Mending Relationships

When Julie, the social worker from Hospice, visited my mom last week, she left a paper titled "Five Things".

It is one of the few papers she has kept, not given to me to file away in the Hospice File.

I went looking this morning on the Internet to learn more about The Five Things.  They come from a book by Dr. Ira Byock, Dying Well:  Peace and Possibilities at the End of Life and are described more fully in another book, The Four Things that Matter Most.  They are:

I Forgive You

Forgive Me

Thank You

I Love You

Good-bye 

I have put aside all hurt or resentment I might have had against you.  For all those hurts, large or small, I forgive you.

For those things I have done in my life which have hurt or harmed you, please forgive me.

Thank you for all the moments of light and friendship you have brought into my life.  Thank you for being my friend.  Thank you for being you.

I love you. Unconditionally.

Good-bye.

They fit beautifully into the theme of the study currently ongoing in our church based on Dr. Timothy Keller's book The Prodigal God.  Keller talks about unconditional love, families vs. community, and the restorative power of forgiveness, building his message from the (mis-named, he says) Parable of the Prodigal Son.  It, too, is worth exploration.

Give thanks for those who love  unconditionally.  Especially those who love you unconditionally.  

Don't forget to pray.

Another Milestone

The milestone is that I am out of the laundry business.  That is a good thing.  I hate having to do laundry on deadline when working around the whims of the weather.

The reason is not particularly good.  My dad is no longer able to help dress himself.  He is permanently in a hospital gown. I don't have to launder hospital gowns.

My mother surprised me.  I don't want her to ever say that we -- my brother and I -- prevented her from doing something she wanted to do, either from ignorance or neglect.  So periodically I offer her the opportunity to visit my dad.  I know better than to expect that she will accept.  This afternoon she asked when I will go again to see him.  She has a big shopping trip planned for tomorrow morning, so my late afternoon meeting with the Hospice RN is less than convenient.

"When are you going after than?" she asked.  

I suggested that Friday morning would be good.  It just might happen.

Seeing her again, her giving him permission to move on, just might be what he needs to take that next step.

Fearless hearts.  Peaceful minds.  Give thanks.  Hug someone.  Let someone know you care.  Don't forget to pray.....

Letting Go

You need to read my brother's post at ilind.net to understand my mood this morning.  It's titled, "Still too Strong for his Own Good".

Our dad is aware of what is happening in his body.  On the last two or three times I've seen him, he's said "I'm in bad shape."  He told me before the medical diagnosis was made that he had pneumonia.  He recognizes that coughing blood is not a good thing.  He knows what he can no longer do, no longer enjoy.  He knows there is no possibility he will enjoy those things again in this lifetime.  But he will not let go.

I think he is afraid.  It's a big unknown on the other side of that door.  Will he walk out into empty space?  Will he simply disappear from the universe?  Will he, as he was promised in those church-going years of his  youth, step into eternal glory?  Or eternal damnation?  Will he rejoin his parents and brothers who have gone before him?

Will he continue to live in the memories of those who knew him, who care about him?  Will he be remembered as a good guy, or a bad guy?  Will he fade out of memory and cease to exist, even there?

When my maternal grandmother was dying more than 50 years ago, her priest was a relatively young man who chose to follow his father's footsteps into the ministry.  He had a gift for working with the elderly.  My mother asked him one day why he, a vibrant young man, chose to work with 'old people'.

"When you are young," he said, "you need the church to give you something to live for.  When you are old, you need something to die for."

I continue to wish for my father a fearless mind and a peaceful heart.   Pray that he, and all those in a similar place, will find something to die for.

What a Difference a Walker Makes!

We put the new walker to the ultimate test on Saturday morning.  Can it do a craft fair?  Short answer:  YES!

I took my mom to our annual Daughters of Hawaii fair, an indoor-outdoor event featuring food, music, and a good selection of mostly upscale artisans and craftspersons.  She loved it.  And could never have done it without the walker.

To be fair, it would not be a good thing to turn her loose totally unsupervised.  There are little bumps like thresholds and fat extension cords and low curbs where it is nice to have someone unobtrusively pick up the front end of the walker to help it over the bump.  Down slopes need control, and up slopes need a little extra pull power.  Grass is not ideal.  Paved surfaces are great.  She would go,go,go -- then sit down to shop at a particular stall.  She could go where ever she wanted, meet people, enjoy being out in the world.

She shopped in "Dale's Attic", the rummage component of our fair.  She bought a bottle of marmalade, a lemon and a lime -- which look identical.  She tried on hats, looked at haku lei, exclaimed over the wiliwili lei made from a brilliant orange-red seed that you don't see much any more.  Maybe because an immigrant bug has killed off a large percentage of the population of wiliwili trees.  She looked at plants, and when I bought my Treasure of the Year (a gold and silver bracelet by Donna Cockett of Kauai, who happens to be married to a cousin), she bought one, too.  Different design, same maker.  I think she bought it because she liked the bracelet.  But she also bought it because the maker is 'ohana.
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By 11:30, she was tired and ready to go home.  But she never would have gotten past Dale's Attic without that walker!

Give thanks for the openness that allows us to swallow our pride and invest in the tools and aids we need to live a full life.
Don't forget to pray!

