No Heroic Measures

Periocentesis is a procedure in which the abdomen is drained of fluids via a long, narrow silicone needle attached to a bag. The needle enters the abdominal cavity and drains it of the waste that the liver is failing to filter out. The procedure can stink up a room for days, and is a potentially dangerous procedure, since the risk of sepsis is high. A physician friend of mine recently told me that the average body suffering from liver failure could only stand to be drained twice. By my count, my father was drained seven times before he died.

When I got to my father’s house that day, it was obvious that he needed to be drained immediately. He was unable to move on his own and could barely breathe. But, I was afraid to call any of our local hospitals. He had been to them so often. They recognized his face, and knew his name when he called. They all made that familiar face when he showed up. You again, it said.

Also, dad owed them a ton of money. He hadn't paid a medical bill in years. Little Company of Mary, a Catholic charities hospital in Torrance seemed to be our best bet. I pulled up their website. At best it felt familiar to me, with its nuns and stained glass everywhere. After several rounds of phone calls, I got in touch with the hospital’s community social worker who gave me the number of a clinic in Redondo Beach that would see my father at a discounted rate and try to get him on Medi-Cal.

When I picked him up on the day of his appointment and helped him into his wheelchair, I felt we were making progress. This was something I could do, something I had control over. We were going to the doctor.

The building was crumbling, dirty, and old. I filled a life history worth of stock forms in a smelly waiting room with a television mounted to the wall, blaring Fox News. Every seat was full. I tucked him into a corner, in his wheelchair and stood next to him, clutching my purse, not making eye contact.

“Maybe I can talk to the doctor about this.” He picked at the wart on his palm with his left hand.

I found it incredible that Dad would be concerned with a plantar wart right now. But he listed off a few other things that he could get checked out, “Now that I have a regular doctor.”

“Dad, lets just get you drained first. The rest will come later.”

He began talking, loudly enough to be heard over the TV, about one of my brother’s friends who brought him pot cookies.

“Dad! Shhhh!” I looked over at a Sheriff guarding the doors to the doctor’s offices.

“Well why the hell not? You don’t think people here smoke weed? I bet you that guy does.” He pointed a shaky finger towards a slight figured young Hispanic man, with a hoodie pulled over his head, which was tipped back and seemingly asleep.

“Oh, I get it. I’m embarrassing you. Okay, sweetie.”

The doctor took one look at Dad and told me to take him straight to the emergency room.

“But it was the hospital that sent us here.”

The doctor shrugged and turned away.

Not once did this doctor touch him.

I loaded Dad back into the wheelchair, got the car and buckled him into the front seat. “I’m hungry,” he said. He asked if I could take him for tacos.

We drove through Taco Bell. I ordered him two tacos, so he could save one for later if he wanted to try and eat again. We drove a half-mile to Lomita Park, where my brothers and I used to play as kids and parked in a shady spot where I rolled all the windows down to catch a breeze. Dad ate one taco, fell asleep for a moment, then asked could I please take him home now. “I’m tired.” he said, his eyes still closed.

I didn’t have any choice but to drop him back off at his house. I had to go get my kids, and make the hour-long drive back home. I got him into his bed, left a note for his roommate that I would be back ASAP and locked the door on my way out.

His roommate drove him to the emergency room that night, and they checked him in and kept him for six days. I made the long drive there and back to sit with him, to watch and wait. He was so thin and frail the nurses used pillow wedges to stop his body from rolling over. His abdomen, yellow and distended, rose high above his hipbones. When he was alert enough he complained about the catheter, the bed, that no one came to visit him anymore, that he couldn’t eat, couldn’t drink, couldn’t smoke. He called me and cried.

He did this four times, get admitted, get stable, demand to go home. And they would have to let him. And I would have to drive him back home.

He always wanted to go home. His little yellow house with the old vegetable garden was flea-ridden, dark, with no heat.  He couldn’t use the bathroom by himself anymore so he relieved himself in his bed. Eventually he gave up changing his clothes or his blankets. He slept almost all day, only waking up to smoke and drink, take another little bite of a Snickers bar or a Pay Day, drink from a bottle of gin, then the bottle of Pepto-Bismol right next to it. I’d had a phone put in, in case he ever had to call 911. But instead of calling 911, for anything – ever – he called me constantly. He complained about his pain. He complained about the neighbors. He talked about the news. Even then he was still fascinated by space. The day NASA launched their last space shuttle he called me seven times to tell me more about it, then cried because no one else cared.

You wouldn’t think it was possible for someone to call a dying man an asshole, but I did.

