The Call

It came just after 7:00 this morning.  RN Mike made the call.  My mother had slipped away  only moments earlier, shortly after a  bath and shampoo.  Both nurses were at her bedside holding her hands, assuring her that she was not alone.  When the time came,  it was quick and peaceful.   It was just a struggle getting there. 

Here are two of my favorite photos of my mother.  I believe the earlier photo was her University of Hawaii graduation portrait.  She graduated with a degree in Food Science in 1935, and went on to teach for several years in the Home Economics Department under the mentorship of Carey D Miller.  She earned a small pension which provided medical coverage for both my parents once she reached retirement age. 

The second photo was taken at the Honolulu Academy of Arts (now the Honolulu Museum of Art) where we celebrated her 96th birthday over lunch at the Pavilion Cafe.  At 96 she was still ageless and sparkling, with a quick smile and a keen memory.  She told us that day of her experience as a teen giving loom weaving demonstrations at the newly opened Art Academy.  The Academy opened in 1927; she couldn't have been more than 14 or 15 when giving those demonstrations.  At the time she was an honor student at Kamehameha School for Girls.  

Helen  Mililani  Yonge)  Lind
15 May 1914 - 29 Jan 2013

1935, age 21

 2010, age 96

 

My mother was the last of her generation.
She was the last of her siblings.  

She was the last of my father's siblings and their spouses.

In her own generation, she is survived by one first cousin and one high school classmate.

She counted as descendants a granddaughter, a grandson and 5 granddaughters. 
Ian and I are now the kupuna in our line -- the elders.
That's scary! 

If you are so moved, she asked that
memorial contributions be made to the
Helen Yonge Lind Scholarship Fund
University of Hawaii Foundation
2444 Dole Avenue
Honolulu  HI  96822

Our mother was a fighter,
a heavy contributor to what to her are important community causes.
Ian and Meda have a favorite card which expresses her philosophy.
It is attributed to labor and community organizer
Mary Harris "Mother" Jones  (1837-1930)

Mother Jones said, 

Pray for the dead.
Fight like hell for the living.

 

Hanging In

At some point the battle will end.  The body will fail.  Not the will.  This has been a real battle, not the peaceful crossing for which we hoped. 

My mother is hanging onto life by the finest of threads.  We felt sure that she would pass late on the 25th or in the wee hours of the 26th.    She didn't.  We visited, we watched, we waited. 

Yesterday I prayed.  "Please, Mama, don't go today, it is Christie's birthday."  

Christie is her first grandchild and only granddaughter.  We had a little chat about the birthday.  OK, it was a monolog.   "Do you remember when you came to Palo Alto?" I asked her.  "Do you remember the flowers you brought?  Two dozen anthuriums in the palest baby girl pink."  They were spectacular.  No single flower was less than about 6" across at the widest point, and there were so many!  She had purchased them earlier in the week and hand carried them from Honolulu to San Francisco.  "You got to the hospital and proudly carried those flowers down the hall to my room.  'It's a good thing this baby is a girl,' you told me.  'I would have looked pretty silly with all this pink for a little boy.'"  

The boy came 3 years later.  "You picked him up at Honolulu Airport, brought him home, and called all your friends and neighbors to come and see your grandson before his parents saw him.  You had bought him a beautfully soft blue crib blanket, and wrapped him in it before you returned him to the airport for the rest of his trip from Maui to Los Angeles."  

My mother had not been supportive of adoption.  I asked her what changed her mind.  Short answer.  "You didn't tell me you were going to adopt a Hawaiian baby!" 

The 28th arrived, gloomy and wet.  Still no phone call. 

I left her bedside at 4:00 this afternoon.  Ian had been there in the morning.  Today she is sleeping deeply.  Periodically, her chest heaves as she pulls in a deep breath all the way from her diaphram.  The breaths between are shallow.  There are occasional gasps following a few seconds of apnea -- no external breathing.  Her hands and feet are cooling.  The tips of her fingers are taking on a blue cast.  Like mine do when my hands get cold.  But these are all early signs, not the ones that say, "It's time." 

Although she is totally unresponsive, the nurses assure me that she can still hear and on some primal level is aware of what is going on in her room.  So we talk quietly and avoid conversations that could be heard as trying to hurry her on her way, shove her out the proverbial door. 

This afternoon I indulged in a bout of retail therapy at Kahala Mall.  I will return to Palolo Hospice House tomorrow afternoon.  If The Call does not come before then.  And each afternoon until she decides it is time to leave. 

Keep on giving thanks for all those dedicated health care professionals who specialize in palliative and hospice care.
Don't forget to pray.

