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Archive for the ‘dying’ Category

Rest In Peace Precious Pogo


PogoAndMeIs it serendipity that I euthanize my dog 12 years, almost to the day, that we met each other on that fateful walk around my neighborhood? And the night before my birthday no less. Then he was my birthday present – my first, ever, dog. Now what is it? A lesson on the cycle of life? An exclamation of the impact this 25-pound perpetual puppy has made on my life? An exercise in extreme grief and mourning?

I’ve loved Pogo with an intensity I’ve not felt before and I’m an animal lover, a mom to a couple dozen cats by now, all of whom I’ve exchanged deep bonds and connections with.  I’ve buried my fair share of kitties and mourned each one, some more deeply than others. But Pogo … Pogo is different. He’s the love of my life. Part of my heart has been ripped from my body and thrown into the ether. My best little buddy is gone. My greatest fan. My fiercely devoted companion. My tireless cheerleader. I’ve never been loved like that before.MyBabyPogo

I’d heard that a little brown dog had shown up in our neighborhood 12 years ago. Our wooded peninsula seems to be a magnet to stray or discarded animals who’ve become neighbors’ family members over the years.  Though I walked the neighborhood everyday I hadn’t yet spotted him.  And then I did!  Or rather, he noticed me and decided I was his long-lost mom – I guess that’s what he meant by jumping up and down and smothering me with kisses. He was beside himself with joy, and so life together was never questioned. Pogo and I instantly became family. And for 12 years he’s never wanted to leave my side, always looking up at me with his big cheerful smile and love drenched eyes. Buds forever starting at his estimated age of 2.

PogoOnWalkBoy did he love the summer we spent in Boston. Every morning I walked and he romped through the Esplanade, bounding into The Charles River to take bites of water. Chasing the geese and making friends with pups and people, alike, because of course they had to say hi to him! He’s Pogo!

He was the little boss of everyone and everything. Anyone coming near me had to pass his inspection. Even in the vet’s office. On our RV trips he owned our camper and was the self-appointed boss of the cat. And, of course, the trail we walked, always trotting ahead of me to make sure that the coast was clear. At campgrounds he was on leash. But at home I never leashed him. Never needed to. He was very familiar with our environment, having lived by his wits for about a month before we met. Truth is, he never wanted to be too far from me and always looked over his shoulder to make sure I was near, even if he had sprinted after a deer.

Pogo

Pogo

I’ve often wondered where Pogo came from and how he made his way to our neck of the woods. Perhaps a hunter came looking for game of some kind and Pogo ended up lost. As a Feist Terrier he was a squirrel hunter, very fitting for a dog bred in Tennessee. But as my baby he wasn’t allowed to hunt squirrels, or anything else for that matter. I turned him into a mama’s boy and I’m proud of it!

Things I’ve learned from Pogo …

That loyalty runs hand in hand with unconditional love

Suffering is optional

Simple things in life matter

Tomorrow’s another day to be cheerful

It’s unnecessary to feel sorry for yourself

Deep bonds are not fragile

To live is to love

Forgiveness

Pogo3I always told him he wasn’t allowed to die, that we had to be together forever. Anticipating his eventual demise was not something I could bear to do and yet now I have to.  His precious heart was in failure, his only eye blinded by cataract, his legs severely weakened by arthritis and dementia made him fearful, irritable and confused.  I’ve wailed myself empty and somehow the grief fills to the top again. I’m drained, I’m hollow, I’m numb. And so deeply, deeply sad to my core.

Goodbye my special, adored, feisty little friend. You’ve taken a piece of my soul with you.

“Until one has loved an animal, a part of one’s soul remains unawakened. ”   Anatole France

More about Pogo …

And again …

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Dear Marilyn,

PWHatPointing

I’m at your house sitting on the lanai and watching an impressive thunderstorm whip through the palm trees and create a rapid water flow down the canal. Just the kind of thing you love to watch. But you’re not here with me, and won’t be, ever again. In fact, these next few days will likely be my last moments with this particular view. I soak it in and think of all the hours we’ve sat here together over the last 17 months, your favorite place to whittle away early morning hours and cool afternoons. I’ve seen sunsets and sunrises right here. And watched an alligator amble lazily down the canal. Today the summer bushes bloom with vivid pink flowers and your orchid soaks up the moisture from the rain.

