Breathe

Jim glanced at his watch. 10:45. Where was that damn doctor? A respiratory therapist named Alisha had come right at 8:00 to administer a spontaneous breathing trial. Alisha had been really great. His dad was getting pretty agitated until she came. She took his hand between hers and explained exactly what would happen in the test. She talked to his dad, not to Jim – and she talked to him like an adult. Jim never would've imagined he'd appreciate something as simple as that, but he sure did now. By the time Alisha was ready to start the test, his father was calm. In fact, he was relaxed as long as she was in the room.

The test went smoothly as she progressively reduced the level of support Ted received from the ventilator. At 8:35 Alisha declared the trial a success and said Ted could now breathe on his own. The next step, she said, was for the anesthesiologist to come in and remove the tube. Ted nodded in vehement agreement when Alisha explained to Jim that breathing through the ventilator tube was like breathing through a straw. She set the vent on low to give Ted a little assistance while he waited for the doctor.

By the time Alisha had finished her explanation, answered Jim's questions, and gathered her things to go, it was nearly nine o'clock. On her way out the door, she'd congratulated Ted again and said the doctor should come by shortly.

And they'd been waiting ever since. The minutes had stretched to an hour, an hour and a half, nearly two. Ted started to become agitated about fifteen minutes after Alisha left. Jim watched his father's mood degenerate from impatience to hot anger and then something that approached sheer panic. He tried to distract him by reading or making small talk but neither tactic worked. Of course they didn't work. How could he even have thought that listening to a funny story or inane chit-chat could possibly make his dad forget that he had a rather large tube jammed into his mouth and down his throat? Or that he was quite literally chained to his bed?

Jim watched his father's slow, feeble maneuvers. He had neither the strength nor the freedom of movement to shift his body more than an inch or so in any direction. He was restrained, his wrists wrapped in thick, quilted bands that were tied to the bedrails. They didn't look uncomfortable – sort of like beer cozies wrapped around his wrists – but his dad fidgeted against them constantly. Jim wished he could remove the restraints but Nelani said they were to protect his father from pulling out the vent tube or his IVs. So, he watched his dad shifting around, blanching with each movement of his head or shoulders, finally sagging back against the pillow in resignation.

"Dad?"

Ted shifted his gaze to Jim's direction.

Pointing his thumb over his shoulder, Jim offered, "I could call the nurses to shift you to a more comfortable position."

Ted listlessly shook his head. No.

Jim picked up Mort from the tray table beside him. He hesitated just a moment. "I could read to you again?"

Ted again shook his head, nearly imperceptibly as he turned his face away from Jim.

Damn. There had to be something he could do. What were some of the things Pam did for his parents? She'd been doing little things all the time. Oh –

"Massage you with some lotion? Your skin looks kinda dry."

Without even turning to look at him, Ted shook his head yet again.

A hint of desperation in his voice, Jim asked, "Is there anything I can do to make you feel better?"

Ted slowly turned to fully face Jim, eyes wide and imploring.

"What can I do for you, Dad? Tell you what – I'll get a pen and paper so you can write it."

Ted narrowed his eyes, his brow furrowed in frustration. His expression clearly said You've got to be kidding me as he impatiently gestured toward the tube in his mouth.

Jesus, he was fucking clueless. Of course there was only one thing his father wanted – and Jim couldn't do it for him.

"I know, Dad. I know. That's gotta be incredibly uncomfortable." Jim stopped short at the irritated expression on his father's face. Holy shit – had he really just used that patronizing sing-song voice like one of the nurses? "Ok. Not helpful. Look, Dad, I know you want that thing out but we have to wait for the doctor."

His father's eyes narrowed as he fixed Jim with a look of utter contempt. It was the exact same look his mother had given him right before she barked, You aren't helping me at all. Just get the hell out!

He was probably thinking what a waste it was to have his younger son with him. Probably wondering how he'd ever ended up with such a worthless jackass for a son. All Jim could think about was his conversation with Jon about a week ago. Jim, you gotta cut this shit out. You can't hang up every time Dad answers the phone. He's right. You are being a jackass … He's right. You are being a jackass … He's right. You are being a jackass…

This sitting here with nothing to do was making him crazy.

