the other side of birth

Michael Hugh Nash left the land of the living on Sunday, December 12, 2010. He opened his eyes for the last time at 12:40 AM, he drew his last breath at 6 PM.

He was not a perfect man but he was damn good.

and so ends the great chicken experiment

Yesterday morning the daughter and son-in-law of a friend of my sister came and fetched all fourteen of the chickens. They chased them all around the chicken yard with a big net until one by one they caught them and put them in a big dog kennel. Then they carted the chickens, the feeder and waterer, the nesting boxes and the hay bales away. My sister, who has spent a fair share of time chasing those chickens around, remarked when we laughed at the spectacle of the catching of the hens, that she often thought to herself “What the heck am I doing chasing chickens, I'm a city girl!”

So no more fresh yard eggs for us until we find a new source.

She's been wanting to get rid of them for a while now but her husband Mike liked having them. Chickens need daily attention and right now chickens are the last thing on her mind. Besides, they weren't paying for themselves. It cost her more in feed and scratch every month than she got back in eggs. You need to have either just a few chickens or a lot of chickens to make it worth it.

She spends a lot of time contemplating her future life while Mike sleeps, can't even begin to visualize what spring and summer are going to be like. She has never lived alone. Back when, a girl lived with her parents until she married. After her divorce her two girls were still young and then she remarried. Now, her husband lays dying in the living room.

It's not been as hard as I thought it would be, to help her, to sit vigil over him as he becomes less and less responsive, to hold his hands when he becomes agitated, to soothe him, praise him, to let him know it's OK to go. When he's not grimacing in pain he looks much younger. He's lost a lot of weight and the skin on his face has smoothed out, his 63 years of living slipping away. If you look just at his face...his forehead, eyes, nose, cheeks...you can see the handsome man he had been.

Yesterday his elder step-daughter and his best friend, the one who had sat with him in the hospital one day, arrived. He woke up for them, his eyes alert as he mumble/whispered. Speech is really beyond him now unless he is extremely agitated and then every curse word he ever knew comes out clear as a bell. Today his youngest step-daughter is coming over and tomorrow his son arrives. Earlier, my sister and I weren't sure if Mike would last til then but judging by his small rally yesterday we think he will.

Monday is also his and my sister's 30^th wedding anniversary.

metastatic carcinoma unspecified

That's the diagnosis on his discharge papers. What that means is that the cancer is rampant in his body, in every organ and bones and they haven't been able to determine where it originated from. They will eventually be able to determine that but it takes time consuming and difficult staining of the cells to examine the insides of the cells which is why the results from the bone biopsy were/are taking so long. Without the test results to back them up, they can't say it positively but they are as positive as they can be without those results that it originated in his lungs. Which stands to reason since he smoked two packs a day for 50 years, starting when he was 10 and only quitting about three years ago.

I left here Tuesday to head up to the hospital so my sister could go home to get a good night's sleep and start the arrangements for the hospice care. She came back to the hospital Wednesday morning to consult with the doctors for the final diagnosis and sign the necessary paperwork. They decided to go ahead and discharge him without the results of the bone biopsy which they still did not have conclusively. When we questioned the need for this final test result since there was no treatment that could save him, they told us they needed it for the death certificate. They gave him three days to three weeks.

I asked how the death process would go. The doctor told me that once home the calcium levels in his blood would start to go up again and he would start to exhibit the same confusion he was experiencing when we brought him in. He would probably go through a period of irritability and then as his organs started to shut down, he would go into a sleep from which he would not wake up. His breathing would gradually become slower until he finally just never breathed in again.

My sister left, while I stayed, to go home again so they could deliver the bed and the other equipment they would need. Unfortunately, they forgot to get her to sign the DNR-in-transit paper so as an 'authorized family member' (one of the options) I signed it. They ordered the ambulance, disconnected him from the monitors, took out his IV and dosed him up with morphine. The ambulance arrived about 6 PM and then I had a long two hour drive home. I was met by my husband with a glass of wine, a good dinner and a blanket on the couch while he did the dishes, a reception made all the more poignant by the knowledge that my sister is losing her partner.

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Family members are coming in. Both my children visited him last Sunday in the hospital. His step-daughter (whom he fathered longer than their natural father) was with her mom and helped get the house ready. His other step daughter who lives in Albuquerque is coming in on Saturday. His son from a previous marriage is due in on Monday. There are other family members from whom he is estranged, all his blood relatives and his daughter (twin to his son), who are not coming and, in fact, have not even been notified. That can wait til it's done.