Today’s summer storm finds you in bed, breathing down your final days on earth, with family at your side.  Today your hard fought battle to stay alive ends with your diseased pancreas and liver winning the war.  60 good years Marilyn and 17 months intensely aware of the gift of life.

Marilyn&MeDinnerDuring those 17 months I’ve been hyper-tuned to living too – coming down to Florida to play, commiserate, share confidences, reminisce and to re-energize a friendship that began more than 50 years ago.  Every few months we’d resume our ongoing conversation, as though our past years of periodic contact were mere minutes apart. Our friendship was as easy as always with intimate conversation developing within moments of walking in the door. You’ve always been the perfect blend of friend and sister – frister?  You’re my Byer and I’m your Richey

 

M,Bob&MeSushiGeeze – was it really 50+ years ago when I’d run two doors down to your house every Christmas morning? Sometimes still in my pajamas, never wanting to be late for presents.  And there was always something under the tree! And a big family dinner to anticipate.

KidsWeekdays we’d rush home from school to watch General Hospital and Days of Our Lives with a giant can of Charles Chips between us – sometimes barbecued, sometimes not. You loved the burnt curled ones, which was perfect because I wanted the big flat chips!  Then during commercials we’d grab a cup of coffee and whatever wonderful something your mother had baked. Or a piece of white toast, butter, sugar and cinnamon. Your house was the only place I ever had that concoction.

Your family summer vacations down the shore always had me in tow. We’d walk the boardwalk looking for cute boys and singing Beach Boy songs. You’d wear short shorts to advertise your beautiful, tan legs.  Mine were covered but I’d display other attributes (wink, wink).  Then we’d talk the night away in bed til your mother  – achem – “asked” us to go to sleep.

Your family picnics, years’ worth of them. Yep – I went to them too. Aunt Edie, Uncle Rennard, Mickey, the Dearys, Uncle Lee – weren’t they my family too?

And all the evenings I had dinner at your house and all the sleep overs where we’d whisper in bed til the wee hours of the morning – even on school nights.

And weekends playing Barbie dolls and as we got older, riding in your Volkswagon Beetle. And sometimes even liking the same boy. That wasn’t as much fun.

And choir practice and colored guard and Marble Hall Swim Club.

Marilyn, Bob, son Michael & family

Marilyn, Bob, son Michael & family

 

And then Michael was born. You’d just given him a bath and placed him on the bassinette to be diapered then – woosh – his water fountain started and landed in his ear.

We laughed so hard we could barely breathe!

Marilyn's grandchildren

Marilyn’s grandchildren

 

 

 

 

 

 

Down the road came Bob Kile. Oh, I remember hearing about that handsome farmer you met whose blue eyes made your heart melt. You found the one – you told me – and were off to become a farmer’s wife.

Eventually you brought him here, to this house in Venice, FL – where you’ve loved living for 5 years now?  Your beautiful home, beloved lanai, bright sunshine and warm community. It’s where you belonged. And it’s where Bob took very good care of you – in many ways – most recently as a selfless, devoted caregiver.

 

Marilyn & husband Bob

Marilyn & husband Bob

 

 

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M&BobXmasHat

M&BobBoat

 

 

 

 

 

 

 

 

 

 

 

MarilynBySwampArea

 

Byer, you put up a noble fight these past 17 months & lived well because of it. Your determination kept you going – and fighting spirit inspired everyone around you.  That insistence to hang on catalyzed me to consider some important questions about life.  Thank you for that.

You’ve always been so full of life & so strong – laughed easily, loved big, vivacious and an easy conversationalist. Those who know you would call you a big person – not in size, but certainly in presence.

 

All the different places you’ve lived, all the different phases of life you’ve experienced, with the same being true for me. Yet we always stayed in touch and up to date on each other’s lives.

M&MebikeYou’ve been an important friend to me Marilyn. And because we’ve had 17 months to talk, you know how and why.  As a kid, I needed you and your family and you were always there, as were your parents. I told them that before they died. And I’ve told you.

 

What’s left is to say goodbye, my oldest and dearest friend. I love you, I’ll think of you often and I’ll miss you.  Til we meet again …

MSmiling

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Alzheimers ribbonThe last time I saw Martha everything seemed status quo even though it had been a month since my last visit.  Her head was resting comfortably on a pillow, mouth was wide open as usual and she was sound asleep.  She was usually sleeping when I arrived and when I left, and her husband said she now spent much of her time asleep.  It was getting more difficult to awaken her for meals.  That was the sign we’d been waiting for.

