The process of dying

How long will it last, the process of dying? Nobody really knows for sure. It could be days, weeks, or even months. I am ashamed to admit it, but why is it that at times I want it to happen sooner...? Why is it that my mind is afflicted by all these terrifying dreams and images when I close my eyes to rest?

Mum had diarrhea today, five times no less, which is very strange as she has not been eating much. In fact, she has been eating less and less every day. I may prepare something for her for lunch, and when I head home for a few hours to nap and return to the hospice in the evening,  the same food is still there. It's happened for several days already, even today.

Though tonight I happily brought a feast to the hospice, partly because mum's youngest brother came to visit (second time this week...), mum threw up almost as soon as she took a sip of chicken soup. She did not eat the wontons I left her for lunch, and she barely ate any of the turnip fried rice or boneless chicken she so enjoyed just last week. Her taste is changing, her metabolism is changing. Her body is changing...

I sat with her for an hour or so before bed. Just sat next to her, held her hand in mine, and closed my eyes. I could hear her laboured breathing and the 'hiss' of the oxygen tube. In the room hung the scent of lavender and camomile, a new fragrance that one of the very kind and gentle nurses introduced me to. Mum did not say much, and if she did, it is almost a whisper (almost, so not even a whisper...): "I am so tired...." she manages to say, and I had to lean in close to hear her words.

I do not tell her why she is so tired, but even if I do not say anything, I think she knows it herself. She is the one with the body that is slowing down, she is the one in the body that is soon to stop functioning. So perhaps mum knows better than anyone else. All I can do is sit by her side, hold her hand like i often do, and meditate quietly: "Namo tassa bhagavato arahato sammaasambuddhassa..."
I repeat these words often, silently in my mind, and wish mum peace and happiness, peace and happiness...
  
I end with the text I read to mum just before bed. It is very pertinent to our circumstances and what we are going through, and I could not have put it better myself:

The Great Teacher saw that all sankharas [conditions of the body and mind] are impermanent, and so he taught us to let go of our attachment to them. When we reach the end of our life, we'll have no choice anyway, we won't be able to take anything with us. So wouldn't it be better to put things down before that? They're just a heavy burden to carry around; why not throw off that load now? Why bother to drag them around? Let go, relax, and let your family look after you.

Those who nurse the sick grow in goodness and virtue. One who is sick and giving others that opportunity shouldn't make things difficult for them. If there's a pain or some problem or other, let them know, and keep the mind in a wholesome state. One who is nursing parents should fill his or her mind with warmth and kindness, not get caught in aversion. This is the one time when you can repay the debt you owe them. From your birth through your childhood, as you've grown up, you've been dependent on your parents. That we are here today is because our mothers and fathers have helped us in so many ways. We owe them an incredible debt of gratitude.

So today, all of you children and relatives gathered here together, see how your parents become your children. Before, you were their children; now they become yours. They become older and older until they become children again. Their memories go, their eyes don't see so well and their ears don't hear, sometimes they garble their words. Don't let it upset you. All of you nursing the sick must know how to let go. Don't hold on to things, just let go and let them have their own way. When a young child is disobedient, sometimes the parents let it have its own way just to keep the peace, to make it happy. Now your parents are like that child. Their memories and perceptions are confused. Sometimes they muddle up your names, or you ask them to give you a cup and they bring a plate. It's normal, don't be upset by it.

Let the patient remember the kindness of those who nurse and patiently endure the painful feelings. Exert yourself mentally, don't let the mind become scattered and agitated, and don't make things difficult for those looking after you. Let those who nurse the sick fill their minds with virtue and kindness. Don't be averse to the unattractive side of the job, to cleaning up mucus and phlegm, or urine and excrement. Try your best. Everyone in the family give a hand.

"Thank you..." mum said weakly when I finished reading for the night. I smiled at her, and gripped her hand. She responded and tightly held onto my for a brief moment.

"Alegria
I see a spark of life shining
Alegria
I hear a young minstrel sing
Alegria
Beautiful roaring scream
Of joy and sorrow,
So extreme
There is a love in me raging
Alegria
A joyous,
Magical feeling..."

