The Sunday Rumpus Essay: Through the Throat
This past July, I stood over my father’s hospital bed and contemplated suffocating him with his pillow. Five weeks earlier, Dad had walked into hospital in his good clothes, uneven shoe heels, and with his small bag of belongings hanging from his large, gardener’s hand—a fit and hale seventy-eight year old man still graced with his full faculties. He felt afraid and irritable, nervous about his surgery to treat an aortic aneurism in his abdomen but hoping to recover and return home.
“A bulge,” he had told me over the phone from his home in Dublin, Ireland, to my home two oceans away in San Francisco. “Like in a bicycle tube.” Doctors told him it was surgery or rupture and certain death. He decided, in his own words, to let them at him. I reassured him over the phone, said I had researched the procedure and believed all would be well. He said, “Easy for you to say.” It wasn’t. I had faked my optimism; my false words bubbling up like the condensation from my breath on the phone receiver. From the outset, I’d had a bad feeling. That Dad’s surgery was scheduled for the 11th of the month, the same date as my mother’s death just two months earlier, made me shake. Worst fears realized, the operation went horribly wrong and Dad suffered massive internal bleeding.
After Dad spent twelve days in ICU on heart, lung, and kidney support, an anesthesiologist handed me a tracheostomy consent form to sign: The ventilator tube in Dad’s mouth, aside from being uncomfortable, put him at high risk for infection and for becoming dependent on life support. Conversely, a tracheostomy, where the ventilation tube would go through Dad’s throat, would feel much more comfortable and could remain indefinitely. The consent form quivered in my damp hand. I didn’t want to sign. My gut, despite Dad showing improvement, whispered he wouldn’t make it. Why, then, put him through another procedure, and something as invasive and robbing as a tracheostomy. The tracheostomy would slice his windpipe and he would lose the power to speak. Talking, to Dad, was like breathing.
Dad didn’t talk to people so much as he told constant stories. “Wait till I tell you.” He didn’t even talk to his six children all that much, except through jokes, anecdotes, and stories. Like the story about his healthy and intact sister coming back from Lourdes with a broken leg, twice. The first break, she fell on the slippery riverbank after getting blessed in the Gave de Pau; the second break to her leg happened a few years later, when her return flight from Lourdes crashed on landing. Or the story Dad liked to tell about his never-used pen name, Nathaniel J. Bergman—Nathaniel after Hawthorne and Bergman after Ingrid. “But, Dad, you’ve never written anything?” “Ah, yeah, that doesn’t matter.” I neglected to ask him what the ‘J.’ stood for, and this torments me now. The atrophied, bent baby finger on his left hand, too, that he refused to have surgically removed because it was such a great conversation piece: “Ah no, sure if I got rid of this I wouldn’t be able to talk about it.” For as far back as I can remember, I had needed to hear Dad talk of other things beyond stories, sports, trivia, and current events. I yearned to hear certain things from him. Like I love you. Like I’m proud of you. Like thank you. Like I get you. Like I read your story. He and my mother had never read my work. I couldn’t bear the thoughts of a tracheostomy taking away Dad’s ability to speak, of the hope of his ever saying those things of the heart gone forever.
The doctor looked from the consent form to my face and down again to my shaking hand. The previous night, my five siblings and I had discussed the tracheostomy, all seated together around the kitchen table in our parents’ home. The table clean by then, empty of Dad’s usual tea mug, dirty plates, tiny blue pen courtesy of the bookies, and his scatter of newspapers—usually opened to the racing forms or the crossword puzzle. We are a family of six children: three boys and three girls. A family that mirrors the makeup of Dad and his five siblings, right down to the one set of twins. Since the night of Dad’s surgery, my two sisters and I had shared the same belief: Dad would not survive. Our brothers, and in particular our youngest brother, believed that he would. My sisters and I had periods of hope, certainly, especially because Dad’s dependency on the ventilator had gone down incrementally from one hundred percent to forty percent and his need for dialysis had reduced from every day to every second day. He was also off almost all medication to support his heart. Most importantly, he had in his favor the fact that he wanted so very much to live. However, he looked so wretched flat on his back on the hospital bed and inside the noisy monochromatic forest of tubes and machines, and our intuition told my sisters and me that he would die.