"Dad?

"Hey, Dad, I'm gonna just go see your nurse and find out if she can't tell us anything about when the doctor's gonna come, ok?"

Without waiting for a response, Jim jumped up from his seat and rushed to the nursing station. Pam wouldn't want him to have an attitude with the nurses – it wasn't their fault the doctor was two damn hours late – so he took a deep breath as he approached the desk.

"Nelani? Do you have any idea when –"

Suddenly a shrill, piercing alarm rang out. Jim glanced about, startled, as Nelani rushed into his father's room.

"What's wrong?" He followed quickly behind the nurse but stopped, aghast, at the door to his father's room. His dad was coughing, struggling for breath – and there was nothing in his mouth. The ventilator tube dangled from his right hand, looking gruesome and alive. The tube was covered in a mottled, slimy mucus, which also dripped down his father's chin and onto his hospital gown. And it waved about in tiny motions, jiggling with each puff of air. A small balloon was inflated at the end of the tube. Holy God, had his father torn anything in his throat when he ripped that thing out?

Nelani moved quickly, attaching a clear mask and tubing to a valve behind the bed. Jim followed her glance up at the monitor over his father's bed and watched in horror as the O2 number dropped. 89, no 87, 85. By the time Jim tore his eyes away from the screen, Nelani had placed the mask over his father's face and secured the rubber band behind his head. She then disabled the alarm on the ventilator.

"Ted." Nelani spoke in a voice that was somehow warm and strong and authoritative all at once. "Ted, look at me."

His father turned toward Nelani, eyes wide with fear. She took his hand into her own and gently stroked his arm. Now that he looked closely at his dad – holy shit – his face was kind of ashen and fingertips were actually bluish.

"You feel like you can't get any air." It wasn't a question.

Ted nodded in agreement as his chest rose and fell in rapid, tiny bursts.

"I've put an oxygen mask on you Ted. That will help." Lightly brushing his cheek, she continued, "Now we're going to work together, ok? Can you breathe with me, Ted?"

Ted quickly shook his head, no.

"Yes you can, Ted. Watch me and breathe with me."

Nelani began to breathe slowly through her mouth in an exaggerated motion. As she inhaled, her chest expanded and she tilted her head back slightly. With each breath out, her chest collapsed, her shoulders relaxed and her chin dropped. She held Ted's hand firmly as she encouraged him to breathe with her. Jim watched in fascination as the nurse made a little drama of each breath, inhaling slowly and holding for a moment before she exhaled.

Whatever she was doing, it was working; his dad wasn't so panicked and he'd begun to breathe a bit more normally. Thank God. The O2 reading on the monitor stopped falling. Nelani stayed by Ted's side, breathing slowly, all the while maintaining eye contact except for brief moments when her gaze flashed to the monitor. When the O2 number stabilized at 90, Nelani squeezed Ted's hand.

"That's perfect, Ted. Do you think you can keep breathing just like that?"

Ted nodded weakly.

"Good. Your son's here, Ted." Nelani nodded toward the door. "Would you like Jim to sit with you?"

Jim felt his breath catch and his heart pound as he awaited his father's response. Don't say no. Please don't say no.

Ted looked directly into Jim's eye for a long moment, as if considering his options.

Oh shit, Dad, just don't say no.

Ted nodded emphatically, yes, as he shakily lifted his free hand in Jim's direction. His hand dropped limp onto his lap.

Nelani nodded her head. "Good. Jim, can you breathe with your dad for a minute? I'm going to get the doctor."

"Sure, Nelani."

As the nurse rushed past him in the doorway, he whispered, "How did he do this? How could he get that tube out with those restraints?"

Nelani shrugged her shoulders, "They manage sometimes. When they're determined enough, patients can yank the tube." She nodded her head toward Ted. "Keep him as calm as you can. Breathing is a struggle right now."

Jim glanced up at the monitor. The O2 was holding steady at 90. That was better than 85, but didn't Pam say 90 was the bare minimum? That anything lower was really bad? He stepped quickly to his father's bedside, fighting the panic he could feel rising in his throat. Shit. His dad could see it. He had to get a grip so he could help his dad stay calm. Ok, he could do this. He could.

