Documentation of a Death Well Done- The Passing

Today is my first Father's Day without him. Last night in the shower, as I was going through the mental to-do list, I mentally noted "call Dad for Father's Day". It makes me suck in a little, but the tears are still reluctant... In honor of him, I'll try to finish his story tonight.

In the early afternoon on Wednesday, April 6th we settled with Dad into his new home at the hospice center in Cottonwood, AZ. The room was spacious and light, with enough room for another bed for Mom to be moved in next to his. There was also a large transforming recliner that would serve as my bed if we were there long enough to need it... On the far side of the room, there were floor-to-ceiling windows that filled the entire wall. The windows held a view of the desert at the base of the Sedona mountains. There were hummingbirds, squirrels, rabbits, foxes and deer making their homes near Dad's private patio. Wild flowers spread themselves over the long prairie grasses, making his "yard" pop with spring colors. There could not have been a more idilic Arizona "Louie L'Amore view", yet Dad was unable to wake up to see any of it.

Anyone leaving Dad's room and turning to the left, would find a chapel room with a bible and devotional-type materials. Across the hall from the chapel, there was a gathering room used for community meals, parties or entertainment. In the corner of that room, my brother John discovered an electric piano. For hours he filled the hospice center with the music that his hands were writing as he played.

To the right of Dad's room and down the hall was the nurses station, main entrance and check-in area. There was a spacious, vaulted ceilinged, living room. A large kitchen with gorgeous counter-tops, sinks, beautiful appliances, most importantly, a commercial coffee station stocked with ground beans and filters for months of use...

The living room and kitchen area led outside to a covered patio, complete with cushioned furniture, porch swing, coffee tables and fireplace. The view held the same view as Dad's room, a spacious panorama of the Sedona mountains.

Beyond the main entrance and living room areas, there were two smaller private family living rooms for use by people, like us, who needed to be together but were not interested in mixing with other patient's families in the common areas. There were two bathrooms with showers available for family members of patients as well.

After a quick tour of the facility, our family gathered in Dad's room and settled in around his bed. The staff had brought enough chairs for everyone. Even with thirteen of us around his bed, there was a spacious, light and airy feel to the room. The mood was somber; on the air hung exhaustion. Dad seemed to be hovering between life and death again, immediately following his ambulance ride. Breaths were again very shallow and unpredictable in their rhythm. Whispering, sobs and softly blown noses were the only sounds as the afternoon minutes turned into evening hours. We spoke our love over him as he labored to live. I asked him "why won't you let go?" Almost as soon as I asked, I heard his voice in my mind reply "well, Little Girl, I'd like to enjoy my family for a little while now that I have you all together." I laughed out loud as I thought it. My brothers and sisters, I'm sure, thought I was crazy, so I explained. "Is that it Dad, you just want to hang out with us?" He hadn't moved a muscle since arriving in Cottonwood, but with that he squeezed my hand and purposefully nodded in the affirmative. What a relief! Dad was still Dad, even when his body was trying to quit.

Eventually, people came and went from the room, unable to continually watch Dad work so hard to breathe for the entire day. John kept finding himself at the piano or walking the grounds outside. Susan, who hadn't been feeling well since she landed in Phoenix a few days before, made herself a bed on one of the couches in a private family room. An aunt found a place to read near the fireplace on the patio. My uncle found a spot to sit in the Chapel. Brian and his wife, Hannah, took a walk around town. Deborah and her son alternated, with me, between patio, kitchen and Dad's bedside. Mom curled up next to Dad on the bed they brought in for her, sleeping fitfully off and on. Gary wrestled with what to do...

My brother is precious to me. He had worked hard on the logistical details needed for Dad to be moved to Cottonwood. He had driven the two hour round-trip drive, twice, to the facility. He had paid the initial deposit and signed all of the paperwork. He then found a nearby hotel and made arrangements there for all of our siblings to stay. He arranged for Mom and I to stay with Dad in his room. He thought of every detail. Now he was stressing. Weeks, even months, prior to this first week in April, Gary had made a promise to help a friend in California on April 7th. The appointment was not flexible and there was no one Gary knew that could stand in for him in there. He HATED the thought of leaving with Dad like this, but he also knew that Dad would expect him to keep his word with his friend. Although Dad was unable to wake up or speak, Gary explained the situation to him. He told him he'd have to leave soon to make it back to California in time. He promised Dad he'd turn around immediately following the appointment on Thursday and make the five and a half hour drive back to Cottonwood. Dad gently nodded with one quick nod, seemingly approving of what Gary was saying. With that, he reluctantly said goodbye to our father.

