The Beginning of the End ~ A Nurse to the End

It was January 21, 2010. I woke at 4:34 AM thinking that it’s still too early to get up for work. But then I realized that Mom was calling me. She tells me that she can’t breathe and can no longer function. I knew this day was coming but I wasn’t ready for her to go yet.

She tells me to call the Portland Clinic, and I do. Her long time physician, Dr. Craven, is not on call. The doctor on-call calls back after 20 minutes.

When I explained what is happening and I tell him that she wants to go to the hospital in an ambulance. He says to call 911. I do.

I sit beside Mom, holding her hand, helpless. In the meantime, I call Kristi and Steve to tell them what is happening.

First, a fire truck arrives, lights flashing, lighting up our small street. Four large men, dressed in blue, crowded into Mom’s bedroom with their cases of equipment and tools hanging from their belts. I stand aside.

Mom had advanced directives not to code but in violation of her own predetermined decisions, she tells them she wants help breathing. She tells them in full sentences, everything they need to know while she’s struggling to breathe. They take her vitals. I stand silent knowing instinctively who’s in charge.

Then, the ambulance arrives. More men squeeze into Mom’s, what seems now to be a, very tiny bedroom, each carrying more equipment. Mom reiterates everything to the EMTs that she just told the other guys.

Quickly, they wrap her up in her blankets like a sausage and two guys grab handfuls of the blankets from the top and carry her into the living room where they put her on a gurney. Then they wheeled her out to the ambulance.

Two guys are in back with Mom and I climb in front with the driver. Mom continues to tell them what they need to know. She struggles to breathe until they use a c-pap to blow large quantities of oxygen into her lungs. She can no longer talk. I can’t believe she’s been talking through this whole ordeal.

After the EMTs get an IV started, we take off across the St. Johns bridge. Once we get across and onto Hwy. 30, the lights and sirens are turned on, as Matt tells the driver to step on it. I can’t see Mom and I can’t hear her. This is not how I want it to end.

In the emergency room, the nurses and doctors get to work putting who knows what in the IV.

Before looking, the doctor shows me the chest x-ray along with an old x-ray from 2005. Her lungs are hazy and her heart is large. There is fluid around the lungs, a sign of congestive heart failure. It’s something she’s had for 10 years. He says she probably won’t live long.

Mom is breathing with the help of oxygen and the doctor wants to keep her in the hospital. When she’s stable they move her to a private room. Here she stays for a couple of weeks.

Mom was in her element. This very hospital is where she spent 40 years as a career nurse. She seemed to have recovered from the emergency. For those two weeks, I visit her daily while friends and family stream in and out. Many visitors were physicians and co-workers who stopped to tell stories of working with her, or under her supervision and nurses who were once students who she had mentored.

I learned more about her professional life in those weeks than I ever knew before. I knew she was a VIP, but I didn’t know how respected and loved she was.

Mom talked about going into a home when she leaves the hospital. She swore up and down that she wanted to. We had already gone over and over this. I didn’t believe her. “No! Mom. Absolutely not. You can stay home, this is where you’ll stay.”

Kristi and I decided to acquiesce and went to look at a few small care homes just to satisfy Mom. Though Mom and I had lived together for nearly 20 years, she kept insisting that she did not want to burden me. After visiting, we were more convinced than ever that she wasn’t going into a home.

How would we manage to go to see her if she weren’t at home with me? It was enough just to go to work and back again, run errands, cook dinner, shop, etc., without having to drive across town to visit Mom. And I knew Mom didn’t really want that, she just didn’t want to put me out.

For the next four months, Mom sits or lies in a hospital bed situated in the living room directly in front of the windows. From here she can see what passes in front of the house. She can also see her many visitors arriving.

I took family medical leave until hospice care came in to relieve me five days a week so that I could return to work. And Kristi drove hundreds of miles every weekend to help out.

Mom lost all strength in her legs but every other function worked perfectly well. That meant that she needed assistance to maintain her hygiene. Though these were not chores I relished, I did them with love. Unlike Mom, I had no inclination to nurse but I would not abandon her. She had seen me through polio and cancer. This was the least I could do.

Mom and I had dinner together every evening and she filled me in on her day with the caretakers. Apparently, she enjoyed their companionship and had many stories to tell.