Dragon Boat Festival

I woke up from a dream, I woke up tired and agitated from a dream I cannot remember. I woke up to the sound of mum gagging an choking, and the sound of a plastic bag rustling.

Mum looks particularly unwell today, and there are dark shadows around her eyes. She has no appetite, and the vomit just came out of nowhere. The last thing she ate/drank was a mouthful of Ensure. And that was over ten hours ago...

"Open the curtains..." she said weakly. It seemed like a strange request, but I did as she asked of me. Outside the sky was dawning, a brand new day is dawning.

When I turned around to look at her and take her by the hand, she had closed her eyes and fallen asleep...

1AM

130612.0155

I was dreaming of flying and airports before the dreams were interrupted by a gagging sound. I turned my head, and saw mum vomit into a plastic bag. I remember this... I remember this all too well.

I rushed to her side. The carer already held the bag next to mum's mouth and was stroking mum's thin throat. Mum gagged and gagged. I held onto her had, which was hidden under her blanket. I looked at her with eyes that tried to comfort her, reassure her and remind her that I am by her side. A thought of choking, a gruesome image of mum chocking to death flashed across my mind...

Mum has become so thin. Her neck looks like that of a vulture, and is veiny and her bones are exposed under the thin flesh. I stroked mum's thin arm and held onto her hand. "It's ok... I'm here now. I'm here at your side no matter what..." I silently said.

A few more gagging sounds, and the discomfort mum was in seemed to have subsided. "Why is it like this...?" she asked, sounding puzzled and confused. I stroked her arm. I was reminded of what the doctor said hours earlier when he came in and when I asked him to update me on the latest. "The cancer is progressing. The duodenum and bile duct areas seem to have become blocked. That's why she has trouble eating now, and that's why she's throwing up more and more..."

"Go back to bed..." she said, "Go back to bed..." She looked at me with begging eyes. I know it pains her to vomit, not just because of the discomfort it causes her, but also because she feels "guilty" that it upsets me to see her sick and gag.

I stroked her arm a bit more, and patted her forehead and her hair. Her face has changed since I last saw her. She is thinner, more frail, bonier. I loathe to see her naked body, see how much of her body mass has been eaten away by the cancer to leave behind just bones and skin...

But cancer, you can change the way mum looks, you can rob her dignity and cause her to involuntarily vomit ad gag, you can "punish" her with vomiting and being sick... But I will continue to love her, hold her, stroke her arm and with the softness of my voice reassure her...

Losing her taste

Mum sounded so weak on the phone today. It was just past eleven in the morning, and she said her cousin had just left after visiting briefly. The cousin came to chat with her a little bit, and when she realised mum was tired, she left.

Mum revealed she did not feel well. "My taste is going, and I have little appetite..." That is worrying, because she's already so thin, so frail when I last saw her, and she told me last weeks she lost even more weight. If she has little appetite, how is she going to get her strength back...?

She said she vomited a couple of times yesterday. More than usual. Mostly stomach juices, but also when she ate. It sent a pang of shock down my spine. Is it already so soon? Is it already as the doctor predicted...?

"If there's anything, I'll let you know..." mum said weakly.

"What do you mean?" I asked.

"Nothing, we'll let you know..."

There is something. Brother wasn't around to talk to, so I couldn't know what was wrong. But something is up.
"Just go to sleep, it's late..." mum said.

Before I could say anything else, she hung up the phone.

Something is up...

Vomit

Happily, I rushed to the hospital thinking I've made something mum can finally enjoy after so long of not eating. Earlier, for lunch, I made her what she requested: egg fried rice with smoked salmon and chopped onions ad carrots. She ordered it, and I delivered it. Imagine my joy when she finished half a rice bowl of my fried rice, and even a few small slices of wax-apple and loquat!

Yesterday, the nurse came in and provided us with a list foods mum can now eat. The focus is on foods that are not too acidic (dairy and red meat are no-no...) and low in fibre, so that the intestines and digestive system can get used to digesting and expelling excrement after such a long break. Also a low-fibre diet can give the intestines time to repair and get used to the flow of things.

