A Quiet Friday

It's quiet right now in the apartment.

Ardis the hospice day nurse sits at the dining room table, Buddha-like, where he can keep an eye on Mom. Mary is working on her latop. Ever the journalist, I think she's drafting an obituary. Adrian is sitting in Mom's spot on the sofa, in the captain's chair, working on his laptop. I am without laptop, so I'm using Dad's PC, just back from the computer emergency room with a new motherboard.

Dad just walked down to the apartment office and walked in with a beautiful bouquet of flowers from June Bishop, an old friend (going back to grade school) of Mom and Dad's sister Marybelle. Helen and Will walked in at the same time as Dad. Susan just called, she's out of school for the day and so she's headed over. Travis called before that and he's going to be on the road up from San Antonio either late tonight or first thing in the morning.

It's quiet now, but it's going to get noisier.

I doubt it will get as noisy as it did last weekeend when EVERYBODY was here, laughing, telling stories and drinking champagne. It put a smile on Mom's face to hear the music of her family. Her grandchildren were thrilled to see one another and their energy was contagious and continuous.

Her response has lessened during the week. She did not turn her head to me when I visited on Tuesday. Today is the first day Ardis has officially confirmed that she is non-responsive. But her heart keeps beating. She continues to breathe.

It's hard to imagine that her body can continue, that she can get any weaker, but she does. Living proof of Zeno's paradox of Achilles and the tortoise.

But ultimately the paradox will be proved wrong.

It's just a small matter of time.



Arrival and beyond...

Mother liked her night nurse very much; she left this morning when the new day nurse, Ardis, came, but she will probably be back when Glen and I leave.

The swelling in Mother's face has subsided, and her lips are a not as puffed up, though they are still red and she's had a little bleeding today.

Sharah came today. And so did Isabel. So Mother and the house are clean.

Mom had a little anxiety attack this morning, so Ardis gave her some lorazopam to calm her.  She is also taking dilaudid instead of morphine; Ardis calls it the "Mercedes" of painkillers. Well, of course.

But Mother has been extremely lethargic today. She rallied a bit this morning to talk to Betsy on the phone, but most of the day she has been sleeping. Really sleeping, not just dozing. We had to wake her up to take her shower and wash her hair. Then she was awake long enough for me to read her some of her fan mail, but not all of it.

She is weaker, Daddy says, but the main change he sees is how sleepy Mother is. And, he says, "I don't like it."

Ardis says she will probably continue to sleep more and more until she slips into unconsciousness.  He, of course, has seen this before. She hasn't eaten or drunk anything all day.

It does not seem like a good sign. Maybe we should toast on Friday night.

Now for a Great Weekend

It's been a roller coaster of a week.

Sunday ended with us planning up a storm for this coming weekend and the arrival of the rest of the family. Two main issues: was Mom going to make it? and how to break the news to Mom about her impending visitors. (She doesn't always take well to surprises unless she's in on the surprise. No surprise!)

Susan called her cousin Debbie who has had a long career in social work most recently in hospice. Debbie can talk about such things, she lost her own father last year. End of life does not always come quickly. As long as the patient is drinking water, urinating, is talking and has reasonably good blood pressure and oxygenation, life can go on for quite a while. Susan's concern was that Polly stay around to visit Mary the following weekend. She called Mary with a report that things seemed marginally stable.

Then I called the apartment to talk to Dad. Of course Mom answered as well, but she was not conversant, a radical change from the previous day. I was left with quite a dismal impression. Michael Malouf visited the same day and did not have an alarming impression as you can read in his comment to the Sunday blog post.

Susan's sister Meg visited Mom Tuesday and had a good visit. She stayed with Mom while Dad went to his rehab class and found her time in Mom's room to be slow, quiet, peaceful and relaxing, much as Susan had found it relaxing Sunday morning. However Mary talked to her yesterday afternoon and had the same alarming reaction that I had had. So much so that she flew down Wednesday, a day earlier than planned.

Mom's nurse was surprised as well by the sudden decline in Mom's condition. She suspected an allergic reaction to the morphine and has switched her to synthetic opiates and a strong dose of benadryl. Mom's skin had become exceedingly dry and her lips were swollen and cracked. Her mouth and throat were inflamed as well, making eating painful as well as difficult. I hope the synthetic works as well as the morphine making her attempts to breathe more comfortable. Jean-Aimee (her nurse) also ordered round the clock nursing as well, so someone will be there besides Dad.

Wednesday I took a long lunch and spent a couple of hours with her and saw the changes for myself. Mom was in good spirits and Dad said she was having a much better day. We had a good visit. Before I left, I asked her if she remembered that Brother Stephen (nee Andrew, Michael's best friend growing up) was being ordained Saturday. "Oh, of course, yes. And you received an invitation!"

