Mountain Jim

by Kelley Farley, PT, DPT

Wandering

Your father had a stroke. They life-flighted him to Denver. I found him on the floor this morning and couldn’t get him up.

The words lingered in the early spring air of March 2020. My scrubs were on and I was ready to head to the neurologic inpatient rehabilitation unit for my final clinical internship before graduating from physical therapy school in eight weeks.

Two days before I received an email confirming my acceptance into a post-doctorate neurologic physical therapy residency. Two weeks later the world would shut down for COVID.

My father was always a wanderer. He joined the military early in life, served as a travel nurse for 25 years, and in his free time could be found wandering the Rocky Mountains looking for wildlife or enjoying a beer and cigar on top of a 14,000-foot peak. My brother and I share that wanderlust - the desire to see, do, be, and experience.

The wandering led him away from my mom, my brother, and me but closer to himself, a fact I would later struggle to process as part of the complex grief surrounding his severe stroke. Yet, a deep gratitude surfaces as I reflect on our memories of skiing, lake days at the family cabin, and long hikes to the top of mountains, always finishing the adventure with a sweet treat and a solid nap, easy blues playing in the background.

The Event that Changed Everything

I biked to work following the news, unsure if I could focus enough to operate a vehicle.

Misty-eyed, I shakily told my clinical instructor, who urged me to take the day off. That afternoon I was on a plane, barely registering the breaking news of COVID outbreaks all over the televisions in the airport terminal.

Entering the ICU was not new to me. My father is a nurse and my mother is a nurse practitioner, I became familiar with hospitals growing up. My preferred clinical setting throughout physical therapy school was a hospital. Despite the organized chaos, they feel comfortable, predictable, and structured.

But this time was different.

After a hug from his girlfriend and a quick kiss on his cheek, as he lay in the bed with a helmet on, post-emergent craniectomy to relieve the pressure building on his brainstem, the doctor led me to the computer to show me the MRI. I knew enough to notice the entire right side was black as he scrolled through the transverse images of my father’s brain. I don’t remember the doctor’s words, but I do recall his empathetic half-smile and concerned eyes.

That image and the uncertainty surrounding it will forever be seared in my memory.

Returning Home and Journey of Decline

My father survived the surgery and several weeks in the ICU. He then spent three months at an intensive inpatient rehabilitation unit, not unlike the kind I was working in just one state away. By this time COVID was in full swing and visits weren’t allowed. I relied on videos taken by the therapists or nurses, Zoom calls with his medical team, and one in-person visit outside in a courtyard where I stood 50 yards away, desperately trying to have him recognize me.

The intensive rehab worked - he was discharged to his girlfriend’s home with her as his primary caregiver and plans for home health and outpatient therapies. His left side still didn’t function, leaving him wheelchair-bound.

His memory and learning capabilities were severely damaged. He couldn’t find the food on the left side of his plate and frequently bumped into corners in the house. He no longer wanted to play music in the background or go for a drive to see the elk.

A few months in, the invisible yet extensive cognitive damage became apparent as he struggled with severe behavioral and emotional changes. We problem-solved as much as possible, but fate prevailed and he transitioned to a long-term care nursing home within two years.

Becoming a Caregiver

Unable to make decisions for himself, I became his medical power of attorney, conservator, and executor at the age of 28.

I joined a new club called “caregiver” - one I had heard of but never fully understood.

As a healthcare professional, I had so many questions and potential answers, but as a daughter, I was lost. I played both roles to the best of my ability for both myself and my family who would call to check in. It was akin to learning a new dance - one step forward, several to the side, a trip or two here, and a missed step there.

The daily discomfort of always wanting clear answers but never finding them all while trying to live my own life plagued me for months. I stepped away from all social media as I became resentful of other people my age getting to live a life seemingly carefree without this burden, and my husband and my relationship strained under the massive burden of this new role.

