A year before my father died, he had a stroke. He could blink his eyes, and not much more. Once we realized he was conscious (tough to tell when only the eyelids are working), we tried Morse code. He knew it, we did not.
We finally got a child's alphabet board--bright yellow, with big letters. Eventually he would get good enough to point rapidly with his arm, but that was weeks away.
His own doctor was fighting lymphoma, and understood that life is finite. Not all docs work with that assumption.
Dad was on a ventilator. He wanted to die, not an unreasonable desire under the circumstances. His physician agreed it was reasonable.
When I was a pediatric resident, cystic fibrosis, a brutal disease, killed people even faster than it does now. A young man wed to a ventilator asked to be removed. On his 18th birthday, the legality of his request was no longer an issue. He got morphine, his family was at his side, and the tube was removed. In issues of survival, the brain stem trumps the cerebral cortex. Air hunger is difficult to watch.
A day or two after my Dad's wishes became clear, the only two functioning neurons in the voluntary part of his brain fired simultaneously, and he managed to wrench the tube out of his throat.
My brother was there, I was not. He had never seen someone dying of air hunger before. In a small hospital in Vermont, a doctor covering the ER ran up to the room and asked my brother what he wanted to do--reinsert the tube or let Dad die. The doc had no business asking that question, and my brother could only answer one way. It was a cowardly question.
A year later, my Dad, drunk on rum and orange soda (one of these days I will try it for Dad's sake), piloted his motorized craft down the double yellow lines of Stockton Avenue on a late June afternoon in Cape May, gurgling and laughing as I chased him down the middle of the roadway.
He used to fly A4's off carriers. I, like an idiot, tried to chase him. Piece of advice--don't chase ill-mannered dogs or drunk Dads.
When we asked my Dad how he felt about being reintubated, he merely said he remembered none of that. I think he was lying.
If you asked how he felt less than two months before he died, on a late June afternoon full of rum and life, he would have laughed, then choked, gurgled, turned purple. He did that.
June 21st marks the end of the growing sun. Litha. The day the gods taste mortality.
There are two good ways to measure a child for an endotracheal tube. Guess her age, add 16, then divide by 4, a fairly simple arithetic for my generation, even with a bleeding child in front of you. If your brain freezes, you can use the child's pinky as a rough approximation for the outside diameter of your tube. Just hold the tube next to the pinky. When a child is in shock, the pinky and the tube feel remarkably alike.
A Midsummer Night's Dream happens on the solstice. Any other day it would just be another comedy.
August is not midsummer--by August, you can smell death in the warm breeze. Lughnasadh. The Corn Mother wanes--we used to make corn dollies to honor her.
My Dad died in August--but he died without a tube, surrounded by his family. And a few days later, after most of his energy had been released back into the sky, his bones were scattered on his garden.
