My mother ז"ל died in 2002; this was quite a surprise. She had been hospitalised a few days beforehand, but there was talk of discharging her when overnight all the systems in her body collapsed. At least her actual death was peaceful. My father had never been alone since having met my mother in 1952, so we were quite worried about how he would cope. To our surprise, he coped quite well, suddenly discovering a modest talent for cooking (in my childhood, there was a running joke that all he could cook was burnt toast). In 2012, we even celebrated his 90th birthday in a restaurant in Tel Aviv.
About a year later, he suffered from a minor urinary infection, which to a young person would have been negligible, but apparently such infections in the elderly cause a scrambling of the brain. We took him to a gerontologist in Jerusalem where he was asked basic questions like what day of the week is it, what year are we in, and who is the prime minister of Israel. While getting the third question wrong would be understandable, he failed the other questions; his mental condition was much worse than I had suspected.
Even before this, we had been given 'points' from the National Insurance that covered the cost of a few hours a day of help; a woman would come from Bet Shemesh, clean his flat, cook some meals, and talk with him. But after the gerontologist, it became clear that he shouldn't be left alone, and so we received permission from the Ministry of the Interior to employ a foreign worker, or in the colloquial, 'have a Philipina'. We also got more points from the NI, but a full time worker meant that her salary had to be supplemented; fortunately my father's pension easily covered this.
I've noticed that when people are forced to get around by golf cart, they cease walking; a similar phenomenon happened when the Philipina arrived: my father did less and less, retreating into himself. Still, she would bring him to us for lunch every Saturday, we would visit here and there, and he even was photographed with his first grandchild.
Sometime in 2019, I noticed that he basically was in a world of his own. People used to ask me how he was, and using my terms of reference, I would say that he is like a computer that is plugged in but lacks a screen and keyboard: his body was working but he couldn't communicate with us, nor us with him. I requested our family doctor to look at him: her verdict that physically he was ok and not suffering from anything that could be treated. The nurses would check on him once a month to see that there was no deterioration.
The first year of Covid-19 was problematic, as his regular Philipina had gone home for a holiday in February 2019 and was due back in mid-March - the day the airport closed. We were fortunate to find a replacement, someone who might be termed a free agent who was also somewhat illegal, in that she wasn't funded by the NI. This carer was actually much better than the regular one; on the one hand, we wanted her to continue, but on the other hand, she was costing us a great deal of money, and one day the regular carer would manage to return. This state of affairs lasted for about five months. One major suggestion of the free agent was to place my father in a mechanical bed that could be raised and lowered as need be; we got the bed from Yad Sara, an organisation that provides and/or loans medical equipment for the home.
Vaccinations for Covid-19 became available at the end of 2019. At first, the Philipina didn't want to be vaccinated: we had to talk to her several times about this. We very much wanted my father to be vaccinated, more as a precaution, as the chances of him catching the virus were minimal - except via the Philipina. Although her age (the same as my daughter) would have made her ineligible for vaccination, people in her position were vaccinated along with the people that they looked after. So somehow I got my father into a wheelchair and took him to Bet Shemesh; here we faced a problem: how to explain to him that he was about to be vaccinated for a virus that had caused a great deal of disruption in the previous year? Of course, there was no way, so he reacted physically (and probably cried out) when the needle went in. Fortunately, the vaccinations were over extremely quickly. There were no side effects, and three weeks later we repeated the procedure.
It wasn't until one Friday night in June when the Philipina phoned me as we were having dinner: she was very worried about my father. After a few minutes of indecision, I decided to go and see how he was, which was exceedingly not good. He was undergoing contortions and every few minutes would stop breathing (completely unlike sleep apnea). I called the on-call medic (there is always someone on the kibbutz who can handle emergencies, primarily heart failure) but he quickly saw that there was nothing that he could do.