Chronically bed-bound, frequent hospitalizations, severe depression with suicidal ideation - the writing in the stars became more and more apparent. Though he did have moments of lucidity and excellent long-term recall that gave us all hope for a more normal future, he was by and large a man who thrived on freedom and fresh air now stuck in a facility unable to adequately communicate his pain and suffering.

In January of this year, I made the hardest decision of my life after much processing and consultation with my family.

My father was transitioned to hospice services and passed peacefully three weeks later on February 18th, nearly three years since the initial stroke. I was fortunate to spend a beautiful long weekend with him, recalling memories, recording videos of his voice, and bringing him apple fritters for every meal.

The Process of Grief

It wasn’t until a few weeks before I decided to transition my father to hospice that I acknowledged the prolonged and complex grief that plagued me for years. Since the day I received the call I knew my mental and emotional landscape had changed, but until his death was imminent I hadn’t allowed myself to process any of it.

The process was exactly that - a process. It still is, if I’m honest. I had three years of acute changes and a lifetime of relationship confusion to unravel, as he wasn’t the most present or communicative father.

I’m writing this nearly five months later and still have waves of suppressed emotions arise unexpectedly and last for undetermined amounts of time. The difference now is that I allow those waves to pass as they may - without judgment or fear that they’ll be around forever.

Grief feels like a constant dark cloud or wet blanket. Leaning into difficult emotions has never been my forte, but as I did I felt the weight of the blanket lifting, the sky opening up for streams of light to poke through again.

My process looked like leaving the city for respite in the country, taking a break from working with patients with neurologic deficits as they reminded me so much of my father’s (and my own) pain, journaling, talking to a therapist, literally sitting with my emotions, and leaning into co-workers and family who understood what I was going through. I also ate a lot of cookies, blasted music in my headphones, took a lot of bubble baths, and cried.

A lot.

Despite all of my efforts, I still worked in healthcare. I still experienced a daily reminder of humans’ financial, familial, environmental, physical, emotional, mental, and spiritual struggles.

When I found myself dreaming of running away from all of the pain and suffering, I leaned even harder into the process, somehow knowing deep down that going through it was better than going around it.

I also transitioned to a position at a small community hospital where part of my role was to provide wound care services. The irony and serendipity of life were not lost on me - tending to the physical wounds of others as I tended to my emotional wounds at home.

In Loving Memory

The transformation of grief into awareness and connectedness is nothing short of other-worldly.

As a kid, my father wasn’t always around; as an adult, my memories with him are even fewer.

But somehow I sense him near me now more than ever. I’m blessed to live near the mountains where wildflowers speckle the landscape and deer roam freely through my backyard, and it’s not lost on me how much he would have loved this environment.

I honor and remember him now by noticing the present moment - a hummingbird at the feeder or the first sip of a good, cold beer.

I’ve chosen to let go of the lack of memories and instead hold on to and recreate the ones I do have - hiking up mountains, dipping my toes in the icy river, and dancing under raindrops. I appreciate and welcome the traits we share - a desire to see the world, gain perspective, and show kindness to all beings.

Kelley Farley is a daughter, wife, sister, dog momma, and physical therapist with experience across the clinical spectrum in various care settings. Professionally, she prides herself on being a dynamic, avid learner who infuses empathy and compassion into her day-to-day interactions with all beings. She provides consulting services and physical therapy subject matter expertise for individuals interested in holistic health/wellness, and for larger companies whose work directly or indirectly affects those suffering neurologic diagnoses and dysfunctions. She is open to and excited about the world, and the growth that occurs by connecting with humans on a real, genuine level to bring deeper understanding for all. In her free time, she enjoys spending time with her two dogs and husband, hiking or trail running, fan-girling the United States Women's National soccer team, baking new treats that go well with coffee, and drinking said coffee while reading or consuming content related to human behavior, personal development, neuroscience, and psychology.

To connect with Kelley, find her on LinkedIn