Monday, September 27, 2010

Please help me ...

This is an excerpt from my 'work in progress' ... Chapters of Goodbyes ... stories of my experiences while I was a Hospice nurse.

My father-in-law was a doctor in Oklahoma for over 50 years. He, himself, discovered that he had prostate cancer in the early 80’s. J. P. had a very healthy ego, but he also knew that to treat himself would be foolish, so he consulted with an oncologist promptly. Over the next six months he underwent radical surgery, radiation and chemotherapy. All this took a toll, forcing him to cut back on his patient load, as he continued to practice medicine. The cancer spread to the colon, requiring a colostomy. J.P. refused to learn how to care for the colostomy, again the head in the sand attitude. My mother-in-law became quite proficient with changing the bag, a feat that surprised even herself. It was after this last surgery and the resulting chemotherapy that he was forced to retire. On more than one occasion, he would remark how much a person would endure “for a few more days on Earth“. He was often philosophical, saying ‘one must play the cards they are dealt’. Sadly, though, he would not or could not talk about his dying with my mother-in-law. Whether he was trying to shield her, or unable or unwilling to discuss his death, we will never know. He preferred to talk about the past, and there were some wild and funny stories to tell. He had taught my mother-in-law to play golf, after she was 50 years old. They discussed shots and what she was doing wrong, watched golf on the TV for hours on end, but tuned out the rest of the world and its problems. They chose to block out any ‘unpleasantness’, be it on the evening news or a movie or the fact that J.P. was failing more each day. They could spend hours with a crossword puzzle and J.P. was quite proud that he didn’t cheat with the dictionary. He often told her that he had “saved the best for last”, referring to the fact that she was his 5th wife. They had been married 17 years when he died.

The cancer spread further to his spinal cord, he would attempt to sleep in a recliner chair, but could never really get comfortable. The oncologist was the first to mention ‘hospice’. Both of them said no, it wasn’t needed, they didn’t want strangers in their home. My mother-in-law finally allowed a nurse to visit, I think more for company than for any other reason. The nurse didn’t push hospice, she chatted with both, encouraged them to talk about themselves, made a few suggestions for his comfort. Could she return next week, always calling first to see if the day and time were convenient? My mother-in-law told me later that they initially thought hospice just meant visiting, the nurse didn’t seem to do anything else. But slowly, changes were occurring. First an aide was brought in to help with the personal care of my father-in-law three times a week. This allowed my mother-in-law a respite and, again, someone else with whom to communicate. A hospital bed was brought into the home, not only allowing him to rest more comfortably, but making it so much easier to tend to his needs. Clergy visited, social workers, some old friends, even some former patients would come to see J. P. Always, he was charming, but stoic, never letting down his guard. My mother- in-law would respect his unwillingness to talk about the future, but she began to open up to her family.

Hilda was a breath of fresh air in that house!! Hilda had been a nurse in her homeland of England, but could not practice in the states. When her husband had been transferred to Oklahoma, she volunteered her time to Hospice. She had the patience of Job to listen to all those tired tales of his youth, but the eye of a trained professional to see and hear what wasn’t being said. J.P.’s mother was in her 90’s, still living by herself, just a few minutes ride from his home. She would visit only rarely, but she talked with him on the phone daily. My mother-in-law would pick her up and no sooner had Jenny sit down beside the hospital bed, than she would announce that she needed to return to her home. My mother-in-law and I could not understand this seemingly cold behavior. Was she so self-centered that she couldn’t put herself out for a few minutes, or was she so afraid that she would break in half at seeing her only child dying. Later when J.P. was in the hospital, I made one final attempt (in a driving rainstorm) to go to her home to take her to the hospital. She wouldn’t come to the door, I had to let myself in with the spare key and then hunt for her. I found her sitting quietly in her darkened bedroom. There was no sign of emotion on her face, but her hands were in a constant twisting motion. I pleaded for her to come with me, back to the hospital, while her son was still coherent enough to know her. She refused, shaking her head so that her upper body swayed back and forth. “ I cannot go, please, no...I can’t....please, go.“ I left, furious with this old woman, angry about the rain, not understanding why a mother would not go to her son’s death bed. I was later told that Jenny had not gone to the hospital when her husband, also a doctor, died from a stroke. I wondered if she had been afraid that she might ‘catch’ something if she had gone to the hospital. While we never learned why Jenny behaved in such a manner, I was finally able to realize that this was the only coping mechanism Jenny had to buffer the loss of her beloved son. My mother-in-law tried to replace J. P.’s attentiveness to his mother, after his death. Jenny’s physical and mental health declined rapidly; she refused to let anyone stay with her and she was unable to live by herself any longer. My mother-in-law reluctantly was forced to have her admitted to a nursing home; Jenny died less than 24 hours after being admitted, her heart simply quit beating, she no longer had her son or the will to live.

