My father's left hand
Gorman, Geraldine
MY FATHER'S LEFT HAND A DEATH HE DID NOT DESERVE GERALDINE GORMAN y father died early this year, hours after his transfer from the drone of an intensive care unit to the stillness of a hospice...
...Unfortunately, the treatments decimated his immune system, leaving him vulnerable t O any opportunistic infection loitering in the ICU...
...We firmly rejected life-at-all-costs arguments and agreed, with our father, that it is the substance of days, not their quantity, that gives life its meaning...
...He recalled only nothing: no before the operation, no during, no afterward...
...complete it" and let him fall backward into nothing again...
...He had been a scrappy kid who came of age during the Depression and he knew no dependency...
...When his time came, he would go...
...How quickly theories crumble when they meet reality, in this case when the nurse becomes the daughter of the desperately ill patient...
...The multidisciplinary conference we requested lent medical sanction to the obvious: aggressive treatment had become useless, crossing the invisible but crucial line between support and maintenance...
...I have left the hospital for community-based nursing...
...It was a joke, the blackest sort...
...We removed the restraints, freeing our tethered father from the tinkerings of specialists...
...And then three days after voluntarily entering a hospital for the first time, two days after the diagnosis that explained the dramatic weight loss, he was at the brink of respiratory failure...
...D 18:16 July 1993 Commonweal...
...As a nurse privy to his records, I watched the lab reports chart his inexorable decline...
...He saw now the recovery room, the nurses, his family...
...We left him that night in hopes of better luck the next day, but during the early morning hours he developed intractable hiccoughs and when thorazine did not work, he was restarted on a sedative drip...
...It speaks to what can become the shackles of medical technology but it is more than a reiteration of the limits of specialized, reductionist medicine...
...asked the Irish poet from his tower...
...And we, his children, would counter with cultivated irreverence: we would maintain him at all costs, prop him in his favorite chair, a permanent spectator of the televised sports he so enjoyed...
...We were catapulted from holiday celebrations into a medical morass we could not control, justify, or escape...
...We are enlightened adults, my father' s children...
...With so little left to do for him, we directed our solicitude toward each other, taking turns in the chair closest to his left hand which continued to gesture with an eloquence made more profound by all that had been stripped away...
...He was placed on a ventilator which the pulmonary specialist described to him as a "breathing machine...
...On the eve of my birthday, he squeezed my hand and smiled, delivering as sweet a gift as this daughter shall receive...
...It did so in testimony to that which tests cannot measure...
...Three years before he had climbed to the top of Yeats's tower in County Sligo and surveyed the landscape of his ancestral Ireland...
...We watched and he disappeared, leaving behind not a grin but the legacy of his left hand...
...Steroids sent his blood sugar skyrocketing and insulin was added to his hyperalimentation...
...status and watching him die, eyes wide and chest heaving...
...There were principal specialists--pulmonary and oncology-and auxiliary specialists--infectious disease and nutrition...
...Then, seconds before the pain and discomfort took over his body, it came to him: It is all right if I live...
...His grip remained strong even though his body was exhausted...
...At the foundation of current nursing philosophy is what is known as systems theory: We are, each, a web spun of interconnecting strands, multiple systems...
...The full burden of all we cannot know still weighs heavily...
...Multi-system failure" is the convenient term to describe the body's surrender to disease or its attendant treatment...
...We were repeatedly cautioned not to relinquish hope prematurely...
...it was loss of dignity and control he could not accept...
...What happened to my father and his children serves as a caveat...
...When it Richard E. McMullen I! Came to Him From nothing he woke to a dull dream about nurses...
...Through the operation...
...MY FATHER'S LEFT HAND A DEATH HE DID NOT DESERVE GERALDINE GORMAN y father died early this year, hours after his transfer from the drone of an intensive care unit to the stillness of a hospice unit...
...This was a man who had driven himself to his routine checkup two days earlier...
...The ventilator was turned off...
...Try to just be a daughter, not a nurse...
...It continued to breathe for him after numerous unsuccessful attempts at weaning, during which his heart raced with the sheer effort of attempting to do what, until recently, had come quite naturally...
...His consciousness dimmed, his eyes glazed...
...With it to guide my practice, I hope to help others to live and die more simply, with less fragmentation...
...his breathing improved...
...now we want to do this: explain something complicated...
...To remain alive to the mystery and preciousness of the whole, this is the legacy and lesson bestowed through the power of my father's left hand...
...We waited, hoping he could somehow mend these disparate parts by force of will...
...The treatments had so ravaged his body, at the end the malignancy was the most benign of insults...
...The initial diagnosis that propelled him into the foreign world of high-tech medicine was oat cell carcinoma...
