Poignant Timing

I have a slight fascination with the events leading up to the actual timing of someone's death. Some may call this recall bias, in other words, I simply just remember the one's that are unique giving me a false sense of the reality relating to the timing of death. This is likely true, but I still find certain narrative's inspiring.

In the last several weeks I have had several of these perfectly timed deaths. One family feared their father might die on his daughter's birthday. They had discussed this with him while he was still lucid. The birthday arrived, and he was actively dying. Perhaps he had a choice in the matter, because he hung on until 3 hours past midnight, just making it past the birthday date.

Another patient, an elderly woman known for her vindictive controlling behavior, seemed to be punishing her daughter,who had an overseas trip that had been planned for over a year. The two had the kind of relationship that was tolerant at times but bitter mostly. During an argument, the daughter told her mother, who seemed still to have months left to live, that she was leaving for her trip no matter what.  Looking from the outside, it seemed the mother wanted to put this to the test, suddenly taking a turn for the worse and dying on the eve of her daughter's big trip. The daughter kept her word, leaving for the airport, and thus missing her mother's graveside service.

This week I experienced a new one for me. The patient was a young 96, having lived in the same home on her family ranch/farm for the past 71 years. Her only son had adopted the responsibilities of the farm after the death of her husband. I assume it was a combination of a mild stroke and leaving her home that started the slide into a dying state.
The conversation they had went like this:

 "I don't think I've got long to live" she whispered to her quiet natured son.
He sat with hat in hand, well worn jeans and work boots. After a moment he spoke up, "Well Mom, I think we're gonna start cutting wheat this week"
She seemed to mull this over and made her deceleration, "I'll wait till the wheat's baled then"
The week came and went and things started to get a bit rough with her transition. I think she was trying to hold on. The wheat cutting then finished, so after some prompting from us, her son let her know the wheat was baled... and she became peaceful and died soon after.

The lesson for me in all this is that while we may not always understand the timing surrounding someone's death, often there seems to be a reason important enough for that individual to either speed things up or slow things down.

An unlikely artist

When we got the call that Cindy was coming out to the hospice house the warning was, "She's not going to last long." Cindy was in her 50's with end stage COPD.  She'd been in the hospital for weeks stuck on a machine called BiPap. They had worked on weaning her off this machine, but weren't successful and didn't feel comfortable using opioids like morphine to help her breath more comfortably.  She was frustrated and didn't want to continue to live with a mask forcing air into her lungs, stuck in a bed in a nursing home or hospital, so she decided to come to the hospice house.

Cindy was extremely anxious when I met her, years of smoking had left her thin and much older than her stated age. Her eyes had that scared, wide open look, as someone fighting for each breath. Introducing myself, I asked if she would mind if we tried a new medicine for her breathing and explained how morphine actually would ease the work her body was doing for each breath.

Within days, much to Cindy's disbelief, we had her actually off the BiPap machine and on simple oxygen through a nasal canula. Morphine had reduced the work of her lungs to the degree that she didn't require as much oxygen and wasn't in constant panic mode.

Suddenly she went from a woman who thought she had only a few hours or days left, to someone with months to live. Cindy now had another dilemma; an abundance of time to anticipate her death.

One of the things we offered to not only fill her time, but help her process her dying was art therapy. Cindy admitted she'd never done art, felt clumsy and inadequate. However over the next months, our art therapist worked with her on expressing herself.  At one of my visits I happened to mention how fun it would be to put on an art show with everything she'd been working on. The sparkle of pride in her eyes was all I needed to pass the task off to our amazing volunteer coordinator.

This was an art show like none other.  The artist sitting, oxygen tubing on, while her room was adorned with her work. We had refreshments, while friends, staff and volunteers flowed in to admire and praise the artist. Cindy beamed, a long time automobile plant worker, I know she was tickled to think of herself as an artist. When I look at her work below, I see more than the pieces; I see Cindy's peaceful face reflecting the respect, praise and love we gave her.

A fortune

One of things hospice organizations rely on is donations, especially for those of us in the non-profit world. These donations generally come by way of organized fund raisers and memorials.

One particular memorial I will not forget.  It had been a very busy day at our hospice house, several admissions and deaths. I had 2 medical students with me as well, so any spare moment was taken up teaching them little pearls of knowledge. Someone from the reception desk suddenly appeared in my periphery and motioned me saying, "Dr. C, would you have a minute to come receive a memorial up at the front".

