“Betty”, eighty-seven, suffers from dementia. She has been in a rapid decline for the past two weeks. She is getting weaker, more confused and unstable on her feet. She is eating very little and has recently lost over ten pounds.
Betty has lived in a Residential Care Facility for three years as she needs constant care and supervision. Betty has been married sixty-six years to “Greg”. Greg lives a mile away and visits Betty every other day. Betty and Greg have four adult children; of which three live nearby. The family is very devoted to Betty.
The hospice admission nurse and I went out to Betty’s facility to meet with Greg and their daughter, “Gloria”. Gloria and Greg just bragged about all of Betty’s accomplishments. She sounded like such an amazing woman. Nothing would ever stop her from reaching her goals. Greg proudly shared so many stories of their travels all over the world.
Betty loved to hike and Greg said he never could keep up with her. Greg is tall and robust while Betty is a little over five feet tall and petite. Greg would laugh while sharing stories about Betty. The family all have a great sense of humor and laugh easily. A few tears were shed, though, when talking about how Betty is today.
Betty doesn’t talk and often does not even recognize her family. She looks content and willingly goes along when staff slowly walk her to dining room for a meal. Likely it is a blessing for her not to remember all that she has lost. Her legacy will remain alive as long as Greg continues to brag and share Betty’s amazing life and stories.
THE HIKER
She loved to hike.
She’s trekked all over the world.
He bragged about her endurance.
How he never could keep up with her.
She hiked Mt. Kilimanjaro.
She hiked parts of Mt. Everest.
Nothing she did ever surprised him.
She was a trailblazer from the start.
He bragged about her intellect.
How she got a degree in Chemistry,
while other women her generation
were proud to be homemakers.
Seeing her now, one would be surprised.
Tiny, frail, confused, helpless.
Any resemblance of her adventurous spirit,
now buried way too deep inside.
He still sees an inspirational woman.
He sees her pioneering spirit.
He sees the woman he fell in love with
so many years ago.
The trailblazer;
the hiker.
Saturday, December 27, 2014
Saturday, December 20, 2014
A MOTHER
“Diana” was diagnosed with uterine cancer three months ago on her forty-first birthday. Diana has been in the hospital for several days and initiated the hospice referral herself. Diana wants to be able to control everything. She has had so many losses due to her illness, that she, like any of us, wants to be able to keep control as much as she can.
The hospice nurse and I went out to the hospital to admit Diana to hospice. We met with Diana and her mother, “Shelly”. The nurse will make the arrangements for Diana to be discharged home this afternoon. The plan is for Shelly to move in and care for her daughter for the duration. Diana is single and has no children. Diana has two siblings and a three year old nephew. This is a small, but close family. Diana’s brother is also moving in to help out with his sister‘s care. Diana’s sister is eight months pregnant and is limited in what she is able to do.
Diana has a PhD in Sociology and handles her emotions intellectually. Shelly says that her daughter has always been very stoic and accepting of whatever comes her way. When I asked Diana how she is coping, she says she has such a good family and friend network that she is doing fine. She focuses on the tasks that are needed to be done.
Shelly, on the other hand, was appropriately tearful. While the nurse was attending to Diana, Shelly and I spoke at the foot of her daughter’s bed. Shelly was bragging on her daughter’s accomplishments which embarrassed her daughter. Diana does not like her mother talking about her as she said “Mom, take it outside in the hallway.”
Shelly then started to talk about how she would do anything to help her daughter, even die for her. Shelly and I talked about how this is somehow all out of order. No parent should ever have to attend a child’s funeral. Shelly was very open and honest with her emotions. She is angry at the doctors for not diagnosing her daughter sooner. She also feels so helpless as there is nothing she can do to save her daughter.
I listened to her and told her how normal all of her feelings were. So much of what she said, I could relate on one level, but then could not even imagine such pain. She then got tearful and I gave her a hug. She then crumbled into my arms and just sobbed. Shelly, too, needs a mother who can nurture her. No matter what age, any of us do need nurturing now and then.
Hopefully when Diana gets home tonight with her friends and family around, she, Shelly and all can get the support and care they all so need. I wish them well.
