Exactly a week ago, it was clear that my dad was dying and unconscious even to know what was happening. The day shift SICU doctors at Sakra counselled us that his right lung was irreparable and he was too weak to be given any further treatments. And we were right in not going ahead with the ventilator. His lungs were filled with 90% CO2 and also some air around his accessory muscles around his collarbone. The fix to remove the air involved making a hole in his right side and such procedures would only cause him more pain and weakness. So it was time to give him the final stage of palliative care i.e. morphine to enable to him to die painlessly. Sister and I were inconsolable but we agreed in verbatim and also in writing. We were also told to give a heads-up to his friends and out-station relatives that he was dying and they could come to pay their last respects. I started with his brother, I suppose or Raghu. As and when I made the calls, the script became better and my feelings got under control.
The doctors asked us to wait near him and the fentanyl injection was administered to him in IV slowly. We knew that he was finally dying and painlessly. We spent couple of hours in grief, took a lunch break, returned and waited with him until sunset. Mom called us to come home and we left our dad to die painlessly and alone. The next morning, 25th May, Saturday, while I was getting ready to go to the hospital, I got the call that he died couple of minutes ago. I can recall how I froze. I still went ahead and made breakfast for myself and rushed with BIL and dad's younger brother. When I saw dad dead, he was freshly bathed, plastered with bandage around his head and chin to keep his mouth from opening more, cotton balls in his nose and stuffed in his mouth. His one eye was open and one eye was closed, totally lifeless. It did look like he was sleeping but his skeletal appearance was more obvious. The hospital staff were kind and gentle. I went to the mortuary with BIL and uncle and saw my dad gift-wrapped in bandage and a dark blue plastic cover. The bandage was put like a flap on his face. I lost it when the nurse did her duty to ask us to identify the body before she put him in the mortuary freezer number 8. What a number. She asked me to step out but it was enough to make me realize how it must be to be dead. While dad was waiting in the freezer in the mortuary to be taken home, we waited for the insurance procedure to come through. After a wait of 5 hours, I got into the ambulance with my dad gift-wrapped in bandage and a dark blue plastic cover. I have a picture of him in that and also a video of him suffering to breathe. Morbid but I think it is to remind me that he is actually dead. Uncle and aunt took photos of his dead body so insensitively and shared with all on whatsapp. My morbid instinct stopped just before that. I couldn't bear to see his mouth stuffed with cotton and temples sunken around his ears. His beloved older sister arrived before we reached and she took the intiative to cover him in a new dhoti and silk veshti around his face. She arranged the garland and put the green leaves to cover the cotton stuffed in his mouth. I definitely felt that I was not looking at my dad. It was his relic. The lung fibrosis had leeched him from inside, despite the expensive steroid and oxygen therapy.
Until we got him admitted, we were unaware of such developments in his body. Not our fault. He was too weak to be taken to the hospital and so, we chose to treat him for his lung infection at home with our family physician's help. If things went downhill (which all of us feared that would lead to his death eventually), we wanted him to be at home amidst his family members. Mom especially would not have been there to spend time with him in the last few weeks, if we had gotten him admitted. The family physician did suggest that we take him to the hospital for PEG surgery to get him to eat, after he recovers from the infection. The entire family was not for PEG surgery but he had me convinced to give it a try - because nobody should die of starvation. Dad had already starved because of lack of appetite and inability to swallow, the curse of lung fibrosis, causing severe decline in the weight and thereby, energy and immunity. The Ryles tube kept him fed enough to take the antibiotics.
But the lungs just gave away on the fateful evening of 23rd May 2024. I had given him 2 teaspoons of water few hours before that afternoon because he was breathing with his mouth more and more open with the days passing by and lips getting dried up. He coughed so bad that my heart broke and intuitively, I felt that it could be the last few sips. At 4.30 p.m. or so, the Ryles tube was out of his mouth supposedly and the nurse pointed it out. I called the doctor and he arranged for Anitha to visit. I tried to ask this nurse to put the new Ryles tube and was checking the items required to be ordered. He heard our conversation and said - Anitha... Expert.... Saying these two words itself took a lot of energy but I sensed he was listening keenly and I consoled him that I will check and follow up with Anitha. I decided to resume work meanwhile because work was suffering in the middle of all this.
Close to 6 p.m., my sister observed that he had removed the nasal cannula out of his nose and lying there with labored breathing. She called out for me and I also panicked. Over the past few months, if the nasal cannula wasn't there or if the O2 concentrator was acting weird, the poor man PANICKED, for the fear of dying. And here, he had removed it on his own and was unaware of his actions. When we asked him what he was doing, his response was that it was very noisy and none of us liked it. And why were we panicking. That was sufficient to make me search for Sakra ambulance. I was caught in a dilemma to wait to ask Anitha to come and confirm to hospitalize or go ahead and make the call. During the dilemma, he showed more restlessness to remove the cannula, even the new mask-like cannula and the nurse Jyoti had increased the O2 levels to almost 6L. She tried to tell me that it was to help him breathe better in the new mask cannula, I doubt it if she was right. Things were happening so fast and his SPO2 was not crossing 90. Giving more oxygen is also a danger without the pulmonologist's guidance. Which meant getting him admitted. So I dialed the ambulance and it reached in 30 mins. Meanwhile, he spoke his last few lines to my sister and mom, while I was preparing for the hospital visit. He was supposedly coherent. In the ambulance, he asked me the time - I said 7.45 p.m. Things spiraled faster after that. He lost consciousness and opened his eyes feebly when I called out to him. Touching him did not give any response. I realized I was losing him. Emotions crept up and the duty doctors tried BIPAP. He was not conscious enough to mimick the BIPAP breathing and next was ventilator option. I said no, BIL said no. The doctors arranged for x-ray and CT scan and we waited and waited. I broke down completely and BIL held me in his arms. After sometime, they got him admitted in SICU and put him on drips. The SICU night shift doctors told us for the first time that his right lung was irreparable and he was too weak to be given any further treatments. And we were right in not going ahead with the ventilator. His lungs were filled with 90% CO2 and also some air around his accessory muscles around his collarbone. The fix to remove the air involved making a hole in his right side and such procedures would only cause him more pain and weakness. There was some convincing done to try to give vasopressors to increase his BP - I agreed reluctantly. We drove back home in BIL's car at 1 a.m.
I had warned my husband to come with our daughter the next day without fail to meet him one last time (at home because that was my instinct again) and he finally reached the hospital around the time we reached the hospital from here. My husband's face was ashened when he understood those long conversations with me describing dad's suffering and his skeletal appearance. Sam did not get to see my dad in the SICU, good in a way. She did not get to see him suffer since May 12 because I had kept her away in Vijaya nagar and she wanted to complete her swimming camp. She also felt that she was not looking at my dad when we brought him home and put him on the freezer. Ironically, I got the news from my mom's youngest sister that my mom's oldest sister died that afternoon on May 25th when I was on my way home with my dead gift-wrapped dad in the ambulance. So, most of my mom's siblings are yet to visit and pay their last respect to my dad and condolences to mom. Out of dad's siblings, two came - the oldest sister with her grandson in his car, thanks to her husband allowing her to get out of the house for those hours from Chennai. And the younger brother, for the sake of rituals aka patriarchy. If he had not come, my BIL would have done those rituals. And now he has to do it anyway for the 11th day.