Firewood.

Firewood.

January 22, 2008, 12:16 pm
Filed under: Alzheimer's, Government, Health, Hospice, movies, Sleep, Society

I sat, my back to the fireplace, feeling the heat from the fire, listening to the pop and crackle of the fresh log I had just placed there. Across the room, the hospice nurse and my wife were sitting at my MIL’s feet, the nurse doing her routine examination for the second time in a week.

This is new. Previously, we’d only been on weekly visits. But as it is clear that we’re in the final days of my MIL’s life, we decided to schedule an additional time. And, thanks to how hospice works, we’ve the option of calling for additional visits as needed, or adding in more regular scheduled visits each week. Just knowing this resource is available is comforting.

Lisa, our regular nurse, listens, touches, looks. I am struck by just how much good medicine is still based on these simple techniques, when it all comes down to it.

As it does when you are dying.

* * * * * * * * * * * * *

“What do you need, MIL?”

“I need to call my mother.”

I go get her cordless phone, dial the number and hand it to her while the phone is still ringing. Someone answers on the other end.

It is a brief conversation. She just wants to let her mom know that she is all right, not to worry. The voice on the other end reassures her, tells her to wait until she comes for her. She hands the phone back to me, and I disconnect. She is happy.

My wife and I had set this up weeks ago, in the event that the occasion would come that we needed it. Simple, really – an incoming call to my wife’s cell phone from my MIL’s number would be the cue that her mom needed this kind of reassurance. No need for me to say anything, contributing to the illusion.

* * * * * * * * * * * * *

We watched Waking Ned Devine the other night. A quirky, offbeat little movie that I love. The central theme is about love/friendship, played out in the story of a small village in Ireland where a local lottery winner has died before he can claim his winnings, leaving no heir. The villagers band together to claim and share the money, but as much out of memory and fondness for the departed Ned Devine as their own greed. It’s the sort of movie that always leaves me with bittersweet tears.

And after, surprisingly, my wife got to talking with her mom about MIL’s own situation. From an email my wife sent her sister following this:

When the movie was over Mom was obviously tired but also looked like she wanted to talk. I’m not sure what made me do it, but I started talking to her about her own death much more directly than I have before. I did so as carefully as I could, but I really felt like I needed to be very direct and clear (probably also influenced by the conversation with you). I told her that the nurse that comes every week does so because we think she may be dying, that we are caring for her the best we can and will continue to do so for as long as necessary. I mentioned that she often talks about people who have passed on, and told her that it would be OK for her to do so as well. That we love her very much but we want her to be happy, and if her parents come for her it is OK for her to go with them. She actually seemed to understand what I was talking about, though now and then, she seemed a little unsure, so hopefully the permission part (at least) will sink in.

Permission? To go. That it is OK to die. Often people who are in hospice need to hear this, one way or the other.

* * * * * * * * * * * * *

Lisa is surprised at just how cold my MIL’s legs are. “They’re like ice!”

You don’t usually get that kind of reaction from a seasoned hospice nurse. And, perhaps a bit out of embarrassment, she shifted over into more clinical terminology. Blood pressure. Indications of reduced lung capacity, congestion, observation of ancillary breathing mechanisms. Compromised circulation. She asks about appetite, kidney and bowel function, signs of pain or distress, coughing. Clinical terminology or not, her voice is always concerned, compassionate. “I detect a number of changes.”

We nod. My MIL is worried with whether her lap shawl is straight.

“When she is showing signs of breathing difficulty, or coughing, use X or Y medicine as necessary.”

She looks at my MIL for a long moment. “We want to make sure she is comfortable.”

Indeed we do.

* * * * * * * * * * * * *

They usually won’t tell you this beforehand, but there comes a point in hospice care where the usual restrictions about medicine dosage and usage becomes, let us say, somewhat more casual. The rules are in place to control the abuse of very dangerous and addicting drugs, after all. But when the end comes, no one in their right mind is going to be worrying about addiction, when there is comfort to be given.

We’ve reached this point. My wife and I had realized it last week, but were reluctant to act too much on this knowledge without confirmation from our nurse. No, she didn’t tell us to exceed any prescriptions, but was willing to answer our questions about what medicines were suitable for what problems. So, in response to anxiety, or breathing difficulty, or coughing spasms, we add in a few drops of this solution, another one of those pills, maybe a small shot of whiskey.

* * * * * * * * * * * * *

My wife smiles slightly, amused, as I add another log to the fire. I know what she is thinking – she is remembering my protestations earlier in the season that we didn’t want to be too profligate with the wood I had stockpiled.

Yet it is very cold out, and my MIL does so love a fire.

* * * * * * * * * * * * *

Jim Downey

(Cross posted to Daily Kos.)

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