the rally

People who know their way around the hospice experience will tell you about “the rally,” or the bounce-back. Terminal lucidity is the more formal name. For reasons science can’t speak to definitively (though there are theories), patients on hospice care who can be in states of deep unconsciousness, or deeply altered consciousness, sometimes “wake up.” They become lucid and conversational. They want to tell and hear stories. Sometimes they’ll have cravings for food or drink.

And so it was late Thursday night that I was starting to doze off in the recliner they’d brought into the room, I heard Dad stir. He moaned a bit, coughed a bit, and then said, “Where the hell am I?” This was after nearly a week had passed since he’d said much of anything at all. I got out of the recliner, went over to his bed, and asked, “Dad? Are you awake?” And he looked at me like that was the dumbest thing he’d ever heard, brows arched, his bright blue eyes cutting sharply through the dark. “Of course I’m awake!”

It took him a few minutes to come all the way to. There was some confusion and repeated queries about where he was and how he got there. I told him, “You’re in a nursing home, kind of like the last one, but this one is in Brookfield, by the zoo. Closer to Julie and me so we can visit more easily.” He nodded acceptance, though I don’t think he ever truly put all those pieces together.

Once he was done pondering that, he said firmly: “I want to sit up. I want a Coke. A can of ice-cold Coke. That’s the best thing when you’re parched. Get me one.” It’s not really feasible to just get a can of Coke at midnight in a nursing home. I was alone, and I didn’t want to jump in the car and go get one only to come back and miss this window which I knew might be brief. So I offered some water instead, told him it was the best I could do. He wasn’t anywhere near strong or adept enough to manage a cup, so I fed it to him with a spoon. Plus his swallowing reflex had deteriorated, so gulping ice water down (never mind a carbonated beverage) wasn’t gonna work. So the water was thickened.

“There’s something in this water. Why?”

“Well, it’s thickened. You’re not swallowing as well as you should be, so we thicken the drinks. That makes it easier.”

“Bullshit!”

He tried to negotiate the point further, but that wasn’t really something I could flex on. Thin liquids could lead to a choking/aspiration event and a brutal outcome. He came to accept this thick water, too. His mouth was so dry after several days of no intake at all, I think he was happy just to get some moisture on his tongue.

He looked up at the TV, which had ESPN’s wrap-up coverage and analysis of the first day of the NFL draft. “Was the draft today? Who did the Bears take?”

“Well, they took Caleb Williams with the first pick, and then at 9 they took Rome Odunze, the wide receiver from Washington.”

Again, that look of indignation came over his face. Skeptical disbelief. If you know the man, you know the look. “Another wideout? They already have Keenan Allen and DJ Moore. There aren’t going to be enough footballs to go around.”

You could have knocked me over with a single breath. This was a man who hadn’t uttered anything more complex than one word at a time for about a week, now issuing completely trenchant NFL analysis that would rank him in the top quartile of callers to the Score.

“When I woke up, I asked you for a Coke. Where is it?” Again, another round of explanation that it wasn’t really possible at the moment. It’s midnight. “I’m going to need a full explanation for ALL OF THIS!” I tried again, but some things are just inherently hard to explain.

We talked for a few more minutes about things mundane and massive. “Am I going to die?” “I don’t know,” I told him. I didn’t feel the pat answer of “we’re all gonna die” was appropriate, and we’re not the sort to invoke a Man Above Who Only Knows That Answer. He nodded as he took that in. He wanted to know if it was going to rain.

Right about then, Eric, the night nurse, walked in. He, too, was utterly shocked by what he was seeing. Eric took vitals: BP 120/70, pulse 82, SpO₂ 97, temperature 98. Numbers you might have seen if you measured them two decades ago. As Eric was waiting for the blood pressure reading, Dad told him, “You know, recently I was on an antibiotic. Floral, or something. It was delivered intravenously in a sodium chloride solution.” Eric and I stared at each other in complete shock. That drug was about 10 days ago, and it was Flagyl. (We’ll forgive him that minor mispronunciation.)

After Eric left, Dad got quiet, though he was still clearly wide awake. It was obvious he was taking a moment with his thoughts. “More water, please.” I gave him a few more spoonfuls. Then fairly suddenly, his demeanor changed again. He now was becoming fearful and agitated. His speech was no longer as clear. I asked Eric to come back and take a look, and he suggested a dose of Ativan to help calm him. I asked Dad if he wanted something to help him sleep. “Yes, but only for 30 to 60 minutes.” I said I don’t think it works that way, but we’ll do our best. He agreed. Eric put a few drops under the tongue and he was asleep very quickly.

In the morning I left and other family took over. My aunts Mary and Jane, my sister Julie, our friend Pat. And they got a second, much longer, much more vivid session of lucidity with him. They were even able to get him that Coke, and while he again protested the thickener, they sold it to him as a slushie. Acceptable. They talked, they sang. He did a British accent and flirted with the nurses and aides. At the end, he said something like “I’ve had a great day.” I wish I’d been there to see it, but the joyful updates I was getting in the family text filled me. I had to get some rest, and I’d had my quality time the night before, anyway.

By the time I returned Friday evening, he was asleep again, though I wouldn’t call it restful. Saturday morning, our hospice nurse, Denisa, came by and suggested some additional medicine to calm him further. She then took us out into the hallway and told us in terms more definitive than any of the hospice people had used so far: it’s time to get family here. Maybe today, maybe tomorrow. We appreciated her calm directness, delivering hard news with such kindness and empathy. Hospice people are made of different stuff.

We went back into the room and sat on either side of him, starting to talk about who would call whom. Denisa, packing up to leave, looked at him again and said, “I’m going to stay.” She knew. A few minutes later he took two or three deep breaths and then, finally, was at peace. My brain is already busy erasing the trauma of the last three months, and deeply etching that mystical, magical final day and a half.

Safe travels, Dad. You did good. <3

There will be a memorial service later this spring / early summer. Details TBD.