ADDENDUM: Diana died peacefully four days later with her family at the bedside.
A MOTHER
Her heart is breaking.
This is all too new; too fast.
A mother watching her child die.
I cannot even imagine.
She is my age; my generation.
Her daughter could as easily been mine.
Somehow it is all out of order.
“I would do anything for her.”
With so many obtrusive emotions,
it is hard to sort her feelings out.
Sorrow, anger, helplessness.
Nothing can take her pain away.
She needs to share her feelings,
but what words can she use?
Her daughter handles things so differently.
She is in a totally different space.
I listened to her anger.
I listened to her grief.
She cried while I held her.
Tenderness no words can replace.
She will be by her daughter’s side.
She will put her daughter’s needs first.
After all she is,
and forevermore
will always be
a perfect Mother.
The hospice nurse and I went out to the hospital to admit Diana to hospice. We met with Diana and her mother, “Shelly”. The nurse will make the arrangements for Diana to be discharged home this afternoon. The plan is for Shelly to move in and care for her daughter for the duration. Diana is single and has no children. Diana has two siblings and a three year old nephew. This is a small, but close family. Diana’s brother is also moving in to help out with his sister‘s care. Diana’s sister is eight months pregnant and is limited in what she is able to do.
Diana has a PhD in Sociology and handles her emotions intellectually. Shelly says that her daughter has always been very stoic and accepting of whatever comes her way. When I asked Diana how she is coping, she says she has such a good family and friend network that she is doing fine. She focuses on the tasks that are needed to be done.
Shelly, on the other hand, was appropriately tearful. While the nurse was attending to Diana, Shelly and I spoke at the foot of her daughter’s bed. Shelly was bragging on her daughter’s accomplishments which embarrassed her daughter. Diana does not like her mother talking about her as she said “Mom, take it outside in the hallway.”
Shelly then started to talk about how she would do anything to help her daughter, even die for her. Shelly and I talked about how this is somehow all out of order. No parent should ever have to attend a child’s funeral. Shelly was very open and honest with her emotions. She is angry at the doctors for not diagnosing her daughter sooner. She also feels so helpless as there is nothing she can do to save her daughter.
I listened to her and told her how normal all of her feelings were. So much of what she said, I could relate on one level, but then could not even imagine such pain. She then got tearful and I gave her a hug. She then crumbled into my arms and just sobbed. Shelly, too, needs a mother who can nurture her. No matter what age, any of us do need nurturing now and then.
Hopefully when Diana gets home tonight with her friends and family around, she, Shelly and all can get the support and care they all so need. I wish them well.
ADDENDUM: Diana died peacefully four days later with her family at the bedside.
A MOTHER
Her heart is breaking.
This is all too new; too fast.
A mother watching her child die.
I cannot even imagine.
She is my age; my generation.
Her daughter could as easily been mine.
Somehow it is all out of order.
“I would do anything for her.”
With so many obtrusive emotions,
it is hard to sort her feelings out.
Sorrow, anger, helplessness.
Nothing can take her pain away.
She needs to share her feelings,
but what words can she use?
Her daughter handles things so differently.
She is in a totally different space.
I listened to her anger.
I listened to her grief.
She cried while I held her.
Tenderness no words can replace.
She will be by her daughter’s side.
She will put her daughter’s needs first.
After all she is,
and forevermore
will always be
a perfect Mother.
Saturday, December 13, 2014
CAN'T AGREE
“Ingrid”, seventy-two, took a fall six days ago. She says she lost consciousness and fell flat on her face. The left side of her face is bruised from that fall. Ingrid has a history of lung, cardiac and kidney disease. Ingrid lives with “Edgar”, her husband of fifty-five years. The couple have five adult children; although only two live locally.
Due to Ingrid’s recent decline, the hospice nurse and I went out to admit Ingrid to hospice. Ingrid’s husband and two of her children, “Jim” and “Liz“, were at the bedside when we walked into her hospital room. The plan was to discharge Ingrid home today.
After we introduced ourselves, Edgar, Jim and Liz immediately started talking all at once, overpowering Ingrid. The three of them would interrupt each other and order each other around as to what to say or do.
