Exactly one week ago (September 11), my father collapsed at home. Today (September 18) he is still in ICU - he has not regained consciousness since surgery - and the prognosis is still uncertain.
He is 73 and has been extremely active: gardening, digging, golf, swimming in the sea, keeping bees, involved in various societies and still acting as a consultant for the yacht brokerage business he sold five years ago. But like many Englishmen of that generation, would not go near a doctor or hospital unless carried in unconscious. Besides, he was fit, barely drank, hadn't smoked for decades, and only continued to eat too much butter (on the basis that dietary theories would come round to favour it again one day).
He ignored months of back pains, putting them down to muscular strain, but which in reality were a series of aortic and femoral aneurysms making themselves known. If he had been checked out by ultrasound, would the aneurysms have been detected? Probably. Would he then have elected to undergo surgery? Here's the tricky part. Possibly not. In truth he would fear being an invalid more than instantly dropping dead, preferably while digging the vegetable patch. Well, his wish was nearly granted.
After an uncomfortable night, he went for a walk early in the morning, came home, sat down at the kitchen table with a packet of Neurofen and was still clutching the packet when my mother found him, slumped, ashen-faced, sweating prolifically and retching. A paramedic arrived by motorbike in ten minutes and administered fluid and oxygen. Twenty minutes later he was in an ambulance on his way to hospital. As I understand it, the odds of getting that far were less than 10%.
Six hours of surgery followed (during which they recycled his own blood from his abdominal cavity) and then recovery and the ICU. On the second day they tried to reduce his sedation and bring him off the ventilator, but he was too stressed and in too much discomfort. The lower aorta had been clamped off for some time, so kidney function was next to zero and there was worry about damage to oxygen-starved intestines.
The third day they put him on dialysis to take the load off his kidneys. By that time, an infection had started on his chest, reducing his ability to absorb oxygen let alone attempt to breathe on his own. Antibiotics joined the array, alongside morphine, sedatives, dopamine to stimulate his kidneys, saline and a bag of intravenous feed.
Fourth and fifth day, the nurses are regularly hoovering off phlegm from his chest, turning him now in a special swinging bed. Did I mention that the nurses and doctors are fantastic? Well they are. The buildings and equipment too. New, state of the art and all provided by the NHS. (This is Chichester BTW, a relatively affluent part of the South of England). My mother is coping fantastically and I have two brothers who are keeping the support team going.
Meanwhile, the anxiety is very tiring as we wait in limbo not knowing which way things are going to go. We now understand that it may be a long haul, with very gradual signs of improvement or deterioration. Also, reading the stories in this group, I realise that things could get worse, and still get better later on.
Last night (but surely it is all night to him?) he had a bad period and looked unwell in the morning, but during the day he was better and his blood oxygen was improved. But, he is still unconscious and maintained by machines, and it would be so rewarding to some signs of life. We talk in his ear as if he were a coma victim. Does anyone know if such messages even get through while under sedation?
I hope to follow this up in a week or so.
Update 3 Oct 2001
I'm sad to report that my father did not make it. He died at one in the morning last Sunday, 30th September.
After the first weeks there were some good signs. His chest infection cleared up and they were able to reduce his sedation level so that he could breathe on his own. His heart beat and blood pressure stabilised and they were able to take him off cardiovascular drugs.
On the other hand his kidneys did not recover any function. They expected his bowel function to 'kick in' of its own accord, but it did not. An enema was unproductive and food administered via a nasogastric tube only came back up. And he did not look at all well, as his muscle mass began visibly to shrink, his eyes looked sunken and yellowing of the skin suggested liver and blood problems.
Nevertheless, as less sedative was given, he was expected to 'wake up' a little. From the appearance of deep sleep, it was almost more disturbing to see him like someone having a bad night - frowning, clenching his chest and shoulders, eyes slightly parted but not really open or aware. Clearly when the talk was of 'waking up', we weren't about to find him sitting up one morning wondering where he was and telling us he was hungry. We visitors continued to talk to him, to tell him where he was and what had happened, and to tell dreamy, comforting stories of walks on the beach and white sails idle on calm blue seas. And we rubbed his feet, hands and temples with lavender and peppermints oils. The nurses certainly said they felt a lot more relaxed!
In order to find out what was going on inside, the doctors performed further surgery on day 15, which resulted in the removal of the lower section of intestine and bowel.
Sixteen days after his collapse came the day we had dreaded. Visiting in the morning, we were taken into a special little room with chairs drenched in the histories of bad news. As feared, the blood supply had not been restored to all the internal organs or indeed any of the pelvic region. While they had surgically removed what they could, there was still bleeding and necrosis and the body had started to respond with its own cascade of emergency hormones and chemicals. In short he could not stand further surgery and, in any case, there was nothing surgery could offer. Nor was there any other medical solution. Sadly we concurred with their proposal to withdraw treatment.
Twelve hours later, his blood pressure dropped off the monitor and his heart stopped.
In the end it could have been much worse - he would have hated being less than 100% capable. For him, it was as if he had died quickly at home, for he never really regained consciousness in the hospital. For us, we had two agonising weeks full of hope and anguish, but also a period for getting used to the idea of his going forever, and a chance to whisper our goodbyes.
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