Last 3 Weeks

The last 3 weeks of Dad's journey were spent in the hospital, with all of us often at his side. Dad was hospitalized on 4 Sep (Tues), but for me, it started the day before.  

Dinner @ Dad's

It was our usual Monday night dinner at Dad's place (or was it). Dad cooked my favorite chicken, and his delicious vegetables stir-fried with succulent prawns (shells were peeled before cooking, as Dad wanted us to eat with ease). Dad looked a little tired that evening, but it was a lovely dinner nonetheless. As usual, he was sitting on his favorite seat in the kitchen, peering at us as we munch along. I decided to ask him something that has been weighing on my heart for some time "爸, would you like to return to Penang (his birth place) for a trip during end of the year? 姐and I have been thinking of bringing you and the kids back to Penang for a visit". Although I kinda guessed what would have been Dad's answer, I still had to ask. Dad replied "Penang? For what? The place must have changed a lot by now, and all of the people I know are no longer there. No need." Then, me in my attempt to perhaps rouse his interest in a getaway trip suggested "What about we take a cruise? Then we can look at the ocean and enjoy the sea breeze." Dad smiled, and having looked through my intentions, said "Bin, 爸have sailed for so many years, which ocean have I not seen? I had enough time to enjoy the sea and the skies. When I was younger, I have sailed to Amsterdam, Brussels, through the Gulf of Aden and Mediterranean Sea, Indian Ocean et al. What have I not seen yet?" His response made me feel a little silly, like a little boy, but those words set my heart at ease. I knew I had to ask just to hear from Dad's own words that he has no other unfulfilled desires in life. That was a God-given night, because Dad was hospitalized the next day.

Hospitalized

On 4 Sep (Tues), I received a call from Ann at 1930H, explaining that Dad needed to go to the hospital because he had a fall. The ambulance was on its way to Dad's place, and I was to head straight to NUH and meet him there. Apparently, Dad claimed that he "sat down" at the void deck after feeling his legs were weak while walking home from the coffeeshop. That was about 1530H. His friends helped him back home, and after trying to shake off the pain for 3 hours (to no avail), he finally called Ann and said "Ann, I think I need to go to the hospital". As I drove, I recall how Dad had a similar fall incident one year ago. "Perhaps, this time I can convince him to stay with us", I thought. I managed to arrive at NUH A&E before the ambulance, so I waited anxiously not knowing how bad his injuries were. When Dad was reeled off the ambulance on a stretcher, I caught a glimpse of him. He said he was not in pain, and that he did not fall - merely "sat down". He also told me that he has passed $1000 to Ann to safe-keep, as that was his winnings from striking 4D 1st prize over the weekend (Dad has been striking 4D regularly since Mum's passing - 3 x 1st prize, 1 x 3rd prize and a number of consolation prizes; Dad believed that was Mum expressing her care and presence to him). I remember I had to hold back my laughter when I heard that, seeing him half-drunk and showing so much concern for his 4D winnings (because that was Mum's gift) while insisting he did not fall (that was his ego).

Diagnosis showed that Dad had a hip fracture, and at a place that would be difficult to heal. Surgery may be imminent if he was to walk again. So Dad was warded that evening, and being the introvert, he wanted to stay in a single-bed ward. It was a decision we had to make, as Dad's insurance (even with rider coverage) covers fully B1 Ward (2-bedder) only. For the A Ward (single bedder), 15% of the medical bills would be payable. I had wanted to give Dad what he requested, but Ann advised us to be prudent first as we were unsure of the extent of medical follow-ups required; besides, it'd be easier to upgrade to A Ward than to downgrade to B1 Ward thereafter. That choice was indeed guided by God's hand, as Dad was moved to the ICU the following day and the medical charges would be fully borne by the insurance under the B1 Ward rates. God did afterall grant Dad his wish - a single-bed environment.

Warded into ICU

On 5 Sep (Wed), 姐and Ann were visiting Dad in the afternoon. He was very tired, and looked listless. He ate very little, due to a "sore throat" (we were to discover later that it was his esophagus hurting). 姐and Ann prayed with Dad before they went home that afternoon, and to their amazement, Dad actually repeated sentence-by-sentence after Ann. I've not heard Dad pray out loud (he's an introvert afterall) although he had been a Christian for some years. And the beautiful prayer ended with "I love you, Jesus", and Dad said "I love you Jesus". Later that evening when 姐went back to the hospital to visit Dad, she saw that medical personnel were surrounding Dad's bed because he was experiencing breathlessness. She was worried, and called all of us, and we rushed down to the hospital from wherever we were (I was in the middle of a ranking board, and when I left abruptly after explaining to my boss, many in the room were surprised - but I had to do what I had to do). When I arrived at NUH, Dad was already moved to the ICU. 姐said Dad was waving her away (in his typical style of "Aiyah, you don't come and disturb. Let the doctors do their job!) as he was being pushed out of the B1 Ward. We kept vigil outside the ICU till 0200H that day. While the doctors have managed to identify the source of his breathlessness - oozing blood from his esophagus due to lining erosion over years of smoking, Dad was still in a critical condition as his blood had difficulty clotting due to low platelets count. Dad was given blood transfusions and cardiac medication where necessary to sustain his body, so as to facilitate his blood clotting. We left the ICU worried and praying that Dad's body would fight back and recover.

