Tuesday, August 5, 2014

Palliative Care




It was hard being in Kansas City away from my Mom, my Dad and my sister. I wanted to be there for them and with them while Mom was going through her first round of full brain radiation.  I worked Wednesday, Thursday and Friday and as soon as I got off work for the day we headed to Omaha for the weekend.  

Once again God’s timing was perfect!  Josh and I had worked flex hours in order to help minimize daycare costs.  When Bryson was first born, I worked Monday through Friday from 5:00 a.m.-1:00 p.m.  Josh worked Monday through Friday from 2:00 p.m.-10:30 p.m.  We literally were like ships passing in the night.  Our 10 minute conversation consisted of Bryson’s feeding schedule and bowel movements.  All you Moms know what I am talking about.  We never saw each other but we valued our one on one time with Bryson.  We continued to work opposite hours after we were blessed with Holden in May 2010.  We were so thankful to spend quality time with the boys. We continued to work these hours for approximately four years. 

 A position became available at Josh’s work in a different department which would allow more family time.  The hours would be Monday-Thursday from 9:30 a.m.-8:00 p.m. with Friday’s off.  We were very excited for this opportunity because the odd hours we had been working were starting to take a toll on us.  We felt more like roommates rather than a married couple.  Should Josh get the position, I would be able to work 7:00 a.m.-3:00 p.m. and we would get to spend more time together as a couple.  This also meant I would not have to go to bed at 8:00 p.m. so I could get up at 4:00 a.m.  Josh applied for the position late Spring 2012 but unfortunately there was a hiring freeze so changes were not being made.  His application was being held until the hiring freeze was lifted.
Josh received an offer for the new position the same week Mom was terminally diagnosed!  Our prayers were answered and Mom was thrilled when we told her Josh was offered the position.  We were so excited and of course he accepted the position.  He no longer had to work on Fridays which would allow us to travel to and from Omaha as a family! This made life a whole lot easier.  We could leave home a lot earlier on Friday afternoons to see Mom and we did not have to continue to be separated from one another.  How awesome it was to watch God’s perfect timing play out right in front of our very own eyes.  His timing is always perfect! 

Rochelle and Scott opened their home to Mom and Dad.  Knowing Mom’s doctors were within minutes versus hours provided tremendous comfort.  Mom and Dad were hesitant at first because they did not want to interfere with Rochelle and Scott’s lives.  Even more so, Mom expressed she did not want to leave bad memories associated with her illness at their home.  Rochelle and Scott insisted and with some convincing Mom and Dad finally agreed.   The wonderful acts of kindness and compassion were displayed when Rochelle and Scott opened their home up to Mom and Dad.  Dad is a very capable man but I am not sure he would have been able to care for Mom by himself at their home in Indianola given Mom’s rapid decline in health.  There is no doubt in my mind our neighbors, family and friends would have helped with Mom’s care but there was something very special about being able to spend as much time as possible as a family during Mom’s final days.

Not surprisingly, my boss accommodated our situation very well.  He told me to do what I had to do in order to spend as much time with Mom as possible.  I worked Monday-Wednesday and after I got off work on Wednesday I would drive to Gretna.  There were times Josh would take off work and come with me and there were other times I brought the boys and Josh would come up on the weekends.  We would stay until Sunday afternoon and head back home so we could be back to work on Monday.  Rochelle’s co-workers and boss continued to accommodate her schedule as well.  They were willing to switch her days so she could spend time with Mom. 
Fall was Mom’s favorite time of the year.  She loved winter and Christmas but fall was her favorite!  When she was terminally diagnosed she brought up the fact that it was around the holidays and we were always going to associate the holidays with her diagnosis.  Typical Mom, thinking of others rather than herself.  

A major part of the hesitation to temporarily reside in Gretna was the fact that harvest was right around the corner.  Once again, Mom was concerned with harvest.  As you recall, she waited to mention the lump in her breast in September 2010 because she wanted to get the crops out.  At this point, it was clear there was no way Mom would be able to drive the combine and Dad was not going to leave Mom’s side.  As noted in a previous entry, God knew what he was doing when he blessed us with the most amazing neighbors!  The area farmers once again stepped in and took care of the farm.  It was quite the operation!  Several farmers offered their time and equipment to get the crops out!  We would periodically receive text messages with pictures and it was breathtaking!  Multiple combines, tractors, grain carts, semis and other equipment were in the fields ensuring the crops were going to get out before winter set in.   Our family is forever grateful for those that helped lift the burden of harvest so we could spend time with Mom.  These generous people put their own farms and livelihood aside so they could help our family.  Below are a few pictures taken by our good friend Doug.  Dad always enjoyed getting pictures of harvest while we were in Gretna caring for Mom.





It is definitely a lot easier to help than to be helped but we were positively overwhelmed with the acts of kindness towards our family.  That was the first time in 35 years Dad did not participate in corn harvest.  It was hard for him to not harvest but he knew the farm was being taken care of by some of the most talented, caring farmers around.  He was so thankful to be blessed to spend every second of the day with Mom knowing her time on earth was limited. It was sad to think just a year prior, Mom was running the combine and life was “normal” and then to fast forward a year seeing Mom in the position she was in.  It still brings tears to my eyes to think about how quickly life can change and how often we take life for granted.

