One Step Closer (part two)

I decided I had better split this up, so it can be digested in smaller segments.

Here is what has changed since my early morning conversation with Grandma:

My fiancé, Brian (who is, by the way, quite wonderful) has to leave for work a little after 6 in the morning.  Most of the time, I try not to get up when he does, because I am NOT a morning person.  However, I am a very light sleeper, so I can't help waking up when he gets up.  Often, I go back to sleep for another hour or two after he leaves, but this morning, I could not - my mind started racing, and after about twenty minutes I realized that sleep was impossible, so I might as well get up.

I checked on Peggy, and she seemed to be sleeping peacefully, so I grabbed some coffee and turned on the computer.  After dealing with some e-mail, I was not quite ready to think about business, so I created this blog.  A few minutes before 8, I checked on her again, and she was still sound asleep.

At 8:30, when Ali, the hospice caregiver arrived, we went to Peggy's room and found her moaning and thrashing around, her eyes still closed.  There was a congested rattle in her lungs as she breathed - something I hadn't heard before.  When I touched her hand, she opened her eyes a little, but she seemed disoriented.  I think she knew who I was, because she smiled at me, but seemed confused when she looked at Ali, who had never been here before.  I wrote a note on Peggy's white board to introduce Ali, but I could see that she couldn't read it - she seemed to see the board, but there was no sign that she could comprehend what was written on it.   Ali found her condition alarming enough to warrant a call to Toni, the hospice nurse and case manager.

About this time, my mom arrived.  Grandma was getting more restless and agitated - she couldn't keep her eyes open, and she didn't seem to be able to focus on anything when she did open her eyes.  She mumbled a few words, but what she said was unintelligible.  She didn't seem to recognize my mother.  This was, naturally, very upsetting for Mom and she left the room in tears.

Ali and I decided it would be good to give Peggy another dose of the morphine, as well as a dose of Lorazepam, which as I understand it, is an anti-anxiety medication.  I've pretty much got a handle on the morphine now, but the Lorazepam was a challenge.  It comes as a tiny, tiny pill.  If the patient is not conscious enough to take it - which Grandma wasn't at this point - you have to crush it, mix it with a a few drops of of water, suck it up in a syringe, and, like the morphine, squirt the solution into the mouth.  I made rather a hash of the crushing, mixing, and sucking. I tried to do it on a saucer, and I don't know that I got all of the solution into the syringe, but I did my best.  Within a few minutes after receiving the medication, Grandma started to calm down.  She seemed to be breathing a little more easily and she wasn't thrashing around quite so much, but she still looked uncomfortable.

A few minutes later, Toni arrived.  She and Ali adjusted Peggy's bed and pillows to try to make her more comfortable.  When they rolled her, they had discovered that she had soiled herself a little - it wasn't much, because she hasn't had much to eat in the last few days.  They gently and efficiently cleaned her up.

I left the room at this point.   I am a fairly strong person and can handle a lot of awful emotional stuff, but when it comes to dealing with bodily function issues, I am next to useless.  I have a volatile and uncontrollable gag reflex.  I can barely pick up dog poop without choking.  My fiancé very kindly tells me that I have an extra sensitive sense of smell, which is one of the attributes that makes me a good cook.  What it boils down to is that bad smells make me vomit.

I went downstairs to see my mom.  She was really having hard time dealing with the turn of events. "She doesn't even know me.  I can't go up there - I can't stand to see her like that," she sobbed.  The last few weeks - and the last few days in particular - have been really tough on my mother.  In many ways, I think her spirit is a lot more fragile than mine.  Most people who know me would say that I'm a fairly tough cookie.  Only a select few who know me well have seen that there's a marshmallow under the outer crust.  My mom has no crust - she's ALL marshmallow.

Besides just being better equipped to cope, I have been dealing with my grandmother's gradual deterioration 24/7 for months now.  It's not easy, but after a while you learn to roll with it.  You have to.  You also don't have a clear perspective, because you're around the person all the time.  You're never away from her long enough to be shocked by the changes you see the next time you see her. Although my mom has come to the house pretty much every day for the past two months, she hasn't developed the tolerance for handling the changes.  She goes home, gets away from it for a little while, and then it's that much more of a shock when she comes back.  She sees the alteration in my grandmother's condition  more clearly than I do, and it frightens her.  Proximity gives me a little more immunity.

The other thing is, I'm a generation removed.  This is her MOMMY.  I am sure that, when we get to this stage at the end of her life (and believe me, I don't even want to THINK about that) I will be feeling what she feels now.  Right now, I feel that it's up to me to hold it - and her - together.  I don't say that to be an indictment of her, or to be self-congratulatory in any way.  It's just what is.

So my grandmother is upstairs dying, and my mother is falling apart downstairs, and I'm not sure WHERE I should be.  After running up and down the stairs a few times, I finally voiced this in front of Toni and Ali.  Toni had just given Grandma a second dose of medication, to try and make her a little more comfortable.  She showed me the RIGHT way to liquify the Lorazepam, by crushing it between two spoons, then adding just a tiny bit of water to dissolve it before sucking it up with the syringe - much more simple than the way I had done it earlier.  "Come downstairs with me," she said.  "Ali will be here."

We went downstairs and Toni and I sat down with my mom at the dining room table.  Toni explained, very calmly and gently, that Peggy is in the end stages of life - her body is starting to shut down, but her mind is not quite ready to let go.  Today is Friday - Toni said she doesn't think Peggy will make it to Monday.  It's a matter of days - maybe even hours.  She also told my mother that although Peggy may not be able to "see" her, she knows that she is not alone.  She knows when she is being touched, and she can recognize the touch of someone familiar.  (I don't know if that is true, but it made us feel better to hear it.)  It also helped my mom to find the strength to go back upstairs and sit with Grandma.

Ali left at about 10:30.  Toni stayed a little longer to make sure Peggy was comfortable and we were prepared to deal with whatever was going to happen the rest of the day. Mom stayed with upstairs with Grandma, and I came down to my office.  I tried to do a little work, but I couldn't focus on anything more than what's going on here in the house.

And so we begin the death watch.