• LAST STOP

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    Lately I’ve been thinking about dying.  Not that final “Kachunk”, but the process.  The Grim Reaper is not yet in view, but I know he is lurking somewhere just below the horizon. 

     

     

     

    Last Stop

     

    Paul walked into the reception area, but his path was blocked by a grizzled old man pushing a walker. “Welcome to Hell,” the octogenarian said.  “What?” Paul replied.  I said, “Welcome to Hell, something wrong with your hearing?”  “I was just looking for Miss Rachet, the manager.“  “Why on earth would you want to see her?”  Paul tried to slide by the cranky old geezer.  “I’m looking for a place for my grandfather and Serenity Meadows was highly recommended.  My granddad basically raised me and I want the best care for him.”

     

    “Come, sit down a moment, I’ll give you the real scoop.   What’s wrong with Grandpa?”  

    “Quite a bit.  He has Parkinson’s, a tendency to fall if someone doesn’t assist him, and he can’t remember to take his meds. He really can’t take care of himself and there is no one around during the day to watch him.”

     

    “So you are going to stick him in here until he goes into the ICU as his Last Stop before death, or takes a Dirt Nap from the swill they serve at Serenity?”  “By the way you can either call me Henry or Geezer, whichever you prefer.”

     

    “Before we start, how old do you think I am?”  Paul always dropped 10 years when someone asked him that question.  “Oh, I’d say you are in your middle seventies.” “That’s a crock.  I’m not in my 70’s and you know it. They say that age builds character in a man’s face.  What about my face, do you see character or just blotted skin that is sagging south?” “Well a lifetime of experiences has entitled you to every wrinkle,” said Paul.  “What are you, a politician or a lawyer or an insurance salesman?” Henry said.  “I look 90 if I look a day and I’m only eighty-one.”   

    “I see you looking at my fancy red-and-white shoes.  Don’t apologize; they are special keds, with two big red Velcro straps instead of laces.  No coordination left in my arthritic fingers, and I can’t see well enough to tie a knot anyway.  Do you know how embarrassing and shameful it is to not be able to tie your own shoes or button the top button on a shirt or pants?  Look at these hands – there are enough age marks to mistake me for a spotted hyena.”

     

    “Oh, hello Stewart.” Paul looked up to see an even older man rolling his walker slowly along with a nurse right behind.  He was doing a baby step shuffle.  “Must of not heard me,” said Henry.  “Why is the nurse following so closely?” asked Paul.  “She isn’t a nurse, she’s a Filipino aid who makes $10 an hour.  She was lifting him up by his belt, otherwise his legs would give way and he’d be on the floor.  That could be your fate, my boy.”

     

    “Let me show you two pictures that I keep in my wallet.  Did you ever see ‘Dr. No,’ the first James Bond picture?” asked Henry.  “Yes I did.”  “Do you remember in the film there was a girl who comes out of the ocean wearing a white swimsuit – in the film her name was Honey Rider.  She was played by Ursula Andress?  I was in love with her from that day on.  I felt that way all my life until about three years ago when I saw a current picture.  My fascination died that day.  She should have gotten someone to shoot her up with potassium chloride and exited this life before morphing into a crone with bad plastic surgery.  Most people should be gone before they look this bad, and as far as I’m concerned there should be an enforced moratorium for any one who lives beyond seventy-five.”

     

     

    “Serenity Meadows is called a convalescence home – skilled nursing facility.  As if you are going to “convalesce” and return to your normal life.  The residents never leave here, unless they croak, run out of money or are headed for the hospital; then an ungraceful exit, unless if they run into a compassionate doctor who will aid their demise with some good night – sleep tight forever drugs.” 

     

    “What about the visitors who come to see you?” said Paul.  “I do have one or two relatives I still like to see, but for the most part, my visitors only come because they feel obligated.  Their standard greeting is ‘How are you feeling today’.”  They check their watches to see if they have put in enough time to stay in my good graces. 

     

    “But enough of that – let’s go upstairs and I’ll give you the real low down.”  They got in the elevator and went to the third floor.  “This is the worst level.  These rooms are for people that have run through their hundred days of Medicare and now are dependent on Medicaid, Social Security and relatives to pay.  They had to give up all of their assets otherwise Serenity will attach them.  Walk down the corridor and you can see what your grandfather has waiting for him.  But first take a deep breath. What do you smell?” “It’s heavy on the Pine Sol, but underneath I can smell a bit of an odor,“ said Paul.  “That odor is the excretions of 80-year-olds who couldn’t make it to the bathroom in time.  No matter how the staff scrubs, the smell hangs around.”  ??