As April 6th waned, my aunts and uncle took Grandma back to their hotel. At 87 years old, she was in no condition to hold round-the-clock vigils. I had been wondering if Dad was being given choice as to when he would breathe his last. I wondered if he was waiting for alone time, not wanting any of us to watch his passing. Maybe he just wanted it to be my mother by his side... now it was too late to ask, we would simply have to start living out those options for him... Despite all of our efforts to make him comfortable enough to "let go", he continued to hang on to life.

As the thick, heavy, night settled in, I asked the nurse where I could do my laundry. I had only packed enough clothing for my three days in Washington over the Easter weekend, and now I had been gone from home for nearly two weeks. The clothes I was currently wearing had been the last of my clean ones, when I put them on four days before. Now that we had moved from Flagstaff to Cottonwood, my belongings were with me, rather than at a hotel. The night staff set me up with detergent and their "staff only" laundry facility. I put on a robe and found a dark corner to collapse in.

I no longer had the emotional ability to be strong and the reality is, Dad wasn't looking to me for anything anymore. Regardless of that fact, I felt defeated. I had promised not to leave him, and although I was physically in the building and often at his bed-side, I was mentally detaching from the entire situation. I was annoyed at everyone else's process around me, especially those who were still feeling desperation that Dad would die. That was old news, and I just wanted him to get on with it. I could only think of me. I wanted to cry. I wondered if I would ever laugh again. I was annoyed that Dad was dragging this on and on... or was Dad even in control of it? I tried to think graciously about the situation, knowing that not everyone was "ready" for the inevitable like I had become. I craved sleep. I craved clean hair and skin. I wanted new clothes. I never wanted to see that purple and grey bicycle sweatshirt again... I thought about petty, emotionally immature things and then marveled at my childishness.

I must have slept some. I awoke, confused as to where I was, with my sister's update. She had changed over my laundry and had hung things that weren't dryer-friendly around our father's room. There was at least one outfit ready to wear, did I want a shower? A few of our siblings had gone to the hotel as had her son. Susan was still asleep in the family room. She was taking the "awake shift" in Dad's room while Mom slept fitfully next to him. Deborah was now my care-taker as she found a towel, soap, shampoo and conditioner. I accepted my little sister's mothering and obediently slipped into the shower. I stood there crying, scrubbing and re-scrubbing my filthy hair. I wanted to be anywhere but in Cottonwood, Arizona.

While the shower made me feel new on the outside, I was still lacking feelings beyond hardening numbness on the inside. Dad was sleeping, or at least rhythmically breathing, when I got back to his room. Mom was still holding out hope that he would wake up and be ready to leave. She was alternating between silence and perkiness and desperation and despair. It was horrible for me. Months before, while our family was in the car, my five year old, deep in thought, broke the silence with this statement: "Mom, I don't want my grandpa to ever die. I don't want him to die mostly because that means my grandma will be alone. What will happen if she is alone?" That day the thought had moved him to a puddle of tears as he imagined her plight. On this day, the burdens I felt for him and for her and for me and for them, all of them, was more than I could process. I couldn't handle the sounds of my mother's desperation, and with that, I broke my promise to my father. I deliberately and with forethought left his side for what I believed would be the last time.

The shower, the coffee breaks, the laundry, the one hour naps, none of those were a "leaving" in my mind- I knew I'd be back and half expected to drop everything and run to him if they should call me. This time, I had no intentions of returning to his side. I knew I just didn't have anything left to hold myself together for another minute, much less to be strong for anyone else. My body drifted left down the hall as I left his room. The chapel would be peaceful I assumed. I couldn't pray. I couldn't cry. As I curled up in the fetal position underneath a chair next to the coffee table, I imagined a dozen years of bible studies and visits to my parents friends' homes, in which I tapped out too soon as a child and found a place to nest under a piece of furniture. I felt like a preschooler in every way. I needed a mother, but I didn't have one I could access. I needed a daddy, but it was too late. I imagined myself orphaned as I drifted off...

I woke up to my phone buzzing next to my carpet imprinted face. I have no concept of how long I slept and once again, I woke up confused. My sister Deborah was calling. "Collene, Mom needs you in here. Dad needs you. Where are you?" I didn't even remember where I was I told her... "Besides, I can't."

"You have to. It's almost time."

I might have walked, or crawled, but in obedience to my little sister I found myself on the floor outside his door, sitting on the floor, unable to go in. Mom found me there, sat down and curled up next to me. "Please come back in with me," she begged. I tried to explain how I couldn't lose her and him and my whole sense of security in the same desperate breath. I wanted to leave. We lay crumpled in a heap in the hall for awhile, until I realized that I couldn't live there forever...

