Occam's Razor

Dear old Dad is dying. It’s been an inference most of us have made based on his condition, which has been slowly but steadily worsening. Yesterday it became more explicit in his email to us. Dad’s left lung basically doesn’t work anymore. In his case it is due to a condition called pulmonary fibrosis. With just the right one working, he doesn’t get as much oxygen as he used to. Consequently he is frequently tired. He now joins a dubious but rather large club at his retirement community of men getting supplemental oxygen. His wife (my stepmother) now gets to wheel him to and from the dining rooms for his evening meals.

That’s not the half of it. He’s lost weight and is continuing to lose weight. For a man that was once six feet tall, he is down to 146 pounds. He looks gaunt. He has little appetite. In fact, his stomach hurts most of the time. It hurts more when standing and less when lying down.

When we saw him last toward the end of April he could walk unassisted. He can still walk but of course it will tire him so it’s not a great idea for him to do too much of it. He could also engage in conversation, although my stepmother was the more articulate of the pair. That he can still type an email means he retains motor skills.

If you have to die he is doing it pretty well. He is still at home, which is his apartment in his retirement community. He may be able to avoid assisted living altogether before he goes. How much longer he has is a mystery, but his time is likely in months, if not weeks. He has clearly given up trying to prolong his life. At 88, his body is simply wearing out. Even if he had extraordinary surgery like a lung transplant, he is very susceptible to infection. Visiting his dying sister last year involved flying cross country, which meant he caught pneumonia somewhere across the country at 35,000 feet. He informed us last month that he won’t be coming to a planned family vacation in July. His driving days are likely over. Unless he needs to see a specialist or go to the hospital, he’ll probably remain inside his retirement community until he dies.

Dad is pragmatic about death. In a retirement community, death is hardly a stranger. It is all around you. It is simply a matter of wondering when your number will be called. The community mailboxes have new death notices posted nearby pretty much every day. People drop out of your life rather mysteriously. It usually means they have passed on but didn’t want to make a fuss over it. You either accept death pragmatically or you let it rule you. My Dad has opted for the former.

His will has long been in order, along with end of life directives. He tries not to look too far ahead and take each day as it comes. He is gracious in his decline and grateful for his life. He realizes his dying could be much worse. He probably won’t lose his motor skills, like my mother did. He probably won’t end up in a nursing home, except possibly at the very end. If he needs hospice there is a good chance it could be done in their apartment. He could die in his bed, which is probably how he would prefer to go, the same bed (moved many times) that he and my mother inhabited over their fifty plus year marriage.

It probably won’t be the pulmonary fibrosis that kills him. Most likely he will succumb to some sort of virus or infection. In the end it was not the Progressive Supranuclear Palsy that killed my mother ten years ago, but a common bladder infection that she could not fight off. At this stage of life, what once you could fight off now is more likely to kill your overwhelmed body. His last bout with pneumonia required a hospitalization, but he survived it. Another one would likely kill him.

Still, he is grateful. He is grateful for his long and mostly healthy life. He is grateful for all of his eight children who turned out to be all good eggs. He is grateful for my mother and grateful to find a new partner in marriage late in life. He is grateful for having his wits together, being able to speak, being able to think clearly and being able to participate in much of what makes life enjoyable. He has lived a long life but he senses his end is not too far away. He neither wants to postpone it nor accelerate its end. He is tired of fighting what he cannot change. He is dying and he is content to die when he is called.

I can’t speak for all of his children but in general we are content to let him go in his own way and his own time. Of course it saddens us that he is dying and of course we will grieve when he is gone, and probably a lot before then too. But he has lived a long and rich life. He has done all those things that good people are supposed to do and much more. While my mother was dying, when he wasn’t caring for her he was tutoring one of the staff in the nursing home in math. Until very recently he ushered at church. He gave generously of his limited treasure. He loves us all and treated us all with kindness and respect, which we returned. He retains a serene confidence in his Catholic faith and his belief that he will be in heaven soon. His issues are not so much dying, which is inevitable, but day to day issues. Like most aging men he has an enlarged prostate. He needs convenient and frequent access to a bathroom.

Still, it is hard not to feel some grief as he declines. Some parts of him simply are no longer there. He took enormous comfort in food. Chocolate cakes used to be his passion. Chocolate anything was largely unsafe in his house. With so little appetite, chocolate is no longer a passion. He most likely has eaten his last slice of chocolate cake. He hasn’t the interest or the appetite for it.

I’ve urged my siblings to go see him and tell him what he has meant in their lives, although I think he already knows. I need to see him again soon too. Now that I live in New England it is not as easy, but I can probably drive down monthly to spend time with him. It’s unclear to me how much handholding he needs. It may be that I simply need to hold his hand a few more times. He is serene in his decline and accepting of it, seemingly without apprehension, taking one day at a time and eking out whatever remaining joy it will offer him in the time he has left.