     

    “Here is my friend Earl.  Earl, are you dead or are you just playing possum?”  “Did you bring me the Potassium Chloride?” said Earl, removing his oxygen mask.  “Next week, I promise.”  “What is Potassium Chloride?” Paul asked, “That is the second time I’ve heard you mention that chemical compound.” “ It’s the drug they use to execute death row prisoners,” said Henry. “I’m trying to mail order some from Bangladesh for Earl.   It stops your heart and then dissolves into your tissues so no one can tell the cause of death.”

     

    They started to walk by another open door – a tiny, frizzy-haired woman sprung out and grabbed Paul by the arm.  “Hello,” she said, “I used to be Alma Highstep, come on in and see my refrigerator magnet collection.”  Henry whispered, “Don’t do it, you’ll never get away, she’s got somewhere in the neighborhood of 435 magnets.  We got to go Alma, medical emergency.”

     

    They looked in a couple of other doors.  The residents were either napping face down or were dead, it was hard to tell.  Then they headed downstairs.  As the door to the elevator opened, there to meet them was Nurse Rachet, the manager.

     

    “Hello, I see you’ve met Mr. Grumpy,” said Nurse Rachet, “Don’t pay him any attention, he just likes to say outrageous things to bring attention to himself; he complains, but he really likes it here.  Are you going to go to dinner Henry, we’re having Salisbury steak and succotash?  Don’t forget to bring your bib; we’re getting tired of loaning you one.”  “What time is dinner,” asked Paul.  “Four PM,” Henry said.  “Oh, an Early Bird,” said Paul.  “Are you kidding, four is the regular bird?  The early bird is at 3:15.”  Nurse Rachet walked away, telling Paul she would be back in ten minutes to give him the real tour. 

    “How would you like to live inside this madhouse?” said Henry.  “Any chance of you running over me in the parking lot about ten times?  I’d consider it a favor.”  “No, then I’m going to set you up with my nephew, Dr. Richard Smart, he’s an ICU resident at the university hospital.  Works mainly night shift – sometimes he is on for 36 hours straight.  He’s not stuffy, and will be willing to bring you in at night. I’ll call right now, give me your cell phone, mine was stolen during this morning’s Old Maid card game.  Okay, we are all set – he’d like you there at 2:00 AM day after tomorrow.  Then come back here and we’ll talk some more.” 

     

    Paul called Dr. Smart and introduced himself.  The Internist seemed to have a good sense of humor about his uncle and told Paul he was in for a treat.  Two days later Paul showed up at the ICU at 1:30 AM.  “Hi, I’m, Dr. Smart, just call me Rich.  Let’s get you suited out with a white coat, stethoscope and badge.  We’re going on a journey through Dante’s nine levels of hell.  I’m the senior night resident although I have been here since 6:00 AM yesterday.  Just look semi-intelligent and drowsy – you’ll do just fine.”

     

    “This is ICU Ward Six, take a look around.”  Paul looked at the patients, some were sleeping; a few were glancing at TV; and a couple were being examined by a nurse or doctor.  “Eighty percent of these people will exit here in the next week or so.  They have been badly injured, stricken with a quick spreading disease, or had an operation.  If something doesn’t go wrong, like the Mersa Virus that lurks in all hospitals, they’ll escape – only two are on life support at this point.  But this isn’t the real ICU, that’s up stairs where I reside.   Let’s creep up the backstairs – the elevator’s too slow.”

     

    “First let me tell you about my professional staff here at the real ICU, Ward Five. I’m surrounded by my intelligent, well-trained, dedicated nurse corp, as they would tell you themselves – otherwise known as the Buffet Queens.  They make sure the vending machines are fully stocked, and if they are not grazing and gorging they actually can be helpful – they certainly have a lot more experience than I do. We’ll go down to the buffet laid out by the Queens around 3:30 AM if it’s relatively quiet.  They each bring a main course every night.  Don’t get in line ahead of any of them unless you are willing to take your life in your hands.”

     

    “Here comes Bertha, our Head Queen, you’ll see why I call her and the others The Buffet Queens.”  A huge woman with a ponderous rear the width of an axe handle waddled toward them.  “DD, you need to go to bed six, the soon to be corpse is rolling his eyes back again – he’s going downhill fast.“  “Why did she call you DD?” asked Paul.  “It stands for Dr. Death, since lately I’ve had a lot of patients die on my shift.”

     

    “In the ICU we have beds surrounded by curtains – so we can supposedly listen to the monitors and patient cries for help – but mainly it’s so we don’t have to look at them.  Take this guy Bert, for instance – 63 years old.  Been marinating his liver in Jack Daniels all of his adult life.  Smoked for 40 years.  Ate red meat at every meal and had a 32 oz. Prime Rib wrapped in bacon on Sundays – cholesterol level of 297.  Finally caught up with him about a week ago.  Heart attack – then another while he was in admitting.  The attack flat-lined Bert, but they got him going again with the defibrillator paddles and shipped him up here.   So much heart damage they cracked his chest for cardiac surgery, but it was a waste.   We’ve got him on a ventilator, a feeding tube and an exterior pacemaker.” 

