Calculating ‘quality of life’ amid my not-finished-yet goodbye

We were singing the first worship song at church Sunday when I felt my phone vibrating in my pocket. It was a voicemail from a nurse at Artis. “Please call me ASAP.”

I reached Dylan, who told me they couldn’t wake Evelyn and her blood pressure and oxygen levels were dangerously low. I went back into the auditorium to grab my umbrella and tell my friend why I was leaving.

A long wait

By the time I got to Artis, the life squad was already in the driveway. I found Evelyn’s hall, and they were wheeling her toward me on a stretcher. She was sitting up, but her eyes were still closed.

I pulled my car behind the ambulance and waited several minutes for them to leave. Traffic was light, and I had parked at the hospital and was hurrying through the rain toward the paramedics as they wheeled Evelyn into the hospital. “Can I come in with you?” I hollered.

“No, you have to go through the entrance in front.”

I sat in the waiting room for almost 30 minutes before they would let me in.

Evelyn was still sleeping, with plastic oxygen tubing in her nose and a variety of wires attached to connectors I could see on her chest and others disappearing under the sheet. I had been composed and even calm with every interaction all morning, but when I saw her, I broke down. She seemed more frail than usual. More vulnerable.

Texts and tests

Soon the texts started coming. Because I’d been at church, the news of my emergency departure had traveled quickly. Three different friends came to the hospital. Several others offered to come.

Later after many blood draws, X-rays, and two CAT scans, I could text all these concerned friends with what I was told.

Evelyn had multiple blood clots spread across both lungs. They were causing stress to her heart, so she was headed to the ICU with a heparin drip for observation until that pressure was relieved.

The kind and patient doctor in the ER, and another when we got to her room, explained that they don’t administer “clot busters” these days because they had proven to be risky. A procedure where the blood thinner is sent via a catheter in the groin through a tube directly to the heart would not work for Evelyn, because the clots were too widespread. We would settle for administering the blood thinner intravenously and discuss next steps later.

Speaking the unspoken

The Artis nurse and two emergency doctors used phrases we don’t speak often: DNR, heroic measures, limited options. Quality of life.

“In an emergency, we tend to want to do, do, do,” one doctor admitted. “But sometimes we need to think about what kind of life the patient will have after we’ve done it all.”

I didn’t argue. I’ve thought a lot about this. I agree philosophically that there comes a time to let nature take its course. Dying is a part of living. Especially those with high hope for a better hereafter should not fear this next step.

But our instinct to protect and preserve life is hardwired, and goodbyes are difficult. A final goodbye can be impossible to contemplate.

Long goodbyes

Some have described living with an Alzheimer’s patient as a long goodbye. Some have said of surviving spouses, “They grieved for years, before death finally came.” I’ve been grieving for five years now myself, and I’ve thought there wouldn’t be many tears left when this journey is finally over.

But I remember Paul Boatman’s testimony, writing about the moment of death for his first wife who suffered with Alzheimer’s for ten years before congestive heart failure took her.

“Because I knew death was coming, I thought I was prepared,” he wrote, “but I held her and sobbed for the better portion of an hour before I began making those phone calls.”

Calculating quality

I’m writing this in Evelyn’s hospital room. Her fingers are sticking out of brown socks that cover her arms, extending from her elbows to her palms to keep her from picking at her IVs. She’s been reading aloud from a newspaper for an hour or longer, since she finished off her breakfast of scrambled eggs, fresh fruit, blueberry muffin, and cranberry juice.

I can’t hear what she’s saying, and I figure she doesn’t understand most of it. But she seems satisfied: not unhappy or upset or in pain.

Quality of life? What measure of it does this picture represent? I’m pondering that calculus even as I try to comprehend what it will mean when a scene even this pleasant becomes impossible.

Maybe I’ll be ready to say goodbye then. But not today.