One of the first questions I like to ask patients and families is about their understanding of why the doctor made a hospice referral. The doctor may have predicted a life span of six months or less, but often one can be selective to what they are ready to hear. There are times, when the doctor doesn’t even share why it is time for hospice to be involved. I don’t want to assume the family understands why.
I had directed that question to Ingrid. She was attempting to answer my question, but was struggling with the words. The family started to talk for her. Each one had a different answer as to why a referral was made. Finally Liz told her brother and father that I had asked Ingrid about what her thoughts were. Ingrid has been on oxygen since in the hospital, but hadn’t been prior. With her extensive lung disease, her fuzziness may be from lack of oxygen to her brain. The family did not have the patience to allow Ingrid to articulate in her own way.
Between the three of them, there was a lot of anxiety and impatience to get things done right now. One could feel the tension in the room, but also feel the love all three had for Ingrid. This frenzied behavior is normal for this family and somehow works for them. The one thing any of us miss most is our normal. Normal is what Ingrid needs. I just bet she can’t wait to get home to her “lively” normal.
CAN’T AGREE
The three of them were so vigilant.
Their concern directed only for her.
She’s been in the hospital for almost a week.
They just want to get her home.
The plan is to discharge her later today;
once the oxygen and bed get set up at home.
She’s been a bit fuzzy; not quite herself;
since she took that dramatic fall.
All three believe they know what’s best.
None of them think to simply ask her.
They interrupt each other constantly;
each determined in what she needs.
He gets anxious; his son says to calm down.
She starts to say something, but stops midway.
The three of them jump in all at once,
finishing up what she must mean.
They can’t agree on anything.
They all have their own ideas.
What she needs; what is best.
All three set in their own ways.
Between the bickering and the interruptions;
there is at least one thing
they can easily agree;
their love and devotion
to her.
Due to Ingrid’s recent decline, the hospice nurse and I went out to admit Ingrid to hospice. Ingrid’s husband and two of her children, “Jim” and “Liz“, were at the bedside when we walked into her hospital room. The plan was to discharge Ingrid home today.
After we introduced ourselves, Edgar, Jim and Liz immediately started talking all at once, overpowering Ingrid. The three of them would interrupt each other and order each other around as to what to say or do.
One of the first questions I like to ask patients and families is about their understanding of why the doctor made a hospice referral. The doctor may have predicted a life span of six months or less, but often one can be selective to what they are ready to hear. There are times, when the doctor doesn’t even share why it is time for hospice to be involved. I don’t want to assume the family understands why.
I had directed that question to Ingrid. She was attempting to answer my question, but was struggling with the words. The family started to talk for her. Each one had a different answer as to why a referral was made. Finally Liz told her brother and father that I had asked Ingrid about what her thoughts were. Ingrid has been on oxygen since in the hospital, but hadn’t been prior. With her extensive lung disease, her fuzziness may be from lack of oxygen to her brain. The family did not have the patience to allow Ingrid to articulate in her own way.
Between the three of them, there was a lot of anxiety and impatience to get things done right now. One could feel the tension in the room, but also feel the love all three had for Ingrid. This frenzied behavior is normal for this family and somehow works for them. The one thing any of us miss most is our normal. Normal is what Ingrid needs. I just bet she can’t wait to get home to her “lively” normal.
CAN’T AGREE
The three of them were so vigilant.
Their concern directed only for her.
She’s been in the hospital for almost a week.
They just want to get her home.
The plan is to discharge her later today;
once the oxygen and bed get set up at home.
She’s been a bit fuzzy; not quite herself;
since she took that dramatic fall.
All three believe they know what’s best.
None of them think to simply ask her.
They interrupt each other constantly;
each determined in what she needs.
He gets anxious; his son says to calm down.
She starts to say something, but stops midway.
The three of them jump in all at once,
finishing up what she must mean.
They can’t agree on anything.
They all have their own ideas.
What she needs; what is best.
All three set in their own ways.
Between the bickering and the interruptions;
there is at least one thing
they can easily agree;
their love and devotion
to her.
Saturday, December 6, 2014
MISERY
“Dylan”, fifty-six, suffers from tongue cancer. He had been doing well until two months ago when he started to decline. Dylan was admitted to a Skilled Nursing Facility shortly afterwards. He is now bedridden and requires assistance with all of his needs. He appears to understand, but his words are few.
