Yom Kippur

As the sun sets today, Jewish people all over the world will don their robes of pure white.  Even now they make their way to the Mikveh, the solemn bath of Living Waters that purify body and soul, in preparation for the Day of Awe, where we stand fasting before the King of Heaven and Earth to confess our sins and beg for forgiveness.  On this day our sins are forgiven, we are released from all vows, the slate is wiped clean for another year.

We wear white, because we are buried in white robes.  In fact, the men wear a kittle, a lightweight embroidered garment, in which they are married, and in which they will be buried.

We fast, and we wear white, because on this day we are like the Angels, who neither eat nor drink.  We wear our burial garments because on this day we are judged, as we will be on our deathbeds.

We fast for 26 hours, both from food and from water.  It’s a hard fast, especially in the Land of Israel where the air is hot and dry.  To add to this hardship, we stand for much of the day-long service.  Some people take on a personal service to stand during the entire service.

It is a day of examining the heart, a day of much weeping, a day of release from the burden of sin.

This Yom Kippur marks the first anniversary of Dad’s departure from this world.  His death.

I don’t know where Dad went when he died.  He didn’t know where he was going.  All he knew was that he was on his way out, and he was terrified.

He was sure he was going to be punished.  For what, he didn’t say.  He couldn’t say.  All he could do was shudder.  He was that terrified.

I have some ideas.

I know that he felt overwhelming guilt for things he had done in the war.  World War II.  He was sure he would have to pay for those things, one way or another, and the not-knowing gave rise to all kinds of imaginings.  He was a man who lived by imagination, by visions, by images, in the shadow-world.  It was the magic of his art, and the plague that visited his dreams.

I knew he would choose this day.  It was the deepest, darkest, most awe filled day.

Why not?  Dad never brooked folly.  If he was to die, it would be on the heaviest day of our year.

As evening approached, he gripped my hand for hours.  My hand screamed with arthritic pain, mine and his.

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Darkness fell.  His lips were dry and cracked.  I took some of the Hospice lemon flavored gel out of the cooler and brought the spoon to his lips.

He clamped his mouth shut, with the slightest shake of his head, “no.”

“Your food is spiritual now,” I suggested, knowing that this, his last Yom Kippur, would be his first and last fast.

He nodded.  It was nearly the last movement of the symphony that was his life.

He slipped into a peaceful dream, and I lay down on the vacant bed in the room reserved for dying people.

I must have drifted off, for near midnight an agonized cry jerked me awake.  I rushed to his side.  His face was twisted, his body arched.  I wanted to throw myself upon him, but I knew there was no way to save him from his pain, so I sent him wordless messages…I’m here….I’m with you…I won’t leave you…

Then I knew.  One more thing….

“Dad, it’s Yom Kippur.  Your sins are white as snow.  You are forgiven.  You can go.”

His breathing changed from the near-death Cheyne-Stokes pattern: a period of no breathing followed by several deep breaths, to the imminent-death pattern of rapid air-hunger breathing.  I called the Hospice nurse.  She gave morphine.  I called my mother, and in my doctor calm voice asked her if she wanted to be there.  At first she said no, then thought better of it and said yes.

Soon after she arrived, Dad had grabbed my hand again and I stood there, watching him struggle with the Angel of Death.  At last he knit his brow, and with a determined effort, made the leap.

Oh, how many times have I seen that look, when steeling himself for some odious task!  Dispatching a dying animal, gripping his usual weapon, the shovel…

And now, gripping his own soul, as he let go and tumbled out of his body, into….what?

His grip on my hand disappeared.  I looked at his hand, so tight just a moment ago, now flaccid and white.  His fingers, now blue sausages.

“Lower the bed.  All the way to the floor.”  The Hospice nurse and my mother obeyed.  I got my Siddur, the Hebrew prayer book, while I cried out,

“Shemah, YIsrael, Adonai Eloheinu, Adonai Ehad…” 

Hear, O Israel, Adonai is Our God, Adonai is One….

Kaddish….

Yitgadal ve’yitkadash Sh’mei Rabbah…

May The Great Name be glorified and sanctified…

As the Deathbed Prayers stretched on, and my mother’s weeping grew louder, the Hospice nurse grew impatient and she called the mortician, who arrived with his impatient gurney.

“The mortician is waiting,” announced the nurse, just as I finished the Deathbed Prayers and was beginning to wash the body that used to belong to my dad.

I should have said FUCK OFF, this is my dad’s body, this is our religious tradition, this is Yom Kippur!

But I didn’t.

I watched them load him up, like a piece of meat.  They were casually chatting.  His dead face hung out; I pulled the sheet up to cover it.  My mother screamed.

His precious blue arm, the one that used to give me jovial hugs, had got caught between the gurney and the strap that held him on.  I pointed this out to the mortician and he fixed it, visibly irked.  My mother had declined a casket, since Dad was to be cremated.  Why waste money on a casket, only to burn it up?  No money in this deal for the mortician.

