I didn't picture it like this.
I pictured a darkened room, shades half-drawn, subdued sunlight negating the need for anything artificial. A neatly made hospital bed, with a single IV line connecting my dad to a single IV pole with a single IV pump and a small, clear bag.
I imagined him sleeping comfortably, and, if he stirred, pushing IV morphine myself and watching him settle back into a satisfying slumber until his breaths rattled thin and irregular and eventually stopped altogether. He would not be awake. He would not be present. He would not be in pain.
Memorial Day at 2pm my mother called me at work, never a good sign. She said he had been in so much pain all weekend he was crying. She wasn't wrong. I left work at 7:30 to come home and immediately call the on-call hospice doctor, at 9pm at the end of a 3-day weekend. My dad has always had a way with good timing. We upped his pain medicine strength and dosing schedule. I woke him up throughout the night to make sure he took his pain medicine. I eventually slept around 10 or 11 and set my alarm for 4:30am for pain medicine. By the time I woke him up, he was in a different place. He was relaxed, awakened easily, aware, and wanted to talk. So we did. For 50 minutes. He smoked a bowl, we watched the sun rise, he ate breakfast, and at last, he took his pain medicine.
It was an incredibly pleasant memory because it was impromptu and genuine. He was himself. So completely unexpected timing, but we take the memories we get whenever they happen. Life never fits neatly into perfect boxes. Sometimes the most lucid, peaceful moments come after 18 hour days and 5 hours of sleep.
I never pictured it like this.
2 weeks later, he is even thinner, if that is possible. His right leg is large and red and his right arm is small and white. DVTs. His skin would be pale if it wasn't yellow. Inconceivably, he still has a watch tan. We match. He twitches a lot, but his pain is better managed. His Hospice RN, and he, surprisingly, too, articulated that his pain is as much emotional as it is physical. When were we supposed to learn that? Because of that, we give him pain medicine for both. I never knew. Our kitchen table has been transformed into a home-cooked controlled substance cocktail lab. Blue morphine, crushed pills, and small syringes lined up methodically, with detailed recipes at the side for each time and dose we administer. The opposite of a locked pyxis requiring a fingerprint, accurate count, and audits for appropriate use. Here we leave large doses of potent opioids in unmarked syringes mixed with ativan and haldol, in whichever concentration is best, whenever we deem best. It is both strictly regimented, ever 3 hours, but also totally up to my dad - whenever he needs it. Today I gave him a morphine syringe and then my mom and I realized we didn't even know who had mixed it or what specifically it contained. This morning, he was crying from pain again, so I unflinchingly doubled his liquid morphine dose, without consulting anyone. Then I stopped to marvel at this foreign system. While polar opposite of the regimented, heavily regulated hospital system, this is no less effective. The nurse sat cross legged in my dad's bedroom on his bed in the dark and stroked his stomach in the direction of his bowels to relieve gas. Bedside nursing indeed.
I never imagined the dark humor. A close childhood friend, whom he's known for 15 years, asked me to tell him she loved him, as he is no longer receiving visitors. I joked to my brother I'd tell her my dad said "Who?"
He has begun dreaming of deceased loved ones, and speaking with people who are not physically present. I woke him up this morning and he looked behind him, mentioning he thought he heard someone. He told my mom this morning, "But I have so many places to go." The hospice RN told us she sees this commonly in people passing on to the next life, and that people from his past have come to keep him company and ease his way. This was a part I did not expect, having never seen the dying process this intimately. It's cathartic, and seems to bring a closure to this life and an invitation to the next. It is as beautiful as it is heartbreaking. A journey set in motion, and he is moving on to places where I cannot go with him.
I never imagined letting go would be so difficult. I have always loved him, and I have always wanted a peaceful death for my dad. But after spending so much time and effort on his care, it is difficult to finally see that he is transitioning, and that my part will be less needed, and will end. It is more pushing a boat away from a dock than it is scuttling a tumor-ridden dingy. This does not feel like an end, because he will not be gone. His network of loved ones lives on, as will his memories and impact on so many people. I did not imagine death would feel like a transition, instead of the end.
In one of his last sustained, present moments, he dictated part of a post to family and friends. He ended it with,
"The river's getting rougher, and the support that I am so honored by can only help so much. When you're swimming through a class 4 rapid, it's really just you and the river."