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Wednesday, March 23, 2011

Being Me - Or One Little Old Lady and Two Dogs Hit the Road

I have a Packing Thing. Packing to go anywhere sends me into a tailspin. I religiously make lists and check and recheck to make sure I haven't forgotten anything and still I’m a nervous wreck. The Packing Thing starts chewing away at me a couple of days before the actual packing is to take place. If ever there were a case for prescribing Valium for little old ladies, this is it.

So, on Saturday morning, I took my dogs to the beauty parlor and came home to - dum-ta-dum-dum - pack for our long weekend on Sea Island. But first I had to shower and wash my curly mop of graying brown hair so it would be dry by the time I was ready to pick up the dogs.

I packed two smallish bags for a short trip, sometimes walking in circles and gnashing my teeth. Don’t ask why I was so anal about a trip that was supposed to be a personal retreat. I don’t know myself.

Did I remember my medicine and my hair fixing stuff? Check. Jeans and boots? Check. Pajamas and a warm-up suit (for walking the dogs and myself)? Check. Toothbrush? And yes, I have gone off without my toothbrush. Check. And so it went. I took my new 3-pound dumbbells in the trunk of the car so I wouldn’t forget them. They are blue, a perfect match for my new workout pants, and I pictured myself walking along Ocean Road while pumping them energetically.

I cleaned Mr. Palmer’s bowl and put him in the box I use to take him on the road, making sure I packed his food. He’s a Betta, dark blue with fabulously flowing fins. Yes, I do take my fish when I am going to be gone for more than one night. I think he likes the adventure of going someplace new. He seems to, anyway. I carefully placed his travel box on the floor of the passenger’s seat and surrounded it with stuff (my laptop and some other things), so the movement of the car wouldn’t splosh him all around and make him seasick. Satisfied that Mr. Palmer would have a smoothe ride, I stumbled back into the house to finish packing and, oh yeah, dress for the trip.

I packed my cooler with three Lean Cuisines, my almond milk and a carton of nonfat half and half. I use those little things you store in the freezer to keep things cold. There was room for a bottle of wine, so I tucked in a bottle of Trader Joe’s Chardonnay. (You just can’t hide class, can you)?

Then I packed the dogs’ bag, measuring food into a big plastic zippered bag so we wouldn’t give out, making sure there were two kinds of treats for them, one chewy kind and one crunchy kind. You would think I were going to a monastery, not to the coast where they actually have stores that sell dog food.

Are you sensing and OCD pattern here?

With everything packed and in its place, I set the alarm, made sure all the locks were secured and fired up the old Lincoln that was Clint’s and started down the driveway. I hit the brakes. Where was the skirt I planned to bring? The tops to go with my jeans? Uh-oh. I turned off the car, went back into the house and found my hang-up things dangling from a hook on the swinging door between the kitchen and great room. I placed them carefully in the trunk on top of my other things and once more got in the car, cranked it up and headed to Petsmart to fetch the dogs and get on my way.

It was a slow and rambling trip from Macon. We took mostly back roads to avoid all the spring-breakers on the interstates. We ambled along through little towns with courthouse squares and past pastures where cows were grazing and fields turned over for seeding. There were old falling-down barns blanketed with wisteria, and acres-wide pecan groves that stretched out on both side of the road. Lots of people out in the country were having yard sales. Though tempted to stop at a couple of them I reminded myself that I am simplifying my life, not looking to clutter it up any more than it already is.

I rolled down the windows to breathe in the perfumed spring air, and Belle pushed her nose out of the half-opened back window to take it in, too. I opened the sun roof and before long, my hair was standing up all over my head.

The trip took about four hours, and I listened to "The Help" while tooling down the road. The Packing Thing behind me, I allowed myself to relax, enjoy the scenery and the book. One time, I pulled over thirty miles outside of Macon to check the trunk. No shit. I really did that. Aside: Don’t read "The Help," listen to it! Four women narrate it beautifully.