When I re-entered my Father's room somehow I felt rejuvenated. I found his pink sponge mouth swab and gently gave him water on his lips and tongue. He bit the sponge with surprising strength. His strength had always amazed me... I felt guilty as it became obvious that he had been thirsty while I slept. I reaffirmed my commitment to be there until the end as I sat holding his right hand. Mom invited me to join her on the bed next to him and for the last time, I snuggled next to him and felt once again like his "little girl". I may have stayed for 30 minutes, or 45... People were starting to return from their various hotels for the morning shift at the center. The sun was rising over the red desert. Dad was missing it again, but I took the time to describe everything I was seeing out his window.

As the busy buzz of the building started to pick up, we became aware of my sister Susan's overnight decline in health. She had been feeling under the weather since she arrived a few days before, but now she was fighting a high fever. The head nurse, Debby, checked on her and insisted that we take her to the emergency department of a nearby hospital. My sister Deborah and I decided to keep the information on the down-low, at least until we had answers. Mom didn't need that kind of worry. John, Brian and Hannah would keep her pre-occupied as we slipped out the front of the building. Our nurse Debby was concerned enough about her situation to follow us to the ER to make sure we got seen immediately. Knowing that our father had hours to live, made the entire trip that much more stressful. Susan's fever was around 102 degrees and her blood pressure and heart rate were both high. After several rounds of tests, the doctor found nothing conclusive and prescribed an antibiotic anyway. A few of the tests would take a couple of hours at the lab and our doctor was sensitive to the fact that we needed to be back at Dad's side. They promised to call if anything came up on the lab work... (As a side note, because this blog post won't include the following days, the hospital in Cottonwood never did call. At around 3:00 a.m. April 8th, we left Cottonwood to take my sister back into Flagstaff. Her fever had spiked to 104 degrees overnight and her breathing had become laborious. Back at FMC, she was admitted into the hospital with a case of H1N1, or Swine Flu. Her room at FMC was on the same floor as our father had been for a week and a half, just around the corner...)

We arrived back at the hospice center in the early afternoon on Thursday the 7th. Susan spent some time saying "good morning" and "good night" to Dad, then went back to lay down. My aunts and uncle, along with my grandma took themselves to the patio to read and rest. John found the piano. Brian and Hannah left for a short walk. Deborah searched her phone for music that Dad might like. I sank into the chair at Dad's feet, snapping pictures of things around the room. Mom wandered around the room looking for something useful to do; her worn bible on the edge of her bed. She had been reading scripture out loud to Dad for much of the night. He always appreciated her loving and encouraging him in that way over their lifetime together.

I saw Dad's shaving kit nearby. My mind flashed to the numerous times over the years that, that kit had made an impression on me. Dad NEVER went a day without a proper shave, even if he was in the wilderness camping. I thought about the day before; in the hubbub of leaving the hospital, I realized he hadn't had his shave. I thought about how he would have hated that had he been given the opportunity to lucidly object.

Almost as if she was reading my mind, Deborah asked "Mom are you going to shave him today?" Mom looked a little surprised. She was almost excited at the idea of having something useful to do with her hands.

"I guess I could, although I'm not sure he cares anymore" she replied as she glanced at his unconscious body. I said as gently as possible, "it would be easier now, than it will be later." She was already at the sink warming the water.

As I watched her line out his shaving cream, razor, warm wash cloth and water bowl, I asked "are you going to leave on his oxygen or take it off?" I was aware of how resistant she had been to allowing him to remove it only 24 hours before.

"Oh, I usually take it off to shave him" she replied.

As she began to lather his cheeks I started snapping pictures. Deborah was at his right side playing music softly near his ear. Mom slipped off his cannula and cheerfully shaved his right side. Her tender hand traced his jawline to ensure she hadn't missed anything. He was meticulous when he shaved, she knew every stroke of the razor mattered. As she turned to rinse the razor I noticed Deborah's face change. She had been watching his chest, watching him breathe. Snap, snap, snap... I simultaneously had been documenting frame by frame... Deborah looked at me. "He stopped breathing," she mouthed to me. In the same millisecond, I had already been searching for signs of breathing. There were none.

"Mom" I said.

"Yes?" She asked cheerfully.

"He was waiting all night, just so you would shave him."

"What do you mean?" She wasn't following me; she didn't see Deborah's face. She hadn't noticed his still chest. She began to shave his left side.