So for dinner I made fish soup, as recommended by the nurse, for fish is high in protein-- which mum needs for repairing her cells after surgery. And I cooked her some soft greens, a soft boiled egg, and noodles and added a bit of tea-tree oil, which is very good for lubricating the digestive system.

She took a bite of the noodles, and the smell of the tea-tree oil made her gag. She continued eating, because she did not want to disappoint me after I cooked her and excitedly brought food to her, but within minutes she was gagging and choking. Her stomach could not get used to the taste. Se gagged and choked for a while, and with each sound, each contorted facial expression, my heart ached... I was upset she could not eat what I made hr, but even more upset she was sort of forcing herself to eat because she did not want to disappoint me. "Why would you put your body through something like that? Why would you keep on eating if you didn't feel well with the first bite?!"

I cleared away the bag of vomit, and she leaned back on the armchair and looked so tired and deflated...

We are still not in the clear yet...

Resumption of liquids

Mum made a noise like she was about to vomit, and her face puffed. I was distressed by that sight, for the doctor finally gave her the go-ahead to start taking in liquid nutrition orally.

"Just joking!" she said with a smile. I was fooled. Fooled but happy that she could start drinking again, for it would make a great difference to her energy levels, and reverse her weight loss. Whereas she was 43kg when she was admitted three weeks ago, today she weighed 47kg. And this is just from IV drips, so imagine how being able to eat will improve her health.

Excitedly, I began to talk about brother and his family's impending return. Perhaps prematurely. "Let's plan a trip! Let's go around the island and stay a few days on the eastern coast!" The eastern coast of the island is an untainted paradise made up of the ocean and mountains. 

A few moments later, mum gagged and vomited.

 It was not a joke.

NG

It was close to one in the morning. The nurse came back with the night shift doctor after I called her and told her about mum's latest vomiting session. Half a bag-ful of stomach juices. The doctor estimates it is about 300ml. Third time since around eight at night, sixth time Since the start of day. The latest time, Mum just kept on vomiting, vomiting, vomiting for around a minute. My heart kept on breaking, breaking, breaking...

The doctor suggested Inserting a tube to extract excess stomach fluids. Not the NJ proposed earlier, but an NG tube, nasogastric tube, which extends to the stomach and either with the aid of gravity or with the aid a pump can draw out excess fluids that otherwise would come out through the oesophagus and the mouth.

"No, no, I don't want [to] insert the tube! No... Too painful..."

Mum's answer was clear, and the nurse and doctor both agreed it may be uncomfortable and "in the way". Of course it would be! something is going through your nostril and down into the stomach! "But it's what I recommend if you keep on vomiting," the doctor said.

Mum looked so drained, so tormented by her body and the uncontrollable vomiting that has disturbed her sleep for so many nights and seems to e getting worse every night. She was curled up again in a foetal position that even for me, being very flexible and soft-boned, looks very uncomfortable. She was displaying a sign of helplessness, of fear, of dread, as if she wanted to be shielded away from everything that hurts, everything that causes her more suffering, more pain!

I recommended her to sit up and try to sleep on a chair, so that perhaps the stomach fluids won't so easily flow up and escape through the mouth.

I held her hands and massaged them... Silently, I hoped and prayed as I held her hands, her pain, her suffering could be temporarily relieved...

Life choices

I somehow felt uneasy about going home to sleep last night when my aunt offered to take the night shift. The doctor always comes early for his routine visit, and I always want to be there to listen, take notes (figuratively) and ask questions if necessary. But I hadn't been home to sleep for almost a week, and was getting very tired. And I know sometimes I need to let go and just let others take over from me, or otherwise I'll over-exhaust myself.

So I went home, slept almost immediately as I got home. Even though I was in the comfort of home, away from seeing mum vomit (and away from the worst night of vomiting ever...), I slept poorly, and woke up two three times from dreams... I set the alarm for six thirty, and made a point to getting to the hospital by seven thirty.

I arrived and the doctor had already been. I missed perhaps the most important appointment of all, for the doctors had another meeting in light of mum's severe and worsening bouts of vomiting (is it still called vomiting, when there is nothing to vomit but stomach juices?). Why on the day where I happened not to be there?