Just as any good nurse would, she was keeping her own chart: recorded type and time of medication administration, size and frequency of BMs and urine output, blood pressure, heart rate, temperature, etc.

I served Mom in bed, while I sat not far away at the dining room table. Soon after finishing her dinner each evening, she was ready for dessert, which I was to bring, post haste. Eventually, I had to gently tell her that I wasn’t her nurse’s aid and that once I had finished my dinner, I would bring dessert. She understood immediately and was quite apologetic.

Though I helped her with her toilet each evening, I also had to tell her that I wasn’t going to estimate her output in size and quantity. She was sorely disappointed but did not utter one disgruntled word. Eventually, I also asked her to either give up charting or trust me to bring her meds on time. It was annoying to be reminded constantly that in 20 minutes it would be time for such and such. She got it. She kept her chart, but kept silent about it.

If one didn’t know why she was in bed, one wouldn’t know that this beautiful lady was just months, then weeks, then days away from death. Nightly, I would mix a dry, dirty martini, Beefeater Gin only please, with 3 green olives or 3 cocktail onions for her and something wonderful for me. Then we would chat and watch Jeapardy and Wheel of Fortune and whatever else was on that we wanted to watch. Mom was a very sociable and gracious companion.

Mostly during the day, while I was at work, Mom would entertain friends or family who came to visit. I don’t believe she had one boring day. If she had a quiet day, Mom would read, do crossword puzzles, read the newspapers and watch the news. The living room filled with cards and flowers.

As we knew would happen, the day came for her passing. She called me in the early morning hours. It was May but not yet light out. I turned on a dim light and I sat with her on her bed and took her soft hand, as she asked me to help her “get off of this”, as she motioned with her hand, touching her chest from where her heart was, out into the air. I asked her what she meant but she would just make the same hand gesture and repeat the same words. I offered suggestions such as, a road, a path, or a trail. But with each suggestion she would say, “no smaller”.

Mom was very calm. I so wanted to understand what it was that she wanted me to do. How can I help her to “get off of this” if I don’t know what “this” is? I knew she was ready to die because we had talked about this at infinitium. But she was worried about leaving me alone. She wanted me to be loved by someone and to be cared for.

I finally remembered something I had learned many years before. It was that our soul is connected to eternity with a golden thread. When I said, Mom, is it a thread?” She suddenly relaxed. I told her that I couldn’t cut it for her but that she was free to go, that I would be fine, and that I loved her more than she would ever know and I knew how much she loved me. I have no idea if she understood when I said a thread, except that it seemed to satisfy her. Maybe I had finally mentioned something that was actually small enough.

We sat there until the sun came up. This morning there were no ablutions, no coffee, no breakfast. She really didn’t want anything. I don’t even remember what we said to one another but I know we spoke soft words.

Mom had everything in order and didn’t need to ask me for anything. Besides the family and close friends I knew who to call. Family began to show up as did her friends to say goodbye. For a good part of the day she would speak to people as they would come and go. But as the day wore on she spoke less and began to spend her time, her final hours, with her eyes closed. When one would speak to her she would make a soft sound as if to say I know you’re there.

Slowly people went away having said their goodbyes. This left Hannah, Kristi and I alone with her to accompany her as she passed away. The hospice nurse that showed up towards the end of the day, stayed to pronounce her death and to sign the appropriate papers. She melted into the background and was hardly noticeable. She told us that as a person dies their last sense to go is their hearing and encouraged us speak to her.

We sat on her bed, touching her. We told her that we loved her and that we would miss her but that it was also okay for her to go, she didn’t need to hold on. She was so relaxed and her face softened with a pink glow and her wrinkles seemed to disappear. Soon we had no more words and all we could do was hum and sing without words. Mom almost imperceptibly took her last breath. It took us some time before we could move away from her. By this time, it was nearing midnight.

Mom had donated her body to the OHSU Body Donation Program. While we waited for them to come for her, we sat talking and looking at this beautiful body that had belonged to someone that had served so many and would be remembered for her love, intelligence and so much more.

But right up until her dying day, Mom was in charge. Two things that I will always remember is hearing Dad say, “Norma, you’re not in charge here at home.” Second, was numerous people saying they’d never heard her say a bad word about anyone. Now that’s a legacy!

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