A mother's hands

"A mother holds her children's hands for a while and their hearts forever."

We have been on a definite adventure the last few months. In January, Gramma started communicating her sense of wearing down and being ready to leave this life. In February, the circulation in her legs became so poor that she almost required a bilateral above the knee amputation. Luckily, we got her to the hospital in time. She continued to get weaker and weaker and more and more ornery. We did the best we could for her, but the day to day pain was exhausting for her.

On Mother's Day we had a fun-filled day, taking her to Chris and Diane's for a lunch cookout and then to my Mom and Dad's for dinner. After a week of not bouncing back from Mother's day, I took her to the hospital convinced she was probably having another UTI. She was pretty confused most of the time when we were down in the Emergency Room and got downright ornery when we got her up to her hospital room. She got it in her mind that she wanted to watch "Pirates of the Caribbean" and was pretty disgusted with me for not making it happen for her.

A couple of days later, I received a phone call from the Case Manager informing me that she was in Renal Failure to the point where she would require Dialysis. Gramma has said for years that she NEVER wanted to go through Dialysis. Since I am her Health Care Power of Attorney, it was up to me to decide whether the time had come to make her a Comfort Care. The plan was decided to finish treating her infection and then bring her home, where she would want to be. I went up later that day and she looked pretty good, sitting up in the chair, feeding herself, and oriented. I reviewed with her whether it was still her desire not to do Dialysis and she agreed that she didn't want to go that route. I saw her Wednesday and Thursday and whereas she didn't look as good as she had on Tuesday, she still didn't look as bad as when I had brought her in. The discharge to home was set for Friday.

Jonathan and I were stunned when we walked in on Friday to pick her up. She was lethargic, confused, and incredibly weak. We were barely able to get her home on our own, but we managed to get her home preparing ourselves for what the remainder of her time might consist of. They discharged her late on a Friday, making it difficult to coordinate the services we would need for Gramma over the weekend. Fortunately, I had given the agency that provided her Nursing Assistants a heads up that I would be needing help over the weekend. We cancelled any plans over the weekend and planned on providing the care she would require.

It was a challenge! Jonathan had never taken care of someone who was a total care patient before, so I had to teach him how to transfer her, turn her, dress her, feed her, bather her, change her....EVERYTHING. She had already started to sleep a lot and her interactions with us were limited.

By Sunday, she had gone even further down hill. We couldn't even transfer her into a chair because she couldn't even sit up and she wasn't really eating much at all. It was a challenge just to get her meds into her. Fortunately I was able to get an HCD that night from work, because that was when the phone calls really began as Gramma's children realized that their mother might be dying soon. We spent hours on the phone helping them to understand, attempting to help them gain peace, and allowing them the opportunity to express their love to her over the phone and some of them in person.

Monday, I called her case manager through Passport and maxed her services to having a Nursing Assistant there 8 hours a day. Gramma was taking lots of care and not knowing how long this might continue on, we had to return to work. The help was essential for us. Her longtime aid, Melinda Grimes altered her life around immediately and was there for us helping us through. Having Melinda there really eased our minds, because we knew that Gramma knew her and trusted her...and we knew her and trusted her. I went to the grocery store and bought her favorite foods, hoping that we might be able to persuade her into eating more.

Gramma continued to go down hill quickly and within a few days we called her Doctor's office and had them consult Southern Care Hospice for her.

Friday, Tommy and Camelia came to visit Gramma. At the same time, the Hospice Nurse and Social Worker came to open Gramma's case and begin providing services. She declined even more over the weekend, and we weren't sure how much longer she would be with us.

On Memorial Day most of the family arrived. There was a hub bub of activity as The Riegers, The Bullocks and Naomi all came to town to see Gramma. Teresa and Ken came. Kenny and Sarah came. Kevin came. Elisa and Bob came. Chris and Diane were there. April, Tim and Jamie were there. If there weren't family members physically here, they were here via the phone. The house was filled with people who loved her....and their love enveloped Gramma.

Feeling the love and energy from her children, Gramma started to perk up. Gramma loved her children and grandchildren deeply. She loved spending time with them. Their presence with her now was a precious gift to her.

Tuesday and Wednesday was filled with visitors in and out. On Wednesday night, I challenged Nicole and Michelle now that they had their opportunities to express their love and make their peace with Mom, that it was time for them to think about giving her permission to go. This was a hard conversation to have, and their hearts were heavy...but we all knew that it was time.

The next morning I couldn't even get Gramma to swallow yogurt to take her meds. Michelle showed up early, appearing as if she hadn't slept, requesting some private time with her mother. I left to run some errands to afford her this opportunity. While I was gone, I called Hospice and asked that they get the Morphine and Ativan to us in case she begins to get agitated or painful. I was only gone a few hours, when Melinda, the nursing assistant called and informed me that Gramma's breathing was starting to become labored and rattling. I hurried home.

The meds came that afternoon. By dinner time, Gramma's breathing and agitation was worsening. Michelle and I decided to give her the Morphine and Ativan to help ease some of her agitation. Shortly after, the family all began arriving. I texted Krisi (who works for Southern Care Hospice) and let her know what was happening. She came to offer support. We opened the bedroom window to allow for some air circulation and Nicholas thought it was good fun to come to the window from the outside and scare everyone. I had asked him to stop, but as usual he thought he knew better.

About 9 pm, there were several people gathered in Gramma's room. She started to act agitated again. It was too soon to give her another dose of meds. So Nicole and Michelle started singing "Three Little Birds" by Bob Marley. They started dancing around. Watching the labored breathing increase, I looked at Krisi inquiring if she might be dying right at this moment? Krisi's eyes told me "she thought so". I looked over at Gramma and she made a pained expression and took her last breath. I went upstairs and grabbed my stethoscope. When I returned to the room and listened, I confirmed for everyone that she was gone. Right at that moment, Nicholas came to the window and scared us all again. Grrrrr! This was at 9:05 pm, but we had to wait for the Hospice Nurse to arrive to officially call her time of death at 9:29 pm.

The rest of the evening consisted of goodbyes, tears, and consoling one another. Since May of 2005, we have been on this care giving journey with Gramma. We were with her every step of the way and did all that we could. In that time we had a lot of laughter, tears, and tons of growth. She taught our family things we couldn't have learned in any other way. We feel her absence in our lives for the time being, but we know we are so much richer from the love we received from her. We KNOW beyond a shadow of a doubt that we will be with her again.
Gramma, We love you deeply and miss you desperately!
"Don't worry about a thing, cause every little thing is gonna be all right!"