     

    “He’s a goner, but the fool didn’t have a living will and his wife, Billie, is convinced he is going to recover.  He’s not; it’s a matter of time until one of his other systems completely collapses – right now we are having trouble keeping his lungs clear.  I think what will finally get him are his kidneys, and then he’ll become septic.  We have to call the code if he gets close because we have instructions from his family.  Fortunately he has Medicare plus a great supplemental policy that has a rider for catastrophic situations – such as being imprisoned in an ICU.  He’s keeping the money flowing to the cardiologist, oncologist, neurologist, pulmonologist, internist, radiologist, monitor techs, me, the nursing staff and anyone else who stops by daily to give an opinion at about $22,000 a day.  You see he’s wearing the normal hospital gown with the back open so his butt  hangs out.  Multi-colored so the blood and other fluids blend in.

     

    You’ll notice that we have his hands tied to the bed rails with four point cotton restraints – if we didn’t, and if he still had enough brainwaves, he would pull out all his tubes.  How would you like all that stuff shoved down your throat and nose and then taped in place as tight a ham-fisted nurse can stretch – you’d feel like choking and gagging all the time.  Really a nice Last Stop here, huh?” 

    “His wife keeps claiming he is responsive to her voice because he occasionally squeezes her hand.  That’s just a normal reflex to touch – I could put a banana or an icicle in his palm and he’d show some response.  He still has a few reflexes, but his brain is moving toward the texture of cottage cheese.  Since I don’t want to do the paperwork, I’m going to try to keep some vitals going until the day staff comes on.  Let them fill out the endless forms.  Plus I just don’t want him dying on my shift.  The day guys do the same to me.  He won’t make it until the end of the week, no matter what.  

    See that rolling table over there?  Notice anything different?”  “Well, Paul said, it looks like a steel table with a valence around it.”  “It’s a got an twelve inch false bottom, so the corpse can settle in below the top level.  We can’t let the others see a stiff being wheeled out.  We send the body down to the basement morgue for a cleanup with the diener, then the mortuary calls for the remains.”

    “Here we have Jennette, fast asleep – respirator only, plus vitamin IV’s.  Weighs 422 pounds, and ends up here when she gains so much weight that the fat presses down on her chest and she can’t get enough oxygen – stops breathing for up to two and a half minutes at a time.  The ICU is basically a weight loss clinic for her.  We get her down about a hundred pounds, try to do a bit for her diabetes; and as she starts to feel better, she checks herself out of the hospital – until the next 911 call.  She’s eating through Medicare, Medicaid, and Disability to the tune of $195,000 a year.  She also has an attorney who has sued the hospital and every doctor who has seen her for improper care and not curing her obesity and diabetes.”

     

    “Lets move on to Fred.  Looks like a dried out pumpkin, doesn’t he?  Fred has been swabbed down with betadine. The orange accentuates his mottled age spots, skin tags and moles – looks like a monitor lizard with a bad dye job.  His primary physician has him on a no code, so no one can stick, pound, or electrocute him with paddles.  He gets to head for La La Land with no one molesting him.  Think about it, Paul what if you were here in the ICU.  Every twenty-four hour period, someone is sticking you with needles for IV’s, putting in a new catheter, drawing blood, checking blood pressure, cleaning you up, changing dressings, rolling you down the hall for Xrays, MRI’s or Ultrasound Scans.  You never get any rest or sleep – it’s a horrible way to exit this life.”  “Look at this gomba, do you want your children and other relatives to see you like this before you die – an orange reptile?  That will be their final memory of you, tying on your bib and wiping your chin, instead of when you were viable and could enjoy activities with them.” Just the thought of ending up like this made Paul’s stomach contract and sent digestive acid up into his esophagus.

     

    “Oh, and here we have Deville, looks like a dead moray eel.  He can still write on a pad.  I know what he’ll say.  ‘Water, please – water’.”  “No water for you Deville, you don’t have any functioning kidneys.  Slip him a couple of ice chips, Paul.  He’s had a colostomy; renal dialysis every day; giant bed sores, a nasogastic feeding tube, and to top if off, he’s come down with shingles.  Still holding on.  Why – I have no idea.  Every time I go out into the waiting room, there is a passel of relatives, who immediately jump me, pleading with me – wanting technical information, the latest update – am I going to save, dad, granddad, uncle, brother, etc.  I’m always upbeat and tell them we are making progress – I don’t tell them that the progress is straight down hill toward a exit.  They bring herbs, Chinese mushrooms, and every holistic remedy known to man that can be found in self-help books – including rubbing the poor soul’s body with garlic paste.  His wife says she has been praying for me in the hospital chapel and has received an answer that I am going to save Deville.  I’m not, and if my mood doesn’t improve, I may cut his oxygen a bit and he can sink into oblivion.  Although the last blood culture shows a rapidly growing staph infection – probably MERSA.  That will take him out in 24 hours.”

