Thursday, February 15, 2007

as death approaches

The DOC explained the symptoms of approaching death; sleepiness, confusion, decreased appetite, decreased urine output, lack of response to calling their name. His breathing vacillated from regular breathing to irregular. With cranial involvement we can expect apnea. She explained Cheynes-Stokes respiration. This is the gradual increasingly quick intake of breath, followed by an episode of apnea, stopping breathing, for 15 – 45 seconds. As the body shuts down, it stops sending oxygen to the extremities. She said to look for cyanosis, which is the discolouration of the skin due to deoxygenated hemoglobin in blood vessels. Sometimes the organs shut down or the body sends oxygen to organs rather than the extremities. There is mottling in the hands or feet. Once this occurs, death is imminent - within 72 hours.
A web site entitled, “As Death Approaches” says: “The fear of the unknown is always greater than the fear of the known” and that is true. It was comforting to know what to expect, not that all of this has to occur. She reminded me to look after myself, to take regular breaks. She said to talk to him and let him know I was there. She felt for his heartbeat, which was weakening. She showed me how to do mouth care and told me that the mouth care he had received so far was excellent. Staff came in and helped them check his position. Dad was moaning and he was twitching. He could have been having more seizures. His forehead, where the tumour was growing, was a brighter red than elsewhere.
Brian arrived to spell me off and I went home for a break. He phoned on his cell phone every few hours, while I supervised the roofers and chatted with them. At 5:00 the clouds began rolling in and we were having snow squalls. I told Brian to come home. I had put a phone call into my brother and was waiting to tell him what was going on.
I made it back to the hospital for 5:30 p.m. after picking up a Sub sandwich and a couple of juices and potato chips – to hell with the weight management. At 5:50 the doctor arrived, he decided to pop in and see if I needed anything. The RN, came in at 6:50 and every hour until she left. She checked him and asked if I thought he needed more morphine. In hindsight, I wish I had given him some. I didn’t see evidence that he was in pain, but felt that he had no way of letting me know. He was still blinking; his forehead and hands were red. He was breathing 5 times every ten seconds. I don’t know why I measured it. It was good to have something to do, other than the mouth care.
I rearranged the big easy chair twice, eventually pulling it out and putting the comforter and three pillows on top. It was comfortable. The oxygen tank pulsed all night. That in and out was a form of white noise that canceled out all the noises in the hall, people, and pages for various staff members, residents wandering the halls. I had brought my computer with family photos on it and was sorting the photos, traveling down memory lane and remembering all of the wonderful things dad was and had been for me and for many others: father, husband and volunteer. At 8:00 p.m., he was breathing six breaths every ten seconds. By ten p.m. I had inhaled my food, had one of my juices and watched four CSIs in a row! It was bizarre and most surreal sitting there checking him every so often. It was comforting watch the TV and removing myself from the situation from time to time. It was a breather of sorts.
I went closer to dad, for the umpteenth time looking for signs. The RN had checked his feet for cyanosis, but I found it in his hands. I looked at one eye and a tear was starting to fall from it. For some peculiar reason I hesitated – do I ask for more meds? He was otherwise quiet and didn’t appear in pain. When the other eye began to tear I pushed the buzzer and asked for morphine. It was 10:45 p.m., I looked at dad’s ribs sticking out, his organs were so small and there appeared to be nothing left of him.
At 11:00 I did mouth care for him, just as Diana had done. I made a mess and got Vaseline on his beard, but didn’t worry about it. I knew he would forgive me.

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