I have a sticker on my windshield that gets me on Sea Island without having to stop at the gate and convince the attendant that this wild-haired little old lady with a Boxer and a Lhasa Apso in the back seat of her 14 year old Lincoln Town Car is really a guest of the Smith’s at 502 Ocean Road.

With that behind me, I moseyed down The Drive, taking in the glorious spectacle of the live oaks that line it. With the windows still down, I realized my car was squeaking every time we hit a dip in the road. Shit. The roads on the barrier islands all have dips in them. It’s because the dirt underneath shifts. I worried that Mr. Palmer might throw up in his bowl. I had known for weeks that I needed new bushings but had put off having them installed, and there I was, in one of the three richest zip codes in the USA- squeaking.

So, it was with an abashed smile that I squeaked up to the gate and told the gate keeper at Ocean Forest that I was a guest of the Smiths. He frowned and peered into the back seat at the dogs. Then he shuffled through a stack of passes, not finding one with my name on it. Shit a blue brick! He eyed me suspiciously, and I offered to call Deidra for him. I pulled forward, letting the car behind me pass while I squeaked over every little dip in the road. I stopped to call Deidra. Thank God she picked up. I took the phone to the Gate Nazi, and he filled out a pass for me, handed it to me with an disapproving sniff and gave my car a long cold stare, like he could stare the squeaking out of it.

Before I unpacked the car, I walked the dogs, a silver doggie-doo bag hanging out of each pocket of the old scrubs I decided to travel in. Belle and Honey knew what they were supposed to do, and they did it, me following along with the bags so as not to leave any dog-doo on anyone’s pristine lawn.

I unpacked the car and hauled my stuff upstairs to “my” room. I could have used the elevator, but I couldn’t remember how to operate it. Besides, walking stairs is good for one’s soul, not to mention one’s fanny.

“My” bedroom is the best place in the whole house for enjoying the glorious views of the Atlantic, the Hampton River and the marshes and creeks winding their way toward Little Saint Simons Island. I opened the door to the balcony, stepped out, leaned over the rail, and breathed deeply of the salty air. I felt like the luckiest woman in the world.

I unzipped my bags and began putting my things away. I hate it when my things smell like luggage, so I always unpack as soon as I can. I trudged back downstairs to get my hang-up things so I could put them in the closet. I didn’t even make a drink before I unpacked.

Even I was amazed at what I dragged out of those bags. (Gentlemen, you may want to skip this part). Two pairs of jeans - one black, one blue, two pairs of boots to match the jeans, my workout clothes, two pairs of socks and nine, count them - one, two, three, four, five, six, seven, eight, NINE pairs of panties. There was one pink cotton granny pair, two black satin ones and SIX pairs of nude ones that are not supposed to leave a panty line. (They don’t work). I can't wait to hear what my therapist has to say about that.

What was more amazing is what I didn’t drag out of those bags. Not a bra in sight, of any color or texture. There I stood in my scrubs with a sports top on underneath and not a single real bra to be found. I routinely take two black ones and two nude ones, but oh no, not this time. I didn’t even pack more sports bras. I would spend four days and three nights in the same sports bra. It’s humid on the coast, so I couldn’t just rinse it out every night and hang it on the balcony rail to dry. Not only would the neighbors have a hissy fit, but it wouldn’t dry anyway in all that humidity. I would have to use the dryer.

I had managed to pack a lint brush, a bottle of Rogaine, Honey’s brush, three brown hair bands and one red one, most of my toiletries, two iPods with cords and ear buds, one cord that didn’t belong to anything, but no charger for the iPods or my Blackberry. I figured a way to charge my iPods by syncing them through my laptop and decided to just turn off my Blackberry, but I still didn’t have a single brassiere. What would I wear to Jim’s class in the morning? The sports top that makes me flat as a pancake? I had four turtleneck tees, two short sleeved and two long, and a cashmere sweater jacket that Clint bought for me the last time we were in Scotland that was way too heavy for the weather.

