If someone asked me a few days ago questions pertaining to death, I would have answered in a nonchalant manner. It’s not something I’m afraid of. It's not something that saddens me. It’s part of the natural order of things, and death will come to everyone sooner or later. I have encountered so many deaths in my few years of medical practice, that I have become desensitized with the whole idea of death. Except for a few patients that I have been seeing regularly for a few weeks or even a few months, I have no deep emotional attachment to most of the dying patients that I have encountered. Once they’ve taken that last breath, I would check for definite signs and pronounce them dead in a very systematic manner. After one patient, I could easily proceed to the next. After all, once a person has died all that remains is a lifeless body, made up of organ systems that have simply ceased to function.
But that was me yesterday. This is how I am now. After more than a month in the hospital, we finally decided to bring our grandfather home. I often advice relatives of terminally ill patients to just bring the patient home and let him spend the last remaining days of his life in a familiar environment together with his loved ones, even though I absolutely had no idea of what it would feel like, how it can be both physically and emotionally draining. Such a recommendation looks so good on paper that I thought it was also the best decision to make with regard to my grandfather. The basic necessities were bought, and one room in our house was renovated to make it look like a hospital room, complete with all the basic equipment. Two private nurses were hired, so that means less work for us. However, more pressure was set on me because I was the one that they would call whenever there were problems. Everything was manageable though, and my grandfather seemed to be getting stronger, even though I knew that was quite impossible. He spends less time sleeping, he can carry conversations again, and the manifestations of psychosis seemed to have lessened a bit. But I knew in the back of my head that whatever sort of reprieve that we were experiencing back then was only temporary. Back in March i thought he wouldn’t even reach April… the fact that we were able to bring him home was nothing short of a miracle.
It was on Tuesday morning when things took their turn for the worse. He barely woke up again, and I wasn’t able to have any decent conversations with him again. Around lunch time I noticed that he was gasping for breath. He was trying to tell me a lot of things, but all that I could make out was something like… he was having a very hard time, he was finding it difficult to breath, and he wants to give up. Oxygen was administered, and after a few minutes he fell asleep. I knew back then that in an ideal setting, he should be intubated already. But it was agreed upon that we would just wait for the inevitable at home. Bringing him back to the hospital wouldn’t do much good anyway. And if it could add a few more days in his life, he may not even be aware of those extra few days anymore. It would probably just prolong the agony.
After midnight I went back to his room... though he was asleep he was obviously in respiratory distress. He woke up when I tried to listen to his lung sounds, and he just looked at me without saying I word. I wasn’t even sure if he recognized me. I smiled and said everything’s okay, and then he fell asleep again. It was on Wednesday morning when the nurses called me up again to check on him. He was lying on his bed as always, he looked exactly the way he was each time I checked on him on most mornings. Except this time, I felt no pulse. I couldn’t hear any heartbeat. There was no spontaneous breathing. Both of his pupils were fixed and dilated, and all his extremities felt very cold. I’ve been so used to the sight of death that I felt nothing at first, but when everyone started crying I felt tears welling up. I knew that it was coming and I thought that I was already prepared for it, but it seemed as if I wasn’t. I tried so hard to fight those tears but ultimately it was a losing battle. A few hours ago I witnessed him gasping for breath, a few hours ago he looked me straight in the eye and I told him that everything was okay even though we both knew that it was not. And now that he has expired, I was the one who would pronounce him dead.
I knew the exact moment when an endotracheal tube should have been placed. I knew the exact moment when vasopressors should have been started. I knew the exact moment when we had to do CPR and when those intravenous injections of epinephrine could have helped... and I wondered if I should have done those things instead of doing nothing. But looking back, those things wouldn’t be able to do much good anyway. All those life saving measures are only temporary and cannot sustain life in the long run. Doing so would only prolong his agony. I just wished I could have given something to have made it easier. I didn’t even give him anything for the pain. We ran out of oxygen during the wee hours of the morning and there was nothing I could do to help him breathe. Looking back, I just wish that he wasn’t in pain or in any form of agony. I just wish that he didn’t experience any form of hardship. I just wish that the last remaining minutes of his life didn't prove to be difficult for him... and I wish that he died with a sense of fulfillment, without any physical nor emotional burden... I hope that he died peacefully.
It has been a long day and I haven’t even slept yet. He had specific instructions that he did not want to have a wake. He just wants a short service in church, and then we should proceed to his burial afterward. Everyone had to do his part for all the necessary arrangements, and with everyone’s help, we managed to pull it off. We picked up some formal clothes in his closet, thinking of what he would want to wear... and what would look best on him. At the church, after mass, when we all took turns at dousing his coffin with holy water, I couldn't even look at his body without breaking in tears. By 6 PM, we were already at the cemetery back at his home town. The sun was setting on the horizon and the wind was blowing softly as we finally laid him to rest. Everything was so surreal, I could have sworn that it was all just a dream. The atmosphere was serene and for me, it was close to perfection. If he was still alive, I knew that he would be happy with what we all saw. We did exactly as he wanted, and taking all things into consideration, i would say that we did a good job.