Another Kind of Transitioning

Someone once told me that it is OK for a parent to brag on their children, because if we parents don't, who will?  So here goes -- I am soooooo proud of my son!

My son is a journeyman craftsman.  His current employer announced the week before Christmas that he wants to retire, so is going out of business at the end of March.  Most of the 40-odd journeymen  in the shop fled, taking new jobs as offered before the market was flooded with out-of-work journeymen all fighting for the same limited number of opportunities.

Kimo, too, has been talking to foremen in other shops.  His name is short and easy to remember.  His  work reputation goes with his name.  He is reasonably well know among his fellow craftsmen, and generally well liked.   He has his eye on a particular shop where for reasons of his own he would like to work.    The lead foreman in this shop offered him a job with a start date in the near future.  "Will you quit where you are and take this job?" the man asked.

With an offer like that, the foreman expects the journeyman to leave his present employer immediately to take the new job.  Kimo has different priorities.  "I told him no, I would not quit.  We still have job orders that have to be honored.  Someone has to do the work.  I will be available when the work in my present shop is done."  

He said the foreman was intially taken aback but quickly recovered.   "Man, I appreciate your stand." he told Kimo.  "When you are ready, come talk to me again.  You have a job."

So Kimo, too, is transitioning.  His transition is different from his grandmother's.  He's not changing trades or general geographical work areas.  He is no longer working with a company where he is part of the family (as with his first employer).  He will no longer be working with an employer who has come to trust his judgement, his work ethic, and his ability to get along with customers and journeymen from other crafts and trades (as has his current employer).    He will have to earn the trust and respect of his co-workers and supervisors in a new shop.  He is beginning by making clear his standard that you work until the job is finished. That goes a long way toward building trust.

Give thanks for peaceful transitions.  Pray for the others.  Pray for those left behind. 

Transitioning

My mother is getting ready to move on.  She is in a Hospice House in Palolo Valley, a neighborhood in Honolulu -- an 8-bed facility operated by the Hospice organization which has provided her care since mid-September.  It is a converted private home, and a perfectly lovely setting.  I refer you to today's earliest posting at iLind.net, where Ian explains how we got to where we are right now.

The RNs on duty this afternoon explained carefully that our mom is clearly on the transitioning path, recognizing  her own mortality.  Apparently she has accepted that this is inevitable and is finally at peace.

No one is making predictions  or attempting to second guess our mom's choice of timing.  They say it could be this hour, or next week.  The end-of-life behaviors are there, but not the imminent  warnings.  Her eyes are glassy, as Ray's were when he opened them just before taking his last breath.  But Ray kept his eyes shut for the last 5 days  of his life, so I don't know when they began to glass over.  "She may," RN Geri told me, "be one of those who just goes to sleep one evening and wakes up in the next world."  That is the ideal, after the last week of struggle.  "Or she may be one who doesn't want to do this very private thing with an audience," Geri added.  "I've seen patients hang on through a family visit, then pass within minutes of everyone's departure."    I can see my mother doing that.  In addition to being fiercely independent, she is also a very private person who does not wear her heart on her sleeve.  She  might have passed on the independent streak, but my emotions are right out there for the whole world to witness -- good, bad or indifferent. 

This morning I forwarded to Islands Hospice a link to Ian's morning posting about ambulance response time for our mother (nearly 75 minutes after the initial call) and our very positive response to Island Hospice services and facilities.  Then added my own thanks to staff for going, in my view at least, above and beyond the job requirements to make a difficult experience as unstresful as possible.  Within an hour the telephone call came -- from the Executive Director of Islands Hospice, thanking me for forwarding the link and for our kind words about his organization.  It seems that extra mile is one of their team priorities. 

The seeds of a new cause have been planted -- improving health care accessibility for all the people of Hawaii, beginning with ambulance response times for lower priority patients like my mom was on Sunday evening.  Even the paramedic who responded  told me that his unit was available and could have responded far earlier if they had been dispatched in a timely manner. 

Give thanks for those medical folk at any level who specialize in pallative care.  Recognize them when they come into your life.

Don't forget to pray....

Awareness

My mom, who has consistently stated to all who would listen, "I am not dying." announced yesterday, "I am dying.  I cannot do anything."  Pointing to her head she added, "There is nothing there."

No hearing?  No memories?  Nothing what?

"Call the doctor.  Tell him I cannot do anything.  Ask him what to do." 
Had already done that.  Doing all we can.  Now it is a matter of willingness.  Willingness to fight.  Willingness to die.

I love you, Mama.

I thank you for all the things you have given me in my lifetime.  I thank you for sharing your love of genealogy and local history that is now so central to my life.  I thank you for demanding that I think for myself rather than blindly accepting someone else's viewpoint.  I thank you for demanding that I take responsibility for my own actions.  I thank you for the love of reading and learning that I've never outgrown.   I thank you for teaching me to be proud to be Hawaiian. 

