They called me yesterday saying that she was breathing heavily and that she had pneumonia. This was her fourth time in one and three-quarters months that she had developed this condition - usually from aspiration. At the nursing home, her first day last Saturday, she started pulling at her oxygen tube, "... don't care don't care..." I could not see myself doing anything like that to her. I put it back on and she acquiesced. She had pulled her feeding tube out at least four times in the hospital. The first week of her hospitalization, she looked at her arm with the two vein 'pic' lines (tubes going up the inside of her arm and into her deep large vein) she said, to me, "take these off, help me up and take me out of here." Then, the second week she started going downhill. She had been in the hospital for so many weeks.
This last Tuesday afternoon, early, before I set out to go to the nursing home, the doctor called to tell me that he was shocked to see her in such a condition. So thin. So weak. "Do you understand her condition?" he asked me. I could rattle off what she was like before April 4, when she had this devastating stroke. And I could tell him all of the moments and doctor decisions that lead her to atrophied muscles lying in bed until that day... "No. Do you understand how she is. Do you understand palliative care?" "I know of hospice type care," I said. "No. Palliative care is a subset of Hospice care. In your mother's condition we are talking about quality of life. ... We can take the tubes out and give her some pain medication." "I would like for her to not have pain and to not have fear" I said, "but I have trouble taking out her tube feeding. She may look like she is not there but, some times she is..."
I was troubled by the doctor's jump to tell me this without meeting me. This was a Kaiser facility. I could not see myself giving the orders to essentially kill my mother. I knew she hated the tubes and being in these beds, having people wash her, and poking needles in her. But she was my mother.
SO, yesterday they called me and I came down to look at her breathing hard. She was heaving hard, trying to breath. Even with the tank oxygen going in her lungs she was gurgling and her eyes were slits staring no where in particular. I called the doctor and said "ok" And then he said, "You made the humane decision..." I had to go outside and look at the mountains, the sky, some tree somewhere. But the nursing facility was a horrid place - depressing. Cinder block and beige. The parking lot faced a Ukrainian Church and the rest of the community were of parked cars and dumpy little houses and lots of trash in the gutter - this was Hollywood.
I went back in and just held her hand and looked into her eyes and asked, "Can you see me?" The doctor was late and I listened and watched her. "I love you, Little Girl." Many times in my life my mother seemed like my little sister. I stayed there and holding her hand, smoothing her hair, watching her chest heave until she got too tired to breath. She had a pain in her chest, she winced, and then lost the color in her face. The nurse came in and I said, "She is gone."
I was thankful I did not make her decision for her.