6/8/10 may seem relatively insignificant, being just a set of random even numbers. Nothing could be farther from the truth, in the eyes of Harlen John Kasler, my grandfather and those who loved him.
6/8/10 was the day he fell at home that resulted in a hip fracture.
6/8/10 was the final day he would see his home of 67 years, which he bought and built onto with his own two hands.
6/8/10 was the last day he would make his coffee and enjoy sipping it as he watched the birds flock into his backyard, supplied with mounds of feed.
6/8/10 was the last day he would ever see his garage filled with every tool and trinket collected over the past 97 years.
6/8/10 was the last day he would ever wake up in his own bed, wrapped in a wool blanket.
6/8/10 was the last day he would pace up and down the driveway that paralleled his home, where the old Buckeye Tree stood tall.
6/8/10 was the last day he would sit in his favorite old chair on the back porch.
6/8/10 was the day my grandfather lost his independence.
Fast forward 3-4 months post hip surgery and rehab, which he “failed” due to probable age and perhaps the team underestimating what this 97 year old coal miner of 23 years, starting at the ripe age of 15 and working until the mine closed, was capable of accomplishing. Papa worked the rest of his life as a jack of all trades both for others and for himself. There’s nothing he couldn’t fix or rig up to make it serve it’s purpose. Pretty sure I acquired that gene, laced thoroughly with some stubbornness. Either way, this led to his transition into the skilled nursing wing directly from rehab at the same facility. I begged and pleaded to either allow him to move in with me 400 miles away or grant me permission to oversee 24/7 care for him in his own home. Anything to avoid having him gain citizenship into a nursing “home.” But, that wasn’t in the cards as the thought of having him so far away from family was too painful for those making his decisions. The big picture could not be seen until further down the road. I never accepted that hard no and continued to ask to be his caregiver on many occasions over the next three years.
I called my grandfather, Papa Kasler from the day I could speak. My mom and I lived with my grandparents for the first three years of my life. I was born to a strong young woman of only 16 years who went against the odds and still managed to finish high school and maintain a job. So, my relationship with my grandparents began from day one, making my desire to care for Papa Kasler purely innate. To care for him during the end of his journey like he did for me during the beginning of mine. Papa would always say, “Is there anything you need?’ prior to saying good-bye. Even still while in the midst of his decline, he wanted to make sure his loved ones had what they needed. I find myself asking my own children that very same question upon every conversation we have today. So many things get passed down over the years that become treasures through the generations.
As those 3 years went by, I managed to visit Ohio every 3-6 months to see him and the rest of my family, I asked repeatedly about taking on his care. Each request ended with the same answer, until Papa began “showing out” and developed dementia. That led to his transfer into a geriatric psychiatric hospital nearby to evaluate his condition and regulate his medications to improve his behavior. Upon that visit, Papa was incoherent and it was obvious the toxicity of numerous medications such as Ativan and Haldol were building up in is system to the point of becoming merely a victim of the system. My quest was put into overdrive as I knew Papa didn’t have a chance of coming out of this drug induced state of oblivion, if left receiving these heavy doses of medications.
He’d become incontinent, could no longer speak, feed himself or recognize any family members. He was sent back to the nursing home after a week and continued to decline. I had to return home but would call daily to receive updates. I asked those making his decisions once again if I could please bring him down to live out his last bit of time with me in a loving home and I would make arrangements to be his full-time caregiver. What I heard on the other side of the line brought tears, “you still want him?” I’d been waiting to be granted permission for over 3 years and the day had finally arrived! I drove up to get Papa with my kids and my stepdad the very next day. I didn’t want to waste time because of the chance of anyone having a change of heart. Papa could no longer bear weight so he was always a 2 person assist and wheelchair bound.
8/6/13 was the beginning of a 109 day journey with Papa. I was fully prepared to care for him for a day, a week, a month or a year. However long this sweet, kind 100 year old soul was meant to be on this planet. My first endeavor was to detoxify him off the meds as safely as possible to see what faculties may return. In my mind, I was prepared to wean him off over a 2-4 week period, if he survived that long. After only a week, Papa gained much of his awareness back and was able to communicate. Slowly, he became fully continent again, began feeding himself and was actually living and laughing again vs merely existing. Papa was able to voice his needs and if that meant dessert for breakfast then we had dessert for breakfast. We arranged a pon-toon boat ride, wheelchair and all, on our local lake when two of his children visited. There were 10 of us who
shared this experience that day, which proved to be his last adventure. Papa loved to fish and be on the water, so to see him have one more day on the water was priceless. Don’t get me wrong, there were many days and nights that I thought I had bitten off more than I could chew, but I had a lot of support and Hospice was coming in to assist on occasion. He was doing so well, they actually considered discharging him from their services but he began to decline prior to that transpiring. I wanted to put my Hospice nurse cap aside and be solely his caregiver. Papa only spoke my name a few times over this time we had together, but he knew I was going to care for him day in day out. Papa seemed to recognize and smile at the old photo albums we would look through, another sign that he was able to process faces and memories. The connection we shared was sometimes unspoken and this bond that began 43 years ago when I was born, was reinvented in a way I had only been dreaming of for so long. As Papa weakened, his appetite decreased and his sleeping increased, I knew this was most probably the beginning of his transition. Papa never complained of pain or wanting to be anywhere else (other than thinking he was back in the coal mine many nights.) This loving man married and buried 3 wives over the course of his lifetime, plus raising 5 children and dozens of grandchildren.
12/3/13 was the day Papa regained his independence again as he peacefully took his last breath. This precious man who, to me, walked on water will forever walk with me on my journey. The privilege of caring for him during his final season was the greatest gift a granddaughter could ever ask for and finally receive. Seems like yesterday and forever ago at the same time. When there’s nothing left to do, there’s always space to hope and where there’s hope, there’s life and purpose.
There is a natural linkage between birth and death. The author highlights this connection, and it is instructive and something to celebrate. She’s also careful to note that this isn't a matter of paying a debt to her papa, but rather an extra note of poignancy and motivator for her to shoulder the effort of caring for someone through to the end. It’s beautiful to read her persistent requests to her nearer relatives that she may be allowed to bring her grandfather home. By so doing, she highlights the joy and privilege it is to be entrusted with another person’s life.
It’s also important to note that she involved hospice. And while this was a helpful addition to their regimen, home hospice by itself isn’t enough. Hospice helps a lot, but it doesn’t relieve family and friends of a whole lot of effort. Consider hospice an invaluable addition, beyond what any other medical service can offer for end-of-life care, but it is not by itself enough.
The author points out how Ativan and Haldol put her grandfather in a fog, robbing him of freedom and awareness. For sure, it’s very possible that he was over-medicated, especially in a nursing facility; we know that happens. BUT, I want to also make the point here that those medications can be very helpful, in the right dose when needed for anxiety or agitation (or nausea). All medications have side effects and all medications can be misused; it comes down to skilled and judicious use, and careful weighing of risks and benefits. It’s also important to note that the main reason her grandfather got clearer of mind and more capable once he arrived at her home could be because he was with her, someone who knew and loved him dearly and surrounded him with familiar cues.
-BJ Miller, MD