SO SAD

I went out to admit “Ben” to our Palliative Care program today.  His situation is so sad, but then his family, so amazingly, focused on reality along with the good.  They have taught us all that the best gift anyone has is their heart and soul.  So often an illness can grab all of the attention as it is so visible and real.  This wonderful family was real but also focused on who Ben is as a person.  I feel so honored to have met all three of them.  Thank you.

SO SAD
 
It was just three years ago this month
while he was just driving home from work,
that a semi crossed over the double line;
                         hitting his car head on.
 
Now at age thirty-four, he is paraplegic.
He has a trach; a ventilator; a feeding tube.
He is forever bedridden as weakness stays.
He is non-verbal, but can blink his eyes for yes or no.
 
His mother and sister devotedly care for him.
They are so focused on following his wishes.
He simply told them recently, “I want to live”;
so, he is now Full Code and Full Intervention.
 
Before the visit, I read about his health history.
The emotion that totally embraced me was sadness.
He suffered a cardiac arrest two weeks ago.
Mom then said, “That is the third time he has died”.
 
Yes, his family feel sadness and grief too,
but focuses on the positives in his life.
They spoke about his children and his faith,
while strongly sharing his heart and soul.
 
Mom said he loved the show “Seinfeld”.
She then shared one of his favorite episodes.
It was then when he laughed with no sound,
but one clearly saw the humor in his eyes.
 
Yes, it is definitely a sad situation, but then;
his family has given his life purpose and meaning.
There is a reason why he is still here.
He may be our biggest teacher
                         of them all.
 

GRANDPA AND GRANDMA

“Jennie’s” grandparents are both critically ill.  Grandpa has respiratory failure while grandma has Lung Cancer.  Jennie is thirty years old and very mature for her age.  She tells her truth as is realistic regarding her grandparents’ symptoms and prognosis.  This is a very large family who are all so supportive to their grandparents and to each other.  Love will get them through.  I wish Jennie and her family the best for sure.

GRANDPA AND GRANDMA

She is the caregiver for her grandpa
ever since he has been so sick.
He is now extremely weak and lethargic;
no longer getting out of bed.

 “He is a very special grandfather
as all in our family love him so.
Grandma is also very sick with cancer.
She, too, is so ready for it to be over”.
 
“I don’t want them to give up.
I want them to fight to get better.”
I shared with her; “It is not giving up;
it is knowing when to let go”.
 
When asked what helps her cope, she said,
“I cry as am very emotional.
We had plans, and I truly know,
                         they will always be around.”
 
“I will always respect my grandparent’s wishes,
but I am not yet ready to say goodbye.
I strongly believe in God and the afterlife
and so deeply know and embrace,
both will forever, spiritually and always

                    be here”.

HER WAY

Penny, 85 years old, has suffered from Breast Cancer that has metastasized to her bones.  She suffered a femur fracture due to the bone Mets.   She has been bedridden for two months since that event.   Penny has always been so independent and lived alone until the fracture. 

I had not seen her since I did the admission over a month ago.  Today, she again, looked wonderful as was vital and spunky like before.  At the end of our talk together, she threw in some humor.  I then said, “When it is my time to be at the gate, please make sure it is unlocked.”  She, with a cute smile, answered, “I will surely do so”.

The nurse and I were there for two hours.  Walking out the front door is when sadness hit me.  She was such a wonderful human being.  What a loss for all of us.

 

Addendum: Three days later, I spoke with Penny’s daughter offering condolences and support.  She and her family wee “doing okay but having sad moments”.  The daughter thanked me for spending time with her mom.  Penny told them all that our talk was “comforting”.  This is, for sure, one patient and family that I will always cherish and remember.

HER WAY

 

 

She planned on taking the meds today
so asked for us to be there at 11:45.

Her three daughters and a niece were there.

“Mom needs to talk to Marilou now.

Let the rest of us leave the bedroom.”

She spoke about her endless suffering.

“Every moment is a continuous struggle now.”

She then shared stories about her daughters,

her grandchildren and great-grandchildren too.

I then thanked her for the gift she gave me; 

requesting that I come today to give support. 