"Mom. He's gone. He stopped breathing. He just waited around all night so you could shave him one more time." I repeated.

She jumped into action at my words. "Oh, I'm sorry Larry! Here, take a breath..." She had quickly replaced his nasal cannula.

With that, at 2:35 p.m. Arizona Time, my father obediently took his final, shuddering breath.

Peace covered the room. My sister left to find our nurse. Mom finished carefully shaving his jawline. I took pictures of his hands, his ears... of him. I watched as my mother was wrapped in an invisible blanket of protecting peace. Acceptance washed over her as she carefully and purposefully removed all things "medical" from him. He wouldn't be needing any of that where he is, she explained.

I'm not sure how the others knew to come back in. I just know that as I found myself at the foot of my father's bed trying to remember how to unlock my phone, I was surrounded by family. Daniel would need to be called. Gary would be heading back to Arizona any minute and would need to know. Charles would need a call. I remember seeing the time on the screen, 2:36, then the phone rang in my hands. It was my husband calling to check on things as he left work.

I slid the screen to take the call. "He's gone," was my greeting. "What?" Coul wasn't sure he heard me right. He immediately went into action. "Okay, I'll call your kids and we'll be on the road in a couple of hours...

The rest of the afternoon was a blur. My brother-in-law, Matthew, had made prior arrangements with the funeral home in Montana- where Dad would be buried and Gary had relayed the information to the hospice center. The Montana home was contacted and they, in turn, made arrangements with the funeral home in Cottonwood. Within the hour, the hearse had arrived to collect my father's broken earth suit.

Mom and the nurse had already dressed Dad in his maroon, snap-button shirt when the mortuary arrived. I remember them introducing themselves at the door. Well, Steve, the shorter of the two gave us his name. The taller one didn't mention his. I pressed him for his, explaining how important it had been to my father to know the name of everyone who touched him these last weeks. "My name is Lurch" he said. With that, my mom said, "Okay, well we'll leave you to do your job. He's in there, I'm sure you can tell which one he is." Ahhhhhhhh, I love my mom. We both have the same "gift" of saying crazy, stupid things in stressful moments. I immediately followed her goofy statement with, "Oh good, Dad is being carried out by two guys named Steve and Lurch. I think he'd appreciate that." Delirium made us giggle for an inappropriate amount of time...

We finished cleaning out his room at the facility and checked into our hotel. I think our Dad would have been happy to know we crammed the entire lot of us into the room shared by his wife and three daughters, for an incredibly randomly eclectic grocery-store-acquired dinner. Reluctantly, the others eventually found their own rooms as we all reached our limits of exhaustion. There would be so much to do in the following days, but for now my Mom needed me to hold her while she faced through her first night as a widow...

Larry Gene Sears

August 11, 1948 ~ April 7, 2016

Documentation of a Death Well Done- April 6th Dawns

Two months ago yesterday my strong, resilient father breathed that final, gravelly, deep breath of death. I'm not sure what my resistance is to finishing this story. Maybe it's because, in a specific way my dad will disappear again, with new kind of finality. Maybe I feel like if I finish telling the story, I'll have to finish the grieving, to be "over it", to "move on".

The reality is, my dad has been gone for an eternity already. He has missed a thousand would-be phone calls from our home- both his grandchildren's initiation and mine. He hasn't heard me relay the detailed account of how God is answering his own specific, earnest, prayers for our family; he already, no doubt, knows the end of those stories- as we are only starting to watch them unfold...

I left you, the observer, at bedtime Tuesday, April 5th. Everyone was physically and emotionally bankrupt.  Along with a few of the others, my youngest brother Brian and his wife, Hannah, had chosen to join Gary and I at the hospital, quietly gathering in the family waiting room; everyone else determined to embrace the exhaustion by putting themselves to bed at their hotel.

Dad had become less and less alert as evening settled into deep night. As the wee hours of Wednesday began, we were increasingly aware that things were changing, although I'm not sure any of us acknowledged the facts with each other for the first few hours. I had been blessed to be allowed the time and space to care for my father's physical needs for a little over a week; I recognized the therapeutic nature of having an element of "control" in a situation that was out of my control. As I watched the helplessness I still felt, mirrored on the faces of my siblings, I consciously began inviting them to help reposition and roll our dad every 15 or 20 minutes. As I was explaining our repositioning routine to Brian while he assisted me, I noticed Dad's skin had become wax-like and his limbs were heavier than ever. I kept my thoughts silent, wondering if Brian saw what I saw.