The vomiting will not be helped by the insertion of an NJ feeding tube, the doctors said, for the cause of the vomiting is due to the inability for stomach fluids to escape through the other end, so instead it all comes out the other end, through the mouth. The feeding tube will only solve the issue of mum getting nutrition the "natural" way.

The alternative is a bypass surgery, which the doctors had put aside before it is a risky and perhaps not hundred percent effective solution. Further, a bypass surgery to reroute the intestines to bypass the area blocked by the growing tumour may, if effective in resolving the issue of food flowing down, will only serve its purpose for a limited time. The tumour in that region, which I saw on the MRI and endoscope images, is certain to grow and grow without chemo or radiotherapy (which if mum opts for later, will certainly make her even weaker or even kill her...).

But now the doctors came back and revives the option, and wants mum to decide. It's a tough, tough choice, and what a "great" way to start the day; a way which set a bad mood for the day and which occupied our minds.

The NJ tube is only able to resolve mum's nutritional intake, but will not be able to address the discomfort and pain from vomiting. Further, it is aesthetically displeasing, and mum was very hesitant to do it from the very start. In fact, I already bought the tube last week, and dared not show it to her, for it is very, very long, and sickening to think about it being inserted into your body all the way to the intestines.

The bypass will solve two problems, vomiting and mum's ability to eat and absorb food naturally. But the surgery i is very difficult, and may leave mum, who is already in a poor state of health, in poorer state of health. It may perhaps even kill her. And how long will the surgery allow mum to eat and drink like before? If the tumour is growing and spreading rapidly, it may could be weeks, months Before mum has to go through the same hell of vomiting and getting so very thin as she is experiencing now. When we come to that, there will be no other cure. And what is the point then of a big surgery, and weeks of recovery time that follows when at the end of the however long period, the problem returns? The surgery only deals with the symptoms of mum's current discomforts, and does not address the problem of the tumour or spreading. The tumour cannot be addressed, for it is in a region close to a lymph node, and if remove will cause extreme levels of bleeding. And sometimes, when you tamper with a tumour, it may be like opening a Pandora's Box, and cause the cancer to spread and grow even more rapidly and ferociously.

Again the choice is a matter of life and death, and more poignantly of how to die... Die from vomiting and vomiting and getting worn down mentally by having to vomit so much everyday, or die from cancer spreading after undergoing yet another surgery that will cause such trauma to mum's body and soul and leave her perhaps so terribly weak for as long as she may live?

Have we come to this now, come to weighing in the possible salvation a quick death will bring against the of pains of prolonging life and dying a painful and slow death when the cancer eats away everything? How crude and cruel it seems that is the only way that mum can leave behind all this pain, all this suffering? How meaningless life has become for her! How painful it is to see a once proud and able human being, my own mother, descend into a level of existence that is just dreading vomiting, bone sores and suffering intense hunger!

I climbed into mum's bed and held her hand. There was nothing I could say, nothing worthy of saying. What do you say to all this? What do you say to someone faced with a choice of the lesser painful way to go, when both options are so painful and so unbearable to think of?

I just held her hand. Silently, I told her I will be by her side.

Eight times

Mum vomited eight times yesterday. Four times during the day, once at eleven o'clock at night, once at close to one in the morning, again at close to three, again close to four in the morning.

She would lie down in bed, only to suddenly get up and reach for the plastic bag I prepared for her.

Bags and bags full of vomit, nothing but stomach juices, because there is nothing else there...

She looked visibly weak and had dark lines around her eyes. Tortured, disturbed, and so very, very tired...

Severe vomiting

Throw up... Seven times today! Seven times!

Mum could hardly stand up after bending over the toilet bowl... The stench of her stomach juices was overbearing, the sight of her sunken and dark-ringed eyes was unbearable to see...

So weak is she... So weak, so drained!

Torment

"I have never felt like this in all my life..." mum said. She looked terribly weak, terribly shaken. Another vomiting session, three, four throw ups in one go, brown liquid pouring out of her mouth into the see through plastic bag I just managed to hand her. It pains me, it really pains me so! I lay down next to her an patted her back, her thin, bony back. I felt her ribs on the side of her body, I felt her shoulder blades, I felt her spine... I felt such pain, such terrible anguish seeing mum suffer again and again.