We got into a routine rather quickly.  Mom and Dad’s belongings were set up their space in the basement at Rochelle and Scott’s house.  The large walkout basement, king size bed, full bathroom and a sitting area was the perfect set up for Mom.   Mom and Dad had their own space but they also had the convenience of 24/7 help from Rochelle and Scott.  Mom’s radiation appointments were scheduled for mid-afternoon so the goal each day was to get Mom up in the morning and move to the main floor for the day.  Mom had to tackle the stairs each day.  One person would walk in front of her to help guide her up the stairs and another person would stand behind her in case she lost her balance.  

Mom struggled with the stairs and each day became more of a struggle than the day before.  She got tired quickly and she had a hard time breathing.  The lymphedema was starting to get more intense which would in turn compromise her breathing. Once we got her upstairs we positioned her in the recliner in the living room so she could catch her breath and gain some energy to take a shower.  We would make her a small bowl of oatmeal and a cup of hot tea for breakfast.  Occasionally she would request fried eggs with toast and jelly.  It took her quite a bit of time to eat because she was pretty weak.  Her eye hand coordination was affected because of the cancer attacking her brain.  Typically she would take a cat nap after breakfast and then we would bathe her.  

I am so thankful Rochelle is a nurse.  Things were definitely more calm with Rochelle and Dad were helping Mom.  The situation was a bit chaotic when it was Dad and I.  Dad did fine but I added nervous energy to the situation.  I freeze under pressure and my mind turns to mush.  I am happy to gather the supplies, make meals and various other tasks but I do not have it in me to be the primary care taker—not because I don’t care but I just do not have the God given talent caretakers have. 
Frankly there were times I failed at gathering the supplies.  The first time I helped Dad with the morning routine, he told me to make some oatmeal for Mom for breakfast.  I was more than happy to help and thought there was no way I could mess up making instant oatmeal.  I remember scrambling in the kitchen and throwing open every cupboard looking for the box of oatmeal.  I couldn’t find it anywhere!  I remember thinking how pathetic I was for not being able to do something so simple but after the first couple of days I became more comfortable and confident with my limited role as a caretaker.  I know Mom was appreciative of our efforts and I am sure it offered her a bit of entertainment seeing us run around like chickens with our heads cut off.  She always remained calm during the hectic situations.  She acted as if she did not have a care in the world!  

I really got nervous with Mom’s medication schedule given the fact she was on so many pain medications.  Speaking of which, we still reminisce and get a little laugh when we talk about our system for giving Mom her pain medications. It was very overwhelming knowing when to give which medication and the schedules and medications were always changing in response to Mom’s needs.  Dad developed a system and it worked quite well.  Rather than using the actual name of the medication, he came up with his own names for each medication so we knew what each prescription was for.  He would write the made up term with a black sharpie on the bottle so we knew what each med was.   I cannot begin to remember all of the medications that were prescribed but I can vividly see “Mec” “Dec” and “Itch” in Dad’s handwriting written on the medication bottles.  You had to be there to appreciate the humor but we laughed at this.  Dad did a phenomenal job at managing Mom’s pain and her medication schedule.  He faithfully wrote down the time whenever a medication was given.  We joked and said maybe he should have been a pharmacist.  

I have to share another funny story.  One evening we were upstairs and Rochelle had given Mom her blood pressure medications after supper.  Once we were done with supper, we headed back downstairs to get Mom settled in for the evening.  She wanted to sit in the recliner down stairs and watch TV before bed.  I was sitting on one of the sofas and was talking to Mom.  I could see Dad in the background at the medication table getting the pills set out for the evening and night.  He continued to give her some of her bedtime medications.  Mom never questioned what she was taking.  A few minutes later Rochelle joined us downstairs and I could see she and Dad were having a conversation about Mom’s meds.  I could tell something was wrong but I wasn’t sure what.  All I could see was Rochelle laughing and Dad lipping, “Shit!” Dad was pacing back and forth and rubbing his forehead.  I was trying to maintain a normal face and continue the conversation with Mom.  Rochelle signaled to me in the background that we accidentally doubled up on Mom’s blood pressure medications.  

Later on in the evening, Rochelle warned us to be careful during the night when Mom wanted to get up from bed.  Due to the fact we accidentally doubled up on her blood pressure medication, her blood pressure would likely be very low therefore she may feel light headed and even more unstable on her feet.  Thankfully the night went well and we had no incidences of Mom having issues with her blood pressure.  Once again you had to be there to fully appreciate the situation but it was funny.  A few days later we told Mom we accidentally doubled up on her blood pressure medication and her response was “Oh well” as she was grinning and shrugging her shoulders.  She also said, “What’s the worst that can happen?” again while she was grinning.  Mom had a great sense of humor and she never lost it during her illness. 