Now there was a group of us chatting quietly around Dad's bed. The emotional atmosphere in the room was peaceful and light, stitched together by exhaustion and a quiet, low, hum of seriousness. It was good to be together. By 2:30 a.m. the final carload of siblings left, electing to resign themselves to a few hours of sleep. Now I had the opportunity to check in with Gary about his observations... Because we had been there the longest, we had the benefit of seeing the patterns of energy and pain, highs and lows, develop.

Gary and I agreed, His breathing pattern had seemed to become increasingly erratic. We vigilantly watched each movement and every breath. We knew there would be no sleep for either of us. Shallow quick breaths were compensated for by deep, desperate, rattling breaths. Eventually Gary and I verbally acknowledged that things were most definitely changed in the hour since the family had left. I started thumbing through my contacts list. Who wanted to be called if this was really the end? Who would feel like I was being dramatic and be annoyed by being awakened mid-sleep? Who had expressed emotional inability to experience Dad in any state other than living? Should I awaken my 87 year old grandmother? Would crying "wolf" make everything harder for her, or for or my mother? I was exhausted and not confident in my assessment of my father's situation.

Gary was, again, invaluable to me. As a team we seemed less likely to fail our family. We made the decision to call siblings, we hovered over the idea of calling mom- we just weren't sure, and we decided against calling aunts, uncles and Grandma. Honestly, it looks so organized as I type it, but it felt far less so. I forgot the names of two of my siblings- or at least, how to look them up in my phone. There were missed calls, missed rides, mixed messages, people who tried, but couldn't, wake-up. It's any wonder anyone came, but before I knew it, my siblings and my mother were at our side as we prayed and cried and hovered over our father. A brother, who had initially elected not to be there at the end, found himself restless at the hotel and posted himself instead in the waiting room. Eventually, even he found a wall to lean on in Dad's room.

Now his breaths were nearly too shallow to see. Eight sets of peeled eyes watched for each slight movement of his chest. I started silently counting seconds between breaths, 28, 29, 30, 31.... then a shallow gasp started the count all over. Mom begged God, cried softly, told Dad to wake up. April 6th, I was convinced, would be the second date inscribed on his headstone... I sat on the filthy hospital floor, clung to familiar fatherly fingers, and fell apart. I could visualize my heart being shredded inside my chest. I ugly cried for what felt like months, unaware of anything except my own brokenness. Eventually I became numb, uninterested in everything and everyone around me. I found myself getting off the floor, searching for a seat, aware only of the feeling of total apathy. A million miles away I could still hear people talking, crying, begging next to me as they participated in this process with my father.

The phone rang. The pastor was returning my Mom's call. She had left him a message that "this is it". He wanted her to know that he and his wife were already in the car, on their way to Flagstaff. Mom hung up the phone and said, "Larry, Danny is on his way here". With that, Dad erupted into a sitting position, his eyes were huge. "I'm not dressed!" He shouted. I snapped back into action, numbness would have to wait. Dad was climbing out of bed. I was in awe at his strength! He hadn't been able to move his own legs to adjust himself for comfort's sake in days and now he thought he could walk?

Things were happening so fast. Everyone stood there in disbelief. He had been barely taken two slight breaths a minute for the last hour, but now he was demanding his pants and telling me to "bring the car around" so we could "load up". He jerked his nasal cannula off his face and refused to entertain our requests to re-establish his oxygen flow.

Mom had the sound of excitement in her voice, "ok Larry, I'll get you dressed, we can go home." Our mom was clinging to the hope that this was all a bad dream and the they would very soon awaken to a miraculous and complete healing. I could see that he was still incredibly frail and that nothing was healed. All I could visualize was him falling from the bed thereby shattering his femurs. I shot over to the  bed and jammed my thumb into the call light to call for his nurse. I told her to bring at least two strong nurses to help us.

The sound in Dad's voice was desperate, angry, and scared. He kept saying, "I can't go like this, I'm naked. Don't you understand I'm embarrassed? Please help me get ready to go. I just want to at least wear pants, pleeeeeeaaaasse." None of us were moving fast enough for him and none of us knew what to do.

He had a determination I had not seen in years; it was a tone that was familiar to any one of his rebellious children who met their match with his much stronger, fatherly determination for respect and immediate obedience. The nurses arrived in the nick of time. I was on the wrong side of the bed, reaching across to try to block Dad from standing. I climbed across the bed and got in my dad's face. "YOU NEED TO STOP," I shouted. "Your legs are going to break and you need to sit down," I said in a calmer, but still-direct, voice. His blue eyes searched my face for understanding. "Don't you understand?" He cried desperately. "I can't go like this, they can't see me in a dress!" I wasn't sure who "they" was. Danny and his wife had been to the hospital several times and the hospital gown situation had not been a problem for Dad before. To me, it was obvious he was referring to a different "they".

