Abstract
Go Down Death…go down
Go down for the Sergeant Major because he has earned his ride
Go down for the Sergeant Major because he has heard the call and is ready to come home.
—Paraphrased from God's Trombones: Seven Negro Sermons in Verse
by James Weldon Johnson, 1871–1928
T
As the heart and soul of our family, Dad was the life blood that nourished and sustained our existence—a true soldier who waged war on the battlefield and with life itself. His life was an experience that his children learned much more about from his dying than from his living. Because in his life he was a relentless man, bound by his commitment to the military; a true Alpha Dog. A Commander who led his men and commanded his family.
As the only daughter of a military family and now a registered professional nurse, I looked upon my father with both fear and reverence. He walked proudly in his uniform—creases razor sharp, boots spit shined, chest forward—ribbons prominent, footsteps echoing over marbled floors. It was expected that each of his three children would serve the military, following his example of perfection. My two brothers did but I did not. It was not until Dad's heart attack that he gained value for my work in health care and appointed me as his advocate. As a learned man, he asked many questions, “What is a living will? How will such a document help me meet my maker with dignity? How can I define the quality of my death?” And directed at me specifically, the most important one: “Will you help me when it is my time to “Man UP?”
“Man UP,” I said. “What's that?”
“Come on, you know—be a soldier,” he responded. “Earn my ride to meet my maker.” Then looking at me earnestly he said, “I'm sorry. I forget, you never served.” For the first time, my father's words no longer stung. Realizing he needed my help, I carefully answered his questions and noticed that he hung on to every word. A lover of food, he wanted to enjoy its taste to the last bite, not fed by “some tube.” He wanted to breathe air through his nose—not “some tube.” And when it came to the end he didn't want any machine keeping him alive. A few days later Dad created to perfection his own living will, which he had notarized and presented to my brothers and me. “This is my death wish,” he said. “In honoring it, you honor me.” Dad was relentless in his dying, taking command of his illness—heart failure—stoic to the end, never letting it get the upper hand. To each inquiry of, “How are you doing today?” he responded, “Happy to be alive; things are going according to plan.” A second heart attack was followed by an ICD placement; however, frequent shocks and instability severely compromised his cardiovascular system. Often, I would ask my father if he had chest pain or felt a shock but he would say, “After me, you will be the next one to know.” Soldiers,” he said, “push through their pain.” I would smile because I knew Dad was reminding me he was still in charge. There were no extra visits to the cardiologist; he kept scheduled appointments and chose conservative interventions that allowed him to remain in command.
As Dad's strength waned, he acquiesced to hiring an aide. He acknowledged his need for extra care and accepted it with dignity. The added support provided a respite for me, as I could now devote more of my visits to idle chatter, reading his correspondence, and writing cards to his legion of friends all over the United States.
This calm in our lives was short-lived, because Dad's death was as swift as it was unexpected. One afternoon in the spring I entered my Dad's apartment and saw my father slumped in his chair confused and lethargic. His aide was hovering over him and said, “I found him like this and called 911—I was going to call you next.” The BP cuff, always close at hand, revealed a dangerously low blood pressure. As the ambulance sped across boulevards to a large medical center, Dad looked at me as he uttered his last words, “I am Manning UP!” His eyes glazed over as his consciousness waned. The monitors showed a regular but tachycardic rhythm and hypotension. As he was moved quickly into the ED I found myself running alongside the gurney as a wave of physicians shouted questions at me. Staff scurried about drawing bloods, monitoring vital signs, finally coming to me with a plan. “We need to act quickly—we can save him.”
“No,” I responded, “my Dad would not want that—save your ICU bed for someone who needs it.” The chief was hesitant, “Are you certain?” I nodded yes, as I produced Dad's living will. As the doctors read the document and consulted with the legal department to ascertain its veracity, I called my brothers with urgency. A social worker found me hovering in a corner of the ED as I spoke hurriedly on the cell phone. She introduced herself and asked, “How can I help? Is your Dad on a hospice program? Is there anyone I can call for you?” Briefly, I explained our circumstances, that Dad had private home care and that when he pulled through this event it was my intention to arrange 24-hour care; I knew my brothers would agree. Yes, maybe hospice could be an option—but right now, I wasn't sure.
In truth, as Dad's advocate, I never entertained hospice. Dad had lulled me into a false sense of security. He hid his pain and if he had fear, he faced it head on—like a soldier. His cheerful nature and winning personality left an impression of endurance. For my brothers and me, Dad was a pillar. Having lost our mother so many years ago, we were not ready to face losing him. Whenever my brothers called and asked, “How is Dad?” I would respond, “He says he feels well; he looks good and he is happy. I think we have time—he is not ready yet.” In reality, I was the one who needed more time with my father, and after each visit I found myself bargaining for more days, more weeks, and more months. “Just a little bit more,” I would implore silently.
Dad died later that night. He never awakened. My brothers and I remained at his bedside as his essence ebbed into the universe. He looked secretly pleased; a tiny smile touched the edges of his mouth as the heart monitor slowed and eventually stopped. Dad had Manned Up like so many soldiers who filled the ranks before him—happy to be heading home.