our last words
There is a memory that sneaks up on me at unexpected times, usually in the quiet moments, while waiting alone for an elevator or on my walk in to work in the mornings. Or, just before I fall asleep at night, the memory jerking me to full awareness and heart-piercing pain. It shoves its way into my mind, and I’m helpless to stop it.
* * *
I am back in the hospital’s emergency room, standing at the foot of my father’s bed as the ER physician tells me he may need to shock my father’s heart to bring it out of the rapid and unstable rhythm it has adopted. The heart monitor alarms over my father’s head. The heart rhythm itself might not be worrisome, but his blood pressure is dropping as the heart races, and this has everyone nervous and hovering nearby. The nurses have wheeled the crash cart to just outside my father’s room. I notice it – a hulking, red box on wheels, filled with everything needed to revive and resuscitate a crashing patient – and I feel nauseous.
First, though, the doctor will try adenosine to break the rhythm. “His heart may stop temporarily,” he tells me. “There could be a period of asystole, and he could have chest pain.”
I know this, as I have used this medication before, when I was an internal medicine resident treating a patient with supraventricular tachycardia (called SVT for ease). The hope is that the adenosine will break the rapid heart rhythm, setting it back into its normal beat. But the ER doctor isn’t sure if Dad’s heart rate is due to SVT or to atrial fibrillation. He thinks this will help him figure it out.
I nod my assent. “I won’t look at the monitor,” I say, lying. I squeeze my father’s hand and smile reassuringly. Dad can’t really hear anything being said, so he looks to me for an idea of what’s going on. I am aware that he’s watching my reactions. The nurses wheel the crash cart in and begin making preparations. I step out of the way and let the doctor move closer to the bed.
I can hardly breathe as the first dose of adenosine is pushed into the IV. I find that I cannot watch my father, and despite my intentions, I cannot watch the monitor either. I focus on breathing. I squeeze my father’s foot. He is wearing white athletic socks, and his foot feels soft and warm under my hand.
The first dose slows my father’s heart but the fast rate immediately returns, and a second dose is ordered and administered. There may have been a third dose after that.
My father’s blood pressure is lower, but the rate has slowed some, which makes the doctor happy. He is not happy about the blood pressure, though. It may not be SVT, the doctor tells me. Maybe it’s atrial fibrillation. The nurses leave the crash cart in the room and hang a bag of saline on the IV pole, connecting the tubing to Dad’s IV. Hopefully, the blood pressure will return to more normal levels as his veins fill with fluid.
Later, he has stabilized some. The heart rate is high, but not as high as before. It is acceptable. His blood pressure is still on the low side, but not low enough that he needs medications to improve it. He will be moved to the Intermediate Care Unit when a bed is cleaned. Not long now, we are told. He is thirsty, and I have gotten him a styrofoam cup filled with ice water. Using a bendy straw, he drinks most of the water and then sighs heavily, closing his eyes. He leans back in the flimsy ER bed, shifting his weight, getting as comfortable as the bed will allow. I can tell he wants to doze off.
It’s a Friday night, and it finally feels like he is comfortable enough for me to leave him for the night. And I trust his nurses.
“I’m going to head home to Sam and the kids, Dad,” I say, loudly, into his ear. His hearing is terrible and has only worsened over the past year. Hearing aids don’t even work any more. I’ve resorted to inadequate sign language over the past several months.
He opens his eyes, as if noticing for the first time that I am there. He nods and reaches for my hand. I take it. His hand is clammy and damp, but his grip is strong. I rub my thumb over his thumb, the one that is shorter. Several years before, he cut the tip off of it with a wood saw, while making a cradle for my daughter, his only granddaughter.
I lean down and kiss his forehead, letting go of his hand. He smells like the nursing home. As I walk out of his room, I pause at the glass doors and look back at him to wave.
He looks more alert and says, “Do they think this is serious?”
“I’m not sure, Dad,” I say, telling the truth. I reassure him that the doctors will monitor him closely and probably do some more tests. I tell him that I’ll be back in the morning, that I will find him in his new room. I’m not sure how much he has heard, but he seems to understand. He nods and settles back on the bed, raises a hand in goodbye.
“I’m sure everything will be okay,” I say, smiling. He does not say anything more but smiles back at me. I walk away.
* * *
It is the memory of this last exchange that brings me to instant tears, even an entire year later. Those were his last words to me, and I had told him that everything would be okay. The stroke that would kill him within the week happened that night.
I can’t help but wonder if I could have prevented it in some way. I know the answer to this, I do. But this thought – this question – fills my heart with dread in the quiet hours of the night, before I fall asleep. When these thoughts happen, I question myself. I question everything.
I think the adenosine was to blame. I wonder if I should have stopped the ER doctor from performing the bedside cardioversion without first having a cardiologist involved, or without first ordering an echocardiogram to look for a clot sitting in my father’s heart. Was there an alternative that could have been – or should have been – attempted? Or was this stroke destined to be, either then or at another time? Is the adenosine to blame? Or is nothing to blame?
I torture myself with these questions. And just as I know that I am not responsible – and gosh, how egotistical it is of me to even think I could control the events of that evening – I can’t help but have these thoughts.
February 27 will be one year since my father’s death. I just want it to be another day, a routine and ordinary day.
But it will never be just another day.