My watch this day began around 8:45 am and it is now 4:26 pm as I begin to write. The object of my duty as sentinel lies in a bed adjacent to the drab green and rather sterile couch upon with I perch, laptop in hand. The couch is made of some synthetic material with ruberized armrests – the kind of material that is easy to wipe down and sanitize.
She is dying. My ward, she is dying. Just last Sunday when I visited her in the ICU it seemed remotely possible she would recover from her fall and the hours she lay passed out on the floor before her friend found her. She became dehydrated from some unknown bug that left her with the “back-door trots”, as my mom used to call it. The bruising around her right eye and down her neck frame the stitches the emergency room doc put in her chin where it hid some hard object.
Nothing broken. The next couple of days her vitals improved and she was moved to a regular hospital room. Recovery went from possible to likely, or so I thought. When I came back to the hospital, Dr. Krill, a beautiful, full of life, young doctor spoke to me. Clearly she was not of germanic descent as the surname suggested. She was a head shorter than me with dark brown hair, almond shaped eyes, and the gold/-brown skin tone that matched her asian accent. She explained the fluid around her lungs and postulated that it could be the pneumonia that the IV antibiotics were attacking or it could be cancer – no one could tell at this point.
The spirit of compassion conveyed in he tone and in the gentle patience resting in her brown eyes permeated the moment as I struggled with a decision – to have them fight for life or have them ease her into death. I tried to split the difference and Dr. Krill gave a slightly befuddled look and the time to realize the discrepancy. Life. Death. My aunt, Helen, was somewhere in between.
I decided death.
Helen still had moments of lucidity when she would lock eyes with me and speak as well as she could. Her eyes were haunted with fear in those moments. Earlier on Tuesday, or perhaps Wednesday – time is no longer clear – I had yelled my questions to Helen who could not hear Dr. Krill’s high, lilting voice. The accent did not help Helen’s comprehension either. As best as I could make out from the guttural words she forced out between wet, rasping breaths, she did not want the needle and tube inserted that would drain the fluid from her lung. I told Dr. Krill to forgo the procedure.
Later, Helen blessed me with a little more clarity. She gave a diminutive wave with her left hand that I had been holding and croaked, “I just want to end it.” I am grateful that Helen managed to say that. The decision to move someone toward death weighs heavily. I informed the nurse of the decision to start palliative care. Actually, that must have been Thursday.
Joanne, the advance practice nurse with Hospice called me Friday around 11 am. I went from the hospital into the office to address the work that was beginning to form little piles in my mind. I truly cannot remember the last time I cried. Other than those little droplets that creep up at some especially moving movie, it may have been years since. No expectation of tears presented itself regarding Helen throughout the preceding days – until I spoke to Joanne. I cried to this stranger as I told he I would come in to sign the forms to start hospice care.
No, I was not actively taking a life. Yes, it is overwhelmingly likely that Helen would die regardless of how heroic the life saving measures. No, there was not a lot left for an 89 year old widower who proudly insisted on being far more independent than most of her years could manage. Yes, no matter how one explains it, the decision I made moved Helen towards the end of life; shortened the in-between. Such a decision flushed pain to the surface of my conciousness. I fervently hope she has or will entered into God’s Kingdom by receiving Jesus. I pray over and for her. I pray.
The nurse and tech just left the room. David, an averaged height, fit and tan man but his gray hair and beard speak to him being in his late fifties or sixties, offers much kindness though he seems to feel a bit helpless. He clearly wants to help very badly asking me each time if there is anything he can do for Helen or for me. Each time, I say “no”. Helen’s blood pressure when last checked was around 60 over 30. The gurgling in her chest has diminished greatly as her body dries. No urine even dribbles into the catheter bag. The hospice folks tell me that dying bodies like to be dry; dehydration is one of the least painful deaths.
Sometimes I look over stare for a moment just to make sure that my other sense has not missed something. She is breathing once about every sevend seconds and so I have to wait and see if she moves again. There is little sign of life in this withered seventy to eighty pound body. A body that she once gloried in, loving to be tan and driving her phenomenally cool green 1960 something Mustang convertible and smoking her cigarettes.
She truly had enjoyed a jet-set sort of life – especially for a Kentucky gal from a working class family. She would recount her time working at a Cincinnati radio station and attending fancy dinners with a suitor name Milt. I knew some of Helen’s history, but I learn so much more from two friends, Amy and Jennie, who stayed at the hospital many hours so Helen would not die alone. That seems right and a way to offer dignity when all else has slipped away. Helen valued her dignity as much as she valued her appearance.
She must have been quite beautiful and charming in those adventuous days of youth. Amy and Jennie both bits and pieces of history Helen has shared with them. Stories of often sharing drinks at lunch with the fellow co-workers, tales of enamored guys who courted her and took her on extravagant trips. Other intimate moments from her past that Helen never let her family glimpse. Helen was a private woman despite her outgoing nature. The stories I hear for the first time in these changing of the guard moments are new to me, but not surprising.
She married and loved Ted who passed years and years ago. She knew no stranger and would talk to anyone in close proximity. Not only would she talk to everyone, she would give abrupt advice and speak her mind in a way that might initially anger you but often ultimately endeared her to you. Her relationships with family were tumultuous to say the least. The events imparted to me by Amy and Jennie fill gaps of my own experience of my aunt. I cannot say she had a gloriouslife in whole; there were glorious moments. But I can say she had an intense one, both instense elation and pain. There was little “in-between” sort of existence for Helen.
Helen survived despite all odds. Even in my struggle over which course of treatment to take, I remain surprised that she lived to 89 years of age. Her chest is flat and scarred from the double mastectomy due to cancer. She smoked her entire life and continued after she was released from the hospital two years ago from that brush with death. Alcoholism robbed her of so much of her life and damaged many relationships beyond repair. There are other, even more traumatic but immensely personal revelations which will remain private. An intense will to live marked this frail frame before me.
Little sign of life now, except I sense her spirit still present. The words used in the Bible for spirit mean a wind or breath. In this in-between I am keenly aware of both the mere physical in and out of air keeping Helen’s body in a state of non-death. I am even more keenly aware of that other breath, that spirit, that I sense even without looking at her telling me she is still here in the in-between.
It baffles me that anyone who has been present at the moment of death could remains an atheist. There is a something present. A breath that exists but that cannot be touched or seen. I do not actually see the air passing in and out of Helen’s open mouth, but I seen the rise and fall of her chest. In like manner, I see no substance we call spirit but I can tell it is there. And I pray that Holy Spirit speaks even now with Helen’s spirit testifying to her in the final hours about Jesus – His death on the cross to forgive her sins, His gift of Spirit to regenerate her heart, and His ascension to the Father where He advocates for her.
I know that the moment will come soon where that otherness I sense – that spirit I am aware of will suddenly be not. If I am here when it happens, I know I will be aware of its absence more keenly that its presence. The in-between will be no more and only death – for this eighty-nine year old body. I pray her spirit will be in the throne room of the Father.
And I can only remember that for us all there is life that flashes for a moment, there is death that lasts, and the in-between that lingers offering a final chance – a final choice.
“Behold, You have made my days as handbreadths,
And my lifetime as nothing in Your sight;
Surely every man at his best is a mere breath.” Psalms 39:5
When this posts publicly, I will be at the funeral of my Aunt Helen. Offer a prayer if you will.
Sans Tache 