So we called an ambulance that arrived several minutes later; the ambulance men checked him out and said that there was nothing that they could do either, so we had a midnight ride to Hadassa hospital (part of the route is on a cliff edge, so driving this fast at night is somewhat frightening). In the emergency room, he didn't appear to receive much treatment. The doctor noticed that he had a fever, so he was given antibiotics and probably paracetamol via infusion; after an hour or so, he became more relaxed. I think that I took him for a CT to see whether there was any internal cranial bleeding (there was none). At about 3 am, we were taken somewhere else in the hospital (I got a bit lost) and he was placed in a room by himself. A resident came in to check him then told us to rest. The Philipina sat in the comfy chair and I laid down on a mini-sofa to sleep. I awoke a few hours later and went in search of some medical personnel; a nurse checked my father out, just to make sure that he was still with us. He probably changed the infusion as well.
Fortunately I had money in my wallet (a rare occurrence) so I was able to find a taxi that would take home. I slept for a few hours then with my wife went back to the hospital; here I swapped placed with the Philipina who my wife drove home so that she could rest for a few hours, shower, change clothes and eat: as it was Saturday, all the shops and cafes in the hospital were closed.
For the next twelve days, I would get up in the morning, do a little work, eat breakfast, then pick up the Philipina and drive to the hospital - she's still working and is required to accompany her charge when in hospital. Sometime between 3 and 4 pm we would return home. She would help the nursing staff (she actually is a nurse herself, although I was not particularly impressed by her skills) and I would interface with the medical staff. I had noticed that my father wasn't capable of closing his mouth, and aligned with the loss of ability to move his left arm, it appeared that he had suffered a minor stroke.
I was told that a speech therapist would come and evaluate his capability; as there were only two speech therapists for the entire hospital, it wouldn't be until the following Sunday (i.e. after eight days of hospitalisation) that he was seen. One day a nutritionist came; one of her questions was how tall my father was. I told her that he was bit shorter than me, but that he had shrunk so I wasn't sure how tall he was now. She saw that the Philipina was feeding him Ensure (which we had bought) and said that the hospital would provide this - but in all the time that we were there, I never saw the hospital provide a can of Ensure.
The day after the visit of the speech therapist, I accompanied my father to the bowels of the hospital where he was to have a feeding tube ('zonda') inserted. This turned out to be a much harder procedure than anticipated, primarily because his head had shrunk, and the angle from the mouth into the oesophagus was sharper than normal. I was told to provide an infusion stand and a pump that feeds the zonda: one gets such a machine from Yad Sara, so that day after finishing our hospital stint, I drove to the main YS warehouse in Jerusalem in order to get the equipment. Unlink the mechanical bed and other items, one has to pay 4 NIS a day for the zonda pump.
The next day, I took the equipment up to the ward where I requested someone to show us how to use it. In the mean time, a doctor had informed me that whilst checking the placement of the zonda, they had seen (presumably by x-ray) that there was liquid in my father's lungs. Presumably he had aspirated something, but because he was continually lying down and his weakness, he was unable to clear this liquid.
Once I heard this, I knew that the end was close. This was on Tuesday, so I was only mildly surprised to receive a phone call from the hospital at about 1 am on the Friday to say that my father was on the way out, and that I should come to the hospital to say goodbye. I replied that I had been in the hospital all day and had already said my farewells, and that artificially maintaining his life so that I could come and see him die was not something that I wanted. My wife concurred.
I tried to go back to sleep after this but it was impossible, which is why my first blog on the topic was posted at 3:40 am. A few hours later, we went to the hospital and up to the ward, where I was given his belongings - the clothes that he had been wearing when he was hospitalised. I'm not sure whether the zonda pump was in his room or whether I had taken this home a day or so previously. A doctor and a nurse tried to explain and comfort me, but I told them that it was fine, that his death was not a surprise and that he was no longer suffering (nor I). We then went home and sat with the Philipina; she reacted more visibly than I did, having looked upon my father as the grandfather that she never knew. The carers are well-known for the empathic bond that they make with their charges, and often at funerals, these people break down crying, whereas everyone else tries to hold their emotions.
The blogs that I wrote in the immediate aftermath of my father's death seem emotionless to me now. It's not that I wasn't feeling anything; it's more that this was an event that I had been anticipating for a few years, and its eventual happening was a release that was more welcome than saddening. I had lost my father several years before he died, and whilst now I wish that I had spent a little more time with him, I know that I did spend the time when it meant something.
The middle portion of David Lodge's "Deaf sentence" is very similar to my experience.
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