Dylan is divorced and has two adult sons. Both of his boys live in North Africa and, fortunately, Dylan was able to visit them this past summer. Dylan has four siblings living locally, who are very devoted and supportive of him.
The hospice nurse and I went out to admit Dylan to our hospice program yesterday. Five weeks ago, Dylan was in the hospital when the doctors put in a trach for his breathing and a feeding tube for nutrition. Both procedures were urgent at the time. The family feels that Dylan likely just went along with the doctors. Looking back, the family feels that if Dylan had time to think about things, it likely is something he never would have opted for
Dylan is so thin, it is obvious that he is no longer processing the nutrition. The hospice nurse spoke with the family regarding the feeding tube and the family chose to stop all nutrition. The goal now is to keep Dylan comfortable for what little time he has left.
The family showed the nurse and I Dylan’s driver’s license photo. We saw a vital, robust man. Now Dylan is a shell of what he once was. The family said he had such a sense of humor and was always laughing. Now, he just lies there, not speaking, with his eyes tracking us.
I can’t get him off my mind. Why does someone have to suffer so? It would be a blessing for God to take him. There are things worse than death. In my opinion, this is one of them.
ADDENDUM: Dylan died four days later with his family at the bedside. They said it was peaceful. I pray the family has some comfort from that and that Dylan has finally found his eternal peace.
MISERY
I can’t stop thinking about him.
Lying there all alone.
So weak; so thin; not talking.
Why does he have to live this way?
His tongue is swollen from the cancer.
He can’t even close his own mouth.
It looks so uncomfortable and frustrating.
He lies there just existing.
He has a feeding tube and a trach.
Machines are extending his life.
He can’t tell us what he wants.
No one would choose to be this way.
The family has to make some tough choices.
Mixed emotions challenge them all.
They aren’t ready for him to die,
but will be relieved when his suffering is done.
If he could talk, what would he tell us?
I am sure most would say, “I’m done”.
I pray for God to take him soon.
Relieve him of this suffering; this misery.
Please God, take him home.
Dylan is divorced and has two adult sons. Both of his boys live in North Africa and, fortunately, Dylan was able to visit them this past summer. Dylan has four siblings living locally, who are very devoted and supportive of him.
The hospice nurse and I went out to admit Dylan to our hospice program yesterday. Five weeks ago, Dylan was in the hospital when the doctors put in a trach for his breathing and a feeding tube for nutrition. Both procedures were urgent at the time. The family feels that Dylan likely just went along with the doctors. Looking back, the family feels that if Dylan had time to think about things, it likely is something he never would have opted for
Dylan is so thin, it is obvious that he is no longer processing the nutrition. The hospice nurse spoke with the family regarding the feeding tube and the family chose to stop all nutrition. The goal now is to keep Dylan comfortable for what little time he has left.
The family showed the nurse and I Dylan’s driver’s license photo. We saw a vital, robust man. Now Dylan is a shell of what he once was. The family said he had such a sense of humor and was always laughing. Now, he just lies there, not speaking, with his eyes tracking us.
I can’t get him off my mind. Why does someone have to suffer so? It would be a blessing for God to take him. There are things worse than death. In my opinion, this is one of them.
ADDENDUM: Dylan died four days later with his family at the bedside. They said it was peaceful. I pray the family has some comfort from that and that Dylan has finally found his eternal peace.
MISERY
I can’t stop thinking about him.
Lying there all alone.
So weak; so thin; not talking.
Why does he have to live this way?
His tongue is swollen from the cancer.
He can’t even close his own mouth.
It looks so uncomfortable and frustrating.
He lies there just existing.
He has a feeding tube and a trach.
Machines are extending his life.
He can’t tell us what he wants.
No one would choose to be this way.
The family has to make some tough choices.
Mixed emotions challenge them all.
They aren’t ready for him to die,
but will be relieved when his suffering is done.
If he could talk, what would he tell us?
I am sure most would say, “I’m done”.
I pray for God to take him soon.
Relieve him of this suffering; this misery.
Please God, take him home.
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