Now we have finished the twelve months of saying Kaddish, to help his soul make the journey into the Next World.  I am pretty sure I don’t believe in any Next World, but since I won’t know until I make that final leap, I leave the subject open.

Yitgadal ve’yitkadash Shmei Rabbah.

Amen.

Sad Days Ahead

Friday, January 18, 2014, 2 pm.  Walmart.  Maneuvering the shopping cart (or “buggy,” as they call it here in Western North Carolina) around the place packed with people gathering supplies for what was supposed to be a blizzard, luckily turned out to be flurries.  I was picking up a few things to top off my Shabbat preparations: mineral water, blue corn chips, orange-and-red striped tulips, and cheesecake.  My phone rang: my mom.  Her cell phone, which was odd at that time of day.  Alarms go off in my head.

Dad has fallen again–the second time this week.  The many-th of this year.  Falls are increasing in frequency, varying in severity, but always accompanied by a decrease in function afterward.  He has a dementia that is not Alzheimer’s.  He’s had many small strokes.  And he’s got a narrowing of his spinal canal that causes him to have to wear diapers because it’s pressing on the nerves that control his body functions.  And to make things even better, his vertebrae–all of them–have been slowly but progressively disintegrating so that he’s bent over in a “C” shape when he walks–if he is able to walk, which is sometimes, with difficulty, with a cane or pushing his wheelchair, which is where he is parked most of the time.

So far he’s managed by sheer force of will to do his shower by himself.  But this time he fell right over on his back, hitting his head for the millionth time on the hard tiled floor, and my mom was not able to get him up; so she did the right thing and called the ambulance.  As of the time she called me they had still not shown up and Dad was still lying prostrate on the floor naked as a jaybird and twice as wet.

It took them a good twenty minutes to arrive.  Good thing there was nothing life-threatening.  And when they finally got there, they came in such hordes that there was nowhere to park both the First Responders van and the Ambulance, which couldn’t even get into the tiny parking spot at the end of the long dirt road where they built their home 40 years ago.  They couldn’t figure out how they were going to backboard him out, given that my parents built their house into the side of a cliff and there is very limited access.  My mother said it was like the Keystone Cops.

After I got her call I put the cheesecake back in the freezer and just left my cart where it was, and drove the ten minutes to the hospital, thinking surely they must have arrived at the ER by then.  But no.  I waited a good half hour.  My mom arrived in her car, and it took the ambulance another fifteen minutes to get around to unloading poor Dad, who was immobilized on a backboard.

CT scan of head and neck were fine, but he had a new compression fracture of L1, the first vertebra below the thoracic (chest part) spine.  And as I gazed at the cardiac monitor, I noticed a very strange rhythm, or dysrhythmia really.  It looked to me (and it has been a very long time since I read EKGs) that he has a partial or intermittent block in the electrical system that runs the heart.  It happened in “runs:”  the pattern would get normal for a minute or so, and then pop back into the abnormal rhythm.  I observed that his level of consciousness varied with the rhythm.  When it was weird, he would get confused and less conscious; when the rhythm was normal, he was more aware and oriented.  That explains a lot, because he’s been “going in and out” a lot lately.  Surely when his rhythm is weird, his heart is not pumping normally and his brain, already battered, is not getting enough blood.

As if that is not enough, he has a urinary tract infection–probably the same one he had about a month ago that was inadequately treated with the wrong antibiotic and no follow-up culture to see if it had cleared.  I was furious then and I’m furious now.

Thankfully, he was admitted to the inpatient service.  The last many times he has fallen and hit his head, they have sent him home, even when he injured himself badly enough to need stitches.  But this time, with the combination of the fall and the dysrhythmia and the kidney infection and the broken back, for heaven’s sake, they kept him.

Today, Saturday, January 18, my mother, the doctor, and I, unanimously made the decision that he will go to a nursing home for “rehabilitation” after his hospital stay.  This is a very sad state of affairs.  In all my years of doctoring, and in all my mother’s years of being a geriatric social worker, neither of us has ever seen an 89 year old person who is sent to a nursing home for “rehab,” be discharged from there to come home, because by that point the person is really not “rehabilitatable.”   If my dad makes it out of that nursing home I will be very surprised and very elated.  But I don’t think he will.

He’s been through at least four six-week courses of twice weekly physical therapy to try to improve his balance and ambulation.  All that’s accomplished is to cause him great pain and distress, but he’s soldiered on with it because he’s not a quitter.  In fact, the main reason for most of his falls is that he’s trying like hell to be independent.

I’m terrified to think of him in a nursing home with a broken back, because I know what they will do: they will leave him lying in the bed, with the excuse that it’s not safe to get him up in a chair, much less walking with assistance, and neglecting to turn him every two hours like they’re supposed to.  I’m terrified that he will develop bed sores.  Maybe I’m just, just, just overthinking….but this is what I’ve seen.  And if he develops a bed sore, he’s gone, because he’s diabetic and his immune system can’t take it.

So I know where I will be spending most of my time, making sure that he’s properly cared for.  It’s a sad time, a time we’ve all seen coming, and now it’s upon us.