I remembered to bring the little packs of instant Starbucks - one decaf, the other regular - but failed to bring my fiber. I had green tea and sugar free Peeps to snack on. Don’t laugh. They are delicious, but if you eat too many, you’ll get some pretty noxious gas.

Close your eyes, boys.

It was while I was taking inventory of what I did NOT have that I got the first inkling that I just might have, I’m whispering now, a yeast infection. I sure as hell didn’t have anything to fix that. For the love of God, I had brought three Lean Cuisines just so I wouldn’t have to go to the store, just so I could really be on retreat with no outside distractions other than Jim’s Sunday School class. I decided to go to the store after I attended his class the next morning.

Boys. it is now safe to read on.

Making sure that Mr. Palmer was happy in his usual place on the kitchen island, I fed him then made myself a martini with three olives, sat down in front of the TV, and, breaking my promise to myself, turned it on and watched us bombing Libya for a while and tried not to cuss myself out for being such a fruitcake.

On Sunday morning, I showed up late for Jim’s class looking like Johnny Cash in drag and wearing a curly brown wig. I was in black from tip to toe, decked out in my favorite black top (which has diagonal ruffles that camouflaged my flatness) over black jeans with black cowboy boots peeping out from under the hems. My socks were even black. I’m not sure why I think it makes a tinker’s damn what I wore to Sunday School, but something just made me include it in this ridiculous tale. And by the way, when I was driving to church, I noticed that my car was no longer squeaking.

On the way back to Sea Island, I stopped at CVS to pick up you-know-what and found out that you can actually buy sports tops there. I helped myself to three so as to avoid washing anything while on retreat.

The remainder of my retreat revolved around writing and walking the dogs and walking myself. Belle made two escapes, but I managed to hem her up before she could poop on the neighbors’ lawns. No TV, no Blackberry, nothing but contemplative silence in which to think and write and enjoy the splendid vistas across the river to the sea. Okay, okay. I did check my email, but I cranked out two blog posts and this preposterous yarn.

On Tuesday morning, as we crossed the Sea Island causeway headed for Saint Simons and the mainland, I rolled down the windows, opened the sun roof and noticed that the old car was squeaking again. Maybe the Gate Nazi really did stare the squeak out of it...........

© cj Schlottman

Sunday, March 20, 2011

Synchronicity Redux

The view from this house is of the Hampton River, the Atlantic Ocean and Little Saint Simons Island. Last night was a Super Moon, and I sat outside with my dogs and watched it come up over the Atlantic, spilling bright orange ribbons of light over the dark waters of the river. It will be about 20 years before such a moon will be seen from the planet earth, and I hope to be around to see it.

It was breathtaking, this phenomenon of nature. I sat and stared at it, awed by its beauty and grateful for my opportunity to see it here in this place - my friend Deidra’s house on the northern tip of Sea Island, one of coastal Georgia’s magnificent barrier islands.

Today is the Spring Equinox, the tide is high, and a northeastern wind has driven the tidal water up into the marshes, making a large lake of them. When I think I almost canceled this trip, I begin to wonder if things really do happen for a reason.

I am in the process of rescuing a Boxer I met at Kottage Kennels, where I board Honey and Belle when I can’t take them with me. He was shot with buckshot, his ear was cut, and he was eaten up with heart worms when he got to the kennel. He was in a large cage just inside the front door, and there was a sign saying, “I AM UP FOR ADOPTION.” I loved the fact that his tail and ears had never been docked. I looked at him, he caught my gaze, and it was love at first sight.

I asked about adopting him, and the kennel owner said he had completed his heart worm treatment, but that he would not be able to leave the kennel for four to six weeks. His veterinarian wants to make sure he is well enough to run and play with other dogs. His name is Sugar Ray, but I’m shortening it to Sugar. I get that he was named for a boxer, but I deplore that violent "sport."

