Ode to Pawpaw: Keep climbing that Hill

This weeks episode tells the story of my Pawpaw.  He was an absolutely wonderful man that was a beacon of Joy wherever he went.  And even though my family and I were convinced that he would easily make it to 100 at his 90th birthday, the decline started rapidly after he broke his hip at 94.

This is the last story detailing how losing an older loved one looks through the eyes of a Nurse that has worked in virtually every hospital department possible.  The hospital is really good at solving acute problems but death isn't acute, it's inevitable.  I know that I have a skewed perspective from the things I've seen in the ICU, but I believe that it is worth sharing in order to bring an understanding that there are things worse than death in this world.

Pawpaw lived his life to the fullest and even though he couldn't get his butt more than a few inches off the water, I do remember him water skiing behind a pontoon boat at the age of 70 something. He was in his mid-80s tubing in the smoky mountains before he got sucked into a hydraulic for a second or two to get out.  Then he stood up and said, I'm getting too old for this.  And somewhere in his late 70s or 80s he had a stroke and then got west nile virus misdiagnosed as a second stroke and survived with a feeding placed and gave him many more quality years.

But at the end he agreed to a feeding tube probably knowing that it wasn't going to solve his problems.  He gave himself to the very end for the woman and children he loved dearly.  I feel blessed that he was able to keep his mind for 94 years and share it with the world.

Chapters

• 1:23 Intro over
• 9:04 Broken Commercial
• 10:41 Broken Commercial Break Over
• 17:25 Outro

Transcript

ODE to Pawpaw:  Keep Climbing that Hill

So you know how everyone says that they don't have a favorite child and you're probably not supposed to have a favorite grandparent… well Pawpaw's it no question about it!  Nothing against any of my other wonderful grandparents, but there was something different about Hill Moore.  He was such a good man, and even though I definitely don't consider myself religious, he's the main reason that I stay interested in that there Jesus fella… 

I believe my Pawpaw practiced Christianity the correct way, he had a heart of gold and an unreal amount of patience. I know it was not their intention, but I believe a lot of people born in the early 1900s and raised families in the 40s 50s and 60s practiced a very Real Faith and perfected reality manifestation… there seemed to be a shared American vision focused on God and family.  He lived his life off of the core principles of the Bible, and basically had Heaven on Earth at least in his 70s and 80s and even up to 90 as far as I could tell. He lived about a good life as I've seen, and even though it was a simple Life ,it was a blessed life. It may sound strange but I can already see that He earned his crown as he had as close to Heaven on Earth, that I've ever seen a man possess.

I honestly thought Pawpaw was going to make it to 100.  As far back as I can remember he just emitted Joy and had to youthful spirit about him.  And even though he couldn't get his butt more than a few inches off the water, I do remember him water skiing behind a pontoon boat at the age of 70 something. He was in his mid-80s tubing in the smoky mountains before he got sucked into a hydraulic for a second or two to get out. Before he stood up and said, I'm getting too old for this.  And somewhere in his late 70s or 80s he had a stroke and then got west nile virus misdiagnosed as a second stroke and survived with a feeding tube both times that was eventually removed after leaving the rehab facility. 

Medicine can be a little different in South Georgia.  During my Poppaw's final days. He didn't want to peg tube but after sitting around for a few weeks on TPN, not Dying and doctors convincing family that he needed a feeding tube again he reluctantly accepted having another one. The problem is the University of Georgia went to the Rose Bowl to play Oklahoma that year, and the only doctor in the area that could put it in spent a week in California having the time of his life while Pawpaw strung along on another week of TPN. I did as much as I could be in four hours plus away from him one time. Well, my mom FaceTime me and I noticed they had a nonrebreather on his face. I won't get too deep into this, but he had COPD and too much oxygen especially a nonrebreather will send a COPD patients carbon dioxide through the roof. I had to call my mom back immediately and tell her that they have to get a nasal cannula at 2 L before they raise his CO2 to deadly levels.  The simple staff at this little hospital see Low oxygen levels and think let's just keep giving him tons of oxygen, not really understanding the mechanics of respiratory drive.

And let me back up for a moment to six months earlier when he fell and broke his hip, reaching for the salt shaker. I know I can't prove it, but I'm pretty sure the song shake it like a salt shaker killed my Pawpaw.  I was convinced that he wasn't going to be another statistics and I can't remember exactly but it's estimated around 60% of people over 90 that fall and break a hip die within the next year. Just because of who Poppaw was I thought he was gonna pull through this again, but this was definitely that domino falling at the beginning of the end. He did pretty well, right after his hip broke, but once the insurance said he had had enough rehab. He went back home before he had completely healed. My dad and his brothers rotated and hired any help they could get for Mawmaw and Pawpaw.  But between Mawmaw’s dementia, and Poppaw's mobility issues things began to rapidly deteriorate.

