Anything But a Happy Ending

Warning: This post verges on a rant, and it will deal with the natural, and, for some folks, the gruesome process of death. 

Corporate stepped in. Due to mom's "stable" condition, she cannot remain at the hospital. Translation: she's not dying fast enough. 

The hospital can make more money on another patient, so it's time to check out. Just not the way we all expected last weekend. Our options are to return her to the nursing home to live out her days or arrange home hospice. 

On the surface, both options seem viable. However, if you read my previous post, home hospice would be akin to dying in a third world for us. There is no air conditioning, and the house is now infested with rodents. Given the house's location in rural Appalachia, there's only spotty internet access and no cell coverage so the caregiver -- me -- would be completely cut off.  Furthermore, my family endured home hospice with my father in January, and the reality is that it is not as warm and fuzzy as it sounds, especially if your loved one defies expectations and undulates toward final breaths. 

Returning her to the nursing home makes much more sense from a medical and care standpoint. However, with COVID, no visitors are allowed, so my mother will end her days alone. I fully recognize how fortunate we have been to have this week with her and know that way too many brave souls -- currently 182,000 in the US -- have died alone this year because of the pandemic. All of it just seems cruel and unnecessary. We have to come up with better ways to help our loved ones navigate their last days. 

For my mother, she has already outlived one hospice; however, the result has been 22 months of being mostly bed-ridden and alone. It is heart-breaking. I've managed to visit her 5 times, but I can't communicate with her in between visits due to her significant hearing loss. Now, in this second go-around, she cycles through ups and downs. These undulations do not portend of miraculous recoveries but rather a delay of the inevitable. Sometimes it just takes the body a while to shut down. 

My parents both seemed to defy odds and the medical teams' expectations and meander toward the end. Since she has been bed-ridden for two years, my mother's plumbing is malfunctioning. Officially, she's been diagnosed with a perforated bowel and resulting abscesses. Fixing this requires major surgery, a colostomy bag, ventilator, and feeding tube for at least a short while and potentially, the foreseeable future. She has an advance directive and "do not resuscitate" instructions on file (as we all should!), so in consultation with her doctors, we chose not to operate. 

Cards from housekeeping notch our days.

The medical team calculated that the perforated bowel would soon result in widespread sepsis, and she would pass relatively quickly, with the process eased by a cocktail of medications. Not only has that not happened, but today (Saturday -- a week since foregoing surgery), she has also been surprisingly cognizant of her situation, including her pain and the inevitability of her demise, and communicative, wailing "please let this end" all day long. The med team has ramped up the pain meds but to no avail. Her doctor was shocked to see how alert she was after seeing how much morphine she'd been given, and it took him some time to come up with another plan. At this moment, that plan is working, and she is now resting comfortably while we wait for the final call to transport her an hour away to the nursing home.

As her caregiver, this has been agonizing. All I can think is that we treat our pets way better than this. When we know the quality of life has run out, and we are looking at death's door, I think the most caring thing we can do is expedite the ending. I recognize that there is a lot of gray area on this subject. However, for many of our loved ones, it's a pretty clear cut case that a facilitated ending is much more humane than what we do now.