All Choked Up

It's common for the elderly to have problems with swallowing.  As the body starts to decline, it's just one of the basic functions that starts to fail.  They are at high risk for aspiration, which is when food, saliva or anything else enters the trachea and lungs, often leading to infection and pneumonia.  It's especially common in people with dementia, because the body essentially forgets how to swallow properly.  The larynx no longer closes, which is key to preventing aspiration.  Oddly, thin liquids like juice and water are especially problematic, because the muscles don't identify them as substances so they sneak past and can cause choking. 

Dad starting having problems with this about a year ago, and ever since he has been on either "nectar thick" or "honey thick"- a thickening agent is literally added to his beverages so he remembers to swallow it.  In the past few months, he has started coughing more and more when he eats and Julie, his Hospice nurse, has noticed more buildup in his lungs.  Three weeks ago we downgraded him to a "mechanical soft" diet, which basically includes foods he doesn't have to chew very thoroughly but leaves room for some texture, such as Sloppy Joe meat and scrambled eggs.  Eating has always been a source of pleasure for him, so I was reluctant to even take that step, but it seemed necessary. 


Pureed lasagna...yum

 I talk with Julie several times a week so when she called this morning I figured it was just with a medication update or something like that.  Instead, she said, "We have to put Henry on a pureed diet."  Then she paused before adding, "He choked this morning during breakfast.  Carrie, he turned blue.   His lips were purple.  It could have been...really serious.  He was visibly scared, actually panicking."  After I caught my breath, she told me that she was feeding him and he started coughing, then stopped coughing and stopped breathing.  Fortunately, one of the hefty med students was nearby and was able to lift Dad out of his wheelchair and dislodge whatever was stuck.  Had that not happened in time, well...I shudder to think...Dad choked on a piece of candy while lying in bed when he was a teenager, and I think it's the only thing he's ever been afraid of.  He's always said it would be the worst way to go, and yet it almost happened to him this morning. 

I had been doing okay.  I had gone several weeks without a breakdown, and can't remember the last time I cried.  It's been a year and a half since Dad was first admitted to Hospice, and it sounds strange but I'm actually sort of kind of getting used to it.  That in no way means that I've stopped my care and concern, or take it for granted that he will be there the next time I visit- I make sure that every time I leave the last thing I say is "I love you" and I am somewhat comforted knowing I will have no regrets, should something happen to him while I am not there.  But still.  The call this morning set me off in panic mode again, and after I hung up with Julie I sat down on the floor and cried.  And the memory of the taste of salt and tears on my face gave me flashbacks to some of the things we've been through, and I cried some more.  The release left me exhausted and nauseous, but it obviously needed to come out.  All day I've pictured his blue face and even now, eight hours later, I can't stop shaking. 

I somehow have it in my head that Dad is going to die this nice, comfortable death that they describe in the Hospice books.  He'll stop eating, become less responsive, his body temperature and blood pressure will go down, and he might even feel like he's in a peaceful place.  Julie will see that death is more imminent, and I'll be able to spend his last two days or so with him, holding his hand and singing.  Even if he does catch pneumonia, which is likely, they can usually predict the actual death within a few days.  But what if it doesn't follow that pretty, linear pattern and something happens while I'm not there?  I've read so much about grieving, talked with so many Hospice workers, commiserated with so many friends going through a similar journey.  But you're never prepared.  I thought I was ready-ish.  But my father almost died this morning without me there.  And I'm not ready.