Caregiving with Gratitude
My father-in-law, Gayle, recently passed away at age 89. This is my caregiving story. As a physician, we often face the added self-inflicted responsibility to “fix” or “treat” or “manage” the medical conditions our loved ones will face. Each of us comes from a unique point of view – here is my daughter-wife-sister-physician story.
Gayle was a lifelong caregiver, serving as a Baptist missionary in Trinidad and Tobago and as a pastor of multiple churches throughout Texas and New Mexico. He preached the gospel and truly was a humble servant.
Our caregiving story started three years ago when my mother and father-in-law were living in their long-time home in El Paso. At first, we saw changes in Gayle’s short-term memory like difficulty remembering the order of the hymns during the service or repeating verses. His wife, Carol, and other members of the congregation stepped in and supported my father-in-law. One day, he went out to get a card for Carol, but no one knew where he was. We were not sure if he had gotten lost, but somehow, he managed to get back home. Then, they had a flat tire, and neither were sure what to do, so they made it to their bank where, thankfully, a good Samaritan helped them.
I flew to El Paso for an urgent visit and encouraged them to move to Dallas into the retirement community where I served as medical director. To my delight, my mother-in-law agreed to come for a visit. She picked out a lovely apartment with a patio, and we planned for a move several months later. This was January 2020. In April 2020, they moved from El Paso to Dallas during the most intense time of the pandemic. Our retirement community was on lockdown. We barely had masks for medical personnel. Our community leaders instructed all residents to stay in their apartments, and we delivered meals every three days. It was a period of total isolation and fear. Fortunately, as a physician with a N-95, I was able to visit them.
With the combination of a move across the state and social isolation, Gayle’s cognition declined further. Both my mother and father-in-law were depressed and deconditioned. Gayle suffered from congestive heart failure and bradycardia which resulted in multiple emergency department visits for near syncope and chest pain. He consistently voiced his desire for no hospitalizations and no aggressive medical interventions. Shared decision-making with Gayle and his son and medical power of attorney resulted in decision not to pursue pacemaker placement and to opt for hospice care. Carol provided day to day care, and the on-site medical center provided medical care to Gayle. Over the course of the next two years, Gayle’s health continued to decline, but with periods of intermittent stabilization during which he enjoyed time with his children, grandchildren, and friends, both new and old. He studied the Bible daily and continued to say the perfect prayers for each of us. He was on and off hospice several times.
In May 2023, he had abdominal pain and black tarry stools and the medical team triaged Gayle to the emergency department. The emergency physicians did not find a cause for the bleeding, and he again refused hospitalization or outpatient workup for gastrointestinal bleeding. He opted to rejoin hospice. Although his bleeding stopped without intervention, his congestive heart failure worsened.
The next few weeks were a whirlwind of activity, with help from friends, healthcare providers, and family. Gayle’s condition began to change rapidly the Friday before Memorial Day. Carol wanted Gayle to be able to stay in their home. We urgently arranged for 24-hour in-home care with the help of the community social worker. Hospice provided a same -day hospital bed and aids to assist with bathing. The hospice nurse came to explain the large box of comfort medications. Two of Gayle’s sons and grandsons came to assist with his care. My husband and I flew in from Los Angeles and his daughter arrived from Atlanta. He was rapidly requiring more care and had become completely bedbound in a matter of days. Close friends and ministers surrounded him with love, prayers, and music, as he applauded for his favorite hymns.
As his shortness of breath increased, we began administering morphine around-the-clock. Carol and his daughter Anissa learned how to give him medications, and we took shifts to insure a loved one was always by his side. Shortly after midnight on June 2, Anissa called to let me know his breathing was changing. My husband David and I sped back to his beside. Just as we arrived, Gayle took two last breaths with Carol, Anissa, David, and me at his side, and then his breathing stopped. The hospice RN, and community security team EMT, immediately came to assist as we awaited staff from the funeral home to arrive.
Although I have been providing end-of-life care for over twenty years as a geriatrician, I have never had the honor of having my loved one die at home, peacefully and surrounded by family just as we all hoped and prayed. I am filled with gratitude for all the kind souls – medical providers, caregivers, family, and friends – who gave us the opportunity to honor my father-in-law’s wishes. As a physician-daughter, being a part of an incredible team like this inspires me even more to provide caregivers with tools they need to honor their loved ones and care for themselves at every step of their caregiving journey.
With Gratitude,
Dr. Mary