We had a lot of laughs despite the rough situation. We also had a lot of tears but I definitely remember laughing so hard at nothing.  Mom joined right in with us during out outbursts of laughter.  We did the best at making the most out of what little time we had.  We never really slept very well so I am sure a lot of the laughter was a result of sleep deprivation.  We never lost hope for a miracle but knew science was saying she was not going to survive. 
My anthem during this trying time was “One Thing Remains” by Kristian Stanfill. I downloaded it on my iPod and I put it on repeat.  I listened to it most of the way to Omaha and back.  I felt an overwhelming sense of comfort when listening to this song. 

Your love never fails
It never gives up
It never runs out on me
Your love

Higher than the mountains
That I face
Stronger than the power
Of the grave
Constant in the trial and the change
One thing remains
One thing remains

Because on and on and
On and on it goes
It overwhelms
And satisfies my soul
And I never, ever,
Have to be afraid
One thing remains
One thing remains

In death, in life
I’m confident and covered
By the power of Your great love
My debt is paid
There’s nothing that can separate
My heart from Your great love


I still hold this song very close to my heart.  I continue to listen to it and last time I checked, iTunes shows I have listened to the song over 300 times!  Yes, that’s 300!  I know it is (borderline) obsessive but I feel a strong connection with Mom when I listen to it so I will continue to listen to it, especially on the days I really miss Mom. 

Mom really went downhill fast.  When we were first told she had a year to live, I was naïve thinking we would have 9-10 months to go on vacation and live a normal life and then thinking the last couple of months would be a struggle.  Unfortunately this was not the case.  Each day it was apparent she was becoming increasingly weak.  Physically she was completely dependent on us to care for her.  Mentally, she was sharp and she could converse but the fight in her was weakened.  She knew where this was going and I feel she felt defeated.  At one point she said, “I knew cancer would hurt but I didn’t know it could hurt this bad.”  Mom also lost her ability to make a decision.  We would give her choices and her response more times than not was, “I don’t know.  What do you guys think?”  For those of you that knew Mom, she was a decision maker and she stuck to her guns.  It was sad to see her lose the functions we all take for granted. 

Rochelle and/or Dad would call me every Monday, Tuesday and Wednesday morning to let me know how Mom’s night was and how she was getting along.  Mom’s skin continued to get worse.  On September 11, 2012 she met with Dr. Reed.  Dr. Reed’s notes from the visit are as follows:

HISTORY OF PRESENT ILLNESS- Nancy presents today with a chief complaint of itching and discomfort of her right arm.  Patient has tried numerous lotions and ointments for the itching and it seems to make her feel more sweaty and in turn itch more.  She has removed compression garment and has applied calamine lotion today and thinks this has helped.  She does say that the itching is much worse during the night and it makes it difficult for her to sleep.

PHYSICAL EXAM- Extensive over entire right arm.  More intense in the axilla and medial arm.  Rash on back and abdomen. She has a normal mood and affect.  Her behavior is normal.  Judgment and thought content normal.  

ORDER- 1) Hydrocodone-acetaminophen; and 2) Zolpidem (Ambien).
Rochelle quickly recognized the decline in Mom’s health so she recommended getting Mom on palliative care.  Palliative care is the step before hospice.  The goal of palliative care is to focus on relieving pain without treating the underlying cause of the pain. This was very difficult to hear and accept but we all wanted the best quality of life for Mom.  The pain meds she was on were not working as effectively as they previously were and we wanted nothing but the best for Mom.  The cancer in Mom’s skin had taken off and she was absolutely miserable.  Her skin was so red, almost purple and comparable to the texture of leather.  Mom described the pain as overwhelming stinging, burning and itching.  We had some special lotion we would put on her and as long as we were applying the lotion her skin felt somewhat soothed.  The lotion had menthol in it and honestly I hope I never have to smell menthol again.  It brings back terrible memories.
 
Rochelle contacted the Visiting Nurse Association (VNA) to start Mom on palliative care.  The VNA is an awesome organization and I would recommend it to anybody with a family member with a terminal illness.  They immediately got Mom on some pain patches to help control the pain.  These seemed to work pretty well for the first couple of weeks.  We had a brief meeting with the VNA and they briefly touched on the dying process. One thing that sticks out in my mind is when they said most of the time, the patient will get a burst of energy in the days leading up to their death.  It was hard to imagine how somebody who is so close to death could get a “burst of energy.”  They are the experts and they have seen it time and time again so I had complete trust in what they were saying. 
Mom got stuck in her routine and she wanted to go to bed at 7:30 every night.  Again, for those of you that knew Mom she liked to plan but she was very good at doing things on the “fly.” Dad was such a trooper.  He was not ready for bed at 7:30 but he did not want Mom to be alone.  The good thing about going to bed at such an early time was they had a lot of time to visit.  Mom and Dad talked about several things.  One thing Mom was worried about was Dad being alone on the farm.  She did not want Dad to be alone the rest of his life.  

Dad asked Mom one evening, “Honey, when you get to Heaven, can you please give us signs so we know you are okay?”  Mom’s response was, “I will give you guys signs if God allows me.”

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