Thursday, 20 April 2017

A death ~ "Ellen has left us"

My mother Ellen has died.  It was expected.  This is the story of those final days and her death, which I share in the hope of providing some insight and companionship to others on their own such journeys.  It is a journey we all take sooner or later, each in our own way. 

For Ellen and me it was the end of a long hard road for both of us, my part of which began in ernest when she had a fall at home and, being in great pain and unable to get up, was hospitalised.  That was three years ago.  From that pivotal point onwards we trekked together through various hospitals and rest homes in her home town, then moved her to a rest home in the city where I live and her house was sold.  Once settled into that rest home room she used to say that her room was her house, so I did what I could to make it worthy of the name.

There had been much good and warm companionship between us during those three years but it did involve a lot of work, which became increasingly arduous towards the end.  My mother never ceased to thank me for my efforts saying she couldn't have managed without me, and I knew this to be true.  I was glad to do what I could. 

Her life ended in hospital, with an infection from which it was not possible for her to recover.

A week earlier when I had been preparing to visit Mum at the rest home I felt exhausted and ill.  She hadn't been well either, and I guessed my visit would very likely be tiring and attended by the usual cluster of difficulties and comlexities, but even as I said "I don't know that I can manage this today", I immediately added "but I must".  Years earlier I had assured Mum I would see her through to the end and I wasn't about to shirk my load.  Off I went.  I arrived to find her barely able to form words and unable to rise.  An ambulance was called.  Her feet did not touch the ground again.  So began that last interminable week in which time seemed to warp endlessly in one direction and in other respects to rush past.  Looking back I don't know how I managed it.  I just knew I had to.  And I am glad that somehow I got through it. 

Numbers of doctors and many nurses attended my mother.  Part way through the week it became clear that she was not going to recover.  Quite apart from the raging infection she could not swallow either food or drink, she continued to be unable to rise and and cried out sharply when moved; incontinence worsened. She had had enough, refused further medication and intravenous fluids, and care became palliative.  Even had she wanted to continue treatment things were not going to improve.  Her GP and I as well as the hospital doctors talked it all through and knew it, and so did EllenAlthough the care was good it was still distressing to see her so diminished and suffering in all these ways. 

Her GP and I had established an Advance Care Plan with her well over a year before so we were prepared for this eventuality and accepted it.  Her vicar was contacted, and as he was on leave the curate attended her a number of times as did the hospital chaplain.  Mum was ready to go and wished it. 

Those last two nights, knowing that the end was very near, I stayed the night, sleeping fitfully on a reclining chair pushed against the side of her bed.  Nursing staff came in regularly to turn her and check hygiene and comfort.

I remember watching the moon rise in the sky from where I lay, and observed that from time to time it seemed to jump a bit higher so I knew I had at least dozed.

From time to time I got up and moved about quietly.  In the streets far below a few miniature people and cars came and went.  I wondered why the university library blazed with light throughout the night...  Rain washed the streets and clouds drifted across the moon. 

I remember thinking wearily that in times to come I would probably look back on this as a rich experience, followed by the thought that at that rate I had better live that appreciation right now, and stop wishing it into the past!  That thought steadied me and helped me readjust.

The day before Mum died she was largely unresponsive, sleeping much of the time, and her breathing very laboured for lengthy periods before settling down to normal again.  Family gathered round and came and went.  I came and went.  My uncle, a retired doctor, remarked to my aunt that it was unlikely that Mum would last the night, "but you never know, just don't count on it".  We all knew it wouldn't be long now.  I settled in for the night.  Lights were turned off and everything grew quiet. 

I was more tired than I can say, but hardly dared sleep.  I knew I must get some rest though, even if only a little.  To help me doze I took a fragment of a sleeping pill.  I pulled a blanket over myself.  Reaching across to Mum I tucked my hand in hers. 

Sometime in the early hours, feeling Mum's hand clammy and unresponsive in mine and hearing her laboured breathing I struggled up from sleep feeling that I must get up and do what I could to ease things for herDawn was yet to come and save for a little light from the partly open door of the bathroom the room was in darkness.  Although her eyes were partly open she seemed unconscious.

Creeping around in the dim room I went to the brightness of the bathroom and wet a facecloth under the hot tap, then carefully sponged her face and hands, talking sweet nothings as I did so.  I gently brushed her hair, smoothed her face with her favourite face cream, and gently stroked it into her hands.  She seemed to be lying awkwardly.  I fetched the nurse and she came with another and they checked and shifted her to a more comfortable position.

I felt restless and teased out, so made myself a hot drink and had a few bites of a sandwich before settling myself back on the recliner.  Suddenly I felt sick, really sick, and wondered if I was going to vomit.  Reluctantly I sat up, hoping to settle it by shifting my position and attention.  It was still dark and still night time.  No good.  I lay down again.