“Please also give my daughters support. 

I want them to be okay after I am gone.”

 

She took the lone pill one hour before as directed. 

It is for nausea that is caused by the other pills. 

At 1:15, she so easily swallowed the EOL tablets.  

Within a few minutes she was unconscious.

 

I said goodbye to the patient as we were leaving.   

Let go when the time is right for you to do so.” 

The daughters really appreciated us coming while saying, 

Thank you so much for the support you gave our mom.”

 

We left at 1:45 and thirty minutes later, she was gone.  

The daughters weren’t surprised that she made this choice 

as she has always lived her life;

                   and now her death;

                                            Her Way.                               

 

 

 

TOMORROW

 California has the End-of-Life Option Act (EOLOA) allowing a terminal patient to take medication that will end their life.  There is a process when wanting this option.  Physicians want to make sure one isn’t taking the pills because the children want the money from the estate etc.   Many of our patients will go through the process.  They will have the pills in the home, but, in the end, do not do it.  They just want it as an option.  

I met “Penny” one month ago when the nurse and I admitted her to hospice.  It was, at that time, that she spoke about wanting to do the EOLOA. Penny’s daughter called me this morning and informed me that her mother plans to take the pills at noon tomorrow.  She then said that her mother wanted me to be there.   Her daughter asked that I arrive fifteen minutes early so I can talk with her mom.  I have no words but will speak from my heart.

TOMORROW

I met her about one month ago

when we admitted her to hospice.

She was bedridden due to a leg fracture

from the cancer spreading to her bones.

She has always been so independent

which was understandably important to her.

Now only seeing a dependent future,

the End-of-Life-Option-Act is for her.

Her daughter called me today, saying

“You said two hospice people can be here

when Mom takes the end-of-life pills.

She has chosen to take them at noon tomorrow.”

She then continued, “My mom wants you to be here.

You gave her so much comfort when you visited.

You were so supportive to us all.”

With tears in my eyes, I softly answered,

                         “Absolutely!”

I was so shocked and surprised;

hearing that I made such a difference to someone,

while doing something that I so deeply love.

All I can say is “Thank you”,

                         but it is so much more.

“You gifted me with witnessing your transition

This is something I will never forget.”

You shared, “I believe in a higher power”.

I deeply believe you will hear, “Well done”.

“But then, what is going through your mind tonight?

Do you have any fears or concerns?

You learned so much during your life that

you will soon know the truth and the love about it all

                         Tomorrow.”

ADVOCATE

“Joan”, ninety years old, has suffered from dementia for many years.  She has lived in a Memory Care Unit of an Assisted Living Facility for ten years.  Joan’s daughter, “Diane”, lives nearby and is very involved and supportive of her mother.  Mom took a fall a few weeks ago and broke her hip.  She had some physical therapy, which did not help her weakness at all.  She returned to her Memory Care Unit this morning.

Due to her dramatic decline, we admitted her to Hospice today.  She continues to become weaker and is no longer able to eat regular food as it causes her to choke.  She is now on a pureed diet with thickened liquids.  She has a lot of anxiety as has been bedridden for three weeks.  I hope that hospice can support she and her daughter as needed.

ADVOCATE

Mom lives in a memory care unit

as her dementia has increased over time.

She's been Mom’s primary contact; the caregiver

for almost eleven and a half of those years.

Mom took a fall just three weeks ago

and has dramatically declined since then.

She is so weak, she is now bedridden;

                         unable to walk like before.

We met the patient and her daughter

in Mom’s room at the assisted living facility.

As we were explaining hospice’s support;

Mom would interrupt us every five minutes or so.

Her daughter would immediately respond

wanting to comfort her; to ease her anxiety.

This visit took twice as long as normal

as the daughter wanted minute details

                         about hospice’s support as well.

Her detailed needs tested our patience

as we wanted to move this meeting along.

But then, I thought, “Be where she is,

as there is no right or wrong way here.”

She had total control during our visit,

wanting to know everything that was available.

As I was leaving the meeting, I deeply shared with her,

“Continue to let us know what you need or don’t understand,

as you are giving Mom the best gift of all; 

                         being her advocate.”