My previous blog post was about losing my Dad. I think I wrote it on a Thursday. Late Friday night, my step-dad Ralph was "having trouble breathing". Instead of calling me, or my brother Robbie (we were at my Dad and Kathie's house, ONE MILE AWAY!), or an ambulance, Ralph drove himself and my Mom to the ER. He was admitted to the hospital after some testing, because "his heart enzymes were high". (About 3700, with normal being <34). On Monday afternoon, the 10th of February- Ralph was sent home, with instructions to follow up with both his cardiologist and his Primary Care physician. As he was being dismissed, the nurse mentioned that Ralph had had a "type 2 myocardial event". This was the first we had heard anything about a "heart attack"! If the Doctor had said anything to Ralph about it, he had not told Mom.
We stopped at the pharmacy on the way home, to fill the new prescriptions. When Mom and I returned to the car where Ralph had waited, he was very agitated. He thought we had been in there for hours! (20 minutes, pretty quick for a pharmacy.) He said that he had passed out three or four times while we were in there, and Something Is Wrong!
I was all for returning immediately to the hospital, but Ralph insisted on going home. It was midafternoon when we arrived back to their house. (I had stayed with Mom while he was hospitalized.) Ralph was having a bad afternoon. He kept telling us, "Something is wrong". Every time he would fall asleep, he would stop breathing. He would awaken with a gasp, and they cycle would begin again. He didn't want Mom to sleep, she had to be awake to make sure he kept breathing. Just as darkness fell, Ralph said that yes, we should go back to the hospital. We loaded up, and went back to the ER. They took Ralph back to triage. They took blood, ran tests... and waited several hours before drawing more blood, and running more tests. I mentioned the stopping breathing to the Doctor. She said, "That is classic sleep apnea. Follow up with his Primary Care for that!" (Ralph had never before shown any sign of sleep apnea).
Later, the Doctor came in, and told Ralph, "You're going to be fine! You just need to follow-up with your primary care physician later today (It was the wee hours of Tuesday morning). You had a mild heart attack (I think she said Myocardial Event) Saturday morning, but your enzymes are trending down! Your enzymes were at 3700 Saturday, 2750 when they sent you home yesterday afternoon, and you're at 2450 now... trending down. The ER is for EMERGENCY CARE. You go home, you make an appointment with your Cardiologist and your Primary Care doctor. DO NOT COME BACK TO THE EMERGENCY ROOM. Not Unless your pain is at a 10! The worst pain you have ever felt in your life! Just follow up later today with your other doctors!"
He was dismissed, and we went home. I got a few hours of sleep. Mom did not. When Ralph would fall asleep, the breathing stopped. He kept telling us over, and over again... Something is Wrong! Something is Wrong!
Mom tried getting through to the Primary care and to the cardiologist... One was completely unavailable and would return our call later. (Didn't happen!) The other scheduled an appointment for the following Monday- a week out! "Sorry, we just don't have anything sooner!"
ALL. Day. LONG. Ralph would tell us, "Something is not right!"
About 4:30 or so, Ralph said, "I hate to make you drive up there again, but I need to go back to the hospital." I didn't argue. It took awhile to get him loaded into the car, because he was exhausted after only a few steps.
Back we went to Tyler. I got help getting Ralph out of the car and into a wheelchair. He kept saying, "They need to hurry, I'm not going to make it. They need to hurry!"
We sat in the lobby for 15 minutes or so. In Triage, he gave them the symptoms again, repeating, "Hurry, I'm not going to make it! You need to hurry!"
The nurses wheeled him down the hall, with Ralph repeating, "Hurry, Oh hurry!
So, they got him into a treatment room. The nurse asked him to get out of the wheelchair and on to the bed. "I can't", he told her. She helped him up and onto the bed.
"Mr Wiggins, I need you to take off your shirt and get into the hospital gown." Ralph just stared vacantly off into the distance. The nurse repeated her instructions firmly, several times. Ralph stared off. The nurse waved her hand in front of hime, snapping her fingers and repeating, "Mr Wiggins? MR WIGGINS!"
I had stepped into the hallway so he could undress, but the door was open.