Suddenly Mum began making the most awful noise, her breath a hoarse tearing sound.  I ran for the nurse, who came immediately.  "She's starting to go", she said calmly.  She checked her briefly then left me with her.

I sat with Mum reassuring her as best I could, holding her limp hand and stroking her gently: "It's okay, Mum, you are quite safe...  I love you... It's okay to let go..." 

I was okay but anxious, so went back to the nursing station and asked for someone to sit with me.  The nurse returned immediately and I was grateful for her quiet presence.  

Those rasping breaths become irregular and further apart.  I continued to reassure her as best I could. She did not regain consciousness, just her eyes partly open, her hand unresponsive in mine. The rasping breaths dragged on.  She did not move or give any flicker of recognition, but I comforted her anyway, remembering that hearing is the last sense to go, and hoping that she heard me.  I stroked her arm, her hair, her back, and held that cool limp hand in my firm warm one.  Then the nurse thought she had gone. There was another long pause after which came another rasping breath.  As she let go one more breath I saw her tongue flop sideways and knew it was over.  She was out of that body, finished with it and gone.  She had gone.  Only the husk of her old body remained, perished. 

The nurse checked with her stethiscope, and called the duty doctor.  The doctor checked with hers, then composed herself and said quietly "I am sorry for your loss".  I could see that she was; that we all were, and at the same time the relief was immense.  Ellen had made it through that great gateway and, in so far as these things can be ascertained, her passing had been peaceful.  Tears flowed, a measure of the intensity of the occasion, and the gravity of it.  It's a huge thing, the ending of a life, and for me the ending of the life of my mother; that one irreplaceable bearer of life who had carried me from the very beginning was gone.  She had left.

Relief washed through me with fresh tears.  I had managed to see the job through.  I had accompanied her along that last hard stretch of the road as well as I could and had seen her across the threshold.  I was very grateful to have lasted the distance, to have been able to help, and I wouldn't have missed it for anything.  

That impulse to get up and help my mother, to attend to her comfort that one last time, was perfectly timed so it was just as well I paid attention to it, and the subsequent nausea passed as soon as I knew what was happening.  One of the nurses had said that family often know before staff do when a patient is dying, and I have am sure that nausea was my body's reaction to my mother's life force beginning to collapse.  I was right with her, and it felt as if the energy of her life had begun to go backwards, and then unravel.  When she died her life didn't seem so much to cease as evaporate.  It felt very complete, entirely natural and absolutely real.  I had no thought at all that perhaps she hadn't died and might just have drifted to a deeper level of consciousness.  It was over.

My sister arrived.  Alerted by my call some twenty minutes earlier, she had rushed to be there, but by then Ellen had gone.  I was glad to have her with me.  We stood by the bed, tears streaming and comforted each other as best we could.  Mum was so completely not there anymore, just this little worn out body in which she had lived those eighty plus years and which could no longer serve her.  It was worn out and in death was not even all that recognisable.  I was glad she was in her own nightie, though, which was so much her own.   
I asked the nurse to call the chaplain to do the commital.  It was 5.30am.  This was important.  Ellen had been preparing for her death over the past year through discussion and prayer with her vicar, and now she had crossed that great threshold.  I needed a priest to say the words, directing her soul from this world to the next and saying words of reassurance to whatever elements of her may have hovered near that she was safe to fully let go, and indeed must go, and also the words that gave assurance that we too, those left behind, were cared for and comforted.  
While we waited we began to pack Mum's things, and I made some brief calls to those who needed to know.  The nurses turned Mum on her back, and made her tidy.  We were assured that nothing personal goes with the patient to the morgue.  

I told the nurse I wanted to take Mum's rings, and duly signed for them.  I slipped them off Mum's hand without any twinge of strangeness - it was still her dear hand.  She had gone, and I knew she had wanted me to take care of them.  We had talked about all such things long ago.  I slipped off her possum fur socks, one of the few comforts left to her in those final days, and tucked them in my bag.  She didn't need them any more.  
The chaplain, having been roused from sleep, was there a very short time later, and quietly, in the bar of light from the bathroom door he spoke the commital and read from the Bible the time-honoured words of Psalm 23, of which these are some: 
Yea, though I walk through the valley of the shadow of death, 
I will fear no evil; for thou art with me;  
Thy rod and thy staff they comfort me [...]  
Surely goodness and mercy shall follow me all the days of my life: 
and I will dwell in the house of the Lord for ever.
It was done.  It was simple but complete.  Later I would discuss details of the funeral with Mum's own vicar, but for now the little ceremony made all complete. 
We continued with our packing, bundling up clothing, toiletries, books, music, photographs and pinboard, and my overnight things.  Mum had been in hospital only a week, but we had needed all  these things.

