Letting Go

It's a straight shot to the finish line, but it's not easy.

Again, the disclaimer. This episode deals with active dying and actual death. If you don’t want to read about that, you’ll want to skip this.

When we brought Nina home, the most explicit instructions hospice gave us involved the nitty gritty of active dying—how to recognize it, what not to do under any circumstances once it started (call 911) and what to do once it had happened (not much). They reviewed things to look for, all of which we’d read in the hospice manual, but now were more in focus. They were things like skin discoloration, lower skin temperature and the “death rattle” when breathing becomes raspy. Once mom passed, they told us, we could wait a bit to call the mortuary, whose contact info we had at the ready. That would be our opportunity to take whatever time we needed to say our final goodbyes. We were pretty clear on the steps that would happen, but had no clue about how long they would all take.

The Waiting Game

The first two nights that mom was home I slept on the floor of her room, listening to her breathing and a few strange and sudden croaking noises. She was sleeping through the night, just as she was sleeping through the days. On the third night Anne joined me. Again, she made few noises, other than the random croak. For the most part, day and night, she lay in her bed, inert. That left us in a waiting game, filling time, and administering meds on a schedule that we made up as we went.

We each clicked into the roles we’d been easing towards. Anne had been part of everything until now. She’d come so far, turning the corner to get mom home to die and facilitating the logistics of it; but giving morphine was a bridge too far, and we respected that. Beatie took charge of organizing the containers of meds and the three of us—Barry, Beatie and I—took turns administering doses. Somewhere during that time, a close friend of my parents came by. He had been through this process with his own wife, offered his help if we wanted it, and repeated the now familiar advice: “There isn’t a dose that is too big to give.”

Died unexpectedly is code for suicide. Died peacefully, I’m now pretty sure, is code for morphine. The moment of death may indeed be peaceful for the patient, but getting there—for the people in attendance— is anything but. Finding the resolve to push forward called for an unlikely skill-set, one we happened to have in house.

Barry had been living sober for fifteen years, but his hard time on the party circuit had earned him an unofficial undergraduate pharmacology degree. Finally, it was going to pay. Barry summed up the task at hand: “Crush up pills, mix them with morphine and suck it all into a syringe? I’ve got that dialed!” We had a good laugh about it in the moment, but Barry was humanizing a scene that felt ominous and alien. His role became an increasingly important one, loaded with emotion and responsibility. As Beatie recalled later, seeing him give mom morphine, with complete confidence and love, gave us the license and courage to do it when our turns came to do the same.

Whereas we started by carefully logging all her doses on a giant, conspicuous piece of cardboard to easily monitor them, our drug dispensing devolved into a wild west affair. As we went into the bathroom to get the meds on our turns, we’d silently look back and mouth, “more?” with a questioning look, and nod to each other in agreement. In this way, we upped first the dose and then also the frequency. Between doses, and heedless of internet history tracking, I googled “lethal dose of morphine,” and still got no clarity. It would be years until I had the courage to talk to people about their experiences, and to understand that this is not an unusual scenario. In the moment, it just felt equal parts wrong and necessary.

At a certain point in the escalation, with no end in sight, Beatie and I couldn’t handle it anymore. Each turn felt like playing Russian Roulette, fearing that this dose would be the fatal one. It was an odd space. We all knew how this would end, and understood that it needed to end. We knew that we were in this together, equally; but still, we were scared. Scared of not giving her enough, and having her wake up in pain, and scared of giving enough and of the inevitable. That is when Barry took over completely. “If we’re on the same page, I’ve got this,” he offered. We assured him we were.

One Last Breath

On the fourth night, I did not sleep in mom’s room. Beatie and Anne camped out on her floor, and listened to her breathing. They had been at mom’s side through these final, brutal years, and they deserved to be with her at the end, which seemed near.

Instead, I stayed on the living room couch, a place I love because it runs beneath a wall of windows. Sleeping there feels is like snuggling under a blanket of stars or bathing in moonlight. When you can’t sleep you can look out at the mountain ridgelines and trees, and the quiet meadow where we had so many nighttime adventures as kids. No place brings me more peace.

When death came for Nina, it was indeed peaceful. They tell you that towards the end people often stop breathing for a long time, and then take one big, surprising breath before stopping entirely. Beatie listened to her every breath that night, and reported it was different with Mom. After taking one final, regular breath she simply stopped breathing. She took that breath just as the waning moon rose over the ridgeline and cast its light on the meadow. At that moment too, the coyotes howled in a goodbye chorus.

Beatie woke Anne, who then woke me in the living room. There was nothing to do but stroke her face, tell her we loved her, and then retreat to our rooms, or in my case back to the couch. From there, I looked at the moon and listened to the coyotes and then to the absolute quiet until dawn.

Up Next:

Oh yeah, I’ll be back with more—we’ve got the morning then the day to get through.