Signs

Mum was especially lethargic tonight. It was worrying. She was slow to respond to questions, and had no appetite. She looked very pale and so very tired. I was getting anxious. Perhaps prematurely so, but I did not know what signs to look for. This is all new for me.

The nurse came in to check up on mum, mainly to check if the IV drips are functioning as planned. That is really what they do here at the hospice ward. Check on the vital signs, make sure that the vitals do not deteriorate, and if need be boost the patient's nutrient intake through shots and drips.
Normally, she would joke a bit and try to make mum laugh. Once she came in at the same time that the carer was hugging mum and helping mum to stand. "Doing the waltz, I see!" That got many smiles. But tonight, she was more subdued, and quietly left the room when she finished checking up on mum.

I followed the nurse out of the room. I told her my concerns, and asked her what "signs" to look for. She did not immediately understand what I meant, for I was being vague and skirting around the word dying. Eventually she understood.

"Mostly it's in the breath. The breathing slows, and so does the pulse. Sometimes the limbs will turn purplish, a sign that  the circulation is getting slower and poorer. And there will be less expulsion of urine," she said. I listened attentively, and made mental notes of these signs to look for. Mum has not shown any of these, but her breathing is laboured and she often has to rely on a tube to help her get more oxygen. Her toes have turned a little purple, and yesterday the entire underside of her feet were dark in colour. But that could be more related to poor circulation...

"Some patients experience hallucinations and they see things. If it's something not too frightening, go along with the hallucination and try to imagine seeing the same thing. If it's something frightening, then reassure the patient where they are and that you will not leave them..." She was very calm as she described the signs of death. She must have seen and experienced a lot of it working at the hospice ward. She was probably there when the latest patience 'checked-out'.

She changed the topic, and asked me what mum liked to do before. "Travel," I said, and described how those picture she saw on the wall are from the trips we have taken together and of places we have been to together. I briefly told her how the last couple of years have been, and that ever since she got cancer, I have been determined to enrich her life and fill it with beautiful, beautiful memories. Did I succeed? "It has been tough, going in and out of hospital so often. But as soon as she stopped treatment, I would take her somewhere. Life has been exciting and colourful, and I think she treasures those memories". I told the nurse about our reviews of pictures. Yesterday, the same nurse walked in on us watching a video on the Canadian Rockies, and she saw how excited mum was to review the lakes and towns she has been to.

The nurse asked what mum liked to do with friends, and I answered that she liked to go shop and sit in a cafe and just chat the afternoon away on weekends. "You know, you could organise a little get together. She may not be able to go out now, but you can recreate that atmosphere and those feelings of sitting around table chatting with friends and loved ones. It's like reliving the trips you made together, but this time it's recreating the feelings and smell of a cafe. It will make her feel familiarity and ease inside. It will be god to her..."

We stood in the corridor for a while, chatting. She gave me a lot of tips on the final stage of life, and how to face it. We talked about Buddhism, and I found out she too is into meditation and understands the Thai tradition that I am practicising. The nurse tried hard to think with me what things we could still do and arrange with mum. This was the exactly the kind of support I need. The kind that can help me take away much of the pain and hurt and transform it into creative endeavours that will make mum's remaining time in the world worthwhile and meaningful, memorable and  so very valuable.

Plans are being hatched, and all the while mum was resting in the room behind us...