In the very early morning hours I lay next to my husband – we were supposed to be sleeping, but neither seemed to be capable of staying in that peaceful state. We didn’t speak, each lost in our own thoughts as we drifted in and out of slumber. We listened to the furnace try mightily to keep up with the frigid December temperature in the largely uninsulated home, and the steady drone of an oxygen concentrator in the next room.
He had a good idea of what was coming, I’m sure. On the other hand, as nurse, I knew exactly what would transpire. We held hands under the covers, our toes touching near the end of the bed. It was cold, very cold in the bedroom of the mobile home that was his mother’s “summer” home – the rest of the year she lived in Florida, in the house I now call mine. She and my father-in-law usually left for Florida in the fall – when the air became thick with smoke from burning leaves that robbed her of what little breath she could draw. Her lungs had been damaged from whooping cough as a child, and a life-time of smoking had exacted a large toll on her weakened lungs.
Earlier that fall I had sat with her in a hospital room – she had insisted – when her pulmonologist delivered the diagnosis. Cancer. Small cell lung cancer. Rapid-growing and likely to spread if untreated. She clutched my hand, gasping for breath, but stoic. She couldn’t bring herself to speak so I asked the questions I thought pertinent. I was her medical liaison. She listened as the pulmonologist outlined treatment options and indicated his thoughts on her prognosis. She left the hospital, armed with referrals, brochures, and faint hope. She made plans to return to Florida and decided on a course of treatment that involved both radiation and chemotherapy.
To me, though, she didn’t seem at all convinced that treatment was the right choice. When we spoke, I told her I would support any decision she made and would do my utmost to help navigate the maze of oncology health care and cancer treatments. Or not. She eventually decided to remain in Indiana – planning the trip to Florida overwhelmed her and she hadn’t much fight left. Eventually, she enlisted Hospice care, and made her peace with God.
She continued to entertain visitors from her little desk near her large “window on the world”. She ventured out occasionally, but every excursion drained her very limited reserves. Her breathing, never good in all the time I’d known her, became more labored and ragged, and she struggled mightily with even the simplest of tasks. Eating was such hard work. Dressing, too. I helped her shampoo her hair and styled it for her each week – and trimmed it when necessary.
My husband arranged to spend as much time with his mom as he could over the next few months, and I visited on my days off from the hospital. Her daughter visited before she became too sick, too weak to enjoy the company. We watched her weaken in body – but never in spirit. She had occasional bad days but was rarely tearful. Her weight dropped and she was unsteady on her feet. On her last outing from her home, she fell and broke her shoulder.
Ten days or so after her fall we had a tremendous blizzard. I was stuck at the hospital and worked an 18 hour night shift before a replacement could make it in to relieve me. I was too exhausted to try to drive home and unsure if I could make it there, anyway. I stayed at my son’s home a few blocks from the hospital and it was after just a few hours of sleep that I received a call – the hospice workers had determined that the end was near. She had asked for me to come. So I did. The highways had been mostly cleared but the below-zero temperatures were brutal.
A hospital bed was set up in the living room, near the window she loved so. She was exceptionally weak, but lucid. Over the next 24 hours she became too weak to get up to use the bathroom, so I contacted Hospice to see about getting a catheter for her – it was too painful to turn her to put her on a bedpan or change her bed linens because of the broken shoulder. I impressed my father-in-law with my ability to completely bathe a person in bed without spilling a drop of water and my ability to change the linens with my mother-in-law still in the bed. But mostly I tried to see to her comfort. Morphine and Ativan. Placed under her tongue because she could no longer swallow. Ice chips, and vaseline for her parched lips.
My husband and his step-father (her husband, my father-in-law) stayed by her side. Her older son was on his way, due in the next day or so, and a steady stream of friends and neighbors called or stopped by. It was evident to see that she was much loved. Even her physician stopped by on his lunch hour – the kind of thing you only find in small-town America. The hospice nurses were wonderful – loving and respectful to her and utterly dedicated to her comfort. Her older son arrived as expected. She continued to stubbornly, and bravely, cling to life.
But after three days of hanging on, in those early morning hours, we were not surprised by my father-in-law’s knock on the door. “It’s time,” he said.
We got up hurriedly. I listened to her lungs – no breath sounds throughout most of her chest, and only gurgling noises up near the collarbones. Her lungs had filled completely with fluid. Her breaths came irregularly – long, agonizing silences in between. Her limbs were mottled and blue. And oh, so cold.
I sat by her side and held her hand – she looked at me, gasping, eyes clouded but seemingly focused. She turned to her husband.
“I’m ready” she whispered.
Her husband leaned in close and spoke softly in her ear. “I’m here. Right here. I can fix almost anything” his voice caught. “But I can’t fix…this. I love you”. A tear slid from his eye. He placed a kiss on her forehead, then rested his forehead on hers. His tears fell on her face.
I leaned in and whispered in the other ear. “I’m right here. You go ahead. We’ll be all right. We’ll take care of each other. You don’t have to worry about us. We’ll be fine.” My own tears flowed onto her pillow.
She breathed a few more shallow breaths then slipped quietly away. We held onto her for a while, then wiping our eyes, hugged each other. When the oxygen concentrator was turned off – then, and only then, was she truly gone. The silence made it official.
I now live in the Florida home that had been my mother-in-law’s. Every day I am surrounded by her spirit, which was mighty. I was always glad that we had come to love each other because, after all, we both loved the same man. And I was honored to care for her at the end.