Letter to Yoda (Dad part II)

Dear Yoda,

As you know Dad had a massive stroke about a month back. The stroke was like Hurricane Harvey in several respects; it occurred around the same time as Harvey, and like the hurricane, it was of unexpected intensity, and left devastation in its wake.

Those who read (perhaps enjoy) my rambling (writing), you included, might recall the story I wrote about Dad and his health issues, dementia per se, not too long ago. I received flak for writing about Dad – in fact, one person came very close to calling it a sacrilegious act of airing one’s dirty laundry. Then there were others, like you, who called the writing a courageous act. I thought I was just writing to clear my head, and since it helped me do so, I decided to share it ahead.

Little did I know then, that Dad was rapidly hurtling towards a stroke (or vice versa?). The night before the stroke, Dad was quite functional - walking around, asking for a kebab sandwich and his small red pills (the wretched Lexotanil). The next morning he was found collapsed on his bedroom floor, unable to talk, his left side completely paralyzed. Stroke’s like that; it doesn’t necessarily announce itself nor asks for permission prior to entering your house.

What followed were a harrowing four days in the Special Care Unit of the hospital during which time it was unclear if Dad was going to pull through. Although Dad seemed asleep through most of that critical phase, it was a hard time for the family. 

Yoda, as you are aware, I work in the medical profession, so I get to deal with worst (clinical) case scenarios of others aplenty. 

However, when your own loved one is traversing a similar path, that narrative takes a life of its own. Outcomes for Dad and for my family were far from clear but I had to decide upon his code status. 

The Do Not Resuscitate (DNR) form is an amusing document at times because it’s like a Chinese drop-down menu with varying degrees of (agreed upon) resuscitation measures that the patient’s family can choose from (Intubation: Yes / No, CPR: Yes / No, Pharmacological support only: Yes / No, etc.). The DNR form is meant to guide the medical team in escalating or de-escalating care if the patient deteriorates further. The bottom line is: deciding whether one lets the patient live or die. Any further discussion on how to decide upon ‘life vs. death’ in such a scenario will be beyond the scope of this blog and best not delved into at this stage.  

I was asked by the medical team what I wanted my Dad’s code status to be on the DNR form. The night I had to sign Dad’s DNR form is etched in memory. It was a surreal night spent in the hospital I had grown up in, first as a student, then as a faculty member. Now I was the son in the same hospital, at his father’s bedside, deciding upon his fate.

After deciding Dad’s code status as DNR, and signing that document, I was quite unsure if I had done the right thing. It was then that writing came to my rescue. I used the notes page on my cell phone to pen my conflicted thoughts. Through that exercise I finally managed to process my own emotions (albeit on ‘paper’) about what had happened to Dad and to speculate upon what to expect in the future - for him and for the rest of the family.

To work through my angst, I listed the following questions.

1.     I’m told by people several times a day ‘I hope your Dad gets better soon’; what does ‘getting better’ for 87-year-old Dad, with dementia and now stroke, really mean?

2.     Some people tell me 'You should be glad you moved back to Karachi when you did; there must have been a higher purpose - to serve your elderly father'. Why am I unable to see a 'higher purpose' in the current predicament, especially after 4.5 years of relocation?    
 

3.     How much time does Dad really have? What would Dad want to do with that time? Would Dad even care for any of that time? [Assuming he pulls through and goes home on full rehabilitation / physiotherapy].

4.     Would Dad recognize the people surrounding him as family, once he is home?

5.     How will he communicate with us? With his ongoing dementia he wasn’t much of a communicator; so how will the post-stroke phase roll out where his communication skills are concerned, or lack thereof?

6.     How do I let Dad go easily and not feel guilty for doing so?

Not having adequate answers to the presumably rhetorical questions, I decided to reach out to the Universe and asked her for Yoda…well, my version of Yoda. Once you appeared, I asked you to address the above questions, answers to which I hoped would help me achieve closure. You gave me several insightful answers, but it was the answer to the question below, that I would like to emphasize today. 

My most crucial question: “Assuming Dad pulls through and has the mental faculties to understand what DNR means, would he approve that I signed his code status as DNR?”

Your answer (in Yodish): “The sick, these decisions don’t affect. If anything, them to be rid of their pain, it enables. The living much more, the decisions affect. Hence, closure with whatever decision one makes, one must find. With you, may the force be!” [English translation: These decisions don’t affect the sick. If anything, it enables them to be rid of their pain. The decisions affect the living much more. Hence, one must find closure with whatever decision one makes. May the force be with you!]

Needless to say, your wisdom, although initially hard to fathom and practice, came in quite handy for me to just move on. I did not revert the DNR.

Thank you, Yoda.

Sincerely,

Asad

Sept. 26, 2017, Karachi, Pakistan

For Abu

[from Narrative Medicine]

CREDITS:

Editorial Note: This is from a 'phase II' continuation of Narrative Medicine at AKU - what started as a Workshop-based initiative on January 20^th, 2016. The editorial work was performed by the Writers’ Guild, an interest group at AKU, with the purpose to promote the love of reflective reading and writing, within and outside of  AKU. The author acknowledges Walid Farooqi for facilitating conversation with Yoda. 

Acknowledgment: First published by the Express Tribune.        

DISCLAIMER: Copyright belongs to the author. This blog cannot be held responsible for events bearing overt resemblance to any actual occurrences.