The discussion on the tracheostomy went round and round, until our youngest brother said, impassioned, “We have to give Dad his best fighting chance.” My sisters and I nodded across the table at each other. We could intuit Dad’s death, but we couldn’t know with certainty, and if he did survive and recover he would eventually regain the power to speak. The surgeon, anesthesiologist, and their teams all supported the move to tracheal ventilation. They were the experts. In the final vote, my siblings and I agreed unanimously. Yet faced with the form in the hospital that Sunday afternoon, I hesitated. The doctor looked at his watch and at the closed waiting room door, asked if I had any further questions or concerns. I heard again my youngest brother, “his best fighting chance.” I signed my consent, feeling as though I was writing with the sinews in my neck.
Less than two weeks later, CT and MRI scans revealed Dad had suffered a spinal cord stroke, most likely during the doomed surgery, and was paralyzed from the chest down. He had also suffered several small strokes of the brain. The surgeon said the results were “disastrous,” his posh South Dublin accent putting the emphasis on “ass”. He advised the game plan remained the same: wean Dad off life support, and then assess the extent of brain damage caused by the small strokes. My heart beating like a bird to get out of my chest, I wondered why keep Dad alive to merely exist, stripped of his independence and dignity, and to waste away until death in a nursing home just as our Alzheimeric mother had ten weeks earlier. I proposed to my siblings that we remove Dad’s life support now, while he remained dependent and on the brink, and allow him to die with grace. Again my sisters supported this decision.
Again my brothers took some convincing, and in particular our youngest brother, the baby of the family—a man of forty and a son with a deep love for his father. I argued we all had a deep love for Dad, that’s why we should let him go. After three days of heated deliberations, my five siblings and I decided, again unanimously, to remove Dad’s life support. When we sat with our hearts we each knew that Dad would not want to live paralyzed and in need of care twenty-four seven; he would rather die. We worried we would have to battle with the doctors. Most, if not all, decisions to remove life support are contingent upon the patient being either terminal or brain-dead. Dad was neither. He had some brain damage, certainly, but doctors could only guess at the extent at that point and they didn’t suspect it was severe. Thus we worried our harrowing decision would be deemed euthanasia and illegal. To our surprise, the doctors applauded our decision and how quickly and equitably we’d made it. They agreed with the removal of Dad’s life support and his feeding tube, convinced his quality of life would be non-existent.
His remaining four weeks, Dad largely remained in a state of semi-consciousness courtesy of heavy medication and sedation—all administered to keep him as comfortable as possible. Doctors told us they believed that even with his levels of superdrugs, Dad could hear and understand us. His surgeon said that studies showed patients could hear and understand even under anesthesia. We had no doubt our words and our touch reached Dad. Throughout his final four weeks, his eyes often remained open, if largely unmoving, and he would nod yes and shake his head no, and smile often. He squeezed our hands whenever we held his, and he sometimes pushed our hands away, too, done with us holding onto him for that visit.
“Dad, are you in pain?” He always shook his head no.
One day, when he seemed particularly agitated, I asked if he felt afraid. Getting those words out was like plucking my eyelashes, words that would have proved impossible for me to ask him in his health. Years earlier, one late night when I was drunk while on a visit home from San Francisco, I worked up the courage to tell my father I loved him, knew I was risking rejection or ridicule. He said, “You’ve been living in America too long.” I felt slapped, but he was merely saying what was true for him. “Stupid,” he’d often say, “all this everyone telling everyone they love each other, over and over, till it means nothing. Sure if you’re family, of course you love each other.” My father never did tell me he loved me. It was not his way, not the way of his generation of Irish fathers. While he lay in that hospital bed, I told him often that I loved him. I would think, almost laughing, that if he were healthy he would have pushed me away. “Stop.”
That afternoon, I again asked Dad, “Are you afraid?” His face creased, but he didn’t move his head yes or no. I promised him he had nothing to fear. I told him I didn’t know how I knew this, only that I did. “There’s nothing to be afraid of, Daddy, I promise.” He seemed to try to respond, his head jutting and circling, like a baby desperately trying to utter his first words. An intelligent man of simple pleasures, Dad had always had something to say about everything. The tracheostomy done, he must have felt as though we had cut out his tongue. My heart races and throat tightens when I imagine his confusion and horror. His sense of powerlessness. I wonder if he thought about the things he’d never gotten to say, if he was bursting with them.