When I returned to the hospital without Jenny, J.P. only smiled at me. While my mother-in-law, The Duck and I stood around his hospital bed, confused and frustrated, J. P. seemed to understand and accept his mother’s absence. My father-in-law was too weak to speak, slipping in and out of consciousness. One of the last forms of communication was when he pointed to the wrist watch on my husband’s wrist and smiled broadly. Several weeks earlier, J.P. had given the watch to his step-son; he was so proud of his wife’s son and wanted him to have his prized watch. He lifted his right hand slightly from the bed and gave the “O-K” sign. My mother-in-law broke down in tears, exhausted from the previous nights. J.P. had been so restless, unable to sleep and seemingly uncomfortable. She talked with the nurse and doctor; both assured her that he could be made comfortable enough to stay at home and die. She never confided in us about her decision to have him admitted to the hospital to die. Several months earlier she had told us that J. P. wanted to stay home. Ironically, 7 years later my mother-in-law requested that she be allowed to stay at home as she was dying from lung cancer. With the help of hospice and with her family at her side, she died peacefully in her own bedroom.

My husband took his mother home that first evening, as I had agreed to stay with J.P. at the hospital. He lay quietly in the hospital bed, comfortable with the medication being infused slowing through the IV. The oxygen tube hissed ever so softly, and his catheter tube showed only a few droplets of urine. I had tired of reading and felt the television might be an intrusion to his rest. The nurses checked his vital signs routinely, as well as the fluids he was receiving. Only when they disturbed him, turning him or raising his arm for the blood pressure cuff, would he flutter his eyes open slightly and moan. In the wee hours of the morning, as I lay my head on my hands on the side of his bed, I thought I heard a noise. I opened my eyes and realized that I had fallen asleep, his huge hand was resting on my elbow. I heard the noise again, it was his voice, muffled and slurred, but definitely repeating over and over “ Please help me....Please help me!” I raised my head and looked into his blue eyes, the dim lighting only magnified his gaunt facial features. “J.P. , it’s Sandy, what do you need? Are you in pain, how can I help you?” His eyes filled with tears, his hands picked restlessly at the linen and one last time he asked me, “Please help me”. In my heart I knew he was asking for help to leave this world, how he thought I could help him to die I can only imagine. I took his hand, so cold and lifeless and yet still so large in mine, and pressed it to my wet cheek. “ I will help you, please close your eyes and rest now.” I closed my eyes and prayed that he would be released from his pain and his tired body soon. I went out into the hall and summoned a nurse to give him some pain medication. Together, the nurse and I freshened his mouth, repositioned his body in the bed and tried to make him comfortable. J.P. did not open his eyes or speak again. My mother-in-law and husband visited the next day, both were aware of the changes and knew that death was near. I argued that I should stay again that evening, but both were insistent that I come home to rest. It was my mother’s birthday, June 8th, we went by her home to have cake and celebrate both her birthday and the birth of my brother’s daughter the day before. I fell into a fitful sleep that night at my mother-in-law’s home. I continued to hear my father-in-law's raspy plea “Please help me”. My eyes were wet with tears when the telephone woke us at 4 am. We could not hear what my mother-in-law was saying, but we heard her soft sobs as she hung up the phone. He was at last free from his pain, having died shortly before the doctor had called. For many years I regretted that I had not been there with him. I felt he had died alone and that was so sad. Only after working with so many hospice patients do I now feel that J.P. was not alone, perhaps he felt his mother was sitting there with him, perhaps his dad, too, helping him to ‘cross over’. I have had it repeated so many times, “Those that are suppose to be there, will be there.” The only thing I could do for him was pray for peace, to try and make him comfortable, and to let him know that he was loved. And in that manner, I was able to answer his plea.

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