They were both teenagers, out-of-town grandchildren, a girl and a boy, spending several weeks of their summer vacation visiting with Grandma and Grandpa. They had been doing it for years. It was tradition.
It was their first time to our ER. An unplanned visit, of course. For all the summers and all the weeks spent in our town, never once did either teenager or their grandparents have to visit us. No lacerations. No broken bones. No typical summer injuries that required our attention.
They were sweet, this girl and boy. Despite their tired and worried faces, they smiled and spoke kindly to one another. And to us. They showered their attention on their grandparents, clearly comfortable and unabashed in showing their deep love and respect. The way it should be.
Their Grandpa was sick. They hadn't planned on Grandma and Grandpa waking them in the middle of this night. But Grandma did wake them, right after she had called the ambulance to have Grandpa brought to us. Pillow creases etched their innocent cheeks, their yawning but feeble attempts to wash their tiredness away.
Their Grandpa had awoken from his sleep with severe and sudden abdominal pain. He hadn't eaten anything unusual, nor had he been ill. No fever. Never had anything like this before. But Grandpa did have hypertension, adult-onset diabetes, and hypercholesterolemia. And his blood pressure readings were dangerously low. Most alarming, Grandpa had diminished leg pulses when compared to his arm pulses. This was serious.
Grandpa had a ruptured abdominal aortic aneurysm. A life-threatening diagnosis
I performed a quick ultrasound to confirm the problem, all the while giving Grandpa aggressive IV fluids, low doses of pain medication, and starting blood transfusions. The cardiothoracic surgeon was called in emergently and the OR was prepared. We worked quickly and efficiently, time not our friend.
Tenderly but urgently, I spoke with Grandma and Grandpa and the two grandchildren about my concerns with Grandpa's symptoms. I explained that a dissecting abdominal aortic aneurysm is life-threatening and, similar to a sprung leak in a water dam, Grandpa's abdomen was filling with blood leaking from the ruptured wall of his aorta, our body's biggest oxygen-delivering vessel. That time was of the essence. That this leak would only get bigger until it ruptured, without emergency surgery. That Grandpa's life was at stake.
Grandpa's grandchildren, with Grandma, stood in the corner of the room, their faces transforming before me, their innocence circling the drain after being bathed by the harshness of reality. Grandma held each of their hands within hers. Eyes began to glisten as tears silently filled their corners, spilling over. Prayers were whispered.
I offered the grandchildren the option to step out and be comfortable in the family room, maybe something to eat. Just a few minutes away from the commotion. They declined, opting to remain in the comfort of Grandma and Grandpa's presence, in spite of the circumstances, rather that keep company with a floral-print love seat and seafoam painted walls. The right choice.
"But," stammered the younger of the grandchildren, the boy, "I don't understand. If Grandpa's this sick, how can he still talk to us? How come he is still awake?"
My heart was heavy as I watched this boy's hopeful eyes. His older sister stepped up to his side, wrapping her arm around his shoulder.
I reassured the boy before explaining to him, as well as the rest of the family, how we were fighting hard for his Grandpa, how we were giving him IV fluids, blood transfusions, and other medications. How these things were helping Grandpa temporarily. How we all wanted his Grandpa to do well and were using everything in our power to make that happen. "But," I said, cautiously and honestly, "there will be a point where we can no longer keep up with the blood he is losing from his leaking aorta, and that will be the scary moment. That is why we are hurrying to get him to the operating room."
They nodded their understanding to me before embracing one another, leaning over the cot's rail to include Grandpa, who was getting visibly weaker. Grandma tenderly stroked his scalp, front to back, as she whispered in his ear. He smiled from her words. The grandkids caressed his hands. He smiled from their touch. I walked out of their room, quite affected by their expressions of love. Especially in the midst of their pain.
Usually, when death is an imminent danger and time is precious, I make it a point to express to the family to share their emotions and thoughts, share those words and feelings that may have been assumed or bottled through the years. Share their love. Watching these grandparents with their grandchildren, though, I felt no need for that. Clearly, they had been sharing their love all along. Right to the end.
Grandpa lost consciousness on his way to the OR. CPR was started in the elevator. Emergent intubation was performed in the hallway that lead to the OR (this had been held off in the ER because the family had requested as much time as possible to talk). Blood transfusions were continued. Pulses, heart rate, and breathing remained fragile.
Despite each of our best efforts, Grandpa lost his life in the middle of that awful night on the OR table.
Damn it all.
At some point, as we expected, his aortic wall just gave out and there was nothing further that could be done. His small leak had progressed to a full rupture, and he essentially bled-out from his aorta into his abdomen.
When I think back to those grandchildren on that fateful night, I still hurt for them. Imagine spending a nice summer day with your grandparents and, at the end of the day, climbing into a quilt-covered, lumpy bed to go to sleep. In the middle of your sleep, you are urgently awoken to accompany your sick grandfather to the hospital. And there, you watch him die an unsettling death. Talking one moment, and gone the next.
I remember the grandchildrens' faces the most. Their pitiful expressions. Their caring. Their pain. Their disbelief. Their worry. Their tears. Their sadness while watching their grandfather grow weaker. I can only hope that those faces are smiling again. That time has been kind. That their good memories have survived, sprouting wings to fly above the breezes of the bad.
You know what most reassures me to think that this family is fine? That they have survived and moved on? It is the simple truth that Grandpa had loved his grandkids. And they had known. Their final moments together reflected this love. Grandpa could give them no greater gift than this, a gift that, I hope, they will carry with them through their life's journey.
A grandfather's love for his grandkids. How privileged was I to bear witness during their darkest hour?
As always, thanks for reading. Next post will be on Monday, March 15. See you then...and watch out Hilton Head, here we come!