13:15, 24 March 2011 — My mother’s body continues to shrink and contract into itself.  Her breathing is shallower than it was.  I think she’s fighting less.  The gurgling sound is still there, though less loud than before, there is simple less fluid left within her or maybe the sound which had seemed horrible at first, is now something I’ve adjusted to.  (It doesn’t seem to bother her.  I think she is beyond feeling bothered by anything.)

Death is a teacher.  The handsome young resident whom I referred to as Doc Bollywood in a previous blog, seems to have learned something and matured in the past couple of days.  He just popped in and asked how she was and seems to have accepted that she is dying and he can’t do anything about it and nobody expects or wants him to.  He’s gone from arrogance to compassion.

The bed opened at the hospice, but the family decided that moving her made no sense at this point, though a hospice might approve a higher dose of morphine which could possibly speed things along, but the dose she’s at seems to be sufficient to keep her from suffering, so speeding things up isn’t important.

Not having monitors, we can watch the process and speculate — count her breaths, debate whether or not they seem more shallow.  They are certainly quieter with less heaving of the body, less struggle.  Like labor, it’s probably best to let it happen on its own time.  It’s humbling.  Even those of us with medical knowledge, can’t know exactly what will happen when.

I’ve turned the music back on and just swabbed her lips and mouth.  I may close my eyes for a bit.

It’s been many hours since she last spoke, but her breathing is steady, loud and labored.  My sister and are sitting in a shit-smelly room in the Albany Medical Center, 5th floor, neurology unit.  My sister is reading her kindle by the light of the patient’s bathroom.  I am writing this backlit by my mac.  The music is something Bach-like via Pandora.  It’s not exactly a softly lit, pastel colored hospice room.  There was no room at the hospice, but at least they got my mother out of the “stroke room” where an eager neurology resident made idiotic statements about an 89 year old woman with advanced CHF and coronary artery disease making “a full recovery” in 6-12 months.

When confronted with the information that she’d had a heart attack as well as a storke and cardiology had told us they couldn’t treat the blockages because of the stroke risk,  Doc Bollywood didn’t blink.  He just said, “Well, that was cardiology. I’m talking from a neurological standpoint.”
To which my brother-in-law replied, “Are you saying she can live without a heart? Who do you think she is, the Tinman?”

That actor had it wrong.  Comedy is easy; dying is hard.

Physical therapy also stopped by earlier. We sat  astounded.  “I guess she’s tired.  We’ll come back later.”

Yeah, tired.  She’s just resting.

Not everyone who works in a hospital is crazy.  Only the doctors and the physical therapists. The nurses get it.  Comfort care when nothing else can be done.

My mother hasn’t said anything in the last six hours or so, and hasn’t said anything we could really understand since yesterday. — though there was a moment earlier  today when I thought she understood me perfectly and I imagined I understood her grunted, garbled reply.  I was telling her how great Jack — her husband, my father was and how much he loved her, how I still felt his presence, and the caring never dies.

She looked at me, and mumbled something, which I imagined was, ” He was a great husband and father.”

I agreed.

Now my sister and I just sit in a dark room and wait.  My mother gasps for every breath.  She was gripping our hands hours ago — holding on for dear life.  Holding on to dear life. But that’s stopped.  Her knees are bent up, the way we remember our father’s being.

On the phone to my friend, a nurse practioner in New York, my friend overheard the 9 PM announcement telling all visitors to leave.

“That doesn’t apply to you,” she said.

“I know,” I told her.

They finally gave her morphine.  A tiny bit.  My sister was worried.  My mother once had a bad reaction to it.  It was after a fall.  She was in pain, but the drug made her paranoid, hostile.  “I don’t want her to go out that way,” my sister said.

But finally my sister agreed it was time.

1 miligram to start.  It’s already quieted the breathing.

We’re staying the night.  Maybe in shifts.  I used to work a night shift in a hospital.  That was years ago, psyche, not medicine, but still it seems familiar to be here and odd, watching the woman who gave birth to me, contracting into herself, becoming smaller, smoother, more fetal.

Her strangely unwrinkled face.  Dying has a beauty too. It is as elemental, fundamental as birth, but not celebrated.  Still, there’s nothing tragic here.  We are not meant to be too long lasting.  None of us gets more much more than a century, and no one gets out alive.

The morphine is helping.