We are hoping Michael lasts and with some of his mental capacity intact until his son can get here. The hospice nurse who was there last night to receive him from the ambulance service thinks the process has already started. He is losing circulation in his feet and circulation to the extremities is the first thing to go so that the body can put it's energy and resources into protecting the torso and brain but even the brain will be sacrificed for the heart, lungs, kidneys. Hence the confusion of his mental faculties. My sister thinks he is waiting for his son whom he knows is coming. She thinks he won't last past that.

what did I come in here for?

Thought I would lighten the mood around here a little bit. I had several posts written before the floor shifted beneath us last week.

I heard recently that statins have been implicated in memory loss so it's a good thing I only take the lowest dose of my cholesterol drug otherwise those signs you see on the highways proclaiming 'missing elderly' might be about me.

I swear, my short term memory has gone missing. I put a pan of water on to boil for oatmeal, for tea and turn my back. Just like that, it is forgotten. I wander to my worktable and carve a bit on some wax. I wander outside drawn by the birdsong. I feed the turtle or check the ground for the last of the pecans or greet the day's blooms on the confederate rose. Any number of things vie for my attention. When I finally remember the pan of water on the stove it is half boiled away and I must start over. This time I linger in the kitchen.

I am easily distracted. Oh, I can focus. Intently. To the exclusion of all else. But unless I am zeroed in on a particular activity, I tend to flit from thing to thing. Like today. It's also the reason that it can take me three of four attempts to do or get the thing I set out to do or get. The minute I am in another room, poof. My purpose is forgotten and other things start clamoring for my attention. Finally I will make it back to my starting point only to realize that whatever errand I had set out on went undone. So I try again. And again.

I seem to have forgotten how to spell too, not that I was ever a great speller but I was, at least, adequate. Now, with these automatic spellcheckers, I am constantly having to make corrections. Some of that can be attributed to clumsy typing and I swear there are days when I can't seem to type worth a flip. But then there are those stubborn words that refuse to be corrected no matter how many times I replace the 'a' with an 'e' or take out that redundant consonant or add the extra one in or substitute the 's' with a 'z'. I seem to be consulting the dictionary more and more.

I don't know if these memory 'lapses' are due to the drug I am taking now or the copious amounts of different drugs I took in the past or just because I'm not dead yet. I don't think I'm in danger of wandering away. Well, obviously I will wander away, that's already been established, but I don't forget where I live so I think I'm safe. For now.

But regarding those highway signs? Keep your eye out for me anyway, just in case.

pain

I've been thinking about pain lately, physical pain, about how invisible it is. Unless you see someone grimace or hear them groan you have no indication that the pain is there. It is a completely internal experience and different people experience it differently. I have a fairly high level of tolerance to pain and my daughter has such a high tolerance to pain that her ectopic pregnancy nearly killed her before she finally hurt enough long enough to go to the hospital.

Those of us who have a high level of tolerance can't, I think, comprehend those that don't.

When my brother-in-law, Mike, first started complaining about the pain in his shoulder and right arm (which the doctors now think was simply arthritis and not damage to his vertebra), we expected he should work it off by being active, loosening and warming up the muscles. We all know the less you do, the less you are able to do. And at first he did. But as the pain spread and intensified, he did less and less until he nearly quit moving at all. And as he moved less and less, I'm afraid we weren't too kind in some of our thoughts judging his actions to be out of lack of effort. Our inability to feel his pain or relate to it caused us to be callous. Of course, we know now that something terrible was going on inside him and we had begun to suspect something dire in the last 6 – 4 weeks.

When we were moving Mike from the recliner to a wheel chair, from wheel chair to front car seat, totally inexperienced in doing this sort of thing (and just where was our advanced wilderness first aid, where we learned how to do stuff like that, when we actually had to do it?) the day we took him to the hospital. The three of us had to lift him up and out and turn him to get him seated. The minute we picked him up, from behind and sides, he started to slide down so that by the time we got him half turned, his seat was too low to get onto the seat and we were having a hard time keeping him from falling onto the floor. It was horrible but we did eventually get him in the chair and again into the car while he cried out and cursed with every small movement. I say horrible for us but we didn't feel a thing. I can't imagine how awful it had been for him.

Now that he is in the hospital and is on real pain management, he's come back to himself a little bit even if his decline has not been arrested. While I stayed with him last night, having slept really all day, he was awake all night. And so was I. Not only to keep an eye on him, to keep him from pulling at his IV or dismantling his heart monitor (which he did in the 30 minutes I was gone for breakfast) or even to help him eat but because these are the last days I will have with him. He's been a part of my family for a very long time and I'm going to miss him.

one day at a time

This is how the sky looked last Friday morning when I got up.

I'm afraid my postings are going to be a little narrow of focus for awhile. We are playing tag team over the next four days or so, my sister and her daughter and a friend today and I so that there is always someone there to help my BIL and be his advocate while he is in the hospital. He has been moved to a regular room and the nurses are very busy. He is eating again so that's good but he is still mostly supine and needs help eating and drinking and stopping him from fidgeting with his IV and oxygen.