On Friday, before I began packing for this trip, I phoned Kottage Kennels to see if I could have Sugar this weekend, while I have six days off in a row, thinking it would be the ideal time to integrate him into our home. The vet said he wanted to keep Sugar quiet for at least two more weeks, so, disappointed, I packed my things into the trunk of the car, leaving the back seat free for Honey and Belle, and down the road we came.

This is going to come together, I promise. If I could have moved Sugar into the house this weekend, I would have stayed home. But, through my disappointment I received a great gift. When I am here, I attend a Sunday School class taught by my friend, Jim Gilbert. I don’t go to church and Jim’s is the only class I attend. He puts an amazingly cerebral twist into his lessons and I always come away in a introspective frame of mind. It always leads to self evaluation and research into the Bible verses upon which Jim builds his classes. Today was no exception, and I will be focusing on the the Holy Spirit for a while.

After the class, I walked over to a regular member and reintroduced myself. He is a boat captain for a wealthy Atlantan, and Clint went on fishing trips with him before he got sick. When introduced to John’s wife, I learned that I had cared for her aunt when she died at Pine Pointe. I actually pronounced her dead. John also knew one of our first patients. Then we discovered other threads of synchronicity - friends in common, his Macon friends, my Saint Simons friends. It felt like being reconnected with some of my roots here, and it felt right.

It is right that I am here, giving myself the gift of a small one-woman retreat. If I had stayed in Macon, the Super Moon would not have been clearly visible from my little house. Certainly it would not have been sending out gleaming rays over the river. I would have missed Jim’s very thought provoking lesson this morning and, and I would have missed reconnecting with John.

Maybe things really do happen for a reason?

© cj Schlottman

Saturday, March 19, 2011

Afraid of Me - An Exorcise?

I don’t know when it happened, but I realized the other day that, at times, I am afraid of myself. Why am I afraid of me? I think this would qualify as one of Rosemary's "exorcises."

I suppose the best example of being afraid of myself is how I felt when I went back to work last year. I second-guessed myself at every turn, scared that I would make a mistake and be judged harshly for it. That’s just one of a list of examples of how my self worth was so wrapped up with Clint. He truly made me believe I was bulletproof.

It happened when I began to write in earnest after Clint died. I wrote and shredded piece after piece, thinking them unworthy, not good enough for anyone to want to read them. There was no Clint to buoy me. Any time I got in over my head (or I thought I was), he was my life vest, the force that kept me afloat. My self-confidence was long in returning.

And there are still times when I’m afraid of myself. It happened again when my job changed, and I began working inpatient hospice instead of home care. I come from an era of nursing when we always checked each other off when giving opioids. So, that’s what I did - and it backfired on me. The other nurses began to think I was unsure of myself, that I didn’t know what I was doing - and instead of talking to me, they told my manager about it. That’s when I got afraid of myself again.

Thank God for Nettie and Karen. They are sisters. Nettie is one of the best nurses on our team, and Karen is the best clinical tech I've ever worked with. They collectively took me under their wings, told me what the others were saying about me, and mapped out a plan for my success. Still I was afraid of myself, but after a couple of weeks of their tutelage, I began to soar, believe in myself. The result has been that I am confident in my work and getting better at it every day.

Self fear, or whatever a psychiatrist would call it, has not been limited to my employment and my writing. After my experience with the MF (Man Friend), I became unsure of myself in social situations. I, who have always been at ease with others, hated being the odd woman out and didn’t know what to do with myself when friends invited me to join them. So, I developed a kind of phobia about going out with couples. I wanted Clint back, still do. He was the other half of us.

But I made myself go, and I also began taking my 82 year old friend, Frances, out to dinner one night every week.

See a trend here? I am conquering my fears of myself. There’s probably a 12-step program for people like me. I’m in recovery! It could happen again and probably will, but I will recognize what’s happening and start a support group!

