Holding Pattern

Homer: Now, we play the waiting game..
Homer: Aw, the waiting game sucks. Let's play Hungry Hungry Hippos!

The Simpsons, “Mr. Plow” (11/19/92)


In our last episode, I was about to get on a plane to Florida because my mother had a severe stroke and my brother was coming apart. For all the bitching I did in the airport, the plane trip itself was uneventful. Because I bought one of the last tickets, and therefore was one of the last to get a boarding pass from Southwest, of course I didn’t get a great seat (center seat—which I hate—and way toward the back), but the company was pleasant enough and I managed to stay occupied with my Kindle. In fact, I was so deep into reading (and my ears were quite pressurized besides) that I didn’t even hear the “turn off your electronics because we’re landing” announcement; a flight attendant had to give me the heads-up.

I got my luggage and moved to the car rental counters, and that went without a hitch as well. Once I got on the road I called my brother (hands-free, thank you ) and let him know that I’d landed and would be at his place soon, or should I go straight to the hospital? He told me to come to the house.

Shortly after he hung up with me, he got a call from the hospital saying that my mother’s blood pressure had dropped and maybe he should come in. He waited for me and we both made our way to the hospital. After a few minutes with a security guard who was having trouble with the Visitors Pass Badge software, he let us through and we headed up to her room. By now it was nearly 2AM.

The figure in the bed was my mother, and yet it wasn’t her. About four IV bags led to a single line inserted in her arm. A ventilator tube was in her mouth. This wasn’t sleep, it was something else again. Shaking her wasn’t going to do any good; this much was obvious. Of course, there weren’t any doctors in the area at that time, but I spent a few minutes with an RN who gave me the score: we’d been called because her blood pressure had gone way up; they gave her some medication and it went way down; by the time we arrived it had more or less stabilized. In short, she’d had a hemorrhagic stroke. Based on the scans, it was likely that something had been going on for awhile, on the order of more than a day. and it finally manifested itself on Friday morning when she wasn’t waking up. According to the neurosurgeon, she continued, operating would have had no positive effect on her situation. While there was some breathing on her own when she was first admitted, it was quite irregular and that’s why the decision to insert the tube was made. In short, we were looking at a very poor prognosis, her time remaining being on the order of somewhere between hours and a few days. My brother and I sat with her awhile and went home to get a few hours’ rest.

“A few” turned out to be far more accurate than I meant it to be; I slept for exactly three hours. Not wanting to disturb anyone, I stayed holed up in my brother’s guest bedroom for another hour or so, mostly reading and contemplating things. When I finally emerged, it turned out that everyone else was also up. We got our act together and headed toward the hospital. First stop, however, was my mother’s house.

One thing in which I struck rather lucky was in the fact that my mom planned ahead for a lot of things, including this eventuality. She’d pre-paid for her funeral, so nearly all of the expenses are covered. She’d set up trust funds for family members. She kept telling me that I was to be the executor of her will, and on and on. At one point over a year ago, I said to her, “Mom, this is all great but I have no idea what it means.” I don’t want to know how much I’m getting after she dies, I need to know who to call, where the accounts are, and so on. Finally she arranged an appointment for the two of us to meet with her attorney. During that meeting she assigned power of attorney to me and set me up as her healthcare proxy. She also signed a Living Will on that day and made some modifications to her Last Will, including a provision that my grandmother be permitted to remain in the house as long as necessary, should she predecease her mother. That was this past December. Prescient, no?

The next day, we returned to the hospital, along with my grandmother, my nephew and my sister-in-law. By now I had the legal documents in my hands and the doctor—who had rather poor bedside manner but I appreciated his candor—went through some of the details and explained them to me. The bottom line regarding the Living Will was that it didn’t really apply in her case because of her condition. This wasn’t someone in the last stages of cancer or a traumatic brain injury where she was able to continue on her own without machines. This was someone, he explained, whose prognosis is Nil. There were no miracles in this case; this wasn’t someone who was going to squeeze your finger on command, then blink their eyes and wake up. At this point, he said, we were due to be approached by a representative from a company called Life Link, which is a local outlet for organ donation, since my mother was listed as an organ donor on her driver’s license. At that point I decided that we really didn’t need everyone hanging around and being on some kind of Deathwatch until the very end. I suggested that my nephew, sister-in-law and grandmother say their goodbyes and go home, and my brother and I would stick around.

A while after they left, the representative from Life Link arrived. What she told us about the mechanics of the donation process was a little different from what the doctor told us, but it made sense. Here’s what happens: after we give the final consent for them to collect organs for donation, we complete a medical history questionnaire. Then lifelinklogoLife Link obtains two letters for the file, called “Brain Death Notes”. The time stamp on the second note becomes the Time of Death for the patient. At that point she essentially belongs to them: staff stays with her the entire time and they take over pretty much everything. Tissue and blood samples are collected for testing and screening, and types are determined for cross-matching to potential recipients. The recipients are notified to get to their transplant center ASAP. When everything’s in place, they set up a time to bring the donor into an operating room. The sterility conditions for this OR are more strict then typical, because they want to reduce the risk of infection as much as possible. Once the organs are harvested, the ventilator is disconnected.

Now, this whole process takes about 24 hours total. We didn’t know that earlier; we thought that she’d be disconnected not very long after we had the initial meeting with Life Link. So the closure to this was being delayed another day for us. Not so great in the short run. They promised to call once the OR had been set up so that, if we chose, we could visit once more. What they couldn’t tell us is what time they’d make the call; it all depended on the other pieces falling into place. The call could come at 4AM or it could come at 4PM. So we were essentially on standby, waiting for the end.

This afternoon, I got a little impatient and curious and called them to find out what was up. The person who answered the phone said she’d get in touch with our coordinator and she’d get right back to us. Five minutes later, a young lady named Inga was calling me up. As it happened, she was just about to call to tell us that the OR would be ready in about 90 minutes. I told her that we’d be coming down. This time around it was just my brother and me. Inga told us to take as much time as we needed. I let my brother go in first and let him say his say. Then I went in.

I’m not going to share what I said to her; I spill enough of my secrets here that you don’t need that too. But I’ll tell you that, even if the timeline didn’t work the way I expected it to, I’d managed to be a little selfish in the way I set things up. I needed my sister-in-law and my nephew out of there. My grandmother—oh, my god, my grandmother. She just buried her only other child a couple of months ago. This is such a perversion of the “natural order of things” that I still haven’t fully wrapped my head around it. But she really didn’t need to be around at the end, so she needed to be out too. With my brother and me, I made the point of sending him in first, for numerous reasons but there’s still a selfish one in place, and I’ll own that. As the oldest brother (there’s a third brother who could not get there in time; we were in constant contact with him throughout this), I got to be with her first, therefore I was taking the “privilege” of being with her last, as well.

When I emerged from the room, my brother was barely holding together about ten feet down the hall. I went to Inga and her assistant, Matt, and told them that we’d be going. They thanked me for our generous gift, “and thank your brother, too,” Matt said, nodding down the hall. “Make sure you thank her, too, “ I said, pointing my thumb backward toward the room. Matt promised he would and I joined my brother. We hugged each other for a long minute and then he voiced the same thing I was about to say:

“Let’s get out of here.”

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