...My father's hand rose and fell, attempting to express something of the man becoming obscured beneath the aggressive assault on malfunctioning systems...
...He slowly faded, exiting by increments, Cheshirelike in a medical wonderland...
...As a nurse, I hope the health-care reforms to be fashioned protect the dignity of the individual from what can be harsh and intimidating in institutionalized medicine...
...There is no final and absolute moral to this family's story...
...At the end, however, I was less certain...
...The gentlest of vibrations spreads reverberations throughout...
...An abrupt death sentence in the face of such recent vitality was obscene...
...His labor produced three liberal arts graduates...
...I'm alive...
...we drew the curtain around us...
...No out-of-the-bodys, no tunnels, no lights...
...So, he thought...
...what killed him is impossible to isolate...
...Don't read the chart...
...Death is a process that does not end with interment...
...On his last "good" day he attempted to write but we could not decipher the message...
...All the while we drew specialists to us as if by magnetic force...
...The nurses would wake him up...
...nutrition must not be withdrawn while a machine continued to pump in breath...
...Milligram...
...As the final reality descended with its attendant remorse, I thought my great sorrow was born from our inability to care for my father as we had wished, to offer him what all our grandparents had known--a gentle death in one's own home...
...Another instructed without solicitation: "A little piece of advice...
...Death was never his fear...
...Some acknowledged our emotional strain...
...O body swayed to music, O brightening glance/How can we know the dancer from the dance...
...He could not tolerate tube feeding...
...That last night in ICU, alone with my father, I shared the quiet and what sleep we could manage...
...For the next three weeks the machine did its job, breathing for him, "supporting" him through emergency, high-dose chemotherapy, through three nightmarish trips to radiation treatments...
...it is all right, if not...
...He never again fully broke surface...
...He was awake--alive...
...his blood gases remained "good...
...The bronchoscopy that had determined the definitive diagnosis produced an inflammatory reaction that, together with the rapidly growing mass, threatened to strangle the airway...
...With our father gasping for breath we faced the choice of agreeing to a ventilator or conferring upon him a "do not resuscitate" GERALDINE GORMAN works in community health as a visiting nurse in Evanston, Illinois...
...At last, after one waking, he realized it was not a dream...
...He nodded, he mouthed 16:16 July 1993 Commonwealwords, he raised his restrained arms in abortive gesture...
...After the intubation, a sedative drip separated us...
...Why the essence of my father, the great vitality of the man, settled in his left hand, I do not know...
...He had lived...
...When titrated off the drip he resurfaced...
...We had been contemptuous of medical technology...
...Always the whole transcends the sum of its parts...
...one gently touched my shoulder...
...But long after his voice was silenced by an endotracheal tube, his arms tied down to protect the airway, and his eyes had been clouded by drugs, his left hand continued to open and close, to rise and fall...
...In the years preceding his last, he would declare with animation----cigarette in the fight hand, left hand sweeping the air-that he renounced the "maintenance" of artificial support...
...And still, with what tenacity 1 struggled to believe further medical manipulations might restore integrity to the whole...
...As Jesuit university students we debated moral ethics in obligatory philosophy courses...
...With my head against his chest I moved in tandem with his breathing and it was unclear who was taking care of whom...
...His limbs swelled, his hair thinned, his mouth dried...
...became clear that extending his life meant prolonging his dying, we gathered the specialists...
...It happened without warning and it unfolded with unimaginable rapidity...
...He would laugh and gesture in affectionate dismissal...
...By the time he died, the bronchial tumor that began his month-long medical odyssey was irrelevant...
...Each specialist had a case to make: his tumor type displayed "exquisite" sensitivity to treatment...
...now we were defeated by it...
...announce, Mr...
...a broad-spectrum antibiotic might be helpful...
...With a daughter's hard-won insight, I hope for a health-care system that does not contort the whole to serve the parts, an environment in which one can be both nurse and daughter without feeling one betrays the other...
...And our father, the inquisitive and gentle self-made man who continued to work crossword puzzles even as his breaths became gasps, where was he...
...There were specialists who spoke to us and those whose existence we knew only by virtue of illegible scrawls in the chart...
...To compensate for the loss of his natural protection he received a variety of antibiotics that may have killed some bugs but also irreparably compromised his renal function...
...Together we comprise an English major turned clinical psychologist, a history major now a journalist, and a second English major who became an oncology nurse...
...Over a month's time, at the bedside, this is how it unfolded: the chemotherapy and radiation, given concurrently, probably worked...
...She is married, has three children, and is the daughter of William Dudley Patrick Gorman, Jr...
Vol. 120 • July 1993 • No. 13