While he lay dying in his hospital bed, I told Dad a story I was bursting with. It felt hard to speak from my heart to his, knowing that in life he would have thought I was crazy, but something told me in his dying days, he would gladly take everything from his children that he could get. My head close to his, I told him a garden awaited him. A beautiful garden with flowers, trees, dancing birds, and a cool, running river. I could even see a blue tree, its branches like fluorescent coral, but I didn’t go so far as to tell him that part, a man of no nonsense. A large granite rock, too, waited just for him. A sparkling rock where he would stand and survey and see all was well and good. He would feel oh so happy and free. He was strong, I told him. The nurses and doctors were all talking about how strong he was. I had learned how strong he was. He had learned how strong he was. His journey was done. We would keep his memory alive, I told him, and tell his grandchildren how good and strong he was. I said, “Go to your beautiful garden,” and I kissed his papery forehead. By then Dad was in the hospital six weeks and I had kissed him more times than ever before in my life combined and sometimes joked to my sisters, “If there’s a mother of a miracle and he gets well, he’ll kill us for all these kisses.” I had felt a similar intolerance toward two of my three brothers for how they went at Dad’s head and hands and arms, as though believing that if they rubbed him hard enough they could—in a billow of white smoke—make a healthy version of him appear.
A couple of hours after I spoke of that garden into Dad’s ear, he died. I like to picture him now standing on that winking granite rock and looking out at that majestic landscape, well pleased. He died six weeks after he entered the hospital, his last three weeks spent on palliative care and without life support and a feeding tube. During his final ten days, he also went without water. This because the saline IV going into his arm had caused the limb to balloon and turn red and hot, evidence his body was breaking down and unable to absorb the fluid. His IV stopped, Dad seemed to shrink by the hour. I worried his skeleton would push through his skin. The bedsore that edged his left ear looked like a purple bug eating on him. Sores too on his elbows. On his toes and feet. Water blisters on his shins. More sores in places hidden beneath the sheets. Over those ten days, and during Dad’s final three days in particular, my siblings and I could hardly bear to watch his cheeks sink and his body shrivel; to hear those long pauses between his breaths that seemed to last impossibly long—labored, intermittent breathing that went on day after day, battering us like the unending beat of waves. Until, finally, forty days after his surgery, Dad’s breath did stop.
My two sisters and I witnessed Dad’s death, his hands and paralyzed feet cool, his lips and fingertips blue, his breathing labored and too much of the whites of his eyes showing—even his veins looked like ghosts of themselves. True to his nature, Dad died quietly and without fuss while my sisters held his hands and I rested my palm on the top of his white head. Just a few clicks in his throat to signal the end and then those final exhales that sounded like a seashell against my ear. At last Dad’s ventilator barrel stopped its dance, a constant concert we had watched for four weeks following the tracheostomy, his breath and the pulse in his throat the barrel’s puppeteer. His fingers would sometimes touch the tracheal barrel or the white plastic edges of the tracheal tube whenever the nurses left it uncovered. The tube open, Dad’s wet breath would exit his throat—the noise as damp and haunting as the howl of rain-tinged wind. The crying banshee. We would ease Dad’s searching fingers away from the sweating barrel or hold his hand like it was a soap bubble we didn’t want to break and tell him, don’t touch that. I also told death not to touch my Dad—it’s not his time. Our mother had died just three months before Dad, emaciated and fully erased from fourteen years of Alzheimer’s and in her final days, drowned by pneumonia. In her wake, my siblings and I had hoped that Dad, free of the burden and the worry of her, would get to enjoy five, eight, maybe ten more years of talking, walking, living, and trying.
He did not.
Since Dad’s death I’ve thought often of the tracheostomy consent form, of my hand trembling above the signature line. On reflection I’ve come to accept that Dad could only live and die to the best of his ability and—slashed windpipe or no slashed windpipe—he would never have uttered the words I so longed to hear.