"Dad?

"You with me, Dad?" Oh, thank God. He sounded more in control than he felt. He took his father's hand securely in his own and began to breathe just like Nelani had done a moment before. His dad tried his best to breathe in time with him but Jim could tell something wasn't working right. It was like his dad just couldn't get the air into his lungs.

"-self extubated. No signs of stridor but his O2 sat's under ninety."

Jim squeezed his dad's hand and stepped away from the bed as Nelani strode into the room with – Doogie Howser? Holy hell, this was the doctor? The guy was definitely younger than Jim. No way was he a doctor.

Without saying as much as a word to his father, Doogie inserted the tips of the stethoscope into his ears and leaned close to listen to his heart and lungs. Lifting his shoulder, he slipped the disc under his dad's back and listened again. Straightening up, he said, "Mr. Halpert, we're going to give you something to help open up your lung passageways so it will be easier for you to breathe. It should give you some relief very quickly."

Then, without asking if his dad or he had any questions, Doogie started for the door. He turned to Nelani and said in a clipped voice, "Get an RT up here right away with a nebulized epinephrine treatment. 5 milliliters of 1:10,000 epinephrine through the mask. After that, 5 milligrams of nebulized Ventolin up to three times as needed to keep the airway open. Call me if there is any sign of stridor." And then he was out the door.

Wow. That whole heartless cardiologist thing that Pam had told him about – it started when these guys were residents? That was just – pretty hard to believe.

Nelani nodded. "Got it." She patted his dad's hand and said, "Ted, we'll have a respiratory therapist here in just a few minutes. You really will feel better after a breathing treatment." Then she briskly headed out the door toward the nursing station.

Ted turned toward Jim with a fearful expression. "Don't leave." he whispered hoarsely. "Please."

Jim pulled up a chair to the bedside. "I'm not going anywhere, Dad. I'll stay here as long as you need me."

Nodding in silence, Ted set his left hand, palm up, on his thigh. Jim gently laid his right hand atop and wrapped his fingers loosely about his father's hand. He watched his father's eyes drift closed. Man, he looked so frail. Kind of like Jim's grandfather had looked in the last months before he died.

Jim thought back to the summer before his junior year at Millersville University. The family had decided that his grandmother couldn't take care of his grandfather anymore and they'd placed him in a nursing home. No one liked the idea but they all knew that they'd lose grandma, too, if something wasn't done soon.

They'd set up a visiting schedule for everyone who lived close enough so grandpa would get at least a few visits every week. Jim was on every other Wednesday. As much as he loved his grandfather, he hated going on those visits. The place had this horrible, kind of chemical, antiseptic smell. Unkempt people nodded off in wheelchairs just parked in the hallways. His grandfather was in a room with four beds – so absolutely no privacy.

The dread built up in Jim every time he made the drive to Abington Manor. He had to steel himself as he walked in the door and signed the visitor log. He watched his feet the whole way to grandpa's room, so he wouldn't have to meet the vacant gaze of any of the pathetic patients who lined the walls. Whenever the evening was cool enough, he whisked his grandpa to the shade of the courtyard, just to get them both out of that horrible, grim environment. It killed him that that had become his grandfather's whole world.

Longest summer of Jim's life. Well, one of the two longest summers of his life.

So, is that what they'd have to do with Jim's parents? Put them in a rehab/nursing facility for a few months? No way could either of them care for the other – not in the condition they'd be in when they got out of the hospital. Neither Jim nor Jon could afford take off work for a couple of months to live with and care for them. And he didn't think his parents could afford to have a nurse stay at the house.

Jim set his forearm against the bedrail and groaned as he leaned his forehead against it. Ted's eye's fluttered open and he turned to face Jim.

"I'm sorry, Dad. I didn't mean to wake you."

Ted shook his head. "No. I'm sorry." His voice was so weak Jim could hardly hear him.

"Sorry for what?"

Ted struggled for breath, "For before. I'm sorry for before." With the slightest squeeze of Jim's hand, he closed his eyes and laid back on the pillow, spent. He was asleep before Jim could even respond.

Many apologies for the long delay since the last post. We're doing some house remodeling and life was just a bit overwhelming there for a while.