7am shift change, that they would probably move her to a Family Practice Palliative Care bed. I cannot remember what the time was at that point but when the nurse said 7am, I remember feeling - courtesy of my regular bouts of insomnia – that it was a time on the clock above the hospital bed that felt like it was half a lifetime away from the current time on the clock.


So we sat, we watched her breathe, we chatted and, effectively, I suppose that we waited for her to die. We were not sure what else we should do - where else would we be?


It was a long night and after the initial drama, the rest of the night was quite peaceful. We sat around her bed and, at one point, we thought her colour had improved greatly. She was breathing so well, we wondered if she might pull through. We asked the nurse about her condition when he came in to suction her breathing tube but instead he confirmed that the way her breathing had started to change was a clear indication of her body starting to fail.


At about 4:30am or so, her breathing became more shallow. A doctor came in and told us that he was going to remove her breathing tube to make her more comfortable. The nurse who removed it was ever so gentle. She spoke to my MIL as though she was awake and conscious, speaking to her by name, telling her exactly what she was doing, what she needed to do and how she might feel the need to cough. After she removed the tube, my MIL breathing was more laboured, so the nurse raised the head of the bed so that my MIL could breathe more easily. Once the bed was raised up, a lot of her colour drained away again and it was clear that she was not doing well at all.


At some point after that, I went outside for some fresh air. While I was outside, I phoned my father to tell him what had happened. I must have been on the phone for longer than I realised as when I got back, it was 6:10am, my MIL had died and the social worker was there to hand us some information leaflets.


I think that the last time I saw a dead body was when when I saw my grandmother in her coffin at her wake. It took me a long time to get over that as she didn’t look at all like the grandmother I knew and loved. This time though, it didn’t feel odd or strange to be in the same place as my MIL’s dead body. It felt like a natural progression from the rest of the night. She had been breathing and now she had stopped. She was sitting up in the bed, looking distinctly grey with her eyes closed and her mouth ajar. I felt a bit relieved for her that her ordeal was over. I do not feel badly that I was not there at the very end. In some respects, I thought that it was right that it was just her together with her sons.


The social worker told us that we could continue to stay with my MIL for as long as we wanted. However, the Fella felt that he’d said his goodbye and now that she had gone, he felt that we should go as well. So I said goodbye to her and as we left, the Fella did something that he often does to me if he is up and I am still in bed - he affectionately wiggled his mother’s foot through her bedcovers and said, ‘Goodbye Polly’.*


‘Polly’, Fella's Family Matriach: 1930 – 2011.



Notes

*A pet name that he and his mother used to call each other. They used to have a parrot.


Written with many thanks to everyone from our local emergency services and hospital who worked on my MIL - your efforts gave us the extra time we needed to say goodbye properly.

We're all okay - the Fella is grieving and we are gently taking each day at a time.