© cj Schlottman

Sunday, March 13, 2011

A Day at Hospice House - The Conclusion

This is the final post of a series I am writing about my job. I hope it will serve to heighten awareness of hospice care and answer some questions my readers may have and give them information that they can pass on to others. To begin at the beginning, click here.

My new patient is a heartbreaker, an eight year old with brain cancer. He is here for what we call Respite Care, a time for caregivers to take a breath, catch up on their rest and in general, recharge. His mother will stay with him here, but she will not have to worry about meals or too much company. We will take care of that. It is 12:30, and I have orders for my little boy, so I can get him settled as soon as he arrives.

Checking on my patient in Room 412, I find him again having jerky tremors and wearing a frown. I give him more medicine, then I call his doctor and ask for an order for a continuous drip. This sliding in and out of pain and agitation is hard on him - and on his family. A continuous drip will deliver a metered amount of the drug every hour. I order the drip from our infusion center, and they agree to deliver it as soon as possible.

It’s 1:30, and I have actually had time to sit down and eat my lunch - a diet entrĂ©e I brought from home. On this rare day, all of us nurses eat together.

Out again to check on my charges, I find the patient in room 406 becoming agitated again and short of breath, so I give him a bolus of morphine and titrate his pump up by 1 mg per hour, then I give him some Ativan and call his doctor and ask for an additional drip - one of Ativan. I get the order and fax it off to the infusion center. Now I am waiting for two drips.

2:30 and my young patient has not arrived. We nurses are all anxious about his admission. Each in our own way, we dread having young patients. It seems so wrong for them to be dying, never having had a chance to live a full life.

I check on my patients and all is well for now. The drips arrive at the same time, and I am tied up for nearly an hour getting them started. In addition to programming a new pump for my patient in room 406, I must start another subcutaneous infusion site.

3:30 and still no word from our youngster. The phone rings, and when our secretary answers, she quickly hands the phone to me. There has been a scene at the home of our little boy involving his divorced parents. His father has taken him to his house, and his mother has called the police to report his father for violation of their custody agreement. The police have arrested the father and returned the child to his mother. Whew. What a mess.

At 4:30, our little man arrives with his mother. He is hysterical. Hysteria is not uncommon in patients with brain cancer, but this little boy has been torn from his mother’s arms, retrieved by the police and taken to a strange place where all he sees is nurses in scrubs, never mind that we are all dressed in soothing pastels. All he sees is strangers dressed just like all the other strangers who have prodded and poked and in general assaulted him with chemo and radiation and needles.

I shoo everyone out of the room, then I leave myself. These people deserve some peace, and it is my job to make sure they have some.

I tend to my other patients, both of whom are resting quietly.

Then I spend an hour sorting out the medicines that arrived with our eight year old. He has been in hospice care at home for some time, and there are many drugs to sort through. I separate out the opioids and lock them in the med room. The others, I take to his mother so she can administer them to him as she did at home.

Ester, my great friend and hospice mentor, checks on my other patients for me. I didn’t have to ask her. Teamwork is what makes this possible. Without it, we would all sink under the burden of all that this job piles on our heads - frustration, sadness, feeling torn between patients, and yes, fatigue.

Back on my feet, I reclaim my patients and prepare to give report to the night nurses. They will start arriving around 6:30, and I want to be prepared to give them a coherent and factual report.

At 6:45, we count opioids and the count is correct. My flow sheets for continuous drips are in order, so I give report, pass along the flow sheets and other medication records, and prepare to leave.

I drive home in the dark, just as I had arrived in the dark. Daylight savings time will start this weekend, so I can look forward to leaving during daylight on Monday afternoon. My dogs are happy to see me and I them. I feed them and sit on the deck while they play and take care of business.

A hot bath with the jets running in the tub - then off to bed, where I write a little but mostly stare blankly at the TV. 4:45 AM will be here soon after I close my eyes.

