My dad died twice.

We were unprepared for either of his deaths. 25 years ago, on a warm evening early in June my dad woke my mother and complained of indigestion. He had a cigarette and took some antacid. Later he started breaking out in a sweat and felt worse. My mother drove him to urgent care. There he was triaged, seated in a wheelchair, and waited to be called. He waited and waited until he collapsed in his wheelchair chair. My mother screamed for help and help came. He was rushed to the back in a clumsy attempt to attend to him, but his feet were dragging and pulling him . . . he was almost falling out of the wheelchair.

Just like in the movies, there was shouting, rib breaking pumps to the chest, CPR a traumatic almost violent but lifesaving act. paramedics arrived . . . this was urgent care, not a hospital. More shouting and rushing . . . equipment coming out of boxes . . . defibrillator . . ., more shouts... arrest! ready? Clear, got it . . . lost it flat line . . . no heartbeat! Again! Got it. No, Nothing . . . over and over. My mother stood in the hall frozen watching the scene play out in slow motion. Then realizing that my father’s life was slipping away she became angry or hysterical . . . shouting you killed him you let him die waiting, you killed him! The staff ignored her. It was just another noise in the chaotic scene.

My father was flat lined . . . cardiac arrest. Then a call for the syringe, the last resort Epinephrine.

Epinephrine, also known as adrenaline, is a hormone that stimulates the heart and promotes the flow of blood. It is injected directly into the heart. 1 milligram of epinephrine every 3-5 minutes during resuscitation. I believe my father only received 1 injection . . . Then field intubation for assisted breathing.

Without an advance directive or a POLST (Physician Orders for Life Sustaining Treatment) this CPR will go on and on until that last resort does not work. In my father’s case take into account that precious minutes are passing. Heart tissue is dying, tissue that will not regenerate nor heal.

They got a sustained heartbeat from a severely damaged heart. My father was transported and admitted to ICU, unconscious, incubated and on mechanical ventilation. He remained that way for 2 weeks. That was the maximum time before a tracheostomy would be required. They attempted extubation and he was stable. We thought he had a close call but somehow made it through. He survived and modern medicine saved his life. There was so much we didn't know but would soon learn...much to late. My father couldn't talk for the first days after his extubation. His throat was irritated from the breathing tube. He put two fingers to his mouth as he did when he smoked. He was asking for a cigarette. We were in disbelief. I guess dad is back and he's alright, I said. The cardiologist wanted to perform a heart cath to determine what caused the heart attack.

Cardiac catheterization involves, inserting a long, thin, flexible tube called a catheter into a blood vessel in the groin.  The catheter is then threaded through the femoral artery and advanced to the heart. Contrast is injected and x-rays are taken. This is a routine procedure that is performed often. Many years Later, in my work, I would go on to read many of these procedures, and often go to the cath lab to discuss these interventional radiology procedures with cardiologists.

But at the time my father’s heart cath, I knew nothing.

After the procedure the cardiologist spoke to my mother and me and I still knew nothing. You see she was in a hurry, and she spoke another language...doctor speak. She had bad news for us but if you give bad news wrapped in medical language...you aren't really saying anything. It's just a report. Just the facts. But so much can be understood by those facts when you know how to interpret them. Years later I could read a heart cath report and know who would die soon and who would live a normal life. I could tell who could qualify for a bypass and who wouldn't. What the doctor told us is that my father wouldn't have Coronary bypass surgery. His heart had a lot of damage.

We thought he had a close call but somehow made it through. He survived and modern medicine saved his life.

My dad's diagnosis was CHF.

Congestive heart failure. He was given multiple prescriptions including blood thinners and dietetics. The blood thinner Coumadin required regular blood tests. An INR (international normalized ratio) to monitor clotting time. One of those questions I reflect on in hindsight was why would they want us to drag my father back and forth and poke him with needles when they knew, even if we did not that his heart would not last much longer? Going through the motions and not thinking much beyond protocols to the human element . . . to my father’s quality of life for the little he had left.

He should have been on hospice but that was 25 years ago.

We should have Googled about it but again, that was 25 years ago. Google had just been founded so there was nothing to find quite yet.

What followed for my father was a fast decline. His damaged heart struggled to sustain his body. It couldn't pump the oxygen needed and that started affecting his brain. He had Terrible hallucinations...he saw little monsters crawling around under the furniture. He thought a plane had crashed in the backyard and wanted to go out and save the pilot.

His doctor suggested that we take him to a psychiatrist . . . a relational perspective on the body would have had them deal with the oxygen rather than medicate his symptoms. We added the unnecessary psychiatrist drugs to his long list of meds . . . another doctor’s visit requiring my very ill father to attend.

My father’s health declined. He was hospitalized again to give a stronger dose of Lasix.

Our neighbor across the street was a RN. She came over to ask how he was doing. She saw our lack of understanding of the situation. She saw our confusion. She sat us down and explained the situation with my father’s CHF. Of course she couldn't cross the line and tell his that he was dying . . . but looking back, she knew. She was in a bind, and it wasn't her responsibility to tell us.

She was the first person to take the time to explain in a way that we could understand.

The next day my mother got a call from the hospital advising us that we might like to get a priest. We were shocked.

We rushed to the hospital and were ushered into a room where a doctor explained that my father was dying. He told us about his damaged heart. He told us more at that point than anyone else had. We were blindsided.

My father died in a hospital room that night with his wife and children around him. It had been a month since his heart attack.

Years later I would come to understand everything. In my work in health information management clinical documentation. It is sad of course that my father died.

What adds to the sadness is the lack of communication, or even consideration for my father as a human being- A man with a family, a man who might have like to spend his final days saying goodbye to friends and family, speak to clergy and ponder the mystery of death.