The next two days were spent at the ICU. We went in and out of Dad's room, and our hearts also swung with the rise and fall of his condition. The blood from his esophagus has clotted, but his blood pressure and platelet counts remained unstable. I remember 姐, Ann and I had a conversation (prompted by the doctors) at a Korean Restaurant at Buona Vista on the extent to which we would want the doctors to resuscitate should Dad's condition turn to the worse very quickly. It was a difficult decision, as we did not want to cause unnecessary suffering to Dad (through traumatic resuscitation techniques) if the chances of recovering is very low. Yet we could not bear not to do what was possible to keep him alive. We spoke honestly as a family (and I thank God for that) and concluded that we would allow up to 2 CPR/resuscitation, as long as it would not result in permanent damage or impact his quality-of-life thereafter. We understand Dad's ego, that he would not want to live permanently from a support machine or suffer from long-term distortion to his body.

1st Week - Gradual Recovery

Dad's condition was to take a turn for the better after that initial few days of scare (although it continued to swing up and down with each passing day). His heart was gradually weaned off the cardiac medication due to low blood pressure and the breathing tube was finally removed after a week after his lungs grew strong enough to breathe unassisted. However, Dad's liver condition remain poor and his ammonia levels were high, causing him to be a little delirious at times. His skin also turned yellowish due to his poor liver condition. We kept watch by Dad's side, whether he was asleep or awake when we visited him, and we prayed the night prayers with him, sang his favorite hymn "Amazing Grace" and just simply spoke with him. Although Dad could not respond due to the breathing tube, we knew he could hear and understand us. This was also the time when we developed a visiting routine - 姐would visit every lunchtime, while we take turns to visit Dad at night. That meant 姐visited Dad twice on certain days, and that was tiring. But I believe 姐treasured those alone times with Dad, seeing him and speaking to him.

2nd Week - Pneumonia

After the 1st week, Dad's condition improved and he was taken off the breathing tube. With the small mask, Dad was breathing on his own and he was able to speak softly to us. That made our visits a little more interactive. I was thankful to God. However, Dad soon developed a lung infection, about 2 days after going off the breathing tube. So the tube had to go in, and Dad was back into a semi-conscious state. Dad had a lot more phlegm because of the pneumonia and the nurses had to do suction for him regularly. That made Dad very tired easily. Nonetheless, the orthopedic continued to maintain supervision over Dad's condition, and in fact helped him to sit up on a chair daily for about 2-3 hours each time. We continue to keep up with our visit routine, and looking back, those were the times that God had blessed us with to have one-on-one alone time with Dad. Although we didn't speak much nor could we do much with him, there was a connection when we looked at him as he rested in bed. For me, memories flooded back often...

Dad was always a quiet person who did not speak much about himself or his thoughts and emotions. So growing up, he was a distant member of the family and both 姐and I grew more attached to Mum. After Mum's passing, we started to have more opportunities to spend time directly with Dad (because with Mum around, it was natural that conversations and attention went to her, considering her bubbly and talkative nature). The past year, every dinner I had with Dad was filled with mutual presence and conversations. I took the effort to look at him in the eye, ask him how his week was, and spur him on when he was in the mood to tell us many stories from his younger days (and I got to know Dad a lot more over the past year than in the 33 years before that). We also text-ed each other more frequently, him telling me when he needs money and me letting him know when I'd bank in money for him. That became our little routine, our "dance of life". 姐used to ask me why did I not choose to bank in a lump sum for Dad each week, but for me, having that communication on a daily or two-daily basis was something I have grown to love. That was my way of letting Dad know that I care for him, and that I'd like to hear from him, and he knew that too. 姐also grew in her relationship with Dad over the past year. She'd bring the kids over to his place once a month, while we bring Dad over to her place once a month - so that makes for a two-weekly contact. 姐asked after Dad a lot more, especially during times when Ann and I could not be there when they visited Dad. I was heartened to hear 姐say during one of our dinners at NUH when Dad was hospitalized that somehow after Mum's passing and over the past year, all her childhood grudges against Dad just disappeared. That was how I felt too, and I thank God for healing our family albeit through such painful experience as death.