On what was to be my father’s last hospital stay, the hospital chaplain had called me to suggest we have a meeting to touch bases, discuss where my father was headed. She used lots of vague wording so I knew something was up. Growing up in the Catholic Church, I’d learned very early on that it was never good when there’s a chaplain on the other end of the line. She was with an organization that my brothers and I started to call the “No One Dies Alone” program.

    As if talking about dying, addiction- wasn’t hard enough, my father was practically deaf, so you had to shout for him to hear you. I envied his defense mechanisms. There was no hiding anything now. I was constantly shouting into the phone⎯

“SO I SPOKE WITH THE CHAPLAIN YESTERDAY.”

“What?” You could hear the pain in his voice.

“DENICE. THE CHAPLAIN. ”

“Oh. Her.” that last part released softly, dejectedly. So he knew, then. I was hoping I wouldn’t have to explain it to him again.

“SO JON AND I ARE MEETING WITH HER WEDNESDAY. OK?”

“Well! I would certainly hope so!”

“RIGHT. WELL, WE’LL BOTH BE THERE.” My yelling was interrupted by his whimpers. I had no choice but to listen to him. It felt as if an invisible audience was watching and judging me, Why aren’t you doing anything! Why aren’t you reaching through those stupid wires and holding him!

“DAD. ARE. YOU. OK.”

More moaning and whimpering.

“DAD. WHY DON’T YOU CALL THE DOCTOR AND SAY YOU NEED MORE PAIN MEDS.” Even as I said this, I knew it wasn’t possible. They’d put him on Fentanyl two weeks ago. It was stronger even than morphine -- the end of the road, as far as painkillers went.

“It’s Sunday. I don’t want to bother him.” Him actually being her. Did he know the chaplain was a woman too?

“WELL DAD. WHY DON’T YOU TELL—”

“You know what, stop it. I can’t do this. Stop jumping all over me. Why don’t you call me later when I’m feeling better.”

He was never going to feel better.

“Or better yet, get your ass down here. You should be here more often. Really, it’s a slap in the face.”

I listened as he fumbled with the phone, intent on angrily hanging up on me. Finally I heard a dial tone once more.

“Asshole,” I said.

But I drove down there. Of course I drove down there. He was asleep.

The nurses hated me; I can see why. For so many reasons they hated me. For letting him live the way he had in that house.

The nurses also hated me because that’s what alcoholism does. It breeds hate and confusion and makes you want to place blame.

On top of alcoholic liver failure Dad also had, MERSA, a blood disease. The doctors couldn’t give him any more antibiotics because his liver had already begun shutting down, and without the antibiotics they couldn’t treat the MERSA. It’s highly contagious, so Dad got a private room. The day of the meeting, his palliative care team, Jon, and I had to wear isolation suits and masks. I could feel the sweat beading up between my shoulder blades, then rolling down my back.

My father looked like a doll propped up in his bed. He was thin and frail, skin yellowed from the liver failure. He looked decades older than his 58 years. The chaplain explained to us that they were no longer going to treat my father. Instead, it was just a matter of making him as comfortable as possible until his organs shut down entirely.

Denice, the palliative care chaplain wore a tailored suit and heels, and even her short brown bob was impeccable. “Do you understand what that means Mr. Hanni?”

He began to cry. No one said a word. It was so quiet in that hot little room.

Marianne, the head nurse, leaned close to my Dad’s bed rail. “Mr. Hanni, we want you to be as comfortable as possible, up until your time of expiration.” It made it seem like he was a carton of milk.

“Dad.” I said. “Do you understand what they are saying?” I tried to meet his eyes. He was silent.

Jon was the one who told everyone to knock it all off. “You can’t talk to him like that. It irritates him.” Jon cleared his throat and scooted forward in his chair, “Dad- you’re dying.”

His eyes met Jon’s. “How long?”

“Do you mean how long do you have?” Marianne said.

“How long?” Dad said.

“At this point,”—she was speaking to my father, but she was looking right at my brother and me— “At this point, Mr. Hanni, I would guess you have about four weeks left.”

I thought it would be days before they moved him to hospice so I decided to drive back home, see my kids, sit with my husband. I had just walked in the house when I got the call from the hospital’s social worker. The kids were still wearing their backpacks. The dog was begging for affection.

“Today?” I said. “That was so fast!”

“Yes. In an hour.”

“But I’m more than an hour away! I just got home!”

“Well, when can you get here?” She sounded irritated. Just weeks before, I’d screamed at her to keep him there in the hospital. She probably hated me.