© cj Schlottman 03/13/2011

Saturday, March 12, 2011

Steps to Meeting my Goals

My writing mentor, Rosemary Daniell, leads an ongoing writer’s workshop in Savannah called Zona Rosa on the first Saturday every month except August, when we are on sabbatical. The group has been ongoing for 30 years! A wonderful and acclaimed published writer and poet, Rosemary has other ongoing workshops and does guest appearances all over the country, speaking and teaching at writing events, retreats and festivals. She even leads retreats abroad. There is a retreat in Aix en Provence, France, in May. The Saturday group is exclusively for women, and we have members who range in age from their twenties to their eighties.

Learn more about Rosemary and her workshops by visiting her web site - Secrets of the Zona Rosa.

One of the many creative aspects of our group is that, each month, Rosemary gives us a list of “exorcises,” topics designed to keep our writing fresh, creative and real. These "exorcises" are not mandatory, but some very good writing has come out of them. They are designed to keep us writing our truths. They can be very therapeutic. It is from Rosemary that I learned how important truth is to good writing.

So, today I am publishing my “exorcise” here on The Red Sweater.

Here is a sample of a few “exorcises” from last weekend:
“How my awareness of mortality affects my thinking and writing.”
“How my house speaks to my writing.”
“Steps I am taking to meet my goals.”
"Write about the thing you most don't want to write about."

I fell headlong into “Steps I am taking to meet my goals.” A little voice in my head tells me that Rosemary was looking for text on writing goals, but I turned it on its side and went in another direction.

My goal is to maintain what semblance of sanity I have left. Here are some steps I am taking to keep my sanity:

1) After all these months, I feel as though Clint died yesterday, not on June 8, 2019 at 6:33 PM. I was unprepared to be actively grieving 21 months later, but here I am, still on the roller coaster of relative peace followed by reactivation of my grief. Stress at work, stress in my personal life, hearing a certain song, gazing at a photo of us dancing at a wedding, smiling, our eyes locked on one another, his side of the bed, stretching out like the ocean reaching toward the horizon - these are just a sample of the things that can leave me unbalanced, sad, helpless.

My Rx? Work, work, work. Write, write, write, especially in my paper journal. When not at work, I find myself fighting an inertia that is difficult to describe. My house is a mess, my housekeeper has been out for three weeks with a sick child, and I hate housework. I sacrifice in other areas in order to have someone come into my house and clean it for me. But, today I am going to attack this little cottage with my Swiffer products and elbow grease - after I come home from the gym, where I have been going every day I’m not at work. I carry a three pound weight in each hand and walk hills on the treadmill for an hour. That, I am certain is helping me keep my balance.

2) The conundrum that is my son, Parrish - mentally ill, as most of you know. He has been putting pressure on me to come back to Georgia, to Atlanta, where he once lived on the streets and in parks and under bridges. I would rather go to prison than see him back in Atlanta, and I have told him so. Nevertheless, he continues his passive-aggressive attempts to change my mind. He has been in hospital three times since he was here in December, and I believe that all three were attempts to get me to jump on a plane and come rescue him. His last hospitalization happened when he checked himself into the psych ward at University of Miami Hospital, saying he was having suicidal thoughts. He called me to let me know where he was but refused me access to his doctor. Last month it was his back (two failed fusions). He said the doctor wanted him to have more surgery but one more refused to give me access to his physician.

My Rx? I love him from afar and refuse to be drawn into another enabling web with him. I am sympathetic when he calls to tell me his troubles, but I refuse to intervene in his life. I have found that, if I simply listen and refuse to buy into his “crisis du jure,” it mysteriously goes away. His illness makes it so hard to detach from him. I do worry about him, but the stark naked reality is that he cannot live with me or in Atlanta. So, we do the best we can. On April 16, I will fly him to Atlanta, where I will meet him, and we will stay two nights. He will be able to see his oldest friend, Michael. Now he has something to look forward to, and my fervent hope is that it will keep him focused on that and not on his living situation, and assisted living facility which is not optimal. Unfortunately, I cannot escape the belief that, when the weekend is over and he returns to Hileah, he will be in hospital within a week, sad and depressed that he could not stay in Atlanta. It is impossible for him to make the best of things and focus on what he has instead of what he has not.