3rd Week - Liver Deterioration

But Dad has a strong spirit. By the 3rd week, Dad has recovered from the bout of pneumonia and was weaned off the cardiac medication. He was breathing on his own by then and no longer on medication or sedation. He was subsequently moved to the High Dependency Ward on 28 Sep (Fri). However, Dad's liver has already suffered further deterioration throughout these 3 weeks, and coupled with his liver cirrhosis due to years of drinking, his bilirubin (a fluid made by the liver) and ammonia levels were off the chart. 

On 30 Sep (Sun), the doctor from High Dependency requested to meet us. I initially thought it was a regular update, and so did 姐. But thank God that both of us were there, together with Ann, to meet the doctor. Apparently, although Dad's condition in terms of blood pressure, breathing and heartbeat were all good, his liver is already below the self-sustaining condition. Therefore, short of a miracle, the toxin in Dad's body would continue to climb. Other than providing rudimentary medical help to assist his passing motion and urine, there is nothing else that can be done to reduce the toxin levels. The doctor informed us that Dad would be moved to the general ward by Monday and continued to be monitored from there. We were advised to make emotional preparation for Dad's deteriorating condition. Then, 姐, Ann and I each spent some quiet time with Dad. It was a much needed time for me to spend with Dad, because I reassured him that I loved him, that I am proud of him and that I'd hold on to his hand till his last day.

That afternoon, we head straight to 姐's place and discussed further with Wing Kwong. We have all come to terms that Dad's condition were no longer sustainable and we all knew in our heart that Dad's passing would be a relief for him, both physically and emotionally (as he has been missing Mum every single day since her passing). We just wanted to do what we can to alleviate his suffering from now on, and the medical options provided in the general ward would help with that. As Wing Kwong was the only one who have not had a chance to speak with Dad that afternoon (as he was at home looking after the 2 girls), he said he would drop by to speak with Dad that evening.

Dad's Entry Into Eternity

As I laid down my head to rest that night at about 2215H, it was with a heavy heart. I knew that I cannot never be fully prepared to be separated from Dad through death. Although I know it would be a relief for him, missing him would still be too much to bear. And so, it was with these thoughts that I fell asleep that night... until about 2310H when I was woken up by a call from Wing Kwong. He said that Dad's encountering much difficulties breathing and he asked us to go down to NUH, quick...

Wing Kwong was there speaking with Dad when he noticed Dad having difficulty breathing. He called for the nurses and then the doctor, only to assess that Dad's in his final phase. Ann and I arrived by 2340H, and along the way, we have also informed Mai Gnou (because for some reason, I feel that other than the 4 of us, Dad would also like Mai Gnou and Ah Bor to be by his side). The 4 of us held on to Dad's hands as he was panting vigorously. His eyes were half-opened, and I could notice him looking at me when we started speaking to him and praying for him. We also sang his favorite hymn "Amazing Grace". As I held his hand, squeezing it occasionally to let him know I am with him, he too held on to mine. It was the greatest intimacy I've ever experienced with Dad, that at his dying bed, I could still communicate with him through holding of hands. This was our "dance of death" that I would always remember - it was God's gift for me and for Dad. As the 4 of us continue to be by Dad's side, Mai Gnou and Ah Bor arrived around 0005H. All 6 of us again sing "Amazing Grace" to soothe Dad into his final lap. Perhaps because of the morphine, Dad did not seem to be in much pain, less the vigorous breathing that soon grow slower and weaker. 

During the last 5 minutes of Dad's life, his eyes were closed and his gasping became faint, almost as if he was asleep. All this time, we were holding on to Dad's hands, assuring Him that Jesus' embrace is awaiting Him, together with Mum, and that there was to be no fear whatsoever. I could feel the intensity of Dad's grasp on my hand slowly weaken, while mine on his grew firmer. I wanted him to know that I would always hold on to his memories (together with Mum's) and the things he has taught me through his own life. At one time, Dad's heartbeat went to zero, and we got the doctor in to assess. Doctor said Dad was still around, albeit with very weak breathing and pulse. That was how peaceful Dad's passing was during the final moments. In fact, Dad was so motionless that we did not know the exact moment that Dad breathed his last. We were just by his side through it all... 

When finally the monitoring machine beeped long and hard from a zero pulse, we brought in the doctor again to ascertain. Dad has finally gone home, quite peacefully, into the embrace of God. Dad has finally entered into eternity, where there is no longer suffering nor pain, where there is only love and joy. Dad has finally joined Mum (after 18-months) to pray for all of us, that we may continue our own good fight, our own triumphant journeys unto our own physical deaths. May we continue to live the mysteries and legacies of Dad and Mum's lives - to grow in generosity of heart, commitment to responsibilities and courageous in love.