Mom had found his underwear and asked the nurses to take out his catheter or to at least help her navigate the Foley so he could at least feel more secure in his underpants. One of the nurses then scooped him into the recliner chair on wheels. He instantly starting fighting to stand again. I jumped over equipment, bedding and people to take charge. Dad had told me days earlier that he needed me to make decisions for him, to not leave him. I held his face in my hands and placed mine inches away from his. We locked eyes and I got my "mom voice" out. "Dad, you told me I was in charge now. You told me you needed someone else to make decisions and to take care of you. You trusted me and you still do. I hear you saying you want to go, and we are going to, but you absolutely need to sit down now. You are not allowed to get up again. Your body cannot handle what you are trying to do and you are going to get really hurt. Now trust me and sit down." Whether it was my tone or the promise of "going", my words seemed to satisfy him and he reluctantly obeyed. I had quickly decided that taking him "on a trip" around the darkened halls of the hospital might make him feel as though he was being validated in his need to "go".

With traumatic fanfare, the ten of us wheeled him down to the closed skybridge. I know we woke up every patient on the floor with the commotion. As we left his room, I had no plan. I hoped I would be able to navigate this trauma and lead my parents well. It felt like the whole world was falling apart and nothing was rational any longer.

Dad's panic subsided only until we parked his chair on the skybridge. He responded as though we had scammed him as soon as the chair stopped rolling. "NO!" I'm supposed to be wearing my pants and I told you I need to GO. You need to understand I have to GO!!!" He was disgusted with us and desperately discouraged. We decided to try putting on his button shirt, the one he had worn when he checked into FMC a week and a half before. A brother and my Mom ran to get it while we tried to calm our father. As I crouched in front of his chair to try to reason with him again, he suddenly saw his watch on my wrist. He snatched my arm up and pulled off his watch. Before I could respond he shoved his swollen wrist through the band, snapping in into place. He gave me a defiant, satisfied look- as though he'd won a small battle. I knew the watch was going to hurt his swollen wrists, but I also knew not to fight that unnecessary battle. I'd wait and slip it off again after we got him back to bed. He stared at the watch for a few moments and then asked me to tell him again what time it was. I knew he didn't want the literal answer. "It's almost time Dad, you have to be patient. You have spent my entire life telling me to be patient; now it's your turn to wait."

A white undershirt and Dad's cranberry colored snap-button shirt were produced on the skybridge and within minutes his gown had been replaced by his own clothing. Mom asked him, "Larry could we please go back to the room and get you on your oxygen?" He nodded and settled back into his chair, ready for his "trip". I obliged, hoping that by the time we returned to his room, he'd be ready to let it all go. As we rounded the corner at the nurses station, just outside his room, he asked "did anyone ever find my fire pants?" He hadn't specifically requested "fire pants" before, he had only asked for "pants". I latched onto the distinction and promised that we'd look again. As we headed into his room, I looked over my shoulder and asked the group of siblings behind me, still in the hallway, if they still needed "Larry" on the fire. Deborah caught on: "Nope, the fire is out, besides I thought it was Larry's week off."

"Yeah Dad, the fire is ready for mop up already, your guys did a great job. They want you to take the week off" I told him.

He replied, "oh, good. Yeah, they are good guys aren't they? I'm glad they don't need me, I'm pretty tired."

We helped him back into bed. Knowing that there would be no way to safely remove his undershirt over his head, I asked the nurse for her medical shears and cut it off him. I then spent a few extra minutes tucking him in, stroking his cheeks, giving him a sip of water and, finally, removing his watch. He gave me a meaningful hug, which communicated complete dependance and trust. He was now peaceful and relaxed into a normal sleep with a normal breathing rhythm. A minute later he forced opened his eyes and looked at me with a grin, "what's going on here? Were you trying to pull something over on me or did I just have a dream?" "No Dad, you were pulling something over on us!" He laughed at my assertion and shook his head with a weak grin. "Alright" he said as he re-settled his head on the pillow. He was suddenly aware of each of us, acknowledging Deborah and Chevvy, nodding at me as I thanked him for listening to me and for trusting me. With my hand on his forehead, he drifted off to sleep. Gary reminded us, "Dad always said he'd be a firefighter until the day he died."

