Take Me Home
In the winter of 1986 I was a 25-year-old hotel credit manager living in Nashville, Tennessee. My father, Charles, was an Episcopal priest then serving as the rector at Trinity Episcopal Church in Gatlinburg, a resort town located in the Smoky Mountains. While our relationship had natural imperfections, he was my hero and closest friend; I adored him. A highly-educated theologian and a skilled preacher, Dad moved through the world with compassion and confidence. He wasn’t loud and boisterous, but when he entered a room people knew it. He was a natural leader with the ability to bear great weight on his shoulders. By the 1980s he was a highly respected senior clergyman among his colleagues in the Diocese of Tennessee and throughout the South. In addition, he had recently begun to establish himself as a literary figure in the secular world. An eccentric character and utterly devoted priest, he was admired by many and resented by some. That was my dad.
He also was known to keep a glass of Heaven Hill bourbon mixed with tap water by his side every evening, and he usually had a Kent cigarette burning. By the time I reached my early teens, it occurred to me that he was probably an alcoholic, but I have no horror stories of a drunk father rampaging through the house or the lives of others. In fact, he was rarely noticeably drunk, at least in my presence. But he did drink every day without exception, and over the years his alcohol intake steadily increased. That, combined with his smoking, his lack of exercise, his high stress job, and his unchecked diet (my mom was an excellent Southern cook) caused him to physically age at a rapid pace.
By the time he turned 56 he was a middle-aged man spreading ancient wisdom from a worn-out body. He set his eyes on an early retirement that would allow him to devote his senior years to writing and teaching. To this end, in the autumn of 1985, his wife Joann—my mother—rented an apartment in Nashville on a reconnaissance mission for employment and real estate. Thus was the situation in February, 1986, when my wife Pati, my one-year-old daughter Christi, my mom, and I made the drive from Nashville to Gatlinburg to visit Dad for a weekend. Upon arriving at Dad’s house, a family friend was waiting for us with news. Earlier that day Dad had suffered a heart attack; he had called 911 from his bed.
When we arrived at the hospital in nearby Sevierville that night, Dad was already situated in a regular hospital room. The next day a series of tests revealed, among other concerns, a mass near his stomach and severe liver dysfunction. The speculation was that the heart attack had actually been precipitated by pressure caused by the failing liver. Surgery was scheduled for later in the week to remove the mass and generally explore the region. There were figures and data provided to verify all this, but his physical appearance was all the evidence I needed. Something was very wrong.
The day after the test results, Dad and I were alone in his hospital room. He was standing in front of the window looking toward a horizon dominated by the magnificent Smokies, his hands on his hips in a familiar pose. I was sitting in a chair by the window. We had been discussing the logistics of his situation, but when he went silent I followed suit. The silence was deep but not uncomfortable. He never shifted his eyes from the view of the mountains. I sat motionless, waiting for words I knew were coming.
After an indeterminable length of time he spoke, still not averting his gaze. “Son … I’m going to ask you a question … I’m only going to ask you once … I will accept your answer and never mention it again.”
I shifted to the edge of my seat, leaning in to make sure I heard every word clearly. “Alright Dad …”
After a brief pause he said it. “Take me home.”
The three words slammed into me. At first all I could do was stammer. If this were a directive, I would have responded without hesitation. But this was a request, not an order. He could have asked his wife of thirty-five years; he could have asked any number of powerful people in the community who would have done anything for him; he could have asked one of many close friends to come and fulfill his simple request. But he was asking me. My mind raced to process the possibilities. Mom would be against it, but she was intensely loyal and if our call was to go home, she would outwardly support it. But what then?
So far there had been speculation but no official diagnosis. I knew it was serious, but I had no reason to see his health issues as being terminal. More accurately, I didn’t want to see them as being terminal. I wanted to do whatever I could to keep my dad with me—but I also wanted to support his wishes. Never in my young life had I been faced with such a dilemma.