     

    The Queen’s buffet was unbelievable. They had fried chicken, ribs, pork chops and meatballs as the main items. No vegetables, whole grains or anything healthy unless you counted mashed potatoes as a veggie.  Dessert was huge individual peach tarts topped by ice cream, with four inches of whipped cream overflowing the entire mass.  The Queens launched jokes about their patients, had a pool on who was to croak next, and made Dr. Death swear he would never admit them to the ICU. They shuffled back, supposedly to work, barely able to stagger under the gargantuan meal.”

     

    “So what do you think, Paul, want to spend your last days in the ICU with the rest of these soon-to-be-flatliners? Finally giving up looking like the Creature From The Black Lagoon, and gasping your way out?”  Paul shook with horror.  “No, I would never want to come here at the end, nor do I want my grandfather here.”  “Then let me tell you what to do short of going to Oregon and the other five states where they have ‘death with dignity laws’.”

     

    “Prepare a living will that says that if there is any question at all about any illness, you do not want any special efforts to keep you alive, specifically no life support.  And talk to the Resident on duty at night if you are in the hospital.  That is when most people die.  Make sure he knows your wishes; it might encourage him to give you or a relative a boost.  Look under my shirt, see the tattoo.  It says, ‘Do Not Resuscitate,’ hopefully the docs will see that before they start pounding my chest.  I also carry a small card in my wallet – a living will directive – I’m optimistic that the paramedics will read it before they try to resuscitate me.”

     

     “Oh, oh, here comes Dr. Conrad, he will want to check each and every patient, and then bill a thousand for no opinion.  I need you to leave by the left door – one of the nurses will take your coat – keep the stethoscope as a souvenir.”  

    Paul skedaddled out the back door and walked to his car.  He got on the internet, read obituaries, and talked to a couple of doctor friends.  Then he decided to talk to his grandfather about the end-of-life options.  After pondering all of these things he had seen and heard, he went back to Serenity Meadows two weeks later.

     

    “So Paul, what did you think of your visit with my nephew?” asked Henry.  “Terrifying,” said Paul.  “I found that death is not what scares people; it’s the dying process.  If you weren’t in here, Henry, what would you prefer?”

     

    “What are my options at this point?” said Henry.  “I just found out that my liver cancer has spread.  They gave me six months, if you call writhing in pain, loosing further control of my body, a feeding tube, etc., etc., living?  No, if I could cut to the chase right now, I would.  I just don’t want to distress my family with any assisted suicide.  I guess my preference would be to go to the home of someone who still loves and respects me, and when I become too much to handle, get the hospice people in full time and pump me full of morphine – maybe a medically induced coma.  I could just sleep until the final good night.  “What can I do to help?” Paul said.  “There really isn’t anything; maybe you could come visit me once or twice more before I’m too far gone.”

     

    Paul came back two weeks later. As he sat in a chair in Henry’s room, he said, “I’ve got some news.  The more I’ve thought about our conversations and what I’ve seen and heard, I decided I’m going to bring my grandfather home to live with me.  I’ve taken six months leave of absence and I’ll take more if he needs it.  It will be difficult, unpleasant, and frustrating, but he deserves back every bit of what he gave me.”

    “Well, I’ve got news for you too.  My nephew, Dr. Smart wants me to come home and live with him.  He’ll get a good nurse with a sense of humor to be there when he can’t, and then he’ll take whatever time is necessary when I need him.”

     

    Paul came to visit Henry three weeks later, at Richard’s place, but talking was difficult.  He was already doped up on pain pills and slurred his words, and he was paper-thin.  Paul stayed an hour, but the conversation was almost non-existent. 

     

    Nine days later Paul got a call.  “He’s gone, isn’t he?” Paul said to Richard.  “Yes, he is, but he wanted to tell you one thing – if you don’t take excellent care of your grandfather, Henry will be back for a visit in the dead of night.” 

     

    “Did you help him transition to the afterlife?”  “I’d rather not say, Richard said with a grin, however, sadly, I was absent the day they administered the ‘Hippocratic Oath’.”

     

    “Henry didn’t want a funeral, but I’m planning a giant wake with endless food catered by the Buffet Queens, an open bar and live music.  Goes from 1 until 5 at the Boilermakers Union Hall and then we’ll put him in the ground around six with appropriate fireworks.  He specifically asked for you to come and raise a glass in farewell.”

     

    “Wouldn’t miss it, said Paul, “I’ll bring my granddad.”

    Joseph Ollivier

    April 2016

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