We all stayed for another hour to watch him sleep. The April 6th sun was just now rising and we had already been to hell and back. I was incredibly thankful that we had not called our Grandmother to the hospital in the middle of the night. However, as it turns out, when we relayed the nights events to her later that morning, she told us she had woken up suddenly just before 4:00 a.m. and paced her room. Whether it was a dream or a feeling, she knew something was wrong. For the remainder of the dark hours she obsessively checked her phone, waiting for my call. It seems like a mother always knows...

As it became clear that Dad's breathing would maintain a healthy rhythm for the morning, people headed back to the hotel for a shower or a few more hours of sleep. Because Daniel would be flying out of Flagstaff in a few hours- headed back to work on the East Coast, he chose to wait with me in Dad's room for Dr. Kennedy, our palliative care doctor, to do her morning rounds. She had already heard the report of the night's events from the night nurses at the shift change meeting. Daniel and I relayed our concerns in low whispers. Dr Kennedy was an amazing listener. She drew out every detail of events and emotions from each of us before she responded.

"What your father experienced this morning was very normal in the dying process. Some people seem to hover between life and death, aware that their body no longer serves a purpose for them and yet there is something beyond this world that they seem to want to experience. Often they struggle to physically exit their broken body, which in reality, sends adrenaline into their blood stream. Your father was trying to "go on his trip" by attempting to force his way out of himself. It's a "soul" separation he craves and is attempting. These types of moments will likely keep happening until his organs and body shut down completely. It is much more traumatic to watch for families than it seems to be for the patient. If this is simply too much for your mom or your family, I can prescribe an anti-anxiety medication which will alleviate your concerns of future episodes. However, if you feel like you have more to say to him, or if you aren't ready for him to stop attempting to communicate, I will hold off on the prescription. He isn't likely to be awake again once we administer the medication."

Daniel and I shifted our attention to another concern without making a decision on the anti-anxiety medication. It was difficult to tell if Dad had injured himself in his attempts, or if we had injured him in the dressing and undressing. I was increasingly stressed about keeping track of the pain medication and was even less confident that Dad would ever be able communicate his needs again. I reminded her that he doesn't ever want us to "max him out" with the narcotics. I would honor that until the very end, but I needed to know what would be appropriate to do now. We agreed to double his dose, which was still half as much as his "max". The doctor wrote the prescription in a way that it would not be optional, but a regularly scheduled dose that no one needed to babysit. What a relief! April 6th was day four for me without a bed and day three without a shower;  I felt my mental competence dropping. I was fearful of failing Dad in such an important area.

Dr. Kennedy took several minutes to give Daniel and I some advice on how to support our mother during this time. She even told us about a store downtown that made custom blends of teas. While we were unable to find the time to go there before Daniel flew out, we appreciated her thoughtfulness and attention to every detail. After much consideration and discussion, my brother and I decided that the safest option for our father, and the least traumatic for our family, would be to sedate Dad with the anti-anxiety medication for the duration of his life. The first dose would be administered directly prior to his ambulance departure from Flagstaff Medical Center to make the transfer most comfortable. We knew that we had all had one or more "last conversations" and the legitimately coherent conversations had already naturally dwindled. Daniel then left the hospital to pack up his hotel room. I have always appreciated his low-key, common sense attitude. He always appears un-ruffled. I love these strong men leaders that I am blessed to have been raised around.

Now that the hospital's day shift was in full operation, the palliative care team went right to work organizing an ambulance transport. There had been some concern as to whether or not Dad would be too fragile to be transported to the hospice center in Cottonwood, and hour away. Dr. Kennedy wanted it to happen in the morning. Dad wouldn't be getting any healthier as the day progressed.

Things were a bustling blur. I tried to feed Dad breakfast, but he was uninterested. He nodded in agreement when we suggested he take another ride to the skybridge to spend time in the sun. Overnight a forest fire had started near Lake Mary. The thick mushroom cloud was visible from the skybridge and I was confident that Dad would be interested in watching it, especially considering his "fire pants" request only hours before.

As we settled him in his chair, positioning him in full view of the fire, he disinterestedly turned his head away. He was outright refusing to look at it despite our encouragement to do so! Instead he had chosen to gaze at Humphrey's Peak behind him. We laughed and repositioned his chair, his oxygen, his blankets. What a process! In typical Dad style, he immediately fell asleep. Our family lined the skybridge, each of us lost in our own thoughts. It was a comfortable silence as we watched a bustling hospital, a city unaware of our pain, a peaceful wilderness just a stone's throw away, a growing forest fire, our sleeping daddy, brother, son, grandpa, husband... There were coffee runs, phone calls from friends and grandkids and in-laws; even a friend of Dad's, who had just been checked into FMC because of an infected dog bite, stopped by the skybridge for one last visit. Dad slept through it all. Morning was turning into afternoon, yet Dad remained stable. Transport plans were moving forward.

