Death of the Patriarch, Part I

Death of the Patriarch

Part I

“Death be not proud, though some have called

thee mighty and dreadful, for thou art not so…”

-John Donne

He was, or he would have liked to believe that he was, the beginning and end of the lives of those who surrounded him. The legions of people who loved (and sometimes feared) him. He rarely wished anything for himself: his major joy was to see his wife, children, and thousands of his students doing well and thriving. Although he worked three jobs and he rarely took a break, old age found him dependent on his pension and social security, because he invariably gave his money away to people who needed it more than he did. Any time that his friends tried to talk him into investments, or savings, he shrugged them off. He felt well; he would work forever. He never bothered to write a will, and he refused to discuss money with his children, other than to ask them if they needed any.

Other than minor issues with his prostate and diabetes he did not visit his doctor. When he was in his late seventies he could still walk three miles to the post office (he never learned how to drive; he walked everywhere and he had dozens of people that he could call and ask for a lift). One day a car ran into him and threw him thirty feet away. He did not break a bone, and he walked away, but his loved ones began to see a change: he no longer trusted himself as much.

Within a year his wife noticed that he slurred his words, and he was weak on the right side. He refused to call the doctor: he would be OK. His children were notified.  Two of them were physicians. His wife called both; maybe they could talk some sense into him.

I happened to be home early that day. Lucky, because there were no cell phones in those days. My mother explained the situation to me. She handed me the phone.

It was clear that his speech was slurred. But I could tell that he understood me.

You are having a stroke. You need to go to the hospital.

He answered with a few objections. For sure, he would feel better tomorrow.

Why did I bother to go to medical school? All the money that you paid for tuition, and now you don´t trust my judgment?

He began to cry. He handed the phone to my mother.

Take him to the hospital. He is ready now.

It did not go well from there. His doctors were not as competent as his kids. The therapist asked for too much effort. The food was not to his liking. He did the assigned exercises his own way, on his own schedule. Changes were made to his home: a walk-in shower was built; a hospital bed was brought in.

To little avail. He improved a bit; then he failed to follow the rules and fell. He broke a hip. He had another stroke. The once proud, brilliant, strong leader was reduced to an unintelligible, contracted mass of human tissue.

His children got together. We decided that no further treatment would be given to him. Our mother reluctantly agreed to this plan. A young, bright, very pretty woman was hired to help to turn, feed, and bathe him. This he obviously liked: his whole life had been based on being around bright young people, most of them female. Maybe he deluded himself into thinking that this woman was his last student.

Months passed. I was home on vacation. He had been ill, and I was doing my best to visit as much as my busy practice allowed. After I hugged my mom I briefly spoke to my dad’s caregiver. I was reassured that he was in good hands. After reviewing all his medicines and symptoms I went into his bedroom.

Things had changed. The hundred-year-old bed (OK: it looked like it was a hundred) had been replaced by a hospital bed. Beautiful oak had given way to stainless steel side rails. You almost had to jump down from the old bed. This one could be cranked to make transfers easy. The mattress was covered with impermeable material. The embroidered sheets, a thing of the past. Hospital white prevailed.

Clean. Convenient. Sterile.

My dad seemed to be asleep. I edged closer, then sat down next to his right forearm.

Papá, I said softly.

No answer. I spoke louder, but still got no response.

The doctor in me took over. I had been in these situations so many times in the past: it becomes second nature to walk into a sick room and assume that this is your show to run. I made the transition in a split second. My mentor and guiding light became a patient.

His pulse was weak and fast. Shallow, rapid respirations followed by spells of prolonged absence of respiratory effort. Warm forehead; cool feet and hands. A bit sweaty.

How long has he been like this?

“Since yesterday,” answered my mom.

He is dying.

My mom was surprised. The caregiver, who had some medical training, nodded.

“We must call the doctor. When he had his last infection, an antibiotic helped.”

I took a deep breath.

We have discussed this. All of us agreed that there would be no more antibiotics. Have you changed your mind?

“Last time, the doctor said that he would die without medicine.”

I nodded but remained silent. I realized that she needed time. Fifty-seven years’ worth of memories had to be reviewed and stowed away somewhere.

“Oh.” She looked to the floor. 

Without any additional words she made it clear that I was taking over. This had been the core of our relationship with our parents almost from the time that we were born. Yes, they loved us. It was crystal- clear to us that they would have done anything for us. But more powerful was the bond formed when we realized, at some point in our development, that they had absolute, unshakable faith and confidence in us. In their eyes we could do no wrong; we would do no wrong. This was probably the reason that we thought three times before we did something stupid, which yes, we managed to do every once in a great while.

I called one of my cousins, so that he could pass the word. The sister in Spain had to be notified. And the one in Kentucky. The sister in Boston, if I remember correctly, was already in town. My mother called the priest, and the doctor was asked to place him in Hospice care.

I was doing the right things. Dotting all the i’s. Running the show; making the same moves that I had made hundreds of times in the past. Making sure that my performance was up to my exacting standards.

Now, twenty years later, I realize that I had forgotten one thing.

That was my father who was dying in the next room.

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