The End has Come

Dear friends, it is with great sorrow that I tell you of Boone's passing today.  I'm experiencing gaps in my memory, so please understand if I get something backward.

Saturday he had a setback where he was unable to hold his O2 level above 90.  He was put on a mechanical respirator that forced air into his lungs.  After a while it was taken off to see if he could hold his oxygen level.  He did fine for a while, then it started dropping into the mid 80's.  They put him on normal O2 set at its maximum level.  That was ok for a few hours, but then his oxygen level started dropping again.  They put the mask respirator back on him.

Sunday morning I arrived earlier than normal to find the rapid response team in his room.  They were stabilizing his oxygen again.  I'm not really clear on exactly what happened, but Dr. B. was there and asked me what I wanted to do.  Te question stunned me.  When asked if this was a life and death decision and he said yes.  The options were to send him to the ICU to have a ventilator put on him, and no doubt be tied down; which he hated, leave him in the ward on the respirator, or I think send him to Hospice.  All I said was that I wanted him to stay on the ward.  They would not restrain him the way the ICU would, and no telling what all tests the ICU doctors would want to do...It's more of a fog to me now.  There were so many people in his room and so much urgency.  I had no idea what I was walking into when I arrived.  I expected him to be in bad shape, but certainly did not expect this.

Dr. B. turned around and said "DNR".   Several people talked to me about what was happening, but honestly, I don't remember much of it, other than he now had an infection in his lungs and lots of fluid.  They were going to give him Lasix, an anti seizure drug, and other drugs for palliative care.  I asked Dr. B what was causing the horrible pain in Boone's knees that the pain meds were not controlling.  He said it was because Boone's blood flow was no longer reaching the parts of the knee and so the cells were dying, and said it is excruciatingly painful.

Boone was semi conscious all that day.  That evening Boone's brother and I discussed his situation and decided to ask Dr. S. on Monday morning if we could stop the respirator.  If Boone had an infection, then that was pretty much the end of the line.  I had been told this many times.  His immune system couldn't fight off any infection of any kind.

Monday morning Dr. H the infection control Dr. came in and told me that all of Boone's organs had or were failing.  Boone had not passed anything through his ostomy bag in 3 days, his urine was almost black, his skin was still getting more yellow, and now he has a gram negative infection in his lungs.  I asked her if taking him off the respirator was the right thing to do, and she agreed that it was.

It was Dr. S's. first day back from his vacation.  He heard something was up with Boone so after he did his clinic rounds he came to Boone's room.  He didn't know what exactly was going on because the last reports he had heard Boone was doing pretty well.  We asked him if we could remove the respirator.  He was obviously shocked at the question, and "no" was the answer.  He said he would do his rounds and be back around noon.  At about 9 o'clock he came back in the room; he had talked to the nurses, looked at the charts, discussed it with Dr. B, and said yes it's time.

Boone's brother called their youngest sister that lives nearby.  It was going to take her a few hours to get to the hospital.  We told the staff we wanted to wait for her to arrive before we did anything.  In those few hours, his closest friends from work came by.  We went out into the corridor while they said their goodbyes.  I could hear them laughing and talking.  Boone could hear them too.  Maybe he was laughing with them inside.

Nurses from other shifts had heard he was in bad shape and came to say how much they liked him and to shed tears with us, rub his arm, and tell him how much they enjoyed having him as a patient.  Of course the ladies from Housekeeping came by with big hugs and tears.

When Boone's sister arrived we were pretty much left alone in the room to say our goodbyes.  After many tears fell I went out and told the nurses we were ready.  After a few minutes they came in and said they needed to bathe him and get him ready.  Everyone excused themselves but me.  Together we gave Boone his last bath.  I washed his feet and one leg and one arm.  It was deeply moving to get this privilege to do this for him one last time.  As we rolled him to clean his back and change the bed pad under him he cried out in pain and fear.  It was an awful sound.  He was heavily drugged and still was screaming from the pain.  It was then that I knew for sure we were doing the right thing.  He was given another injection of Dilaudid, and then an anti anxiety drug so he wouldn't react when the respirator mask was removed.  I asked for 10 minutes alone with him before they called the rest of the family back.  After 20 minutes, I called the nurse to tell her I was ready.  The rest of the family was brought back in and the nurses began the procedure.  The mask was removed and Boone reached up to grab it and began to gasp for air.

We had been told it wouldn't take more than 10 minutes, but stubborn as he always was, he took about 30 to take in his last breath.  Dr. S. came in and listened for a heart beat, found none, consoled us and left us with Boone's body.

I think most everyone left the room while I sat there holding Boone's hand.  As the minutes went by, he became colder, more yellow, and his face muscles relaxed into a smile.

We cleaned out his room of his personal belongings, stayed as long as we could before the nurses had to prep him for the funeral home to come pick him up.

I kissed his head one last time and told him I loved him.