Finally, after what felt like an eternity, I began to form words. “Dad … I can’t do that …” He continued to face forward, not once letting our eyes lock. He was listening and feeling for my response. Pragmatism and fear were guiding me. “If I take you home, you might have another heart attack … I don’t even know CPR … I …” Suddenly my words were done. The issue had been decided. I wasn’t able to fully see the question, and he knew it.
“Okay, son. I had to ask … I won’t ask again.” After a slight pause he turned to face me. “I guess they’ll be bringing the grub they call food in soon.” He had accepted the answer and moved on, but the question would haunt me for years.
A couple of days later a benign tumor was removed from Dad’s stomach. That was the good news; in the process the surgeon got an up-close look at the liver. Dad had cirrhosis, and the liver was done. There was now a tube extending from the surgical incision through which the bile that his liver could no longer process dripped into a bag. Two thoughts quietly crossed my mind when I first visited him after the operation: Taking Dad home would now be extremely difficult, and bile looks a lot like bourbon and water.
A week after the surgery, arrangements were made to fly Dad to Park View Hospital in Nashville where his friend Dr. Morse Kochtitzky was a chief administrator. He spent the next two weeks in a private room with quality care. Many of his closest friends were able to visit and say goodbye. There was talk of his possibly being able to receive home health care, but to what end I do not recall. The topic never developed beyond hope.
One afternoon Dr. Kochtitzky called us into a meeting room. In a compassionate but matter-of-fact manner, he said Dad was not going to leave the hospital alive. Within a day of that meeting, Dad began slipping into a coma. I remember one afternoon he was trying to tell me something. As best as I could make out, he was saying, “I’m sick son.” At first I thought he meant he was about to vomit, and I began looking for a receptacle. Frustrated, he shook his head and said again, more clearly, “I’m sick son.” He was simply telling me that he was dying. I leaned back against the window and looked into his eyes for a long, long time. His eyes showed fear and concern—for me. He knew I was losing my dad.
He spent his final two days comatose, breathing on his own but hooked to an oxygen machine. At one point a nurse started to enter the room while my brother Hal and I were standing by the door talking to Dad’s friend Arch. We politely asked what she was doing. She said she was going to give him an enema full of nutrients. No, you’re not, we said. We knew that, at best, such an action would only prolong the suffering. She started to get flustered and tried to say that it was not up to us. Hal and I were instantly unified and standing between her and Dad, but before we could say anything else, Arch spoke up. “Leave my buddy alone.” His voice was cracking with emotion, but he left no room for debate. The nurse exited.
Soon she was strolling down the hall toward us with Dr. Kochtitzky in tow. He was a massive man and carried himself with both authority and dignity. The three of us were prepared to stand our ground on this issue, just as we each knew Dad would do for us if the situation were reversed. Dr. Kochtitzky walked up and put his huge hand on my shoulder. “We’ve stopped the nutrients. She’s just going to check him for comfort.”
For twenty-four more hours Dad was curled in the fetal position, motionless. Then he quietly died.
Since that day in 1986 I have had many opportunities to observe, and sometimes directly participate in, end-of-life situations. Each circumstance is unique unto itself, so there is no way to prepare a useable guidebook. The best we can do is share our experience and awareness in hope that when others find themselves facing such a moment they might be able to retain something useful.
Over time I have developed an awareness about life and death: they are a singular event for which love is the essence. All life is impermanent in its fabric, and the time in one’s vessel is best measured by quality over quantity. As Dad himself once wrote, "Whether with things, situations, animals or people our relationships are passing things—brief. Some are much briefer than others. The value, however, is not measurable in terms of duration, but in terms of depth. We are twice blessed when we are given both duration and depth—but we can insist on neither."
Recently I came across a medical report from February 3, 1986—two weeks before the heart attack that landed him in the hospital—buried among my father’s files and papers. The report provided details about an examination and various tests, and it included a recommendation “that the patient be hospitalized as soon as possible (today if possible) for diagnostic work up to determine the etiology of the jaundice, anemia and hematuria.” Dad declined, stating his work with the church prevented immediate hospitalization. No word of this examination was mentioned to my mother or to anyone in the family.
