Early Wednesday morning I come in to find my father in the same condition – rapid breathing and heart rate, but now with the 100% mask. A respiratory tech comes to give inhalation treatment. I ask for suctioning but am told that it is only done when the tech hears impaired breathing that can benefit from suctioning. Nomeda comes in and is shocked at what she finds. Soon Ruthie is there too. I spot Dr. Kariya at the nurse’s station and I tell him “my father is in big trouble and no one wants to help him.” “I agree with the first part of your statement,” he replies, “but not with the second.” He gets up and goes straight into my father’s room. As Ruthie watches he asks me to help him turn my father to his side. He explains that he wants the fluid in the lungs to drain in that direction. He listens to my father’s chest very carefully. I tell him how well my father was doing before it all suddenly collapsed. “You are wondering why he is suddenly doing so poorly,” he observes. “I was wondering all this time why he was doing so well.”

Dr. Kariya begins to suction my father. I am across the bed watching. As the secretions come up he mutters to himself “I can’t believe he’s still infected after all that antibiotic.” I tell him that as my father was pulling off his mask last night he pushed me away screaming “go away.” Those were his last words to me. Dr. Kariya asks “Do you think that he may have been angry at you for trying to keep him alive?” I shake my head in disbelief at the disconnect between the reality of what happened (the new mask was simply annoying my father) and what this man was thinking. He makes a point to explain the rationale for having my father turned on his side to Ruthie and then walks out of the room with me. At the nurse’s station he asks if I have funeral arrangements in place. He says he didn’t want to ask me this in front of my father. I tell him I do but that I’m not hoping for a funeral. I ask about the liver enzyme numbers and he tells me they are coming back down to normal.

[Rabbi Koss came in and spoke with me briefly while Dr. Kariya was suctioning my father.]

My father’s heart and respiratory rates continue to clime throughout the day (HR 110-120, RR 38-44) but his pulse 02 levels are in the mid 90s. Finally after a few hours I figure it out; indeed his O2 sat rate is high but he’s paying a terrible price for it. He needs to be intubated and they’re not doing it!

Just then Dr. Shamim walks in and appears as surprised as Nomeda was to see the condition my father is in. He asks me what happened and I fill him in. I point to the monitor and ask him “how much longer can a heart beat like that? I think my father needs to be intubated.” Dr. Shamim replies, “I think you’re right. If his heart keeps beating this fast it’s going to ‘get tired.’ He should be intubated. I’m going to call a pulmonologist.” (A sick feeling comes over me as I realize this probably should have been done a long time ago – but help is finally at hand.)

He comes back a moment later with Dr. Weiner. “Why do you want to intubate him?” Dr. Weiner asks. “I thought you said you were just gonna do this once.” I tell him he has to help my father. “He was getting better and I did this to him,” I said. He asks what I’m talking about and I explain that I very likely caused my father to aspirate by giving him lollipops to suck on. “It would have happened anyway,” he replied, “if not today then next week.” He orders a blood gas test. The lady who draws the blood is wearing a scarf or head covering. As she leaves Dr. Weiner waves his hand toward my father and remarks “I would never do this to my parent.”

I told him how important Jewish Halacha is to my father; the esteem in which he holds Rabbi Anemer and Rabbi Anemer holds him. I told him that the Rabbi is reluctant to even enter an ICU because he is a Kohen, yet he came to see my father. “I thought a Mikva takes care of that sort of thing,” Dr. Weiner replied.

He asks me, “Hasn’t everything I said come true? Remember when I told you on again- off again, on again-off again? Remember when I asked you how many 105-year-olds you know, how many 100-yearolds you know?” I interrupt him to point out that he predicted my father would be on and off a respirator every 3 days; he was extubated 9 days ago, and… “Makes no difference,” Dr. Weiner replies. “I’m sure you realize now it’s not possible that Dr. Nawaz could have told you he’ll let him go home the next day.”

He is standing on the side of the bed near the window. I am across from him and Dr. Shamim is at my father’s feet. I say to Dr. Weiner “my father looked so good yesterday. He was awake and talking – tell him, Dr. Shamim.” Dr. Shamim is silent as Dr. Weiner rips into me: “Let’s make sure we understand this. Your father looked good? You look ‘okay.’ I’m 53 years old. I look ‘okay.’ Your father doesn’t look ‘okay’ and he certainly never looked good.” I reply that 2 weeks ago he was walking outside in circles around our apartment complex. “I did this to him by giving him too much liquid yesterday.” Dr. Weiner walks around the bed to my side and says: “If you take one thing away from this it should be that you did nothing to hurt your father. He was dead the day he got here.”

