Another Hospitalization, Another Birthday, Another Round with Hospice

It was a big week. Mama did a 40-hour tour of duty in the ER and hospital with Rebecca and me as ’round-the-clock support staff. Forty-eight hours post discharge we celebrated her 101st birthday with family, a few old friends, several fellow residents at the Manor, and cupcakes and musical guests.

Thanks to her caregiver’s vigilance and concern, we caught the bowel obstruction in its early stage; the third one in ten months. Last fall, the hospitalist assured us it will keep happening, in spite of due diligence to prevent it.

“She never complains to me,” the caregiver had said, “so I’m concerned.” She always complains to Rebecca and me, it’s exhausting to follow through on every whimper. (This is why we loved hospice checking on her twice a week.) Rebecca took her to her doctor, who sent them for an X-ray, which showed the beginnings of a blockage.

“The ER is totally backed up,” the radiologist told them. The full moon was approaching; the ER staff later told us it really is a thing, how it brings the hoards to the ER. With me in Seattle, we decided to see if she could get through the night in her own bed. Nope. Over the next couple of hours, she began to show more symptoms of advancing crisis. I went straight to the Manor when I got to town and found the ambulance at the door, the EMTs heading for the elevator.

The hospital is just across the street, but calling the ambulance gets her past the waiting room and into a bed. If there had been a bed. Which there was not. They finally got her into the coldest cubicle in the ER, keeping us busy fetching warmed blankets for her as she waited in pain until a doctor finally came hours later to order the morphine. Rebecca and I made guesses as to when she would finally be admitted. “4:00,” I said at 9:30. “That’s what I was going to say,” Rebecca said. We were a few minutes early.

“No one told me she had an obstruction,” the harried solo doctor said. We don’t know how or if that knowledge would have changed anything (or why he didn’t know); from the sounds of things there were some hurting people in there—twice the average the nurse said.

The first line of defense for a bowel obstruction, for readers not in the know—I know way more than I ever wanted to—is the insertion of a nasogastric tube. Look it up. Not pretty. The most painful procedure the ER does, the nurse told us—and it’s only done in the ER, so her doctor can’t admit her straight to the hospital. Even hospice, however, approves it as a comfort measure for this condition.

“I don’t want to do that again!” Mama said when we got to the hospital. “I would rather die.” Rebecca would rather die than watch it. When the time came she excused herself. I went outside the curtain, but stayed close. When it was done, Mama said, “That wasn’t so bad.” Kind of like childbirth, I guess.

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After we celebrated her birthday five days later, I got to thinking about how we as humans cling to life at all costs. Mama is ready to die. She told us at the hospital, she’s said it many times in the past five years I’ve been here with her, and she told the hospice staff (who is back with us, a happy result!). “I thought that was the end,” she said. “I wanted it to be.” But humans are not programmed to let go easily.

I just listened to “Falling Upward: A Spirituality for the Two Halves of Life,” by Richard Rohr. I wasn’t really into it, but a couple of things jumped out at me. The first, that we can’t rely on the tools of the first half of life in the second half of life, intrigues me. The second, that we are the only species in the animal kingdom that clings to life as we do. (Don’t hold me to the accuracy of what I think I heard, I was driving in interstate commuter traffic.) We find all manner of ways to avoid death, even when we are ready to die, keeping one foot in each sphere. (While at the same time, I might add, we find all manner of ways to avoid living; another topic.)

There is nothing wrong with my mother that will be her end. Except bowel obstructions. I’m wondering, now, about choosing to let the next one take her. The NG tube is all that stands between her and life’s end. Her Physician’s Order for Life-Sustaining Treatment (POSTL) includes a provision for IV hydration and intubation. I wonder if we should revisit that. She probably won’t have a heart attack or a stroke, according to her cardiologist, that would take her quickly and without choice. Her lungs are strong. She gets a flu shot every year and has had her two-part pneumonia inoculation. She is rarely sick. But the blockages are chronic.

Life is no longer suiting Mama. She says so herself. Her entire existence is walking, drinking, taking bowel meds, and eating the right diet—and fighting napping, go figure. All to put off the next inevitable blockage. But what if a blockage is the brass ring, her ticket across the great divide? Just because she can avoid dying from one relatively easily, does that mean she has to avail herself of the treatment? I’m glad hospice is back to explore with her, and her family.

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She didn’t enjoy her party. She said it wore her out and wasn’t what she wanted. We are thoughtless daughters. I told her she gave those who were there a gift, maybe that could be enough. And it pleased me to serve bite-sized cupcakes, a strawberry, and tiny cups of pink lemonade to the residents in the sevenfold amen of their lives. It felt like communion.

Perhaps it goes back to avoidance of living versus finding enjoyment where we can, even if there are consequences later. What does she want her last good moment to be? To be partying, or to be in bed gathering strength for the next health crisis? What do any of us want for our end? Or for today, for that matter.

“In the second half of life, we need to like what we have, and cease striving to have what we like” Richard Rohr. (Paraphrased, interstate traffic.)