Because he wasn't moving around very well and he got a cold that turned into pneumonia he began living in the small country hospital a few blocks from his house.  At the same time my Mawmaw be stressing everyone out falling all over the house.  She was always fine which she would contribute to the fact that one side off her butt was made out of Peanut Butter and the Other side was made out of cheese.  But because Mawmaw kept falling on her butt the 3 sons felt this was the time to move Mawmaw into the nursing home attached to the Hospital.  The nursing home attached to it, which by the way takes long-term residents with trachs requiring Ventalators which I find disgusting but Anyway once Pawpaw was medically discharged he agreed to move into the nursing home so Mawmaw wouldn't fight the transition anymore.  Upon the move to the nursing home, his rib got broken and he suffered a couple days in his new nursing home room until going right back to the hospital to get a chest tube.

And just for a moment I would like to Shine some light on a holiday that I BELIEVE does not get enough national recognition! Today I want to celebrate, national AMA day… the day when we salute you, the a hole, that signed that piece of paper and went to the hospital across the street.  After you used your telemetry box like a slingshot and hit that nurse that always has it coming for her right between the eyes like David and Goliath. We appreciate the fact that you no longer want to receive care here… And you're correct it is the Techs and Nurses fault that your hospital food tastes bad.  And we understand that we should stop doing chest compressions down the hall in order to rush to you with your Dilaudid after your phone alarm went off to tell you exactly when you are due for your next dose of pain med.  RN does not stand for registered nurse. It stands for refreshments and narcotics.  You deserve better care. And we're glad you went looking for it.  And remember, if you don't get that unrealistic expectation of what a hospital should deliver to you, you can always leave against medical advice and keep searching for the hospital where They treat you exactly like you deserve every time.  (Play Psyche Ward sounds)

Well, doesn't that sound like a fun holiday?  I really don’t understand why we don’t have a screen saver at the hospital for that one yet…

While Papa was tougher than nails Pawpaw would just keep climbing that Hill.  I remembered when he was 92 and had been hospitalized for a G.I. bleed and I went to visit him. We always like to cut up so I was giving him a hard time and said, hey Pawpaw getting old’s no fun is it?  And he looked at me with a straight face and said well it was fun at first… He still had his mind up to the point his body gave out at the age of 94 and he did his best to stick around with us as long as he could, even though it was hurting him, sticking around here.  

At this point in time and space, Pawpaw Had been yo-yoed between the hospital and nursing home for a couple of months agreeing to suffer through different procedures and treatments in order to stick around a little bit longer for his wife and family. He verbalized many times that he was ready to go but those closest to him definitely weren't ready.

He basically told my dad, his son to still go on his mission trip to Uganda instead of being there if he died before he got back.  I knew in my gut that my dad will regret it the rest of his life if he got on that plane so I drove to Newnan and took him to Colquitt to put his dad on comfort measures. 

As we drove up to the hospital, Pawpaw’s face was swollen from the tube feed that his gut was unable to absorb. Since it took so long to get the feeding tube in and he was surviving on TPN for weeks maybe even over a month his gut had completely shut down, so while putting a tube into his stomach, allowed us to put tube feed into him, he could no longer digest it.  

When we arrived at the hospital My dad told his brother that we needed to stop the tube feed and at first my uncle had a hard time excepting this because his dad could no longer swallow but I was able to help him understand that the tubes were not helping anymore.  Pawpaw was actively dying…

Because his speech was so garbled from fluid build up, everyone thought Pawpaw was getting confused as his speech got more garbled and garbled.  But being experienced nurse, I was able to understand what he was trying to communicate and the first thing he asked me was, where’s Sarah, my wife?  I explained she was at home with the kids and doing well. Then I was able to directly ask him if he was ready for medicine to make him comfortable and to stop all aggressive treatment and he said yes.  

I proceeded out to my car and began bawling until a family member knocked on the window and asked me to come back inside to discuss Pawpaw’s wishes with the Dr.  They asked the doctor to come in, and I spoke for my family and for Pawpaw and asked if we could just start making him comfortable. Before I knew it, the nurse had given Pawpaw some IV Ativan and I had already had my last conversation with my Pawpaw before I even realized it.   

Now during Pawpaw's final week once comfort measures were put in place they started shooting him up with Ativan every few hours and he just hung around sleeping in a hospital room while family and loved ones came and visited and apparently about halfway between when comfort measures started and he finally took his last breathe somebody was saying something and he let out a big Ah Huh before snoring again.

I regret not pushing home hospice harder than I did because He really just wanted to go back home but because they had just gotten Mawmaw into the nursing home, they didn't want to fight that battle of her going back to her house, only to be forced into a nursing home once he died.  He was always willing to sacrifice himself for the ones he loved the most so he did it 1 last time.

At his funeral the preacher said something that really means a lot to me. He was a new preacher at their church and didn't know Pawpaw extremely well, but after meeting all of Pawpaw’s children and grandchildren. He made the observation that every one of his descendants seemed to radiate love. He pointed out the fact that that's a learned trait and it's obvious it started with Pawpaw’s example of how to be an amazing human being.  And I don’t claim to KNOW where he is right now but I know he’s somewhere BEING AMAZING.

So join me next time as I wrap up this series on enlightened endings and share with you how I would wanna be treated at the end of by family and loved ones to get you thinking about how are you actually want to be treated when your times up.