Monthly Archives: November 2013

Next day at the hospice – the procession

B has been NPO (no nutrition by mouth or any other means) for 11 days. Ghandi managed a 21 day hunger strike on two glasses of water, but Ghandi did not have a massively metastasised cancer, nor had he experienced intensive radiation and chemo therapies. Eleven days of survival was far in excess of the usual seven the family had been informed to expect when B entered the facility.  B continued to breathe regularly, receive his injections of morphine and antihistamine, and be repositioned regularly. His day was otherwise uneventful. The intervals of communication of the previous day were not repeated and may be the last we will enjoy since there were none this day.

Members of the family came and went throughout the day with the greatest concentration present after 4 PM. The sporting events continued to unfold on the TV. At one point, all the family present gathered around a computer screen to watch the live feed of a high school soccer game in which his grandson was playing. All of us were cheering his team on and watching his play, except B of course. He was not forgotten. One or another of us checked on him regularly, but his condition remained stable, save his body temperature. Clearly some minor infection had set in and whatever remained of his disease defence mechanisms were at work. No antibiotics were in order for my friend.

The other feature of this experience not yet mentioned was the abundance of food availble for all to eat. The hospice provided refrigeration in another location so that families could bring and store food on site. The location was some sort of lounge with a partial kitchen, tables and chairs to eat at, and a gathering place for family members who wanted to take a break from staying in the suites with their loved ones. Once again, the normalcy of the place, the persistent upbeat music in the halls and the general good spirits of all in attendance (B’s family is the only one I can account for) grated against the reality that was this a place of dying.

The day progressed in the same manner until about 10 PM when we decided to leave for the evening. The only problem was that there was a procession in progress. At this hospice, the clients entered and exited through the same door. There was no back door for hearses to pull up to for the deceased to be spirited away without notice. At this hospice, there was a regular procession to follow the body out the front door to the hearse. This was a very solemn  affair with the now mourning family very much in the fore. This was a place of dying with dignity in the company of loved ones where death was not a something to be hidden or to hide from. We decided to stay out of the way in respect for the family of the hour. The whole affair took about 30 minutes before we could leave for the evening. Staff told me privately that there were three such processions over the last weekend and it was a rough time for them all. These staff were feeling humans capable of working under very unique conditions.

This scenario got me thinking about my previous experiences with death and the dying. The first death I recall was that of a grandmother who had pancreatic cancer. She died about 63 years ago (I was just 6) and she was only in her fifties.  My only recollection of her death was when my father quietly announced that I no longer had a grandmother. That was it, nothing more. Perhaps it was the way of the times, but clearly I was being sheltered from the experience. The next death was that of a patient from whom I was taking a blood sample. I worked as a night lab technician (now in university) at a small urban hospital; taking morning blood samples was one of my regular duties. In this instance, while taking my sample the blood just stopped flowing and that was it. I checked the pulse. I called the duty nurse to the bedside to confirm my observation and left the room. I felt nothing, because a very sick elderly person with whom I had no association had died in the course of events. I also observed several autopsies while working at this hospital. Death was death. Should I have felt something for the old women or for the subjects of the autopsies?

The next several events involved family members. A cousin had died at the age of fifty from a heart attack, but he was a very heavy smoker and also had lung cancer. My paternal grandfather died several weeks after I visited him in a nursing home. I attended his funeral. My maternal grandfather died in the early 1970’s. I was unable to see him prior to his death or to attend his funeral as I was now in exile from the United States due to the Viet Nam situation. I was very close to this man and it hurt me to be excluded from those events.

My father died at the age of 63 from a third and finally fatal heart attack. Fortunately, I was again able to travel to the USA and had visited him just a few days before he died. I was not there at the moment of death.  I was able to fully participate in his funeral and the other religious rites associated with his death. My mother passed away some thirty years later from lung cancer. I was fortunate again to be able to spend several days with her just before her death. She was the first loved one that was under a palliative care regime, albeit not in a hospice. Instead, she was at my brother’s home, but received all the appropriate care from individuals that came and went as needed.  I had exhausted my leave of absence from my teaching position and had to return, but my children came to stay and visit with here the next day. They too had ample time to sit an talk with her for the next day and a half, but she expired at that time. It is the closest I got to a hospice experience. We all attended her funeral. Both she and my father were fully communicative, alert and with-it when I was with them.

The lose of a parent is certainly a sad event and I was affected by each of their deaths, but nothing I had experienced was equal to this time spent with B and his immediate family. He was so clearly debilitated by both disease and cancer therapy, and his hold on life was so tenuous, that the affect on my was greater than I expected from precious experiences. I have no anticipation of an afterlife, but these people were religious to a degree to which I could not relate. They were counting on it. I twice blacked out in my life; once from the effect of something called “divers reflex, and once from the fall resulting in being knocked unconscious. On both occasions, I knew that if I had not regained consciousness that would have been it. There was absolutely nothing on the other side of a blackout, the religious beliefs of others notwithstanding.

Death could not be excluded from beneath my dome of heaven for it is just pat of the human condition. My conclusion from all these experiences is that life is life and death is death, and never the twain shall meet. B had his own procession the very next day. I’ll write about that in the next post.

Until then . . . L

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At the hospice the next day: My dome of heaven trembles around me.

Arriving back at B’s suite the next morning was less surreal for the time being. Only a few people were present. The lighting was subdued and the ever present sports show was on TV  but the volume was muted. B was resting quietly with the help of his morphine injections and his wife, my sister-in-law, was by B’s side holding his hand. Everyone spoke in muted tones and the four of us stood around the bed looking at the inert but living shell of a person that we all cared for.

