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Thanks, Dad

Posted by Dr. Lachlan Forrow  October 14, 2012 07:13 PM

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Tuesday, August 3, 2010, my cell phone rang at work.  I explained to a colleague that I don't normally take incoming calls on my phone (my wife and kids have a special ring tone).  I ignored the ringing, and it eventually stopped. 

 

A few minutes later my phone rang again.  My colleague said "I think you better answer it."  It was my mother, calling from my parents' home in Greenwich, CT.  In a calm voice, she explained why.  She had come home from running errands to find a police car in the driveway.  She wondered whether there was something wrong with the burglar alarm.  But as she walked into the kitchen she saw the police attempting CPR on my father, lying unconscious on the floor.  He had never had any serious heart problem.

 

Eventually, EMTs succeeded in the resuscitation and took him by ambulance to Greenwich Hospital.  My mother said she was about to drive there herself.  She insisted she would be safe doing so.  My older sister Lisa, who lives nearby, would meet her there.  I arranged to leave work and take the next train home.

 

When I got to the hospital it was nearly midnight.  Mom and Lisa were back home.  My father lay in a deep coma, breathing rhythmically with the respirator.  His heart was working normally, with no evidence of a heart attack (damage to heart muscle).  He must have had an "arrhythmia", which can happen out of the blue and might never recur.

 

The wonderful senior medical resident explained that a careful neurology evaluation indicated that there already was very severe brain injury caused by lack of oxygen during the cardiac arrest.  My father did not quite -- or not yet -- meet the strict clinical and legal criteria of "brain death".  It was possible that "he might progress to brain death", and be declared dead.  It was possible that his brain function might recover very slightly, but it was not realistic to think he would ever again live independently.  He might well end up in a so-called "persistent vegetative state" (permanent loss of all consciousness).  Or maybe a "minimally conscious state".  If it were either of these, then with "proper care" he might live for months, or even years.

 

If they stopped life support, he would likely die within hours.

 

Fortunately, they said, he showed no signs whatsoever of any discomfort.

 

*  *  * 

 

At 1:30 am on Wednesday, August 4, 2010, I sat with Mom and Lisa in the quiet, wood-paneled den of my parents' house.  I was in my father's usual spot on the small couch, where every morning he watched CNN before heading downtown for one of the daily lunches with friends he enjoyed so much.  Mom sat across from me, under a framed calligraphy tribute to my Dad from the company he had worked for for decades.

 

I told Mom and Lisa what I had learned at the hospital.  I said that the doctors at the hospital wanted to know what they should do.

 

*  *  *

 

July 4, 2010 was a beautiful day in Greenwich.  That afternoon, I sat on my parents' screen porch with Mom and Dad, my wife Susan, and Lisa.  The "meeting" was Lisa's idea.   She said that we needed to "talk" -- about what Mom and Dad would each want, if Lisa and I might have to help doctors make some difficult decisions.  As often as I preach to others about these conversations -- that "It's always too early until it's too late" -- I myself had kept putting it off "no rush, one day".

 

I have written about our conversation that day, and what Dad himself told us for the first time, in a contribution to the web site of The Conversation Project. 

 

*  *  *

 

Wednesday, August 4, 2010 at 1:45 am, I called my brother Derek in Maine. My conversation in the den with Mom and Lisa was brief. Mom had no doubt: "We just talked about this when you were here in July, and your father was very clear."   Lisa and I nodded: "Mom, you're right.  He told us."  Derek immediately agreed with the plan, and arranged to fly to Greenwich that morning.

 

I drove back to the hospital, showed the doctors the health care proxy form designating Mom as Dad's proxy and me as the "alternate", and I explained that Mom and I both knew, with certainty, that Dad would not want his life prolonged further. 

 

I stepped outside the room while they stopped the machines.  I returned to see Dad looking so much more like my real Dad, without all those tubes.  He was sleeping, and looked peaceful.  Sitting there, I wrote a short email on my blackberry to Ellen Goodman and others back in Boston, explaining why I would not be at the training session I was supposed to lead that day about having conversations with family about end-of-life issues. 

 

Dad died peacefully in his "sleep" later that morning, in a quiet hospital room.

 

*  *  * 

 Tuesday, August 10th I wrote one of few postings I have ever put on Facebook:

 

My father, Brian Derek Forrow (1927-2010), died unexpectedly last week. Very sudden for all of us, but peaceful for him. He had spent July planning the memorial service he wanted one day -- none of us thought it was for anytime soon, but we'd asked him about that when we visited 4th of July. So yesterday in St. Barnabas (Episcopal) Church in Greenwich, a church he co-founded >40 years ago and served as its first Senior Warden, my mother, other family and friends got to listen to the readings from scripture, music, and hymns he wanted us all to hear one day when we would be reflecting on his life.

 

A short tribute to Dad in the NY Times has a formal photo from his lawyer days. The last entry in his handwritten instructions for his service was "Through our great good fortune, in our youth our hearts were touched with fire. --Holmes." A friend directed me to the source -- Oliver Wendell Holmes' 1884 Memorial Day Address: "In Our Youth Our Hearts Were Touched with Fire." 

 

Now I understand better why Dad was so interested in the Civil War, and in Lincoln. And why he chose "God of Abraham Praise" as the first hymn for his service, firmly believing that one day all the descendants of Abraham -- Jews, Christians, and Moslems -- would figure out how to be together in peace (as most descendants of Union and Confederate soldiers take for granted today). And how so much of my own work today in medicine, ethics, and The Albert Schweitzer Fellowship is really just my own variation on the main themes of my father's life -- a belief in the importance and power of ideals, particularly when life presents challenges, in supporting each other in trying to live by them, and in treating everyone, always -- ALWAYS -- with kindness and respect. It's both startling and comforting to realize how much more of Dad I have in me, am deeply proud to have, and hope in the future to have even more, than I ever before realized.

 

Thanks, Dad.

Please make sure that the people you love know how much you do -- early and often.

 

 

 

 

If you haven't yet done so, please start having "the conversation" with loved ones.  Soon.

 

  

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

Lachlan Forrow, MD is Director of Ethics Programs and Director of Palliative Care Programs at Boston's Beth Israel Deaconess Medical Center and Associate Professor of Medicine at Harvard Medical School. More »

Have you had the conversation?

Learn why and how to start discussing end-of-life wishes with your family. Join The Conversation Project.

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