Codes were called. Mom was sent into the hall. Suddenly, Ralph's room was The Place To Be for medical personnel. All hands on deck.
They shocked his heart. Twice. Violent CPR. For 13 minutes.
We could see all that was happening. A macabre ballet, as each person did their job. At least 15 people crowded into the small treatment room.
Ralph's heartbeat was finally restored. He was taken for a base line brain activity scan. He was on a ventilator. He was settled in to a room in ICU, but we were warned there was little hope after so long of CPR. We went home to rest, some time after 10 pm for whatever the next day might bring.
The next morning, we were back at the hospital before 6 am. Ralph had improved just a bit during the night. By afternoon, the breathing tube was removed. He ate some jello that was fed to him. He ate ice, sipped some water. He was mostly "out of it", but before we left for the evening, he told Mom to be sure his shed was locked! That was our Ralph for sure.
The next morning, Thursday, came the hard talks from the Doctors. The heart enzymes were 72,000>. Ralph's heart was severely damaged. They could not do a test to see if it was repairable, because the test would shut down his kidneys, which were operating at <3%. Dialysis was not an option, because his heart would not survive the stress of dialysis. So... Ralph was sent home on Hospice care.
My son Daniel arrived Friday afternoon, and helped Robbie, Ruby, and I get the bedroom set up for Ralph's care. (Dan is a paramedic). The Hospice worker put me as primary on giving Ralph the medications that would help him breathe more easily and reduce his stress. (Mom was in dire need of sleep. She had had one night of rest since the entire ordeal began the previous Friday.)
Dan slept in the bedroom, due to his beautiful Dante wanting to roam the house and chase befriend Mom's kitty. I slept on the couch, where I could hear Mom call if she needed me. We were up and down all night. Ralph needed to urinate, but his kidney function was so low he couldn't go. I gave him the medications alternating every 2 hours. At one point, he was having so much trouble breathing, I called the Hospice emergency line and spoke to the nurse. She dispatched a nurse who arrived early Saturday morning. He evaluated Ralph, and suggested I give both meds at the same time. He was reassuring us that the first week of hospice care is hardest on the family. That we would figure out a routine that worked for us, and we could transfer Ralph to their care facility if it became too much for us.
During the day Saturday, Ralph ate a few bites of breakfast, and a bit of lunch. He assisted Mom on getting him onto the bedside potty. He spoke briefly to visitors.
After he fell asleep in the early afternoon, Mom laid down on the couch for a nap. Dan went to visit Kathie. I was on the computer, messaging with a friend, who has been down the same road. She was telling me of her relative's final days. I had just remarked that it sounded like Ralph's day Friday, and this morning. I heard Ralph call out. It was time for the medication, so I went back to check on him.
He wanted to sit up and get to the bedside potty. To preserve his dignity, I had been stepping out so that Mom could help him, but she was asleep. I called out to her, but exhaustion had taken its toll. She was OUT. I called over to Kathie's for Dan to come right back. It is only a mile. I went back to Ralph, who alternated trying to sit up, with passing out completely. I got him laid back down, and noticed he was staring far away.
"Mama?" he said. "MAMA!" with strength, and the joy of recognition in his voice.
I thought he was gone, but he struggled awake. "I can't catch my breath," he said. He struggled to sit up again. I got him the medication, but he spit it back out, his mouth too dry to swallow. I felt like I needed to pray for him. I asked God to send his Holy Spirit to ease Ralph's way.
Dan arrived, and we saw we were too late to get him on the potty. Mom woke up when Dan came in. She came in as Dan and I took off Ralph's wet clothing, and changed the pad beneath him. Ralph assisted, lifting his hips and rolling one way. Then, he wasn't assisting.
Robbie and Ruby arrived. We were by his bedside, when Dan listened to the faint heartbeat stop.
Ralph Walter Wiggins passed at 5:22 PM.
I had called the hospice nurse and let her know things were declining in a hurry right after I had called Dan, but before he had returned. I called her back to let her know he has passed, less than 24 hours after arriving home on Hospice care.
We lost my Dad on the 5th, and Ralph on the 18th. Less than 2 weeks apart.
I may or not post about the Memorial services next time.
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