When we were ready to go the ward was still quiet.  Mum lay silently on her back.  My sister cuddled her good bye one last time.  I fretted briefly that Mum might be lonely down in the morgue without us.  Views on this point differ and I hesitated, but I knew I had to let go and firmly remembered the priest's words exhorting her soul to go forth on its way.  She had prepared for this and had wanted to go.  She had gone.  The day ahead would be demanding and probably difficult and I needed some semblence of rest in order to deal with it.  I accepted that I had to leave. 
My sister and I gathered up our bags and baggage and made our way out of the hospital to our cars and the new day.  The dawn had come, and I was exhausted.  As I drove home my sister kindly followed in her car to make sure I got there, before heading to her own home in the opposite direction.  Later that day we would clear out Mum's room at the rest home and meet at the funeral directors to go over details but for the next few hours the most important thing was rest.

With Ellen's death the part of my own life which I had shared with her, which during those last three years was a big part, also came to an end.  There was still a great deal to do, attending to details of the funeral and handling the remainder of her belongings and so on, but that old way of life, which had included all the other people who had helped her and the places associated with her care, had also gone.  As well as suffering great loss I felt strangely disoriented, and after several months still feel it.  Writing about it has helped, but it still takes time.  There are no shortcuts. 
In the years before Mum's death two dreams stayed with me and I thought about them often, one was my own, and the other was a dream of a very old lady at the same rest home:

I dreamt I was in a warm swimming pool supporting my elderly mother in my arms.  While she basked she dreamt she was a young girl happily swinging herself on a swing, and singing to herself.  Then she died.  There I was in the swimming pool holding her body.  That was all.  I must say that it made me very cool about any notion I may have had of getting into any pool with her, therapeutic or otherwise, and I was relieved that the situation never arose!  I mentioned the dream to a friend and she sensibly suggested that perhaps it was metaphorical and could mean that for the remainder of Mum's life I was going to hold her in my arms - until she died.  And that certainly did turn out to be so.  Also, at the time she died she was wet with perspiration.  I like to think that the content of the dream may have been complete in that during that last hard stretch she may indeed have been dreaming of some happy and carefree time.

The second dream is the one of the old lady, who knew her only slightly.  I am grateful to her for sharing it with me.  She dreamt that she saw a very beautiful woman in a long green dress.  That seemed to be all.  However, she added that the next time she saw Mum come into the dining room she recognised her as the woman in her dream and said to herself "There she is".  I thought how special it was that somehow in her sleep she had perceived Mum's beauty and presence despite her elderly and withered appearance.  It occured to me then that perhaps this is how it goes, that as our bodies age our inner strength and beauty and all we work towards and strive for, accrues and that when the body reaches it's natural age and dies the full harvest of inner beauty is realised.  A very wise old nun told me that she had observed that the greatest beauty comes at the end, and despite my mother's withered and suffering body, I did see this in her.  So I like to think that at the time of her death the moment of the beautiful woman in the green dress had also come.  Who can say.  I hold these thoughts in an open hand, so to speak.

Staying with my mother throughout the experiences that lead to her death was demanding in every possible way but it was valuable and good.  I had been fearful about it, that I might not be able to cope; I was not in good shape at the time and could so easily have missed much of those precious last days, been less involved, but I did manage to be there and keep going.  It was indeed a rich experience, and when the final moments came it was okay. 
I encourage others in similar situations to stay the course and do what you can to provide help and comfort, even if indirectly.  All deaths will be different.  Nevertheless the chances are that you may be as glad of the experience as I was.  I hope so.  And when we presevere even if or when it does prove difficult we know that we have done what we could to help, for surely what we all want is for those we most love and trust to be with us at the end. 
I have a great deal more to share about all this, but that will have to wait for times to come.
In the meantime other articles in this series can be found via the link below:


Anonymous said...

God bless you for keeping that precious vigil.
I respectfully offer my sympathy to you and your family.
Wishing you comfort and gentle memories.


Leigh Christina Russell said...

Thank you Valerie, that's most kind of you and much appreciated.

Stephen Ratcliff said...

As a hitherto "silent lurker", I have followed your writings with great interest and appreciation.

Thank you for your very authentic voice in describing what are such intense personal experiences. The way you maintain a somewhat external and descriptive manner is I think helpful to the reader, giving them space to relate to it in their own way.

I appreciate very much the efforts and exercises you have gone through in recording things the way you have.

And regarding your recent loss, it's written in the NT that love is one of the three things that endure forever. All your care for Ellen is definitely not "love's labours lost". No loving sacrifice is lost, wasted or disregarded, it is of inexpressible value!

Wishing you peace, rest, and a complete end to your burdens,

Leigh Christina Russell said...

Hello Stephen, receiving your thoughts, encouragement and good wishes means such a lot.
Many thanks and best wishes,