He is still an invalid and his mental clarity did not return. He still gets confused, forgets things on the one hand. On the other, he knows who people are and you can have conversations with him as long as they aren't too long. Now and then his charm and humor show through. He knows now that he has cancer but he also thinks he has had a heart attack. I don't think he knows that he is dying. And he wants to come home. I don't even want to think about that part of it yet.

It's a sad sad situation as Elton John would sing.

a learning curve

This weekend is also the holiday glass art open house that we are participating in. Our friends the glassblowers host this at their studio every year. Marc is having to do it without me though I might drive to Houston after I leave the hospital on Saturday, spend a few hours at the open house to see my friends.

Since we just started making some new cast work what we are going to have at the open house is our learning curve. All the stuff left over from when we were first learning how to do pate de verre. A lot of it we gave away (holiday gifts from us were very predictable for a number of years), some of it we sold and the rest got put in boxes and stored. When we first spread it all out I thought we couldn't possibly sell this stuff, it's our history. The story of our learning. Each piece evoked a memory of where we were and what we were doing and what we were learning. I selected a few pieces to keep, looked the rest of it over for a few days and now feel no qualms about getting rid of it.

several things...

First, I would like to thank everyone who commented on my post 'families'...such warm and loving support and advice. You are all right and I know that most days. I know in my head that I did the best I could under all the circumstances, those under my control and those not. So, thank you from my heart.

Second, I would like to announce that I am a 'Grilled Grandma'. Lisa over at Grandma's Briefs hosts a feature where she interviews grandmothers. If you'd like to see my interview and peruse the archives of all the other grandma interviews, use this link.

Third, I have some terrible news. It is why I have been mostly absent here in the last several days. I wrote about my BIL the first part of November and their acute situation in regard to not having medical insurance and his deteriorating condition. Soon after I wrote this, he stopped eating and the pain he was suffering was escalating to the point that he could no longer walk and eventually could not even sit up. Over the Thanksgiving holiday weekend he started becoming mentally vague and lost his bladder control. They had finally gotten an appointment scheduled at the UTMB (University of Texas Medical Branch) clinic hospital for December 13, but with his sudden serious decline, I helped my sister take him the two hour drive to Galveston to the emergency room there at UTMB. My husband and I and my sister could barely get him out of his recliner where he had been living for the last month and into a wheelchair and then into the car. Every movement was excruciating for him.

To make a long story short, I have spent the Monday and Tuesday at the hospital with my sister while they did all sorts of tests and Tuesday morning, the attending physician told us that yes, he did have the damaged vertebra in his neck but that that could not account for the severe pain and his deteriorating condition, that the cat scan of his head and the chest x-ray had revealed a lesion in his skull, one on his ribs and a mass in his lung. She had to do more tests, to confirm her diagnosis but she was nearly positive that he had stage 4 lung cancer that had metastasized into his bones. They still needed to do an MRI but she expected to find more lesions up and down his spine. They had my BIL drugged into sleep to manage his pain and so my sister and I returned home (it's a two hour drive) so she could take care of a few things and return today for an extended stay. Last night the doctor confirmed that the MRI showed multiple lesions all over his back and a biopsy is scheduled for today to confirm her diagnosis. They have not, as yet, discussed possible treatment since the oncologist won't come on board until after the biopsy results are in. Neither will the attending physician hazard a guess as to how long my BIL has. She is leaving that to the oncologists as she is not a specialist. We are assuming at this point, that he will go straight into hospice care. I am going to be investigating that for my sister to see what kind of services are available for uninsured people in our home county so that she can bring him home to die.

This is, of course, only the beginning of the trouble my sister will have to face in the coming months and we are just in a state of disbelief at how fast this has happened. She is doing the 'if only' thing but even just one month ago he was still up and walking and talking and eating with no indication that anything more than the damaged vertebra was going on. Even if she had taken him in a month ago, I don't think the outcome would have been any different. He had been a two pack a day smoker for nearly 50 years (had quit about 3 years ago), had a slight case of emphysema (if any kind of emphysema can be considered slight) and so got regular chest x-rays. She is certain he had one this year, maybe even only 6 months ago, and it showed no indication of cancer.

Update – I wrote this earlier this morning and have just now spoken to my sister. She has met with the doctors, his condition is worse than they suspected and they are giving him a matter of weeks. She is still waiting for them to do the biopsy and they will have the preliminary results tomorrow to determine if radiation will help shrink the tumors to reduce the pain and make him more comfortable but, they stressed, it will not prolong his life. For my part, I have located a hospice organization that will help her at home regardless of ability to pay, or rather inability to pay.

We are in shock.