Saying goodbye to Grapo was a painful end for those who loved him
By LAURIE KRAMER
My father — called Grapo by family, Archie by friends — died in New York City on Dec. 19, 2014. He was 96 and had told his companion he was ready to die. Still, it was a painful end for the people who loved him.
Grapo had congestive heart failure, which his doctor said would likely kill him within six months. It was time to enroll him in hospice. His internist recommended Calvary, a nationally recognized provider of hospice-at-home services and, if needed, in-patient palliative care.
Enrolling a secular Jew in end-of-life care affiliated with the Roman Catholic Diocese felt uncomfortable. But Calvary served everyone and had rabbis on its chaplaincy staff.
Hospice-at-home services started in September. By early November, Calvary said Grapo no longer qualified. He was not declining fast enough.
Sunday, Nov. 30, 2014, the beginning of the end
Grandson Matt and family, in New York for Thanksgiving, visited Grapo and his longtime companion, Cece. Grapo seemed good. He was delighted to see the little girls. But that night, taking trash to the hallway chute, he fell. He was unable to get up on his own. But he was not injured.
His second fall, inside the apartment, was three days later. The paramedics came. Again, he seemed okay. They recommended a trip to the emergency room, which the family declined. There was no point in subjecting Grapo to an ER visit. Cece had to sign that our decision was contrary to medical advice.
Tuesday, Dec. 9, 2014, the third fall
The third fall came six days later. Getting out of bed at dinnertime — after sleeping much of the day — Grapo lost his balance. He stumbled into Cece, pushing her into a wooden dresser, leaving her bruised and bleeding. They went together to the ER. He was admitted to the hospital. Cece was stitched up and sent home.
Tests showed him to be badly dehydrated, so he was hooked up to an IV line for rehydration. His roommate told Ben, a visiting grandson, that Grapo kept trying to pull the IV line out in his sleep. To stop this, hospital staff put his hands in mittens and tied them down.
Thursday, Dec. 11, 2014, a physician reaches out
A staff physician at the hospital scheduled a conference call with us. Grapo’s dehydration had probably caused the recent falls. And Grapo’s heart was barely pumping any blood. The doc advised us to ask Calvary to reevaluate him. He told us how to reach him if we had questions. We expressed appreciation for his concern about the welfare of a dying patient.
Friday, Dec. 12, 2014, hospital discharge
Late Friday afternoon, my brother Peter drove Grapo home. After three days in the hospital, Grapo could barely walk. With Pete and the doorman supporting him, he slowly navigated the journey from car to lobby to elevator to apartment to bedroom. He was helped out of his clothes and went right to sleep.
Saturday, Dec. 13, 2014, day of decision
My son Eli and I flew to New York, arriving at the apartment mid-afternoon. Still bandaged, Cece was stretched out on the living room sofa. Her daughter Lenore said the Calvary nurse had visited and agreed that Grapo was eligible again for hospice services, this time at a higher level. She ordered delivery of a hospital bed, oxygen and hospice “comfort pack” with morphine.
Cece had been a devoted 24/7 caregiver during Grapo’s decline. But she had been clear she was not a nurse and couldn’t handle end-of-life care. Asked if it was time to move him to an in-patient facility, Cece said yes.
Eli and I checked on Grapo. He’d been in bed since arriving home almost 24 hours earlier. His arm was black and blue from tussles with the IV. Asked how he was feeling, he mouthed the words, “I’m exhausted.” I told him he was going to move to a hospital where he could rest. He nodded.
I called the Calvary social worker. Yes, an in-patient bed at Calvary Hospital was available now. No, they could not give us 30 minutes to decide whether to take it. We had 5 to 10 minutes max. After that, the bed would go to the next caller. Another bed would not be available until Monday at the earliest. Were we prepared to have him die in the apartment over the weekend? As I listened, Eli stood in front of me motioning and mouthing the words “Don’t say no, Mom!”
After quick calls with my sister and brother, we accepted the bed. We were told not to get Grapo dressed. Calvary would send an ambulance and the EMTs would take care of everything. Cece, Eli and I sat with Grapo while we waited.