Five times vomiting today. It seems to be getting worse, though the first few days in hospital it seemed to be getting better. Now, even shots that are supposes to prevent vomiting, which are painfully jabbed into the muscles, do not work. Tonight and last night, mum vomited all the same, yesterday even within five minutes of having the needle stuck into her arm, even barely before the blood has dried...

"What is the meaning of living is this is the way it is?" I asked rhetorically. I know, in this moment when death is lurking so close by, and just before an attempt is made to insert a tube into mum's nose so she can at least sustain her life and her body for just a bit longer, what I said was perhaps cruel and unfeeling. But I suspect that mum feels the same sentiments, or otherwise she would not say that all her life she's never been through something as terrible as what she is going through now...

What is the purpose of all this? All this pain, discomfort, all these sores and mental anguish at seeing your body decline and decline? What lesson is mum supposed to get out of all this suffering if anything? Six years of being sick, six years of treatment and getting even sicker from treatment, and now surgery, now being robbed of the ability to eat and drink

[as I was typing this, mum made a gargling noise, and I knew she was going to throw up again. Six times today! Six times!!!]

What is the purpose of all this suffering? What is the purpose of living at all if all you will get is sicker and sicker and sicker and sicker? I am hurting and crying so badly inside... So badly deep inside...

Oh, cancer! How you torment my dear, brave mother so! Oh, damned cancer! How you cause her so much pain and suffering and do not seem to want to stop anytime soon! Cancer, you are taking my mum away, bit by bit, you are making her so weak, so thin, so very sick... Are you happy now? Have you fulfilled your mission yet, or is your final object to torture her till she dies?

Well, when she dies, you will too...

Desperate times...

Brother cried on Skype, his face torn with grief.

"Please, don't worry... I'll be here till the very end, I'm by mum's side. I'll keep you posted..." I said.

Deterioration

Fall asleep to the sound of vomit... wake up to the sound of vomit... How painful it is to see mum bend over the toilet bowl, cowering in the corner of the bathroom like a thin, malnourished little girl, with a tear  in the corner of her eye. What a harrowing, haunting sight...

A series of appointments planned for the coming week, but can she wait any longer? How long can a human being go without properly eating? Two weeks and counting since she started vomiting severely, and still we do not know what exactly is the cause or how to treat it... These two weeks have been excruciating, painful, nightmarish. And those are just the adjectives I can find to describe how I feel as an onlooker, as someone who can only hand mum a tissue or a cup of water after every single vomiting session...

3.21AM

Can't sleep... So tired, but sleepless. Every so often, as I lie here on my bed on the floor, I hear mum in her bedroom. The rustling of a plastic bag, the flushing of the toilet. It fills me with dread that she is throwing up again, and makes me get up and rush to her room to check on her. Need to get up in four hours or so for a doctor's appointment on the other side of town.

 Can't sleep, but I need to. We, as in mum and I, both need to...

Sick

Mum told me a joke today. Was it really a joke? She laughed while she said it, so it must be a joke. She said she has gotten so thin that when she went to the washroom yesterday and pulled up her  pants , they immediately fell down again. That was a joke, right? Literally, a sick one.

I told her we have to go buy new clothes, because the likelihood of mum regaining the ten kilos or so she lost over the span of a month or so is slim, at least in the near term, if ever. But she just said she has some clothes from long ago that may still fit.

Not long after that joke, she vomited again. I quickly handed her a 'barf bag', one of many that I now carry with me at all times whenever we go out. Every time I see her throw up, no matter how many times I see it, it affects me so, it hurts me so!

There was a heavy load, again coloured brown from stomach juices. She tried to put it away, but was struggling to do so due to her the deteriorating flexibility of her hand and fingers. So I grabbed the bag from her. It felt warm... Sickeningly warm. I was in the middle of eating a box of sushi I got on the go, and I lost my appetite. What got into me that I started to toy with mum's bag of vomit before I threw it away? I cannot explain a lot of my behaviour and thoughts these days, for they puzzle and baffle me too. Perhaps being so very close to illness, seeing symptoms and signs of it every single day, makes me not flinch any more when I look at vomit or even feel it with my own bare hands. Really, after a while of cleaning up bodily fluids or excrement, nothing seems to shock of disgust you any more. You become numb, it seems. The human body is only so much... only just made up of the food we put in, and the waste that comes out, either through the mouth or the backside. What else is there to all of this?
Or perhaps I am no longer disgusted, because the pain of seeing someone you care about and love so dearly overwhelms any feelings of disgust or discomfort...

