Thursday, August 30, 2012

Mom's Death

Margaret Dill Shaner
November 6, 1917 – August 17, 2012
May the Angels lead you into paradise;
May the martyrs greet you at your arrival
And lead you into the holy city, Jerusalem.
May the choir of Angels greet you
And like Lazarus, who once was a poor man,
May you have eternal rest.

My mother died at about 6:00 am on Friday, August 17, 2012.  She died in her bedroom here at our home in Martinsburg, West Virginia.  She was 94 years old.  Had she lived, she would have been 95 on November 6th.

For several years, Mom had complained of extreme shortness of breath.  Around Thanksgiving, 2009, while visiting my brother in rural Northwestern Georgia, she went to the emergency room because she could hardly breathe.  It was the worst her condition had been to that time.  The physician there x-rayed her lungs, listened to her description of on–going symptoms, and diagnosed pneumonia.  Mom was given oxygen, kept overnight in the hospital, and then released.  Returning to her home in St. Petersburg, Florida, she continued to live alone — a situation she almost to the end fought to preserve — and her symptoms continued as before.  In October, 2010, she was diagnosed with mesothelioma, a malignancy almost always caused by asbestos exposure, in the lining of her left lung.  She underwent six rounds of chemotherapy, the side–effects of which almost killed her.  She stopped chemo in the Summer of 2011 and began a schedule of periodic draining of the fluid from her left lung, a procedure that, at first, gave her a lot of relief, but, over time, did less and less to help her.

Early this year, her oncologist in Florida told her that, although there was no cure for her disease, she might live for an indeterminate time and that she should consider making arrangements to live in a place where there would be more help immediately available to her.  I constantly had asked, invited, and cajoled her to come here to live with us.  After hearing her doctor’s advice, she accepted my offer and we made plans for her to come live with us at the end of March.

She found one excuse after another to delay her move.  Beni was diagnosed with breast cancer and had a mastectomy in mid–March — Mom said she couldn’t possibly impose on us.  Mom was scheduled to have a permanent drain implanted in her left lung in late April — she had to stay in Florida to have that done.  Mom had to see her dentist.  Mom had to see her podiatrist.  One thing after another put off her move.

Finally, on May 17th, my daughter, Annie, and I went to Florida to get her and bring her back.  Mom moved in with us on May 19th.

From the time she got here, I felt an overwhelming need to take care of her.  For the next three months, until she died almost two weeks ago, I did just about everything for her that she couldn’t do herself.  Her local oncologist put her in Hospice care in early June.  Three times a week, Hospice staff would come to check her medical condition and to bathe her.  My daughter, Annie, would come every time Beni had chemotherapy for her breast cancer (every three weeks starting in mid–May and ending on August 6th).  While she was here, Annie would sit for hours and talk with Mom and take care of her needs.   When she was able, Beni prepared meals for her and sat with her on the front porch.  Mom was my life, 24/7, from May 17th until her death.  And I amazed myself by loving every single minute of the care I was able to give and the time she and I had together.

As the Summer went on, Mom got weaker and weaker.  She needed oxygen constantly.  She fell three times.  The worst fall, in the evening of June 24th, broke two bones in her pelvis.  We called for the ambulance and she was taken to the hospital here in town.  After making sure she had no concussion or other head injury, the emergency room docs diagnosed the broken bones, gave her strong pain medication, and sent her home.  She had severe pain when she tried to walk, but she was pain–free sitting on her donut cushion.  She made herself walk, however, and within three weeks of the fall she was walking almost as well as before.

Even though she used a wheelchair to conserve her breath, she and I went out a lot.  She invited everyone to go out to dinner with us, and we ate out often.  She and I went shopping for new clothes to fit her smaller frame, and for food.  We went to visit the home she and my Dad had built in 1970 in nearby Loudoun County, Virginia.  We traveled an hour and a half one–way to her bank so that she could enjoy the ride.  We went to Northern Virginia to check out familiar sights there.  We went along back roads everywhere to see the countryside.  Her last big trip was to the Allegheny mountains north of Mercersburg, Pennsylvania, so that she could see spots she loved from long ago.  She was raised in Northwest Pennsylvania and loved the mountains there.  Every night, as she got ready for bed, she asked, “What’s on for tomorrow?”.  Whenever I answered “nothing,” she was disappointed.

The last week of her life was busy.  The Saturday before she died, we went to Penney’s so she could look for long white pants and check out the tops in the petite women’s section.  Monday, she wanted to go to Target to find a lamp to replace one my dog had broken and then go to the supermarket “to pick up a few things” ($75 worth!).  On Wednesday, her final fully conscious day, she went with me to my doctor’s appointment in Winchester, Virginia, and then asked if we could have lunch at IHOP, one of her favorite restaurants.  She loved IHOP's scrambled eggs and turkey bacon, both of which she ordered and ate, along with an English muffin with butter and honey.

