Friday, March 12, 2010

Grandpa's Grandkids

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!


Chrysalis said...

This one brought tears.

J-Quell'n said...

Tears and memories...not the same diagnosis but the same type of situation.

Gia's Spot said...

How beautiful that he went on the wings of their love! We all must die, but we can only hope that we are so loved till the last possible second! Thank you for sharing this!

The Hopeful Elephant said...

Isn't it a beautiful thing? Some of the most beautiful moments I have ever experienced in medicine were surrounded by death.

Beautifully written, friend.

Katie Axelson said...

There are tears in my eyes again, Jim. I have four living grandparents and I live 900 miles from home. I dread the "you need to come home NOW" phone call, but I don't panic every time their numbers appear on my phone because they love me and sometimes they call to say just that. This well-written posts hits very close to home.

Have fun at Hilton Head. Keep an eye out for my crazy suitemates who are headed that direction. :-) I, on the other hand, am headed home to see my grandparents (ok, and the rest of my family, too)!

<>< Katie

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rlbates said...

Beautifully written. Wish the children had not had to experience this, but happy to know of the love shared.

kristi said...

Wow. My Grandpa died when I was 14He was my hero. I miss him everyday.

Carolynn Anctil said...

My father passed away at the end of February. In spite of our difficult relationship, it is unsettling and sobering to see a parent so frail, confused, and vulnerable. Nevertheless, I am profoundly grateful that I made it in time to be with him and to have my last words to him be "I love you".

I think these children will also feel grateful that they had the opportunity to be with their beloved grandfather and to say their goodbyes.

There is closure and peace in that.


P.S. Congratulations on winning your award for writing.

Anonymous said...

God didn't make these bodies to last forever.

I agree with Heather. It is an honor to be present with a friend or a loved one at the end of life. May God so bless me at the end of mine to have my loved ones there with me too.

Beautiful post.


Karen said...

My grandmother died 8 years ago, just shy of her 102nd birthday. I have so many happy memories of her and the knowledge that she loved me just because I was me. Now a grandmother myself, I realize it's one of the best things in life. Like the bumper sticker says "If I'd known how much fun grandkids were going to be, I'd have had them first." :) This was obviously a loving family and I have no doubt that the grandkids were a blessing to their grandmother as she returned to a home without grandpa.

Rositta said...

I'm crying too. Three years ago when my mother was hospitalized my two elder grandsons came from Calgary for one week. They were 19 and 21 at the time and all I could think of was, no, I don't want them to come, I don't want the extra work. I was thinking selfishly because as it turned out they spent most of the week at hospital giving me some much needed respite. They got to spent time with their great grandmother and they still talk about it today. I'm glad now that I didn't actively discourage their visit because as it turned out it was the last time they saw her...ciao

coulrophobic agnostic said...

The last time I saw my dad walk out the door, I had a feeling. I should have listened to it. But I know he knew how much I loved him - at least I think he did. I wish I'd gone after him like I wanted to. (Another important lesson - listen to your gut even if you think you're just being silly.)

My grandpa died three years ago, a few days before he turned 84. We were all horribly sad to see him go, but there were no regrets. Everyone loved him and he surely knew that - he was possibly the nicest man ever to live. I wish everyone could have that.

I wonder if there'll ever be a reliable, for lack of better words, way to treat this grandpa's medical emergency. Like, if there'll ever be a time when someone diagnosis it and says "okay, don't worry, we can fix this."

Cathy said...

You write so beautiful. This is how all families should be, but unfortunately we know that isn't the case. I am very happy he was surrounded by love.

CottonLady said...

My grandfather died of exactly the same thing in 1977. We were all very close, also, so I know he knew how much he was loved. He had had some stomach pains for awhile, but was afraid it was cancer, so didn't go to the Dr.

Thank you for your wonderful posts.


Empress Bee (of the high sea) said...

what a beautiful post and i am so surprised that i know three of your commenters yet have never been here before myself! will add you to my reader and thanks for posting this love story...

smiles, bee

Milo said...

i am sorry.... i am soooo sorry.

SeaSpray said...

Beautifully written post.

So moving and hits home.

Perhaps that even though it was sad ..they also take comfort in that they were there with him to the end. They apparently wanted to be since they opted to stay with him to the end.

I wrote a lot more ..but deleted it. :)

SeaSpray said...
This comment has been removed by the author.
SeaSpray said...

"That their good memories have survived, sprouting wings to fly above the breezes of the bad."

I like that.

WWWebb said...

You just keep getting better.

Your nom de screen is aptly chosen: you tell stories with apparent ease, when nothing could be further from the truth.

I'd call you a "natural", but that would imply that your storytelling capability requires no skil

Keep writing. We're reading.

belladawn said...

What a wonderful story. Thank-you for sharing.d

Elizabeth said...

I have got to stop reading this blog at work - now I've got something in my eye...

Beautiful post.

Dania said...

This post brought a lot of memory and tears. 11 years ago, during semester break, my grandma got seriously ill when my younger sister and me were staying with our grandparents. I was in 5th grade, while my sister was in 3rd grade. Our grandpa woke us up in the middle of the night, then we rushed her to the ER. I remember everything. I was scared to death.

I think those kids were lucky to 'meet' you at the ER. Thank you for answering the boy's question. Thank you for letting them being in the same room with grandma and grandpa. Although it wasn't (and never going to be) easy, you surely made that night easier for them. My sister and I were those kids 11 years ago. And we wish the ER doctor was as kind as you back then... :)

myonlyphoto said...

STORYTELLERDOC this is very heart breaking story, and I thank you for sharing. Its amazing how powerful love is and best medicine even if the life is lost. You made me cry! Anna :)

Jabulani said...

A beautiful post; I concur with several others who say the same.

I would however just add that, were I dying, there's a little part of me that would want to have my husband and children with me so that one of the last things I see/remember, is their faces and presence. Grandpa left this world knowing they were there. Grandma and the kids left the hospital having said goodbye and knowing for certain that Grandpa knew he was loved (as were they). My grandmother died a year ago past February. She was riddled with dementia. She'd forgotten who I was 6 years previously and never remembered me after that. I wasn't with her when she died and I don't actually mourn that because she'd been lost to me so long before. Watching her fade away over 10 years was gruesome. I'd far rather have been through an experience like the one you write here. It's actually less vicious on the nerves.