I remember those chemistry lessons in the kitchen, making up for those chemistry classes I never took in school.  I remember all the things you made Ian and me do as we were growing up.  There was the year that Long's Drugs came to Hawaii,  you bought us each a pair of binoculars, then took us birdwatching.  And had several copies of the George Monroe bird book bound, one for each of us.  There the book about the constellations you gave me for Christmas, and we learned about the stars.  There were the trips, especially camping on Maui  during a hurricane ....  where we composed the Kaupo Serenade, with all the sounds that we heard during that night.  Including the ghosts walking in the cemetery on the other side of the dry stone rock wall.   You dragged us to the Volcano House, and ordered a wake-up call if Kilauea Iki erupted.  Pele came to visit that night.  It was the last Kilauea Iki eruption, and we SAW it!    Thank you!

I forgive you for all the things you have said and done that I found hurtful. 

Please forgive me for the things I have said and done that were hurtful to you.  I guess those  words and feelings are a part of being mother and daughter -- and probably too much alike.

If you choose to move onward to a new phase of life, I honor your decision.  If you want to stick around longer, I am here with a whole Hospice team supporting us both.  

I love you, Mama. 

... and in the sickroom ...

We are struggling to balance my mom's pain medication.  Goal = pain free and somewhat functional vs. pain free and practically comatose.  Not acceptable = in pain perceived as greater than 2 out of 10, with 10 being extreme.   Then there are the issues of nutrition and fluid intake, and a tablet  you have to swallow vs. a liquid medication given with a dropper. 

She surprised me this morning and made the Hospice on-call nurse (who was previously our case manager RN) laugh when she heard the story.  Despite my Mom's apparent lack of awareness, she was very aware of the conversation I was having yesterday -- in her room -- with her Hospice RN regarding the then current medication change.  "Don't give both the pill and the liquid," says RN.  "If you do, you will be double dosing."  This morning, after consulting with Hospice, am trying to give her both drops and half a hydrocodone tablet some 2 hours after trying to give the new, extended release tablet, which I am not sure she actually swallowed.  First reasonably coherent words of the day, as if giving a direction to an inattentive teen:  "I am not supposed to take two pills." 

Deep breath.  Explain.  "The Hospice doctor ["doctor" seems to be a magic word] says if you are still in pain after the first pill, this is what we are supposed to do.  He doesn't want you to hurt."  She  allowed me to give her the half tablet.  Thanks be to God! 

Don't forget to pray ...!

Deja Vu

Some experiences are not meant to be repeated. Today was one of them. 

My mom fell very early yesterday morning.  She didn't hurt her head, and her back -- which hurts -- isn't black and blue.  Her forearms are a little worse for the wear with a bruise at the wrist on the left and some torn skin on the right, but those are not the problem.  On the surface, this is not a life-threatening situation. 

But her back hurts.  Not the whole back, not even the spine. It hurts in the place that should be a multicolored bruise.  She says she thinks she broke a rib.  She says when she moves something sharp pokes on something else, generating a stabbing pain. 

Today I have been giving her enough pain medication (at the direction of her Hospice provider) that she has either been in pain but groggy or pain-free and asleep all day.  That means a tiny bit of morphine every hour.  Around the clock.   It has now been more than 5 hours since she was last awake enough to take a hydrocodone tablet and her allotment of morphine.  I cannot let her go too long without pain medication for fear that she will wake up in the same intense pain as she did this morning.  That was NOT good.   So dropped a tiny dose of morphine into her gently snoring mouth.   If I can get her to swallow another hydrocodone in the next 3 hours, I can sleep a little myself.  Hospice is working on a time-release morphine that works for 12 hours, but we didn't get the prescription authorized today. 

She has not eaten today.  She is barely drinking fluids.  She is having trouble swallowing, and her RN is suggesting a thickening agent.  She might try it, but I don't know if she will like it.  If she doesn't like it, it will go to waste.  I might try  some applesauce if I can get her to wake up long enough to swallow two bites.    Getting out of bed, even to get to the bedside commode, is a struggle today. 

All because she slid off the end of her bed and onto the floor.  In the dark.  Trying to do everything for herself. 

 Been here before.  Didn't like it then.  Don't like it much now.  Hospice is Heaven-sent.  Hospice and friends keep me sane. 

Don't forget to pray ...  Pray especially for those who care for the ill and the helpless -- like Jim, Deb and Terri along the Washington/Oregon border whose fight for Carl is much bigger than the one I face.  Pray for every Hospice worker who has ever lived.  Your affirm my faith in humankind.