We got back home at around 8 PM. Everywhere I looked, there are things that reminded me of him. I got so used to his daily routine through the years, that I would half expect him to show up. 8 PM... that’s the same time everyone usually gets home from work. That’s also the same time he goes up to his room upstairs to sleep, and we would see him on his way up and we would all kiss him good night. At 6AM, I would always expect to see him eating breakfast, and by 8AM I would expect to see him running around the garden as I’m leaving for work, doing his exercise routine. By 11 AM if I’m at home, I would expect him to call me, asking me to join him for lunch. At 5:30 PM he eats dinner, and he would always ask me if it was really all right to take that one shot of brandy after dinner so that it would help him fall asleep. Everyday, at those specific times, I would expect to see him going through his daily routine... his routine that I took for granted and never gave much attention to because I have become so used to it... and after a while reality would set in and I would begin to remember that he's gone... i would realize that i won't be seeing him anymore. I would realize that he'll no longer be there.
I entered my grandparent’s bathroom and the smell of pomade admixed with his aftershave lingered in the air as always. That was the same scent that I’ve smelled as I kissed him on the cheek that last time while he was still confined in the hospital. In the kitchen there are all sorts of herbal medicines in the cupboard... he was never fond of “manufactured” medicines, and we always had minor arguments regarding all those stuff that he used to take. In the garage his car is parked next to mine, that vintage Mercedes Benz that he refused to give up no matter what, despite the many offers from vintage collectors. I would always remember the distinct smell of its old leather interior, and how I always found it embarrassing to ride that car when we were in elementary school because all the other kids rode in cool and modern cars. When I went upstairs, I saw the makeshift gym that he has filled with equipment bought from those home shopping channels on TV, and I would always remember how he tells me I’m wasting money with my gym membership because he thought everything that I needed was already there. In the living room there’s still that Lazy Boy chair, where he sits all day just watching TV or sleeping when he was already too tired to move around the house... and now it's just an empty chair. Inside the makeshift office I saw the words “dada 56 years old” scribbled on the wall. I wrote those words directly below his picture on that wall back when I was 5, to commemorate his 56th birthday. My dad said that dada was how I called my grandfather when I was 2, and somehow it just stuck. Me and my siblings call him such, even to this very day. Scattered on the desk, I see lots of empty billing forms for the tenants in his apartments. Years ago he taught us this weird formula that he made up which was needed to arrive at the proper total billing. He said we needed to learn all that because we will be the ones who would manage his business when he’s gone. During summer he would bring my brother and me to help him do those basic repairs because when he’s gone we are the one’s who would take care of his business... it’s funny that now, both of us would want nothing to do with it. I went up to his room and I remember that talk we had last November, when he said that there’s nothing greater than remaining in one’s own country and serving his own people... and I answered that there’s no money to be earned here, that’s why I want to search for greener pastures. I can’t afford to be a hero or a saint after all. When I got home back in February, that time we talked in his room was also the last time he slept there, because he grew tired of going up and down the stairs already. His body wouldn’t allow him even if he wanted to. He was asking me a lot of questions about his health, and I had to cut it short because I still had plans for the evening. After that he grew too sick. That was the last meaningful conversation that we had.
All this familiarity has resulted into such a huge emotional investment. That’s the reason why his lifeless body is so different from all the rest. That's the reason why reality refuses to set in. I kept crying as I was holding his hand yesterday, wishing for him to still be able to feel my touch for one last time. I wish I could have said something better that last time we spoke, and if I only knew that yesterday was his last, I would have spent all day beside him instead of being holed up in my room studying. There are things that we couldn’t change, and there are things that we couldn’t take back, no matter how hard we try. He has been a part of my life for as long as I can remember, and will all those things that I wish I should have done still in the back of my mind, it makes it so hard to let go. I kept holding his hand for more than an hour since he passed away, denying the fact that the hand I was holding was no longer the hand of my grandfather. It was just a hand attached to another lifeless body, made up of worn out organ systems that have finally ceased to function...a lifeless body that has finally succumbed to the disease... and nothing I could do can ever change that fact. Nothing I could do can ever bring him back.
Nothing like driving on the freeway to keep my mind off things. I don't need a particular destination. I just drove around, moving in circles. It was just me, my car, and the road... with deafening music on full blast on the radio, I was all by myself, completely oblivious to the outside world.
