Friday, June 5, 2020

Paliative care A peaceful death

I took care of my Mom in her last years. 
My wife owned a nice nursing home in Topeka and when Mom could not longer take care of herself we moved her from Florida to Kansas. 
It was an assisted living home. 

She was not one to join into all the social activities. 
She always said when we became old she just wanted a room to herself. 
I worked in Topeka and my wife was the administrator of the Assisted Living Home so we kept a close eye on her. 
Like many elderly, Mom would always be cold, hence she did not like to take baths or showers. 
The nursing assistant would go to my wife and say my Mom refused her bath. 
My wife said to go tell her that she said she must have a bath. My Mom loved my wife but still refused. 
For some reason when I would ask or tell her to do something she would do it.  
She is the only person in the world that when I walked in the room, she would light up and say delightedly, "Oh Brian!"

She had diabetes and lifelong smoking history. 
In assisted living she had to stop smoking. 
She had a living will and was DNR.
Do not resuscitate. 
The nurses would fuss about her sugars and I had to continue to tell them not to worry about it and not to send her to the ER (emergency room)
Finally she was having severe leg problems from poor circulation. I couldn't believe she was sent to the ER and the surgeon advised surgery. We deferred surgery.
Mom had a sudden deterioration and was admitted. 
I had my brothers come as she did not seem much time left. 
She hung in there till they arrived and she could say goodbye. 
She stroked my oldest brother's beard when he arrived at her bedside in a loving and affectionate way.  
More physical affection than me or may other brother ever remember receiving. 
He was her first born and was born with a birth defect that required leg correction as a toddler.  
He had the wear casts on his legs while in a baby crib. 
I think once he climbed out. 
My Mom always wanted to be a nurse and the care and love she devoted to him was the bond that was the strongest among all three sons. 

She was ready to let go. 

The next morning I am called that she had a stroke. 
I go to the hospital and see she is moribund. 
I call my brothers and say if they want to see her while she is still alive they need to hurry to the hospital. 

We are all there as she is still struggling to breath with Stokes Adams  breathing.  She was unconscious.

We are waiting for the Palliative specialist physicians to arrive. 

She had a low dose morphine every hour but it was not enough to relieve her suffering.

My older brother and I are both physicians and we are getting impatient waiting for the arrival of the specialist. 

We ask our middle brother what his thinks of us pushing the morphine earlier at a higher dose? He defers to us as physicians. 

I had privileges in the hospital and thought the nurses might let me write the order. 

Fortunately, the Doctor arrives.  
He orders a higher dose of morphine to be given right away.

My Mom passes away peacefully five minutes later. 

We were brought up not to show emotions in a military family.

To my surprise for the first time in my life I cried uncontrollably like a baby.  My middle brother did the same.
My oldest brother was stoic but.  My kids looked at me surprised.  They had never been close to their grandmother. 

My Mom died with her three sons at her bedside as well as two of her grandchildren. 
I should be so lucky at my end. 









































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