Sure, these are mental health goals, but I think they are as important as writing goals.

So, Rosemary, this post is for you!

© cj Schlottman 03/11/2011

Friday, March 4, 2011

A Day at Hospice House - Part Three

This is Part Three of a series I am writing about my work. To start at the beginning, click, here.

My patient in Room 412 is a sweet little man who took himself off of dialysis a week ago. It is unlikely that he will live another week. When I arrive at his bedside to do his assessment, he is having dramatic tremors of both hands and arms. He is been medicated with Ativan every four hours, and he is still restless and agitated, the toxins that should be filtered by his kidneys building up in his system.

I manage to get him assessed, then I visit with his very anxious family, his wife and daughter. I wonder out loud to them if our sweet man is in pain, though he denies having any. Thinking about it, I note that his tremor gets much worse if we touch him - anywhere on his body. I suggest to them that we might want to give him some hydromorhone (Dilaudid), which is ordered for him to receive every three hours for pain.

Back to the med room for an injection for him. He has a subcutaneous infusion site, a soft catheter inserted under the skin around his belly button, and when I return to the room at 10:10, I inject the diluted drug slowly and flush the site. I sit at his side, talking softly with the family, and wait to see how the hydromorphone will affect his pain. Ten minutes pass, and he is asleep. I touch his hand, and it remains still. He is snoring loudly when I leave the room.

(Aside, I love subcutaneous infusion sites. They are much easier on the patient, need to be changed less often than IV sites. There is little chance that the patient will pull it out - a win/win for patient and nurse).

At 10:15, later than usual, I open the electronic charts for all three patients, quickly making notes. The doctor has visited, and I check my charts for new orders. There are none, thank goodness, so I slurp on my cold coffee and go back to see about my man in 406.

I find him still sleeping and spend some time with his family, answering questions and encouraging them. We give all of our families a booklet that explains the dying process, but most of them cannot absorb at first reading. I go over the signs with them and encourage them to go back to the booklet and read it again.

Returning to Room 411 to find my little lady having longer periods of apnea. More family is in the room, a daughter and a son and daughter-in-law. I look at her feet. They are cold and mottled and her legs are cool to the knees. Her nail beds a cyanotic, and she is approaching the end of life. More family is on the way. I sit with them and offer support, trying to field questions like: “How long will it be?” “How long can she go on like this?”

Some questions are impossible to answer, but I tell them I believe the end is imminent, that if they want to give my sweet patient permission to leave, they should do it now. Sometimes, patients need to be assured that their families will be all right, and if they need to leave, they can. Hearing is believed to be the last sense to go at end of life, and even though she is now in a coma, I encourage them to talk to her.

They each in turn take her little hand and whisper how much they love her and that if she is too tired to live, it is all right to go to the light.

I tiptoe out of the room and find my little man in Room 412 snoring away. I touch his hand, his arm, his face, and he continues to sleep without tremors. We are all relieved, the family and I, that he is peaceful.

Returning to Room 411, I sit with the family as their dear loved one takes in her final breath. I put my stethoscope to her chest and hear no heartbeat. She is not breathing, and I pronounce her time of death at 11:15 AM. I quietly tell the family to take all the time they need to be with their dear one, to call me when they are ready for me to call the funeral home. They want her to stay until other family members can come.

Back at the desk, there are forms to be filled out, and I enter a death note into my patient’s chart.

Then it’s back down the hall to check on the two patients I have left. Returning to the desk, I learn that I have an admission coming..............For the conclusion, click here.

© cj Schlottman