This man was dear to me although we visited with each other infrequently over the last 45 years. I first met B when he was in his early thirties. We got on from the get-go and just genuinely liked each other, although he was 10 years my senior. His wife and my bride-to-be were sisters, hence that fate of our own encounters and choices for life partners brought us together as friends. As I gazed at his gaunt but familiar features, my eyes misted a bit for the first time. On the previous visit there was just too much lightheartedness in the room for my emotions to take hold. I touched his shoulder and spoke a few words, but there was still no obvious response from him.

The day progressed with little change in B’s situation. The only change was the arrival of one of his sons. We were all sitting around in the lounge area chatting except for my sister-in-law, who was sitting by B’s side when we heard “It’s okay B. It’s okay for you to go if you are ready.”, which immediately drew our attention to B’s bedside scene. He was breathing irregularly (something called Cheyne-Stokes respiration) and had a very shallow, almost non existent pulse. The emergency button was pressed and when the nurse entered the duty physician was requested. He appeared and confirmed that B was in crisis and might not survive much longer. There were no tears, only concerned attention and a desire to stand near B during this time. After about 35 minutes of this ominous “death rattle” condition, the nurses arrived to move B a bit as per usual. When they did, B opened his eyes. For some reason, I went to his side quickly, took his hand and spoke to him. Just a bit a friendly patter of the kind that usually passed between us, but this time he responded. B certainly was unable to speak although he moved his facial muscles near his lips a bit in response to my words. I continued talking with him and reminiscing about times we spent together and he spoke with his eyes, and with movements of his eye brows. It was an amazing and special moment since I was able to communicate with my old friend directly. B’s breathing became regular and after about two minutes I decided to call his son over to the bed side and stand aside so he could talk to his father. “Just keep the conversation going”, I said with some urgency.

The conversation between B and his son went on for quite some time, then each of the others in the room went over in turn and spoke (words responded to by eye flashes, facial movements and eye brow raises) with B. These were no random responses on his part, they were deliberate attempts to communicate with all of us. After about 15 minutes B became fatigued and began to drift off, but his breathing was regular and he appeared to be in a very relaxed sort of groove. Those moments caused the space inside my dome of heaven to shake every so subtly. I controlled the tears (mostly) and felt a sense of amazing relief that I had at least one opportunity to communicate with B, as did all those near his bedside in those moments. B rested quietly for the remainder of the day and through the night.

I had looked at death overtaking the life of a human for whom I had deep affection and then saw death rise up and leave my friend B with a little more of his lifetime for a while. The events of that day really got me thinking about death and life. I’ll share some of those thoughts with you tomorrow.

Until then . . . L

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A test of my beliefs

I have not been able to post these last  few weeks because of events related to the final days in the life of a relative.  The experience tested beliefs and philosophy as I lived through those days with family, experiencing the ebbing of a life and witnessing the rites associated with death. This was not an immediate relative, nor a blood relation, but a relation through marriage. Nevertheless, this family and this individual are dear to me. They are all under my dome of heaven. The experiences of the last two weeks led me to look closely at what happens when the equilibrium of life is disrupted by the very human condition of the death.

This individual is not the first close to me to pass away over the years, just the first that I have witnessed the passing of. Parents, grandparents, uncles and cousins are all among the deceased of my close relatives. I may have seen them shortly prior to their demise or attended their funeral rites, but I have never been witness to the final days in the process of dying.  My relative (by marriage only), who I shall refer to as B, suffered a recurrence of a cancer that had been fought and supressed for thirteen years. A year ago, it reared its pernicious head in metastatic form affecting the brain and eventually many other tissues. When we were appraised of the fact that B was terminal and entering a hospice, it was time to go and be with our family members and with B.

We arrived at the hospice several days after all nutrition and fluids had been stopped. B was not on life support, but was on a regime of pain suppression (morphine) and antihistaminic to prevent fluid build up. The only other attention he received was to be turned regularly to prevent bed sores and to sponge bath him. When we entered the hospice suite, most of B’s immediate family was present, but at the time he was resting and uncommunicative. B had come through a crisis a few days earlier but rebounded slightly. The scene was somber and at the same time not. It was at best an unexpected incongruence.  To illustrate my sense of being off balance in the situation I shall describe the setting as best I can.

The suite was located in a pleasant, relatively modern low rise building. The hallways and rooms were very clean and comfortably set up for patient and family alike. The music playing in the corridors constantly was distressingly upbeat with occasional lyrics that seemed in conflict with the reality that lay behind the doors providing privacy for the families availing themselves of the hospice facility. B’s suite was spacious, perhaps 800 square feet or so. There was B’s hospital bed along the far side, a large flat screen TV and sitting/lounging area for the family, a washroom and lighting that was subdued at times. In one corner of the room near the TV was an ample supply of snacks for all. The TV was on constantly at a low volume with various sporting events in progress one after the other, including the final few games of the MLB World Series.

In some ways, the setting was very like the setting in B’s on home when everyone was there. B was an avid sports fan and actively promoted the participations of his sons in competitive sport, particularly soccer. There was always a lot of chatter and laughter when you were with B and so it was in his hospice suite, albeit at a more subdued level than normal. Of course, B appeared to be oblivious to all that was going on around him, or was he? Not only was B in a substantially weakened state, he was receiving morphine injections at regular intervals so it was difficult to assess his level of awareness most of the time. When I took B’s hand it was warm to the touch and familiar, but on that first evening, I am certain that he was not responsive to my grasp, but not certain that he was unaware of it. I spoke a few words but there was no sign of response at the time. I do not mind saying that it was difficult to utter words as I was greatly affected by the scenario in which I found myself that evening.

How did all this fit into my ideas about life, self, and a personal dome of heaven? How did I feel about the idea of a hospice as a last way station before death? Could I get comfortable with the idea of death? More reflections in the next post.

Until them . . . L

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