Tuesday, November 15, 2005

A Sweet Visit

I finally made a visit to my dying patient's home, or rather her daughter's home. I say that she's dying, but aren't we all? There she was, laying on her side in a hospital bed with a special pneumatically-controlled mattress provided by the hospice nurses. These beds are now de rigeur when patients are bed-bound and dying at home---pressure points and needless skin ulcers are avoided. A very valuable tool that most people in the world lack as they lay on their death-bed. What relative luxury.

Now that she's home and really only on "comfort measures", she receives morphine gel by mouth as needed, Ativan and Haldol liquid for anxiety and agitation, oxygen around the clock, and other "as needed" meds for nausea and other symptoms. Due to the large mass in her chest, she is limited to very soft foods and small amounts of liquids. It's said that a human can live a month without food, but only a week without water. At her current intake, she is able to just sustain herself, so no one knows how long this process might last. If the cancer is not advancing, she could remain in this state for some time, though the risk of infection and other complications is always high.

With "comfort measures only", she is no longer taking her HIV meds, diabetes meds, thyroid hormone, etcetera. She is now on a bare-bones regimen geared towards comfort and freedom from pain and psychic distress. This is often very difficult for the unitiated to understand, but it is quite standard practice in these sorts of situations. Additionally, as someone's body begins to shut down and they remain more and more confined to bed, drinking excessive amounts of fluids can only serve to cause fluid accumulation in the lungs, leading to pneumonia, congestive heart failure, or at least the feeling of drowing in one's own fluids. Not pleasant, but also a difficult concept for many families of the dying to grasp and accept. It seems cruel to limit fluid intake, but it is enormously helpful to the lungs and kidneys as they begin their deneoument.

I sat with this woman for about thirty minutes. As always, she asked about my wife, son, and dogs, and looked very deeply into my eyes. Her pupils seemed enormous, and her eyes themselves appeared equally huge---dark pools of feeling and life. I could not get over her eyes and told her how large and profound they seemed.

When asked if she believes in reincarnation, she replied "yes" quite quickly. I inquired about what other lives she has led, and she said that she had been an animal that lived "in the mountains". Pressed for more details, she could not elucidate other than to say that she has been many different animals in her time and that this life is her first as a human. She did, however, state clearly that she and I had met before, but I forgot to ask in what form I had made her acquaintance.

As is frequently the case when I visit her over the last few months---whether in the hospital or at home---we spent a fair amount of time looking into each other's eyes, both with and without a smile as we did so. I encouraged her to close her eyes, and stroked her face and head as she rested on her arm, the small stuffed moose which I gave her in the nursing home cradled in the crook of her neck. In her broken English, she looked at the moose and said, "I love you, cookie", hugging its plush softness to her face.

Sitting in silence at the side of the bed, I wondered to myself what might be going on in her mind at this time, no anti-psychotics to control her long-standing mental illness and anxieties. That said, when asked about her fears and concerns, she readily replied that she had no fears and no concerns, and felt no fear of neither death nor suffering. She seemed at her most peaceful---more so than at any other time in our five-year acquaintance.

I took my leave reluctantly, needing to head back to the clinic. Since I am no longer her medical provider, I can come and go as a friend, assured that the hospice nurses are providing the best care and comfort to my beloved friend. I know the day of her departure is not far off, and feel fairly clear that it will happen before the year turns its unavoidable corner.

Death can be soft, clear, almost effortless, and this is truly my wish for my friend. May death visit her with the gentlest of caresses, and whisk her away in a rush of flower-scented breath. This is my request tonight. May it be granted. May she pass with ease. May her passage be one of joyful release and return to the source. May she return to whence she came, and know that she graced my heart as she passed through this harsh, troubled, and painfully beautiful world.

1 comment:

Anvilcloud said...

When my mother was dying, I was also very concerned about the lack of fluids. Really, she stopped being able to drink without choking, and we wondered whether an IV should be used as it seemed bad to not let her at least have fluids. But they basically said what you did. I still find it hard to grasp, as simple as it sounds.