1AM

Perhaps it's not cancer, but vomiting that will take mum away...

Vomit...

Just as I was about to lie down, I heard the hot water machine turn on. From experience, I've come to know that that sound is occurs either when mum is using the shower or flushing the toilet. And it must be the latter, at a quarter past midnight.

I rushed to her bedroom, and even before I entered I heard the sound of vomiting. She heard my footsteps: "Don't come closer..." But of course I disregarded her remark, and bent down to her level and patted her back as she vomited again over the toilet bowl. This is very serious... The one day stay at the ER yesterday helped, and she did not vomit again last night. But today she is vomiting again (she actually lied to me when I asked her whether she vomited or not during the day today. I was out at the hospital myself, so I couldn't tell... She later admitted that she did vomit when I asked her again just now.)

She lay down to rest again, the shock of vomiting can be very tiring. I patted her back in an attempt to make her feel comfortable. And it was then that I noticed again how thin, how frail she has become... I patted her shoulder blade, and it is really just a protruding piece of bone, which reminds me a lot like a piece of folded chicken wing... I patted her back, and it was a hollow echo... Her arm has become a soft, limp lump of thinness and bone.

What... what has my mum become over the past few weeks? Did I not take good enough care of her?
Where will she find the reserve to fight if something comes back again...?

To think just this time last year, she was around my weight. And within a year, she has dropped about ten kilograms.

It is heart-renderingly awful to think that...


UPDATE: 29-02-2012
Mum weighs 48kg now, a drop of around 16 kilograms compared to last year... Terrifying.

At ER

I slept badly, kept on hearing mum wake up and rustle with plastic bags, a sound that she's either vomiting or coughing out phlegm. Or so it sounded like that, or perhaps I'm just paranoid now...

I woke up early today because I have a thorough physical due tomorrow and must today start a strict regime of liquid diet. Though the bowel pains have more or less subsided, I still need to check my colon and stomach to see if there are risks of cancer developing.

I squeeze some apples and carrots, and added a bit of ginger too. It tasted good, at least to me, and I saved a cup for mum. She drank a bit, and said she didn't feel like drinking more. Within a few minutes, she threw up again. She's been having constipation, and said since last night been feeling very dizzy (literally, "seeing stars..."). Time to head to ER.



The doctor attended to her within minutes of arriving, and asked various questions. A blood test and xray was done, and results came back within half an hour.



Inflamed pancreas, the doctor assessed, otherwise all other signs are normal. It's not because of alcohol intake, or cholesterol levels, I don't think. The only possible reason is stones collecting in the pancreas. Or, as I checked online, there may be a rupture in the pancreatic duct, causing enzymes necessary to break down proteins and lipids to leak into the stomach, and causing her an upset stomach (vomiting..) We cannot know until further tests are conducted, and the doctor suggested an ultrasound. She will still need to have an endoscopy and perhaps even colonoscopy done to see if there are abnormalities, but the earliest either of those can be done is tomorrow. The other problem is that the invasive look at mum's bowels at this hospital is conducted using the traditional method, ie without anaesthesia. If she wants to arrange for anaesthesia, then indeed she would have to wait for two weeks, as the doctor two days ago planned. But she cannot wait two weeks. She just cannot after vomiting on and off for a month and vomiting daily and severely for the three two days...

Mum is very scared of the endoscopy without local anaesthesia, for the last time she did it, she gagged so uncomfortably and felt like her stomach was going to come out... But she must do the examination as soon as possible, for she is vomiting so much that she's really losing weight and becoming dehydrated. It's very worrying.

Back to the hospital again, and mum is now lying next to me, having an IV drip to provide her with much needed nutrients. I rushed home quickly to get her a blanket and her memory cushion and back rest, so she can rest better.