After a couple of hours we decided to return Dad to his room. The staff had already started preparing for a new occupant to use the bed. The cafeteria brought lunch. We tried to send it back, knowing Dad was unlikely to ever have another meal. The compassionate kitchen worker encouraged Mom to eat it. It was a strange time. I suddenly felt like an outsider in the room that had been "home" to me for the last 8 days. I was afraid to touch the sheets or pillows, to use the freshly emptied trash can, or to walk on the just-mopped floor. Mom cleaned out the closet which had been shoved full of medical paperwork, Dad's cane, clothing, snacks, the photos grandma had brought... We were really leaving. It was the first time I've ever dreaded leaving a hospital. As we carried loads to the car and nibbled off of Dad's lunch tray, Daniel announced it was time for him to head to the airport. Almost simultaneously, the palliative care coordinator dropped in to let us know the ambulance was on its way. Dad was still un-stirring in his chair, wedged in by pillows and buried under blankets. His skin was starting to look strange again. Although he had yet to receive his anti-anxiety medication, it was clear he had naturally declined to a much less communicative state over night. I was relieved about our decision regarding the drug.

Daniel, needed the correct keys to a usable car. Wait, he needed a ride instead. Where was Gary? Would they be using one of Mom's cars? Daniel knew he still had things at the hotel on the opposite side of town. There were nurses present to finally administer the first of the anti-anxiety meds and another dose of the new pain meds. There was check-out paperwork being delivered and phone calls coming in. In the stress of the moment, Daniel rushed by our sleeping father, afraid of missing his flight and distracted by logistical things that needed to be lined out before he left. It would be the last time my brother would see his father...

Then ambulance crew was working to get my sleeping and newly sedated father from his recliner chair to the backboard and gurney. He let out a painful yell as they settled him on the gurney. It was the last sound he ever made and rings still in my ears. There was a rush to give our purses and odds and ends to my sisters as Mom and I followed Dad to the ambulance. They would have room for both of us. I was relieved to be able to continue to keep my word not to leave Dad until it was over.

Aside from his rhythmic breathing, Dad didn't move a muscle for the entire hour in the back of the ambulance. The EMT riding in the back with us asked a few questions about Dad's career and life, but chit chat was laborious for mom and I. A lump built in my chest and I no longer trusted my voice to respond. I stared at the waxy skin again developing on Dad's face and hands. Would he survive the trip? Maybe transport was a mistake. I was only comforted by the perfect rhythm of his breathing. What was mom thinking about? I didn't have the energy to ask. I took a few pictures and responded to a welfare check text from my sister. I sat in disbelief. How were we at this moment? I no longer felt anything. A heavy, soaking, numbness fully engulfed my being, inside and out.

We arrived at the hospice center in Cottonwood just after 2:00 p.m. Wednesday. We were immediately greeted by several of the staff members at the ambulance. Most of them were named Debbie or Debby or Debi. It seems like all the good people in my life have a name that sounds like that, I remember thinking... Somehow my body made it to his new room, at his new bedside. I was aware of nothing except my need for a change of clothes and a shower. Everything I had just been through for the last week and a half seemed like a waste of time. I had already been poured out and this process could take another week or more, they cautioned. I knew I didn't have the physical or emotional ability to keep my promise to my dad. I knew I'd "let him down" by leaving his side now that we were here and while I knew that no one else would hold that against me, I would know and hold it against me. I hated myself for being human and needing sleep. It had been four days since I had changed my clothing or slept more than sixty minutes in a row, sitting up in a chair. Although I knew enough to have grace for myself, it didn't stop my own internal, critical voice from mocking my deep longing for a shower. I felt selfish and foolish at the same time. I was cracking up inside, imploding, fully coming apart. I knew this only as a fact, not as an emotion. I felt like I was watching myself crash and burn from a front row seat.

The view from Dad's room at the hospice center; looking towards Sedona.

No sleep, no shower for days. It's good there are very few pictures.

Dad's last morning at FMC was spent sleeping in the sunny window.

Silence.

Dad kept wrestling with his clothing and oxygen. He just wanted to "go".

Transport to the gurney.

His final painful cry. Even his nurse cried as she hugged him goodbye.

The one hour ambulance ride.