I looked at my watch. Five o’clock, rush hour. “I’ll get in the car right now.”

When I got there he was panicked. His eyes were wild and the tendons in his neck stuck out. “Please! Please honey, I’ll do anything. I’ll try walking again, I promise. Please!”

“Dad.”

“PLEASE.”

“Just try and relax,” I said. “It’s going to be alright.”

“No. No, its not.” His body went ramrod straight, his eyes up to the ceiling, his jaw set. “I’m triple pissed. Fuck!”

“Dad!”

“FUCK!”

“Jesus Christ, Dad! Knock it off!”

“Who fucking cares! They’re going throw a goddamned party tonight. Woo-hoo!” He started shaking his pointer fingers as if he was dancing. “Woo-hoo, Mr. Hanni is finally gone, that drunk bastard.” He pointed at me. “You need to get me some cigarettes. I am NOT going anywhere until I have a cigarette.”

Dad was quiet by the time the transport medics arrived. I stood next to his bed, holding his belongings while they worked to move his body from the bed to the gurney. Because he had MERSA everything in the bags would have to be thrown away, but I couldn’t bring myself to put them down. Inside were the Old Navy sweatpants I’d bought him just two weeks ago. I got a size small, with an elastic drawstring in the waist for when he bloated up or got drained back down. He loved them because the soft fleece felt good on his itchy legs. There was his blue-and-grey checked workshirt with the hole in the armpit and the missing button on the breast pocket. I recalled watching him work on his truck in that shirt, and it never failed that he would forget the missing buttons, bend over for something, and his pack of Marlboro Lights would fall out.

They let me ride in the ambulance in the seat up by Dad’s head. It was a short trip, but he dozed on the way. The move from his bed onto the gurney had exhausted him, as they’d medicated him heavily.

Baycrest Care Center. Room 31 A. I was surprised at how clean it was.

I knew he was going to hate it.

The male EMT asked him if he needed anything before he left and Dad said, “Yes, a Scotch on the rocks.”

“I hear that,” the man said. “I can’t wait to go home and have a few myself.” I’d liked him until now. I wanted to punch him in the face. Couldn’t he see what was going on here? But, this was what normal people did. They went home and had a drink. What they didn’t do was go home and have 30 drinks and not bother with a glass.  

“This sucks,” my father told me. “Oh man, this sucks.”

“Dad-”

“No, this sucks. It smells like old people.”

“Well that’s because its full of old people.”

“Don’t start with me. You, of all people - you wouldn’t even listen to me about this one god damned thing.”

“What one god damned thing, Dad?”

A short brisk woman in a suit walked in. “Mr. Hanni! Bobby!  Good evening!”

“Don’t call me Bobby. I ain’t your Bobby, lady.”

She didn’t even flinch. “No problem, Sir. Mr. Hanni, I’m going to borrow your daughter for a little bit, okay? We have a lot of work to do!” She looked at me, took my arm and grinned, as if we were just going to have the most fun ever.

At the nurse’s station, she waved a hand at a tray of sandwiches. Peanut butter and jelly on white bread, cut into triangles and covered with Saran Wrap.

“Oh,” I said. “No thank you.” She shrugged.

“Are you his power of attorney? We have some paperwork for you.” She waved again, at a tiny woman in a Hello Kitty smock. “This is Yumi, and she’ll help you get started.”

“Has he had a flu shot?” Yumi said.

“I don’t know.”

“Has he ever had chicken pox?”

“I don’t know.”

“Measles? Mumps?”

“I’m sorry. I don’t know.”

Yumi frowned. “Oh. Do you want a flu shot?”

“Do I want it? Oh no, no I’m good.”

“No. For Mr. Robert. You want one for him?”

I shook my head. The question seemed ridiculous.

“What about if he has a heart attack?”

“No resuscitation.”

Yumi mouthed, “Oh.” She handed me a pen with a big purple silk flower on top. “Sign here, here, here, and here.”

I read it and wanted to change my mind.

“I, Jessica Lynn Danger, daughter of Robert Scott Hanni, hereby request that no heroic measures will be taken to sustain life…”

I signed it.

She looked at me, with big brown watery eyes. “He is your father?”

It took me a minute to realize what was happening. Yumi was crying.  I looked around, wanting someone else to help her. She looked down at Dad’s file and shuffled the papers around. “I’m sorry. It’s just... It’s just the hospice ones are really hard for me.”

I rubbed her shoulder.

I, Jessica Lynn Danger, daughter of Mr. Robert Scott Hanni, was comforting his hospice nurse.