'Life or death still possible': 31 days at my dad's virtual bedside - CNN - 0 views
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The attending physician at the intensive care unit had called that morning and asked whether they should include a Do Not Resuscitate order in my dad's chart. They had asked before. I had been indecisive. A successful resuscitation would extend his life. But it might also lead to brain damage.
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"If it continues in this direction," he told me, "we're talking about a single-digit chance of survival."
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I suspected that my father had a will and a health care directive inside the house. I put on my mask but couldn't find a clean pair of latex gloves in my duffel bag. It was cold in the backyard. I had a pair of leather gloves. I put those on and entered my childhood home for the first time in weeks. My mother barely registered my presence. She was crying on the couch.
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I was relieved -- we wouldn't have to make what felt like an impossible decision -- but then I kept reading. My father had noted that he did not want to be supported by a ventilator or hooked up to a feeding tube for any length of time. He had been connected to both for nearly two weeks.
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There was grief on her face, but also curiosity. What had finally gotten to her younger son, the one who so rarely showed emotion during his father's hospitalization?
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I called the hospital and approved the DNR. They told me his status was still dire. I called my dad's closest friends and started preparing them for the worst.
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My father's lungs showed no signs of progress. The double pneumonia they diagnosed days before was worsening. His kidneys were failing. Dialysis was required but would put a strain on his blood pressure, which was already dangerously low. There was a special form of dialysis designed for delicate situations like this -- continuous veno-venous hemofiltration -- but it wasn't available at Lawrence
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The morning after I searched for my father's health directive and drafted his obituary, I woke up and tried to turn on my laptop. It wouldn't start. When it eventually booted up, it asked if I wanted to restore an unsaved document. No, I thought, let's see what happens today.
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It was the same doctor as yesterday, the one who asked about the DNR. "Look, your dad is on a ventilator. That's a form of life support. He's experiencing kidney failure and requires dialysis. His situation is still very acute. He was in good health before the Covid, but his kidney, heart, and lungs are 69 years old. It's tough for them to recover. But the numbers from today are undeniably better than yesterday. There's been an improvement at almost every level. Your dad is a tough guy."
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One of my close friends, a nurse practitioner, would help me understand all the terminology and its implications. He was treating Covid patients at an ICU upstate. At the end of our calls I'd ask him how he was doing. "We ran out of gowns," he told me one day. "My ICU is out of ventilators -- we're diverting people to Albany," he said another time.
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"There's a difference between good intentions and good outcomes," I explained to her. She would wave me away and pick up. Inevitably the call would bring her tears. I stewed on the porch. My brother, uncle and I would spend hours trying to ease her mind and pacify her anxiety. Any inquiry or outreach was like sticking a finger in the open wound of her anguish.
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"He's only improving," I told her, "because of the life-saving care you guys have given him. The whole city is in awe of you. They should have a parade for you down the Canyon of Heroes."
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The nurses and doctors who took care of my father -- first for four days at NewYork-Presbyterian Lawrence Hospital, then for nearly a month at NewYork-Presbyterian/Columbia -- were always empathetic, straightforward and willing to trust me with complicated details.
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About a week after writing -- then refusing to recover -- my father's obituary, his condition was continuing to improve.
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I called my friend, the nurse practitioner, and gave him the latest update. He seemed upset. "You OK, dude?" "A nurse from my hospital died," he explained.
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I wrote about my dad's volunteer work -- at the Special Olympics, at an organization he founded that helps police families with special needs, and at just about any Italian-American group that needed a lawyer. He was so proud of his Italian-American heritage. He loathed the mafioso caricatures and stereotypes found on TV -- he wrote countless op-eds attacking those -- but he revered the old-school virtues he associated with his Italian-American upbringing: loyalty, humility, hard work, dedication to family.
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"Yesterday was a stumble, but we're getting back on course," I emailed the group. "We always knew this recovery wasn't going to be a straight line. It's important to remain resilient and optimistic even when there are temporary setbacks."
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"Oh Lou, I've been waiting for your call. I have such good news. They are planning to extubate him tomorrow. They are going to take your father off the ventilator!" She was practically screaming with excitement. I was speechless.
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I had been withholding certain information from my family and friends during this whole ordeal. My dad had developed a blood clot two weeks into his hospitalization. Clots are extremely dangerous, of course, but it was small and in a relatively manageable location.
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I called my brother and told him about the plan to get my father off the ventilator. Since there were a number of contingencies, we debated telling my mother. She was living and dying with every update.
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My father's breathing was labored on the morning they were planning to extubate. They delayed the procedure a day. That next morning, April 16, a doctor called. I was in the shower and rushed out to answer my cell. He said they were doing the extubation within the hour. What do we want to do if the extubation fails?
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"It went as well as we could have hoped for," the doctor said. "His vitals are stable and he's breathing well. He's resting now." She explained that my father was disoriented and it probably wasn't a great idea to speak with him that day. Whatever, I thought, I'll speak with him when he gets home. He had been on a ventilator for 28 days.
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I called the doctor later in the day. She told me my dad seemed distressed. He was trying to speak, but his vocal cords were too swollen. "It's so frustrating," she told me. "I don't know what he wants to tell me."
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"Each facility has their own Covid rules," she explained. "I'll send you over a list." On the list was the nursing home where my grandfather had died several years before. My father had visited him every day.
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I called the step-down unit where he had been the past three days. They transferred me to his nurse. "He's doing better, love. We took him off the pressor and his blood pressure is in a good range. His heart rate is good. He's breathing fine. The doctors decided he didn't need to go back to the ICU. He's ok."
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"I've repeatedly said that recovery isn't a straight line. ... Yesterday we managed the roller coaster ride as a family. My brother, uncle and I were with my mother the entire day. We never lost hope or confidence in my dad's medical care and ultimate recovery. If there's a light at the end of the tunnel, it's a blinking one. Right now, it shines again."
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I drove back to my mom's house. I scanned the block for my brother's car. He had not arrived. I parked. I have to wait for him and then tell my mother, brother and uncle all at once, right? Should I call my wife first? Should I call my dad's best friend?
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I called my wife. I called my dad's best friend. I called the guys he grew up with. I called his former colleagues. I began every conversation the same way, "This is that call." I listened to each of them yell and cry and ask if I was serious. Then I said I had to make another call.
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I wrote about my father's career. How he got his law degree at night school and became a prosecutor at the city, state, and federal level. How he convicted mobsters, drug dealers, and those who abused power.
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He was a Covid patient for 31 days. It was a painful experience, but ultimately unimportant. It doesn't matter how a man dies. It matters how he lives.