Apart from an occasional flinch, I am able to look back on the afternoon when my dad asked me to take him home and feel confident that I made the best decision available. For whatever reasons, he never fully disclosed what he knew about his condition, and no terminal prognosis had yet been rendered. At 25 my intuition and sensory awareness were underdeveloped, and I had no experience with the concepts of home healthcare or hospice. My goal was to get my dad well so that he could continue being my dad forever. Intellectually I knew this was not possible, but I was determined to try. Fight it. Don’t give in to the illness.
Over the years my perceptions have been sharpened by blunt experience. In addition to the loss of family and friends along the way—a consequence of achieving middle age—I was the caregiver during my mother’s slow, six-year decline into vascular dementia and the various terminal illnesses that preceded her death at an assisted living facility in 2012. In the midst of that scenario I also took care of my fiance Janice during her sudden and rapid decline from glioblastoma multiforme, a stage IV cancer within the brain that was discovered exactly one month after our engagement. I stayed by her side for two months of hospitalization before bringing her home as my wife. We spent three weeks beautifully experiencing life together before her journey took her away from me in 2011. In both of these situations hospice played a vital and loving role, and in each I experienced the realities of the modern medical industry at an intensely personal level.
In this light, I would react differently to Dad’s request if it were presented today. I would gather my resources for hospice home care. Ideally the surgery would be skipped, thus allowing him to live out his days without a non-healing wound in his side and a tube connected to his liver, but if it took the findings of the surgery to fully understand the terminal nature of his condition, so be it. Either way, I would take him home. He would have been able to rest in comfortable surroundings, sip his bourbon, smoke his Kents, eat fried eggs and bacon for breakfast—whatever he felt like doing. There is a good chance that he would have still been able to say goodbye to all of the people who found their way to the hospital in Nashville. And whether the circumstances hastened his death or delayed it, he would have left the confines of his ravaged body surrounded by the loving energy of home.
Phrases such as “right to die” and “death with dignity” have increasingly become national topics of discussion, and they will continue to gain momentum as medical science discovers new ways for keeping the human body technically alive. This is a tricky and complex subject, particularly with regard to who gets to decide—and when. But what often gets overlooked in the discussion is that dying is a fact of life, and we all make decisions every day that contribute to the time, place, and cause of our death. The key, from my experience and subsequent awareness, is to not only accept the inevitability of death but to embrace death as being profoundly natural. With this perception the end of life can potentially be as beautiful and celebratory as the beginning of life. This is in no way meant to suggest that death will ever be easy or painless for those left to deal with the loss. Far from it. Grief and fear, which are our two biggest obstacles to the acceptance of death, are powerful and real. And so is love, and that’s the ultimate point.
I respect and listen to medical professionals, but I no longer assume they have the final word. Doctors are professional consultants and skilled technicians—not ultimate authorities. In those moments when we are confronted with decisions regarding end-of-life choices for a loved one, the essence of the question is, “what is the most loving act?” And the question concerns the person facing the transition. Forcing someone to endure the torture of endless medical treatment because we cannot summon the insight and courage to say goodbye is a quest of self-preservation rather than an act of compassion. To be sure, there are times when the answer is more obvious than others, and such moments are never easily navigated. There are no pre-existing mathematical formulas; we simply have to let love take the lead.
In my present view, my dad’s “take me home” request is an expression of true acceptance. His choosing to be home reflects the desire to move beyond this physical plane surrounded by love rather than the machinery and round-the-clock prods of the medical world. But home is transportable. If necessary, home can even be fostered within the confines of a hospital room. All that is required is the awareness of love. Hold the love close and the love will take you home.
Phil Rice is a native Tennessean currently living in Woodstock, Illinois. His writing has appeared most recently in PBS's Next Avenue, The Raven's Perch, and Sport Literate. An editor for Canopic Publishing and The Ross House House Press, Phil is the author of Winter Sun: A Memoir of Love and Hospice.