The lady comes back in with the blood gas results. The numbers are handwritten on an envelope or piece of paper that she holds up to him. Dr. Weiner tells her “We’re not going to intubate.” I say to him “Doctor, if there is even the slightest chance of survival we have to give my father that chance.” He replies, “Don’t you hear what I’m telling you? Zero. His chances are zero. His life as you knew it is over. His condition makes him incapable of life off of a machine. Zero.”

He walks back toward the window. I tell him “I want him intubated.” He responds, “Mr. Neustadter, intubation is a very dangerous procedure. We don’t just intubate anytime someone asks; something can go wrong.” (Even as I sense condescension in the tone of his voice and his choice of words I still accept what he says medically, having never met a doctor who would purposely mislead a patient.) He turns to Dr. Shamim and says something I couldn’t quite make out, and ends with “in any case he’ll be dead within the next 3 days.” As the two doctors walk out of the room together Dr. Weiner stops for a moment near the door, turns back to me and asks “How can you say he was walking around the building? He could barely move.”

I stay with my father and pray. I don’t really understand. Did my father get too sick too quickly to even risk an intubation? What happened? Do the blood gas numbers have to fall below a certain level before an intubation is mandated? Two weeks ago they only intubated when his pulse O2 fell into the mid 80s; now it’s still in the 90s. Was the prognosis as poor from the start as Dr. Weiner just depicted? From my perspective he was certainly getting better over the past few days. I remember Dr. Chanales telling me that Weiner is a very good doctor but with a reputation for being “a little rough around the edges.” All this time were the doctors seeing something that I was unable to see? I don’t know how we got “from there to here” so fast, when things looked so good to me just yesterday – but if they can’t intubate it’s all over, isn’t it?

I went into the hallway and called (or took a call from) Rabbi Anemer. I told him how bad the situation was. I remember relating to him how Dr. Weiner said “I would never do this to my parents” and Rabbi Anemer replied, “Well, we know that. Of course he wouldn’t.” I told Rabbi Anemer that I heard Dr. Weiner say my father would be dead within 3 days no matter what. He said “nu, Baruch Hashem” (thank God he won’t have to suffer too much longer.)

Ruthie came to the hospital toward the evening and stayed for a few hours. At one point my father’s pulse O2 went down to the upper 80’s and I called the nurse into the room. She left and soon came back with 3 or 4 people including lady with the headcovering who had taken the blood gas test earlier. She asked us if we could wait outside while they attended to my father. “We want to try to see what we can do to avoid having to intubate,” she said. I waited in the hallway with Ruthie. While waiting I called Anita and updated her on what was happening and how they were repositioning my father. (She recalls my telling her that I couldn’t find anyone who was willing to intubate but that I was still hopeful I’d get someone to do it.) She gave me encouragement but asked no specific questions. “Hang in there,” she advised, “Just go with the flow. They know what they’re doing, let them do their job.”

The people leave my father’s room and the lady comes over to me and Ruthie and informs us that his oxygen level is now back to around 96. “We have him positioned just the way we want him,” she says. “Be careful not to move him or change the position of the bed.” This reinforces my view that they are trying everything to avoid a much-too-risky intubation. In other words, they are treating my father as best they can. I also began to understand that it looks terminal. They’re just waiting for something to happen because there is nothing else they can do.

Ruthie leaves and I stay with my father. Sometime after 10:00 pm two technicians come in to do an EKG. I lower the bed to the flat position and my father’s heart rate on the monitor goes down to the upper 40’s and 50’s. He starts shaking. I run to the bed and raise it again. He stabilizes. The techs are angry. They tell me they can’t take an EKG this way. I tell them yes, but look what happened to his heart rate; look how he was shaking. One tech says to the other. “I will tell the nurse that the family is interfering with the test.” Turns to me and says, “Sir, we just want to do the test real quickly. It is normal for a 91 year old to shake.” They straightened the bed out again with the same result but they did the test quickly and put the bed up again.

I never felt more alone in my life. It was around 11:00 pm and I asked to speak with a resident. An Asian lady came to see me. I asked her if it was “safe” for me to go home or might something happen. She looked at my father, asked how long he had been this way and told me that nothing was likely to happen but if anything did she would call me at once.