It's very hectic here, with so many patients lining the walls of corridors, so many nurses and doctors rushing back and forth, and so many relatives waiting in the lounge. Mum told me that day, on 26 December, when she checked herself into ER, she was by herself. She could barely walk and had to be assisted by a hospital staff while they did scans and tests on her... At least I am here with her this time..
I am here with her... But I myself feel weak and faint, partly from not eating well over the past few days, and partly because of the bad sleep last night.

Mum is sleeping now , after I gave her a massage of her back and arms. It feels like back in January, when I would spend hours by her side and take care of her needs.

Only, how long will mum have to stay in hospital this time...?

Very severe

The day started off well. I heard mum walk around in the living room at four in the morning, and I immediately woke up, thinking perhaps something was wrong. She was just hungry, she said.

"Say something again!" I said. I may have misheard.

She spoke, and I could swear her voice sounded like its old self. No more, or at least much, much less of that raspy witch-like voice. Delighted, we both went back to bed again until close to nine or so.

We had a nice breakfast, walked around a bit, and then went out to lunch. I was somewhat glad that mum did not vomit, at least not a lot (so she still did, but a  mouthful, which seemed like an improvement). After lunch, I insisted that we go for a long walk, as the weather was clearing up (if only temporarily before it began to pour again...). We walked by the little creek, the same one we often walk along after coming out of the hospital with a heavy heart. This time of the year, as Winter sheds and dons on Spring, the banks are lined with beautiful blossoming trees. Reddish pink in colour, some already in full bloom, others yet to unleash their beauty that has been refuging from the cold of Winter. And when they are all in bloom, it delights the eyes and senses with such brightness, such life!

Mum, and steadily so, could not walk more than a hundred or so metres without feeling like her lower back is about to tear open. I massaged her and struck her shoulders to make her feel more comfortable, until we eventually found a bench to sit on. And mum started to reminisce... How just last year, she would walk these banks without a problem... And just a few  years ago, when she used to live in the old house, she would come jogging here at dawn... Those are days gone by, and forever gone...

Late afternoon, mum's youngest brother came for a surprise visit. "I had nothing to do," he always says, but in truth, he cares deeply for mum's wellbeing, and has been there often when mum needed help. He was the one who made the payment for her surgery upfront, for it was such a large sum of money, and till this day he keeps on saying "Later, later... Not to worry..." whenever mum talks about paying it back.

We had a quiet afternoon at home. Mum sat in her comfortable lean back chair, while my uncle and I gathered around her. We chatted, about mum's condition, about her plans for the future. As we did so, pictures sprang up on mum's screensaver... so many pictures of so many places that mum has been to. Michellin star restaurants, railway journeys, blue, blue lakes, snow-capped mountains and glaciers, misty ocean playgrounds... "I have been so lucky," mum said to us.

"You still are very lucky! You can go to these places again!" my uncle and I said. She can, but does she has the will to? Can she muster the courage and  the energy to just forget about everything, about her worries, about treatment, and most of all, forget that there is this terrible illness inside of her, and just go travel her? That is the biggest question. She must have the will, she must have the courage and push herself, tell herself, "I can, I can..."

Is it too easy for me, for an outsider, to say "You can if you want to?" Is it?

Around seven or so, we went out on our way to go eat. I walked a few steps ahead to let younger brother and older sister bond. But moments later I heard my uncle call my name. I turned around and saw mum stand by a pillar, next to a sewage drain. I immediately understood why. I immediately went to her and handed her the bag containing plastic bags, tissues and bottled water that has become unmissible on every excursion, even short ones around the block, outdoors.

Within seconds of me handing her the bag, mum crouched down and began to vomit. Again, like a river, the vomit poured out. Again, and again. Three times. I extended my hand to pat mum, but my uncle's got there first, so I let him comfort mum this time. I could see on his face was the look of worry, look of concern and helplessness and pity. In a way, I was 'glad' my uncle saw it; not that it is a pretty sight, not that it is a great thing that mum was vomiting severely for the third, perhaps four day in a row. 'Glad' because my uncle saw what only I have been able to see, only I have alone been forced to see and deal with so painfully. I was 'glad', but someone could see my pain, share my pain and worry.

We must go to the emergency room. No more delays...