“Rosebud.” the dying Charles Foster Kane whispered.
“I’m freezing.” my dad says to me.
I’m in the waiting room, ancient 19″ Sylvania hanging in the corner, Citizen Kane playing in the background. I’m alone right now, as my dad sits in one of the 20 recliners, tubes attached on one end to his arterial perma-cath (catheter), the other to the dialysis machine.
I’ve covered dad in the 3 blankets we’ve brought to this place. This place where we’ve come now three times. For some reason, they keep it cold. I don’t know why. Every one of the patients seem to be buried in their own blankets. Why do they keep it so cold? Well, not cold really. Probably a “green” 68-degrees, but would they keep it like this if it were a nursery? Don’t they see that every one of their patients is uncomfortable? Why can’t they turn the heat up?
This is my first experience with dialysis. Dad is 92 and is in renal failure. He was hospitalized for a week or so, until he was strong enough to go home and start going to this outpatient dialysis clinic about 20 minutes from our house. The treatments last three hours leave him drained and tired. His first treatment here, last Monday evening, was disastrous.
You see, renal failure generally shuts down the urinary system, and being on dialysis, patients are advised to limit their liquid intake, lest they drown in their own fluids. However, for some reason, dad is a rare dialysis patient who needs to urinate about every hour. This presents a problem when one is bonded to a machine for 3 straight hours.
So Monday, dad felt the urge to go. He told this to one of the nurses, but apparently the urgency of the situation was lost on her, as she didn’t return with a urinal bottle nor the rolling privacy screens for dad to relieve himself. By the time they got the screens set up, about half an hour later, they realized they had no proper urinal bottle. Whatever cup they handed him was too cumbersome for him to handle, and well, by the time I returned, dad was sitting in his slowly-drying old-man pants.
I felt horribly guilty for leaving him alone, but dad is fiercely independent and insisted I not sit with him for the three hours, and that all had gone well in the hospital dialysis sessions, so he insisted he’d be fine. I went out to the waiting room, checked on him after 20 minutes, (”Go! I’ll be fine!”) and then went out to run some errands.
So we drove home, me in my guilt, he in his humiliation and exhaustion. He said to me, “I don’t think I wanna do this again.” “Dad,” I answered, “You don’t really have a choice.” “Whaddya mean? Maybe if I take a few weeks off, I’ll feel better and then I can go back.”
Obviously dad did not realize the direness of his situation. “Dad, you won’t last a couple of weeks without this.”
“Get outta here.” he replied in disbelief (or denial).
“No Dad, here’s what’ll happen- you’ll start to feel weak and tired, worse than you did before you went into the hospital. Except it won’t get better. It’ll keep getting worse. Your blood will turn to poison and start shutting your organs down, until one of them is your brain and you start losing your mind. Eventually you won’t be able to get out of bed, and after that you’ll spend a week or so unconscious until you die.”
It was a cold thing to say, but he had to know what kind of decision he was contemplating. He was quiet after that for while. I broke the silence, “Dad, give it a week. We’ll go back Wednesday night, then Saturday, and by next Monday you’ll see if you’re feeling better.” He nodded and then went to sleep for the rest of the ride home. Me, I cried a bit.
As expected, Dad was pretty drained all day Tuesday, but surprisingly, still so on Wednesday. This particular Wednesday was the day before Thanksgiving, so the house was a buzz of activity, what with cleaning and cooking preparation and the arrival of my brother-in-law and his girlfriend from out of town. As 6 o’clock approached, when we’d have to leave for dialysis, my dad told me he wasn’t going. “I just can’t do it Matt. I feel weak and lousy. Let’s just wait ’til Saturday.”
“Dad, if you don’t go, you might not make it ’til Saturday.”
He quickly retorted, in all seriousness, “Promise?”
I called the dialysis center and told them we weren’t coming. Their reply was that they’d have to call the nephrologist to let him know, and that he’d probably call us back.
About an hour later, the doctor called. I explained to him how my dad was feeling, and told him what a disaster Monday had been. He earnestly replied,”I feel terrible Mr. Blitz. What you’re basically saying is that our treatment was so bad that your dad would rather die than go back to our facility.” I told him that was spot-on accurate.
He told me that he’d try to set up an appointment for Friday instead of Saturday, and that he would make our feelings about our previous session known to the staff, and that dad would get the royal treatment on Friday. I told him I’d try to get dad to agree to go again on Friday, if at all, and I’d call the doc on Thanksgiving evening to let him know. I told dad about the doctor’s offer, and he said he’d think about it.
It cast a pall over our usual revelry on Wednesday night, knowing that my dad had decided to give up on living. We avoided the subject as much as possible all evening and even after our family showed up for Thursday’s feast.
One of the customs for our Thanksgivings has been to go around the table and say what each of us is thankful for. Usually my wife or I initiate the conversation, but this year, I think neither of us was in any mood. This year, we skipped our “thankfuls.”
By the evening, after everyone had gone, I sat with dad in his room. “So what do you think? Should I tell the doc you’ll go back tomorrow?” He sighed and said yes.
Friday night’s treatment, while better, was certainly nowhere near “royal.” We sat in the waiting room for a half hour past dad’s appointed time. At least this time we’d only be doing a 2-hour session, and I made doubly sure that the nursing staff knew Dad might need to use the urinal and that they should respond to his needs pronto. Of course, this time I stayed with him, asking him frequently about his need to go. After about an hour and a quarter, he said he had to go, but could hold it. I tried prodding him to go in the urinal we’d brought with us, but he said he could wait. He never looked comfortable, but even after a few times of my insisting he’d be more comfortable if he went, he refused. At least he didn’t pee his pants as he finally skedaddled to the rest room after they de-attached him from the machine.
Dad felt marginally better than last time after this treatment, but still wasn’t thrilled with the dialysis center. He agreed to return for the planned schedule next Tuesday, Thursday and Saturday, albeit reluctantly.
On Monday, we went to dad’s regular doc- his GP- who genuinely cares for dad, and who dad also thinks the world of. So I asked Doctor K, “Could you explain to my dad why he’s not feeling better?” “Well, he hasn’t really given it a chance. Sid, you’ve only had one-and-a-half sessions. That’s half of what you should have had so far.” Using a metaphor, he continued, “If you want the medicine to work, you have to take all of it. You don’t take one aspirin and expect your migraine to disappear, do you?”
At this point, I wasn’t convinced Dad was fully aware of his dire situation. I thought that if he heard the truth from Dr. K, he might realize and digest it. “Doc, what happens if he doesn’t do the dialysis?”
“Well, Sid, you’ll feel like you did when you went in to the hospital two weeks ago, but then you’ll start to feel even worse.”
I asked, “How long would that last?”
Dr. K replied, “How long would he last? A month, maybe two.”
I saw recognition in dad’s eyes, and finally I think he “got it.”
That was yesterday. A little while ago, Dad used the urinal about 2 hours into the session with no spillage. Right now, the monitor on the machine next to dad is saying 8 minutes left.
The TV in the waiting room is saying “Rosebud.”