When you are five....

When you are five, your parents are immortal, and will live on forever...

When you are fifteen, you understand that your parents are human, and at some time will pass on, but not for a long, long time...

When you are thirty, you recognize that your parents have noticeably aged, but will still be there for some time...

When you are fifty, you make time in your life to visit your parents, wondering how many more times you can...

When you are fifty-eight, you stand in a hospital hallway outside your mother’s room, discussing hospice care with her doctor...

May 10, 2017

Picking up my car from the body shop on a mid-May Wednesday afternoon, the familiar sound of my phone ringing interrupts my conversation with the technician. I check the caller ID and see it’s the nursing home where my mother resides. “Hello.” I listen to the voice on the other end. Mother has fallen out of her wheelchair, and has a cut on her forehead and is being transported to the ER. (This is not the first time I’ve gotten this same call.) I stop by a gas station to fill my empty tank on my way home. At home I tell Nancy what has happened, and head to the hospital.

This visit began as several others did in the past. She had fallen out of her wheelchair, and has a rapidly bruising and swelling gash on her forehead. The ER doctor says that the cut, while bloody, isn’t deep and will require a couple stitches and some glue to close up and heal. Almost exactly as ER visits in the past. But then, he said that there is another concern. While being treated in the ER, standard protocol is to hook up multiple devices to continually monitor vital signs. The doctor was concerned with her heartrate, which was excessively low, about 36 bpm. It might be something as benign as a potassium deficiency, or possibly something more critical. A cardiologist was being called in to assist with the diagnosis.

The cardiologist looked at my mother’s charts, and ordered another EKG. A few minutes later she returned with a somber expression. I don’t understand all the technical medical talk, but the gist is that the system that supplies the signal to fire to the various chambers of the heart isn’t working properly, resulting in all of the supply of blood to the body is being pumped only by the two lower chambers instead of all four. This could be remedied with a pacemaker, or we could allow nature to take its course. I asked if the pacemaker would improve her “quality of life” (a phrase I’d be using all-too-frequently these next few days). For the last few months, Mother had been increasingly confused as her dementia took a tighter hold on her mind. She was becoming less engaging, she was laughing less, and her singing in the halls of the nursing home had come to a halt. Her quality of life was definitely on the downward slope.

The cardiologist said that while the pacemaker would most definitely extend her life, it would do nothing to improve the quality. Her dementia would continue its progression and she would remain confined to bed and wheelchair, but she would potentially be around to experience this mental and physical state for a few more years. Having “Power of Attorney” seemed like a good idea years ago when my dad had the papers drawn up, but it did nothing to prepare me for this decision. I know that the correct decision is to forgo the pacemaker, but those words were almost impossible for me to utter without breaking down.

The hospital hospice staff was very helpful, understanding, supportive, and patient. They explained the entire process, helped me with the paperwork, and ensured that my Mother would be comfortably placed in her old room with her same roommate in the nursing home as long as was possible. The next day Mother was transferred back to her familiar surroundings, with familiar faces around. Home, as she knew it for the previous two years. The hospice staff said that she would be kept comfortable for the rest of her stay, and she would not see much difference in her daily routine, with the exception of having a few more visitors.

Nobody could answer my question “How long?” Television and movie doctors always have an answer for that! I would find out soon enough, she would last eight more weeks. Nancy and I made sure to continue our regular visits, and other family members and hospice staff and volunteers stopped in as well. Mother seemed in good spirits, but her physical decline was obvious. Her appetite faded, and she spent more and more time in bed. The last few times I visited, she was sleeping, and I’d make a rather feeble attempt to wake her, but she was soundly asleep. I’d stay at her bedside for a half-hour or so looking at all the photos hanging on her walls and shelves, remembering times that seemed so long ago, trying in vain to hold back the emotions that flowed. She never was in any pain or discomfort, but her color slowly faded to a pale sickly hue. I could never escape the realization that she was slowly dying in front of me.

I would receive regular calls from the nursing home staff with updates or changes in her condition. (I must say, the staff at her nursing home was outstanding.) On July 3 I received the last of these calls, informing me that Mother had refused to eat her dinner again. The nurse said that from her experience, this signaled the beginning of the end. Her rapidly deteriorating condition indicated that she might last only about 24 hours. 36 hours later...

July fifth, 3:42 am, the phone rings rousing me from my night’s sleep…I stumble, too late to answer. Voicemail alert...

When you are 58, you also plan funeral services for your late Mother...