The ambulance with two EMTs arrived within the hour. The gurney, too wide to maneuver through the apartment hallways, stayed in the living room. A freezing metal “scoop” was brought up from the ambulance to move Grapo from bed to gurney. Grapo was wearing a T-shirt, boxers and socks. We asked if they were going to get him dressed so he would stay warm. No. He would be on the cold scoop for “just a minute.” And they’d cover him with a sheet before going outside. We called a halt. We ran around gathering bedding to cover the scoop and Grapo.
The gurney was wheeled outside into the mid-December air. Grapo kept muttering “I’m freezing” as the EMTs struggled to adjust the height of the gurney to the ambulance door. Up and down, up and down.
The ambulance drove around in circles. Fifteen minutes later we were still two blocks from the apartment. I was in the ambulance when my cell phone rang. Eli, following in a rental car, asked if the EMTs wanted directions. The driver declined and turned on the GPS system. Meanwhile, the dispatcher kept calling to see what was taking so long. The driver said they were taking it slow because the patient was sensitive to bumps. True. Grapo muttered “Jesus Christ” at every pothole and stoplight.
We arrived at Calvary Hospital and Grapo was wheeled to his room. A Jewish chaplain showed up to introduce himself as soon as he saw a Jewish patient had been admitted.
Sunday, Dec. 14, Calvary day one
The first full day at Calvary was almost joyful. Family visited in a steady stream. Grapo spoke a few words and looked happy. My sister Ellen brought him his favorite ice cream — chocolate and vanilla — the only food he’d eaten with pleasure since summer. He smiled at the sweetness on his tongue. But he could not swallow, and the nurse said it was time to stop feeding him. They would hydrate him to keep him comfortable.
Monday, Dec. 15, Calvary day two
When my sister and I returned to Calvary the next morning, the smiles and words of the previous day, the recognition of family, were gone. Grapo’s eyes were open and he was breathing. That was all. A staff physician said my sister and I should sleep on cots in Grapo’s room Monday night if we wanted to be there when he passed away. We did. But he didn’t.
Tuesday, Dec. 16, Calvary day three
Grapo continued to lie motionless. Calvary staff continued to visit. So did three Jewish chaplains, all Orthodox rabbis. They provided information and humor to keep our spirits up. I asked why there wasn’t a Jewish hospice in New York. The response: “Calvary is the Jewish hospice.”
One doctor, from the Soviet Union, showed interest in Grapo’s life. We described his career in the New York City school system, rising from English teacher to elementary principal to junior high principal to high school principal to superintendent of all 25 high schools in Queens. The doctor responded, “Oh, he was a great man.” We agreed.
Wednesday, Dec. 17, Calvary day four
Grandson Danny, an emergency medicine physician, arrived from Washington, D.C. Checking reflexes on Grapo’s eye and foot, Danny told us Grapo’s brain had died, probably due to a stroke Sunday night. His heart was still beating. But the person we loved was gone.
A staff physician listened to Danny’s report. When Danny said Grapo was brain dead, the staff doctor said his brain was “not functioning.” Asked if “not functioning” was the same as “brain dead,” he reluctantly agreed. But Grapo was still breathing, so in some sense was still alive.
We asked if morphine could be added to the IV line to give Grapo a peaceful end. No. Morphine was for patients demonstrating discomfort or pain. A social worker asserted, “We don’t do euthanasia here.”
Talking to a house physician alone, doctor to doctor, Danny said there was no way anyone could know if Grapo was suffering. Brain dead, he couldn’t grimace or groan. Acknowledging the situation was unknowable, the doctor added a low dose of morphine to the IV line.
Thursday, Dec. 18, Calvary day five
No apparent change in Grapo’s condition. The morphine dose was increased, in case Grapo was in pain.
Friday, Dec. 19, end of the vigil
My phone rang at 6 a.m. Grapo’s heart had stopped. The Jewish funeral home had been called. As promised, the Calvary staff had not crossed his arms over his chest — a position the rabbis told us was connected with the sufferings of Jesus. The vigil was over.
(American Jewish World, 1.15.16)