Dear Byron

What I’ll remember most is this uncanny relationship you built with your two-year-old granddaughter. I’ll remember how she would run to you, her full head of flouncy blonde hair, whipping behind her and collapse across your legs, burying her flushed, chubby cheeks in her hands and head into your lap. You were her safety. You were her rock.  
That two-year-old. She is a smart one. Because that’s how we all felt. You were our safety. You were our rock. We all buried our heads in your lap in our own ways. For me, it was knowing every time we had a crisis with the kids–this kid had a fever and needed to be picked up from school when both Joe and I were working, that kid was vomiting and couldn’t go to school today, or someone needed to stay at our house because Joe was suddenly going out of town and I was working overnight, or we simply needed a night out–you were there. Drop everything. No questions asked. I would look at you with desperate appreciation, and you would look back at me firmly, “that’s why we’re here. Stay out longer. You guys need the time.” And I would sigh and breathe and want to cry, knowing you were there to lean on, time and time again, letting me know that being there for us was all you wanted in return.  
What I loved most of all, was that there was no questioning that your number one priority was always family. And most of all, your wife–the love of your life. At the core of it all, you lived your life to love your wife and family and to protect and take care of us all. Every ounce of everything you were went into taking care of us. I remember how when you became too weak to walk across a soccer field, you would drive your wife to her grandkids’ soccer practice and wait for her in the car. I’ll remember how you would rather be out of breath carrying bags than consider having someone else carry the burden. I’ll remember how you shooed me away from washing the dishes every time you saw my shoulders slump in exhaustion after a long day. I’ll remember how you acknowledged what an amazing dad my husband is for stopping what he was doing to help our son build a lego set he was struggling with. I’ll remember how every time without fail, you would put down your fork, and say, “My Doctor told me to stop eating when I was full”, with a wink and a nudge in my direction. I’ll remember how nothing lit you up the way talking about your kids coming to visit did, and how you were looking forward to walking around the hardware store with your son, checking out new gadgets, just like you two used to do. I’ll remember the afternoons we spent on the lake with you–always the driver of the boat–while the rest of us enjoyed a carefree summer day of sun, water balloon fights, and stops at the ice cream shop.  I’ll remember those pork chops you slow cooked over a bed of hot coals–your famous hot chops.  Oh, we’ll all remember your hot chops.  I’m so sorry if you never had Byron’s hot chops.  

You were never one to want a lot. Just your family. Just to feel useful and needed. Just to be able to provide. Just to see your family happy and comfortable. You spoke loudly with your actions what you seldom said with words: I am here for you. Always, no matter what, because this is how I love you–with everything I can offer.  
You have been the ultimate fixture in our lives. Always steady, always there, never wavering. We all leaned on you.  
Our two-year-old continues to ask, “Where is Abba-abba?” And I will continue to tell her, that you are right here in our hearts. Our permanent fixture.  
Byron, you are truly one-of-a-kind. We all miss you greatly. But you have emblazoned your love into each of our hearts.  
Thank you for being here for us, even in these days when you have gone.  
We will continue to love you the way you loved us–with everything we’ve got.  

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Beyond The Final Breath

Republished at:  https://www.washingtonpost.com/national/health-science/we-didnt-save-his-life-but-we-didnt-disrespect-him-either/2017/02/03/74612afe-d1f6-11e6-9cb0-54ab630851e8_story.html?utm_term=.9e665c02ec43

Republished at:  http://www.kevinmd.com/blog/2016/12/didnt-save-life-better.html

“Well?  Did you save him?” “No. We did better than that.”

He came in pulseless. The machine performing chest compressions with the rhythmic thud, thwack, thump. His ribs heaving under the force of the compressor, keeping his heart artificially beating. The plastic tube secured in his airway forcing puffs of air to inflate his lungs.  His skin slightly purple-gray, on that narrow brink between life and death. His eyes like speckled round pieces of glass, with fixed pupils, staring nowhere.

Our team was assembled, prepared, ready. We worked deftly with experienced hands, our focus and determination fueled by adrenaline, a synchronized team, we worked side by side; this was our life to save and we were going to do everything.

But his glassy, fixed eyes spoke to me. As we regained a heartbeat, and we halted the chest compressions, and our adrenaline settled–here he lay, not out of the woods, but heart back from a standstill. His glassy eyes told me his heart was back, but his life of living was gone. The life that laughed, that smiled, that held his wife’s hand–there was no amount of life saving measures that could bring that part of him back.  We didn’t know how long ago he had stopped breathing. But it was long enough to have robbed him of his mind, his memory, of everything that made him that man his family loved.

His wife and only daughter arrived. I left him in my able teams’ hands and sat down with them. I looked them in the eyes. I told them the story of his final hour of life, from the perspective of his fighting, beating heart.

His heart was here with us, but his  brain had gone too long without oxygen before we could reach him. He would never walk out of this hospital. They listened to my words.  Words spinning and exploding beyond comprehension. They nodded their heads, as if to ask me to keep talking.  So long as I was talking, we didn’t have to move.  Tears were inevitable. It was so sudden. How could they be asked to make a decision of whether to continue with the resuscitation or to just let life walk its final march.

Yes, this was about them, but this was ultimately about him. What would he want? It is true it was sudden. It is true it is the toughest decision anyone will make.  But with the return of his heartbeat, the decision to continue resuscitation is as big, as active a decision as it is to stop all aggressive measures and let him be comfortable. These are both big decisions with big paths for us to travel down.  I needed them to understand that this wasn’t their decision to shoulder. It was their time to respect–in the most selfless of ways–the man they loved.  To step outside themselves, slip into his shoes and honor his wishes in the greatest way possible.  What would he have wanted if he saw himself in this moment?  Representing him in this way is a responsibility no one cares to bear, but this final act is the biggest, most giving way they could love and honor him.

His daughter immediately said, “oh, he would want none of this. He would want you to stop.”

They stood by his bedside. We withdrew all aggressive cares. We turned off the beeping monitors, we stopped artificially putting oxygen in his lungs, we turned off all pumps, we covered him with warm blankets, we let him be comfortable with his wife holding his hand for his final minutes, and his daughter stroking his hair.

And that’s how he left us.

Did we save his life?  No we did not.  Not today.  We did better than that. We upheld our promise to continue to respect his wishes beyond his final breath.