Friday, June 17, 2011

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.

Monday, June 13, 2011

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.