Tuesday, April 15, 2014

A Mighty Heart Beats No More

I raced off on an urgent trip to India two weeks ago, my father was in critical condition after suffering a cardiac arrest, right at the hospital door. He had been resuscitated in time and was recovering well, able to recognize and speak with my mother and other relatives.

My sister rushed with her family to Appa's bedside, as did I. We emerged from the planes, apprehensive of what we might hear from the phone about his current condition. All was well, we felt assured, as he responded to treatment in the critical care, and next, intensive care units where he was placed.

I regularly went to see him for the few minutes visitors were permitted twice a day in the ICU.  He was weak, but in good cheer, glad to see us and tending to speak vigorously whenever he got the chance of respite from the silence of the long hours in bed. The nurses hovered around to make sure he wasn't strained beyond what his fragile state would permit.

On the seventh day of his hospital stay, we were to accompany him on a ride to a diagnostic facility, where they would perform a scan of his heart to determine how much viable heart muscle was left, prior to a possible ICD implant for irregular heartbeat. My brother-in-law and I accompanied him, along with a staff nurse, on a harrowing ambulance ride that broke all speed records (Ulloor to Pangode in 7 1/2 minutes flat in rush hour- unheard of!)

It was the last substantial chunk of time that I would spend with him. The nurse and I clutched at his leg for dear life, to keep him from shifting on the stretcher where he rested, as he grimaced and clutched whatever nearby object he could as well. The siren blared deafeningly where my brother-in-law sat next to the driver, while we were shielded inside the ambulance patient transport cabin.

Two days later, just as a date had been set for the ICD implant, he experienced heart failure episodes. When I went to see him at the 4 pm visitors' hour, he spoke little except to ask me to open a tetrapak of apple juice, insert the straw and give it to him. He slurped it up quietly, and waved me to leave in a few minutes.

Later that evening he collapsed with a second cardiac arrest, even as he was talking with the doctor. This time, he was not so lucky. Despite every effort by the hospital team to resuscitate and stabilize him, several hours later Appa ended up with strong heart beat, temporary pacemaker, mechanical ventilation (with no patient breaths) and minimal neural activity.

Every day next, we would take turns during visiting, striving our best to wake him up from the deep sleep of coma. But he did not respond. We called, tapped his arms, pleaded, pinched. My aunts and uncles (doctors with varied specialties) arrived and tried their best as well to elicit a response. But four days later, we sat defeated. There was nothing beyond the strong heart beat. No patient breaths (as his brain stem that controls that had been damaged during the cardiac arrest and loss of oxygen that occurred till they could restore the heart rhythm). No neurological responses beyond some minimal artifacts that were promoted by the mix of dopamine and other drugs they were giving him. Waxing then waning kidney function.

It was time for tough decisions. Would Appa want to continue to live like this for whatever duration, tethered to a machine to breathe for him? We thought not. We made the request to the doctor to discontinue ventilation. But he said he could not remove it, as it would be against hospital policy and tantamount to euthanasia.  We were at a loss as to what to do.

My sister and I asked for a meeting with the doctor, after a hurried conference with our aunts and cousins (doctors all). I asked about the pacemaker, which the doctor assured me was in 'standby mode', only there to support the heart which he said was beating strongly on its own, set to 65 beats per minute.  He didn't think it was doing anything to sustain the current comatose condition. My sister asked about the drug cocktail being given, especially the dopamine. The doctor conceded that since there was no hope of recovery, there was not any point to continuing them. He still seemed a bit unconvinced by our request to have those discontinued, as well as turning off the pacemaker.

Who knows what went on in the doctor's mind? A couple of hours later, he quietly acceded to our requests, ordering the stoppage of drugs and allowing the turning off of the pacemaker. Over the next two hours or so, Appa's heart slowed down, drifting below the 65 bpm that had been programmed for the pacemaker to kick in. He went into bradycardia resulting in a final cardiac arrest. The time was 7:25 pm.

We were outside the ICU when the doctor confirmed his passing. It was a bittersweet moment. We each had our roles to play in easing his passage, difficult though it was for us to say goodbye.

And so the mighty, generous heart that had beat so long, striving to overcome all the weaknesses that beset it, especially over the last few years, beat no more.

Appa, fare well on your next grand adventure. Resting in peace is not for you.


Balachandran V said...

My heartfelt condolences! That you could write about it both detached and emotional shows how strong you are. My obeisance to your late father...

Sujatha said...

Thanks, Balachandran sir!

subbulakshmi said...

your appa's last days are still fresh in my mind. You have captured them very well.