The Deed is Done

It is official.   My father is officially a Hospice patient.  His diagnosis is "adullt failure to thrive".  He has lost 4.5 lbs, more or less, in the last 30 days.  Not good.  He is refusing most meals, except for his 3 bottles of Ensure daily, and some fruit.  He seldom gets out of bed, although he can still walk with his walker.  We are assured that he is getting plenty of fluid, although they are not measuring fluid in/fluid out.

There are some real positives about Hospice care.  He gets another layer of nursing care, with a Hospice Nurse visiting at least twice weekly.

I asked what that additional layer would add to his care.  The answer?  "Another pair of eyes, eyes looking just at on patient, eyes looking specifically for his comfort, for small changes in condition or attitude, eyes trained to evaluate patients at this stage of life."  Oh, another pair of eyes looking from the same view that we do as a family, looking for signs that might be missed by a CNA who is dealing with 8-12 patients, each one with their own very important needs.  Eyes that are not tied by regulatory requirements to desks, patient charts, or medicine carts.

From my own perspective, it means dealing with RNs whose native language is English.  Don't get me wrong here.  My dad has been getting very good nursing care.  But the primary language of most who work at Oahu Care Facility is Filipino, Korean or Vietnamese.  There are communication gaps.  I wrote about some of them the other day.  In the US, men wear suspenders to hold up their pants.  In the UK, suspenders hold up hosery.  Braces hold up pants.   If I asked about braces from a UK perspective, the American thinks about teeth straightening.  When your first problem is translation, the more subtle differences get lost.  You don't always understand what the other speaker is asking or telling you.

It means having a nurse on call 24/7.   I've used that wonderful service in another lifetime -- another place, another patient.  I am incredibly thankful that there was someone to call whenever I needed them.

From the perspective of the checkbook, Hospice Care is well covered by my parents' insurance.  Ordinary long term care is not.  So we have suddenly dropped out of full private pay status into a much more budget friendly  insurance patient.

St. Francis Hospital, manager of this Hospice program, is a Catholic hospital.  They believe that spiritual and emotional health is important to physical health.  They offer both social workers and a chaplaincy program.  I've asked that a chaplain visit my dad -- not as a Catholic priest, but as a friend who comes to talk and visit, and who offers to pray with or for my dad at the end of the visit. He is not a church go-er, has not been for many years.  But he did  regularly watch Dr. Robert Schuller (TV's Hour of Power), and he did grow up as part of an active church family.  It's worth at least  one visit.

Give thanks for Hospice care in local communities where ever they may be.  Give thanks for those devoted folk who dedicate their lives and service to those whose lives are drawing to and end.

Don't forget to pray.

Decisions, Decisions

Ian and I are of one mind as to the care of our father.  That is a very good thing.

The morphine, even at low dose, is easing his pain, allowing him to sleep, and keeping his oxygen connection in in place.  That's good.  

A chest x-ray taken this morning shows that our dad has pneumonia.  His MD wants to try 3 doses of an antibiotic, to see what happens.  He also agrees that Hospice Care is appropriate, based on the type of treatment plan we are following.  

The order has been written, and the wheels are in motion.  Staff from Oahu Care will contact St. Francis Hospice tomorrow.  From there .... one day at a time.  

I wish him a fearless mind and a peaceful heart.  

Don't forget to pray.  

It was not a good day.

Yesterday when I went to visit my dad, he had to demonstrate that his nose was bleeding.  It wasn't free bleeding, like when you get smashed in the nose and require a small mountain of cold washcloths and some judicious pinching to staunch the blood flow.  Instead, he blew into a paper napkin a moist clot containing about 1/4 tsp of blood.

He complained of pain in his shoulders, more intense than it was earlier in the week.  He has been taking Tylenol to ease the pain.

He seemed apprehensive.

His charge nurse called just after 8 a.m.  He was awake most of the night, coughed a lot, and coughed up more blood.  His 0xygen level was running about 90%; he was placed first on a nebulizer, then on oxygen.  By breakfast, his oxygen level was up to 97%.

When Ian saw him early this afternoon, he seemed disconnected from reality.  Ian didn't think he was recognized.  He age only about two bites of lunch, and then only with assistance.

By 2:30 p.m. when I arrived, he was dozing, but woke when I put my hand on this shoulder, opened his eyes, and called me by name.  He dozed again, but when a little old lady from down the hall "came visiting", he thought she was my mother and greeted her warmly.

"Why, Mrs. Lind, I don't see nearly enough of you these days. Won't you sit down?  Bonnie, help your mother with a chair."

I did not correct him, and he was disappointed when a  nurse came to take the lady back to her own room.

He will continue to receive oxygen when staff can persuade him to keep a canula in place.  Better chance with that than a full mask.

He is receiving liquid morphine on demand, plus one or two drops on his tongue at bedtime.

Today the nurse practitioner, who will consult with the doctor tomorrow, suggested that he be placed in Hospice care.  They may or may not do the necessary diagnostic procedures to determine exactly what is going on in his chest.

At worst possible case, he has recurrent pneumonia.  Untreated recurrent pneumonia can lead to patient death in about 4 weeks.

I think my father is afraid of death.

Give thanks for the long, full life my father has lived.  Pray for a pain-free body and a peaceful heart.  Pray that he feels only love around him.