That night, she asked me to peel and section an apple for her to have for dinner.  I prepared the apple as she asked, and she ate it all.  She started to complain of pain in her lower right leg — not deep pain, but severe pain on the skin whenever it was touched.  I gave Mom her sleeping pill and she went to bed about 10:00.  About 2:00 am on Thursday morning, I heard her through the baby monitor I had set up between her bedroom and mine.  She was stirring and obviously turning on her bedside lamp.  I went down immediately and she said that the sleeping pill wasn’t working and asked for some more pain medicine.  I gave her half a dose of pain medicine and another half a dose of sleep medicine and she went to sleep.  I stayed with her until 4 am when I went to bed.

Thursday morning, about 9 am, Beni woke me because Mom was agitated and insisting that she was going to get out of bed, go to the bathroom, and “go home.”  Between the hours of 4 am, when she was perfectly normal, and 9 am, she had become very agitated and semi-coherent.  I called Hospice and asked her nurse to come check on her.  When Natasha, Mom’s wonderful Hospice nurse, arrived, Mom had no measurable blood pressure, was still agitated, and was still talking about going home.  She said that she had enjoyed the coffee and the food, but she had to be back home by 4 o’clock.  Natasha told us that she was dying, to expect her death later that day or on Friday.  Throughout her stay with us, Mom kept asking me how much longer her doctors said that she would live.  Each time, I answered her honestly:  none of them knew.  I promised her, though, that as soon as they told me how much time she had, I would tell her.  When Natasha told us that Mom's death was likely in a matter of a day, I told Mom.  The first time I told her, she said, "Good!".  I wasn't sure, though, that she had understood, so I told her again an hour or so later when she seemed to be more coherent.  The second time I told her, her response was, "Wonderful!".  I know she meant what she said.

I called my brother and my daughters.  One of my daughters, Becky, left work at Noon and came for a final visit.  Becky talked with Mom for several hours and, during their chat, Mom had a significant period of clarity during which she asked Becky about her recent beach vacation and told her about our trip to Winchester the previous day.  She spoke on the phone with my brother, Bob, and with his daughter Cathy.  When Bob's son, Jim, called, Mom was asleep and couldn't talk with him.

The Hospice people called her oncologist who prescribed morphine for her continuing leg pain and another medicine for her agitation.  She took the first dose of morphine at 4 pm, went to sleep, and never woke up.  She never needed the agitation medicine.  When I went to bed at 4 am Friday morning, she had breathing more labored than usual, but she wasn’t agitated and she seemed comfortable in her bed.  At 5:30, Beni went in to give her the next dose of morphine.  Mom’s breathing then was shallow and very relaxed.  Mom took the morphine, closed her mouth tight to keep it in, and continued sleeping.  Beni had breakfast and, with her dog Lucky, went for a walk, returning a little before 9 am.  When she checked on Mom, she saw that Mom had died.  She died with exactly the same tight–lipped expression she had after her morphine dose at 5:30.  We called Hospice, and Mom was pronounced dead.   When we were preparing her for the undertaker, we turned her over on her side to wash her back and the morphine she had been given at 5:30 dribbled out of her mouth.  Her time fo death was set as sometime between 5:30 and 6:00 am.

The whole time Mom was here was a great time for me.  It was a challenge to find foods that tempted her to eat.  With her help, we gave Mom the foods she wanted, like rice pudding, ice cream, and French toast.  When she arrived here in May, she weighed 87 pounds.  The last time she was weighed, on August 1st, she weighed 94.3 pounds - not bad for someone 4'10" tall.  She was very proud of her weight gain, and so were we.  She and I had so much fun together on our outings, and we had so much time just to talk.  I knew that she was dying, and so did Mom.  We frequently spoke about her death.  As the Summer went on, and she became weaker and able to do less and less, she often said that she prayed each night for death.  She wanted to go to sleep one night and just never wake up.  With the help of the morphine, that’s exactly what happened.  I told her often how much I loved her, how grateful I was for so many things she had done for me, how much I admired the courage with which she had lived all her life and certainly showed in its last three months.  Every night when I gave Mom her sleeping medicine she would kiss me and thank me for whatever I had done for her that day.  She was, until the very end, a gentle, gracious, kind, loving, courageous, and stubborn woman.

I miss her more than I have ever missed anyone in my life.  Her death has shown me a new level of mourning.  I think about her all the time.  Painful as it is, I know it eventually will go away, but for now my grief is my statement of love for her.

May she rest in peace, love, and eternal joy.