This in itself was highly unusual, as typically families just sent memorials to us in the mail.  I must have looked confused because our receptionist  further clarified, "They asked if they could specifically present it to one of our doctors."  Now I was getting excited, speculating that this must be quite a donation!  I had visions of lottery winners being handed over sized checks, as cameras clicked and hands were shaken.

"Sure" I replied with enthusiasm, having the two medical students come with me so they could be wowed as well.  Walking down our long hallway I was trying to speculate who it could be, and feeling just a bit nervous at this unusual request.

As I rounded the corner I encountered 4 people I knew quite well; John a mechanic in his 60's and his 3 adult children. We all hugged, as I began to recall the weeks I had spent caring for John's wife. John teared up a bit when he spoke up, "We just can't say enough about the care Dorothy received here. We wanted to personally present you with this donation so you can continue the good work you all do"  His rugged grease stained hands passed me an envelope and he gave one last hug. I smiled then as he waited for me to open up their gift.

The moment I had seen that it was John, I knew that I had been foolish to dream up some giant donation. This was a family who lived in poverty, who spent everything they had on medical bills and Internet "cures" for Dorothy's cancer.

As I opened the envelope and saw the check for $25, and met the eager tear streaked faces of the family, so proud of what they had scraped together, I too cried.

Walking back down the hallway, one of the medical students who had observed this all, including my uncharacteristic display of emotion quipped, "Wow, that must have been a really big donation! How much was it?"

"A fortune" I said, and left it at that.

A Mother's love

This Valentine's I am remembering Megan and the incredible love she had for her daughter.

When I first met Megan I was extremely skeptical about her ability to care for her newly born daughter Lilly.  Megan, 17 and Todd, her boyfriend, also 17 had just brought Lily home from the hospital for the first time.  They had no home or apartment of their own, so they were "crashing" with friends.  I entered the small apartment just hours after they had been discharged. Four other people were already living in the apartment, which was scantly furnished, yet cluttered and untidy. 

My primary interest was in 4 week old Lily, so I squatted down on the floor to meet Lily, as they had no baby furniture/equipment to put her in.  She was bundled in blankets on the floor, with an oxygen tube taped to her cheek.  Lily had several issues; besides being born with a congenital brain malformation, causing certain parts of her brain not to form, she also was born with a cleft lip and palate.  The combination of the brain malformations and the cleft left her with basically a large whole for a mouth and nose and lopsided eyes which she could not see out of.  All her nutrition was through a feeding tube.  Medically she had severe seizures on a sometimes daily basis, and didn't enjoy being touched and would scream out when being held. 

The reason I was seeing Lily was that she had been given a prognosis of only weeks to live, and I distinctly remember thinking that I hoped, for Megan and Todd's sake this was true.  They were just too overwhelmed.  I left that first night thinking a lot about Megan and Todd, both high school drop outs who had enjoyed playing video games during the day and partying at night. They had unexpectedly become pregnant and decided to do the "right" thing and keep the baby.  Now they were being expected to do something super human, and care for a dying child who had a distorted face and didn't like to be cuddled or touched.

Todd didn't handle it long, and left after about a month at home.  Lily, surprisingly thrived in Megan's care. At my monthly visits, I watched Megan work like a pro, getting the tube feeds ready, administering seizure medications, etc.  Even when she'd been up all night due to Lily's seizures, she spoke to Lily as only a mother could; gently, lovingly, and sweet.  The two of them had moved from one friends apartment to another.  Although different locations their "home" always looked about the same - always other teenagers at my visits, hanging out playing video games, always evidence of fast food meals, cigarettes and alcohol. But also just as consistent was Megan paying attention to Lily, asking about milestones and telling about little victories in Lily's head strength and cognition. I could tell when Megan looked at Lily she only saw beauty and possibility. 

Lily lived just past her 1st birthday.... Her death was tragic, not because she suffered or  had pain as she died, but because over the course of the year, Megan had fallen head over heals in love with Lily.  The immature teenager I first met had been transformed by love to become a wise responsible woman.  Megan embodied the kind of love that "always protects, always trusts, always hopes, always perseveres."