given how things had been progressing, Mom and Roland went on to work for a little bit Monday and i drove over to visit Grandma. i arrived right at the start of visiting hours to find her finishing up a bath with her carepartner. she was much, much worse than she had been to date, pleading and winded, though the carepartner was so kind and sweet with her. the nurse gave her her pills with a tiny swallow of water which she partially aspirated into her airway. though she coughed and coughed, Grandma could not get her airway clear. her agitation persisted and her struggles to cough up the fluid intensified. the nurses had already given all her pain medications and could not give her anything else for anxiety. after about a half an hour of trying to calm her, i could feel hysteria building. this is saying a lot given everything we have been through in the past year and a half. there was no way i could maintain the morning watch alone.
my mind cast about for anything that might bring her calm. her favorite pastor was going to be visiting later in the afternoon. i called Mom to get the pastor's cell - if she could come sooner, perhaps it would help. Mom called for me; she and Roland left for the hospital straightaway. the next 30 minutes crawled by. just as Mom and Rol arrived, the RT came in. after nebulization, Civogne performed NT suctioning to clear the airway. this is remarkably horrible to experience but was truly necessary to ease Grandma's misery.
after that, she was so terribly exhausted that she fell into a sleep of sorts. Sandra, the pastor, arrived and prayed with us for a time. this seemed to sooth Grandma and certainly helped sooth us. Sandra also gave us information on a place called Alive Hospice. after that, Grandma pretty much slept until ~5pm. they woke her giving a shot, after which she did not sleep for hours, and at which point we pretty much drew the line in the sand regarding any treatments outside of pain medication.
a wonderful admissions nurse from Alive Hospice turned around from her drive home to meet with us and get Mickey's paperwork ready for admission to Alive. she stayed an hour and a half completing paperwork and was just an incredible comfort.
Tuesday was better. Grandma had some restlessness but was fairly quiet overall. mentally, she seemed to be pretty much checcked out. the transfer was initially scheduled between 8-12 but the ambulance could not be arranged until 2-2:30pm. they arrived right at 2:30 and Grandma and i headed down to the ambulance right around 3pm. unfortunately, the ambulance AC died while they were upstairs with us. it was ~ 110F inside, obviously unacceptable. so back into the ER to figure out a solution then back to the room to wait for the new ambulance. during this whole time, Grandma was getting more and more miserable - the gurneys are just so very narrow and pokey. she was vocalized, i was crying and eventually even the burly EMT started tearing up.
the poor EMTs came back around 4:30 with the new ambulance and we left the hospital at 5 o'clock on the dot. we made astonishingly good time to Alive Hospice. hydrangeas were waiting in the room to welcome her. the staff is just wonderful and they settled Grandma in. instantly they had her on better and less invasive pain medications. the staffing is excellent - they currently have 7 inpatients in the unit, 3 nurses, a charge nurse, 2 carepartners, a chaplain, a social worker and a doctor.
in the meantime, both Brian and Frank arrived from out of town. we visited a few minutes at the new facility then left Grandma to rest. yesterday, the carepartners gave her a bath for which she was quite peaceful. they brushed her hair and tucked in stuffed animals under her arms. she was much much more peaceful and generally seemed mentally absent even when looking around. this is a very positive sign, suggesting she may be entering the last phase of dying.
one last thing to share today. this is a passage from the end of book provided by the hospice center:
I am standing upon the seashore. A ship at my side spreads her white sails to the morning breeze and starts for the blue ocean. She is an object of beauty and strength. I stand and watch her until at length she hangs like a speck of white cloud just where the sea and sky come to mingle with each other.
Then someone at my side says: "There, she is gone!"
"Gone where?"
Gone from my sight. That is all. She is just as large in mast and hull and spar as she was when she left my side and she is just as able to bear her load of living freight to her destined port.
Her diminished size is in me, not in her. And just at the moment when someone at my side says: "There, she is gone!" there are other eyes watching her coming, and other voices ready to take up the glad shout: "Here she comes!"
And that is dying.
-Henry Van Dyke
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