"Yes," I said, "Well I think he's going to have a surprise guest."

"You mean Travis is coming up?" (From San Antonio.)

"Well, Travis is coming up, but that's not the surprise I was thinking of."

She looked and me and her eyes got wide. "You mean Michael is coming?"

I nodded. "Yes he and Laura will be here Friday morning."

She closed her eyes, took a breath and said softly, "I'm going to get to see Michael."

And she's going to see Britt who's flying in from Los Angeles. Anna is coming from Salt Lake and Caitlin is coming as well. Mary will get to see the joy on Mom's face when she breaks the news.

It took a chain of 23 emails to get everyone moving on the same page. The big question was whether to come all at once or one at a time. Britt used mathematical notation to express it best:

JOY + TOGETHERNESS > ONE-BY-ONE

A Long Sunday at the Apartment

About midnight Saturday, Helen sent an email that started, "Hello all. This is hard, but Mom has worsened considerably the last few days..."

That's the kind of message that keeps you up at night.

So, this morning I called early (though I waited until after 9am) and both Mom and Dad answered the phone. I asked Dad if he was going to church, he said he was and I said that Susan and I would be over to stay with Mom while he went. I decided to dress for church and so I went with Dad while Susan stayed with Mom.

I stood with Dad on the old man's row (these guys make him feel young!) It felt good and I think it meant a lot to Dad.

Susan has the remarkable ability to slow down to Mom's level and worked with her through her complex maze of lists and amazingly produced a couple notes in envelopes almost ready to mail. Ask her to relate some of the high points when you see her. Susan found it quite relaxing and the tension neckache and headache she has been accumulating all week were dissipated.

We visited a little after returning from church, then Susan and I made a chicken run to Bubba's. We brought back plenty of fried chicken including livers, sweet potatoes and green beans. The next trick was to get Mom to eat.

I picked out some small tender morsels of breast meat and liver and buttered a roll, but she said it was too dry and rough to swallow. So I sliced a roll very thin and spread some mayonnaise and thin sliced chicken to make a small tender sandwich. It took her forever to chew and swallow, but she managed to get about half of it down after Susan gave her a talking to. "You are just getting weaker and you have to eat and you have to be strong enough to visit with Mary next weekend. You just have to. Eat for Mary." Mom agreed, and took another bite.

Later Susan cleaned the crust off a liver and cut it into tiny pieces and brought it in with a bit of sweet potato. She had a bite. I called the liver Mom's Little Liver Pills and she laughed as hard as I've seen her laugh in a long time.

So that was it. Half a tiny sandwich, a bite of sweet potato and a few nibbles of liver. And half a small bottle of Coca-Cola. She weighed in at 85 pounds yesterday. That's with bed jacket, night gown, t-shirt and socks.

We left plenty of chicken, rolls, livers and vegetables for Dad. With Mom not eating much, he's not eating much and he's lost more than a few pounds over the last couple of weeks. There were not many meals left in the fridge, but a number in the freezer. Helen is going to help him work out a menu schedule so he can defrost ahead of time and reheat when it's time for a meal. Another learning curve.

He seems to show better patience with Mother. It's so difficult to have a clue as to what he must be feeling. He's just always the same old Dee Don.

Mom is definitely getting weaker. Her morphine dosage is up. When we saw Helen and Will, he explained how the morphine really works for COPD patients. (Let's see if I get it right...)

The problem is the gasping/panic reflex. When the body can't breath and thinks it can't get enough air, it gasps for air. When gasping doesn't work, panic sets in. (If you're in water, that's when you start flailing your arms and you drown.) The morphine calms the gasping reflex. The time release pills were added because her breathing is getting worse and the morphine base line needs to be greater. The reason the patient self-administers the liquid dosage is because they are in touch with the intermittent fluctuations of the gasping. Her breathing is not better, in fact, it is getting worse. As it gets worse, it requires more morphine to calm the gasp reflex.

(Of course more morphine is music to my ears. I love the stuff. I find it to be a warm blanket in which to sink. Calm music and a timeless room wouldn't be bad. It can make the world seem fuzzy and remote.)

Her weakness has its drawbacks. The trip from bed to bathroom is dicey and Mom needs help between the last touch of bed-frame to the first touch of the bathroom counter. Monday I'll ask Dad if they're considered a walker. Not a fancy one with handbrakes, but a basic lightweight aluminum walker (the kind with cut open tennis balls.) Who knows if it will even fit? Who knows if she would use it?

Susan and I left about 4. It had been a long day. After a trip to the Central Market, we met Helen and Will at 7 for some tacos and made plans for next weekend. It will be interesting indeed.