Deciding on Hospice

There's so little left of what used to be my mother.  She's toothless and listless.  She's not eating because she's not hungry.  Even chocolate can't entice her to put sustenance into her body; the same large bag of Hershey's Kisses has been in the bowl at the side of her chair for two months now.  When G'ma's not eating chocolate, you know there is something amiss.

She's still sparkly when I walk in the door, but there's no gleam of recognition beyond responding in kind to the smile in my eyes.  She knows she's supposed to be glad that I am there; she just doesn't remember why.  I remember when that kind of forgetfulness made me very sad. Now, it's just part of the gestalt.

She weighs less than I do, which is wrong on so very many levels.  Losing twenty pounds since May has left her without any padding. Her pants fall down unless her underwear is bunched up, preventing gravity from undressing her in public.  She's always cold, without fat to keep her warm. Add together her lack of energy, her thin skin, and the lack of adipose tissue and you are looking at a recipe for pressure sores.

She has no oomph at all.  Standing up from her recliner is a major effort.  Once she's up, she's too pooped to pop, too tired to move her legs to walk, too achy to exert the effort needed to get to the dining room. The staff has been wheeling her to her seat for the past week or two; there's just not enough time to spend assisting her with the walker.

Once she's at the table, she stares at the pureed food before her and falls asleep.  The ladies who sit with her are understanding and supportive.  There is no judgment, just an acceptance of the fact that she is fading away.

Pain medication is available to her upon request.  The problem is that she forgets to ask for it. G'ma's never been a complainer. When she winces as she's being dressed and aide will request Tramadol or Vicodin; aspirin and Advil have long since lost their effectiveness.  The heavier drugs leave her even more lethargic and non-responsive, though.  It's a difficult ledge on which to balance.

The med tech at the pod castle called a hospice care provider and signed my mother up for services. The fact that she was not entitled to make that decision or that phone call did not impede her.  I received a call from a nurse who was just about to go in and see your mom. She saw G'ma, I canceled the agency with a phone call.

Instead, I called Casa de la Luz, a hospice provider whose first order of business was to assess my emotional situation, then set up an appointment.  The intake nurse met us at the pod castle on Saturday morning.  She brought paperwork and information and a packet of papers and booklets to be read at my leisure.  That was quite different from the med tech's preferred agency, which left only the permission to treat sheet in G'ma's room. Does the med tech get a kick back from the agency?  One wonders.

If you are taking notes, this is the first lesson I learned: shop around and choose a place that warms your heart. Convenience for the care givers is secondary to your own well being.  I felt bullied into following the med tech's orders.  It took TBG quite some time to talk me down off the ledge and aim me in the right direction. Clear thinking is among the first things to disappear as the end nears.

The treating nurse met us this morning at the pod castle. She had no paperwork for me, just a warm smile and a gentle manner with my mom. She saw the lumps which are disturbing but will remain untreated. She measured the circumference of G'ma's upper arm and pronounced her skin and bones. It still makes G'ma laugh to imagine that she weighs less than I do so that is where we took the conversation. There is little left to waste away. She is a structure over an emptying shell.

There will be a hospice provided high-low-raise-the-head-special-mattress-equipped bed arriving this afternoon and, once again, I'll be asking the Fire Chief to move the regular bed out of her room and into.... where?  No charity wants a used mattress; I've called and been refused so many times that I'm giving up. Perhaps one of the caregivers would like it; they are not allowed to ask for items but may accept them if they are offered.  These are the details that distract me from the fact that my mother is transitioning.

That's the current terminology - transitioning.  It's a lovely word, reminiscent of the nesting I did before Big Cuter was born. I was moving from one part of life to another. It was happening without much effort on my part, just as it is for my mom. I washed and folded and straightened and decorated and waited.  She sits and yawns and sleeps and smiles and waits.

What goes around comes around and I am not enjoying this carousel ride at all. I'm well supported and not surprised and I know there is nothing I can do except keep her happy and pain-free and unafraid. Hospice offered a chaplaincy visit, but G'ma's response was classic.  For one brief moment, my mother was back.  With a raised eyebrow and a tilt of her head, she responded to "Do you want a Rabbi to come and visit with you?" simply and totally G'ma: "No. What the hell for?"

If she can smile, so can I.  I am so going to school on being a very old person by watching my mom dwindle.  As always, she's showing me the way.