Martha has been uncommunicative for 5 years, in hospice care for 4 years, and in a vegetative state for about a year.  She’d been living with “end stage Alzheimer’s Disease” during those same 4 years and living with the disease for about 11.  Doctors said she’s the first person they’d met to live “like that” for so long.  Most patients die sooner.  For some reason she’d been hanging on.

Martha finally died several days ago and I seemed to be the only one relieved – for her sake and for her husband’s who’s devoted the last 11 years of his life to her care.

Some background …

rainbow01As a hospice companion volunteer I function as an impartial friend to the dying and to the family who cares for them.  The adage “when a person is sick a family is sick” is true.  Illness can drive a family apart because of a shared history – or together as a united force.  In Martha’s case the bond grew tighter.

When she was diagnosed her husband promised to take care of her until the end, as she did for her mother who finally succumbed to Alzheimer’s years earlier.  He took that pledge seriously, and literally, essentially becoming hostage to his house unless he could find someone to “sit” for her on occasion.  That’s where I came in.  Three years ago I became that person who “babysat” as he called it.

True_Friendship1Over time hubby and I have become fast friends, visiting together before and after he ran his errands.  Eventually I persuaded him to include others in his life, people vibrant and leading healthy lives.  Hubby started going to Bingo at the senior center during my weekly visits.  He made friends there.  Continued gentle prodding inspired him to invite them over during the week for pizza and card games.  Slowly the twinkle returned to his eyes, he laughed again and regaled me with stories from his week’s events.  I got him books to read, movies to watch and together we went through his photo albums of happier days when Martha was his wife and not the living corpse in the bedroom.  He giggled about a couple of the “old ladies” at the senior center seemingly flirting with him just because he helped them on and off with their coats.  He was starting to feel like a man again – all the while – feeding, bathing, toileting, dressing, transferring and giving meds to his wife in the next room.  And he spoke so lovingly to her – calling her his pet names, rubbing her cheek, whispering in her ear as though they were sharing a secret from yesterday.  She laid in bed, mouth wide open and eyes staring blankly, not moving a muscle – while her chest went up and down with each breath.  “She knows it’s me,” he always said, “I can tell by the look in her eyes.”  Really?  It looked like the same blank stare I saw each time I was there.

Probably two – three weeks ago Martha turned a corner.  She slept almost all the time and her breathing became shallower.  Then she refused the spoon he continually tried to put in her mouth with food.  Then she wouldn’t take the thickened water.

And then – finally – she died.

At Martha’s memorial service hubby was drowning in his sorrow, unable to contain the tears that insistently ran down his face.  And his grief remains intense today.

Kozzi-broken-heart-shape-cartoon-772x673His world has a gaping hole in it.  There’s nothing he has to do and nobody who needs his care.  Martha isn’t there anymore.  He’s not sure what he’s going to do.

So my relief for her peace and for his freedom is misguided.  While she is, hopefully, at peace he’s not yet free.  Love’s tentacles run deep.

I have much to learn.  And that’s why I do hospice work.

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Marilyn&Me1My dear friend may have just been given a treasured gift or the worst nightmare of her life – depending on her attitude.   She received the kind of news that none of us ever wants to hear.  The majority of us approach each day with a nonchalant assumption that we have infinite tomorrows.  And she’s certainly no different in that she gets to live her life and someday die.  Marilyn2The difference between her life and mine is that her lifespan now has a calendar attached while I still exist in blissful ignorance of my last day.  Though she doesn’t really know either, she is aware of medical statistics that place the odds of living a long, healthy life in my favor and not hers.

Marilyn has metastatic pancreatic cancer that’s now in her liver too.  With a cocktail of chemotherapy drugs doctors might be able to keep the cancer in check for months, possibly years if she joins the small percentage of people who do.  And time will tell, assuming her tolerance to the drugs goes “reasonably well” (doctor parlance for “manageable side effects”).

While the clock is ticking Marilyn can live each day to its fullest, prioritizing her life in a way that few of us ever do.   I’ve put myself in Marilyn’s shoes, hypothetically, and here are the questions I’m asking myself …

Am I living my life the way I want to?  If not, what do I need to change?

            Who are the important people in my life I need to spend time with?

            Who are the people I need to forgive or ask for their forgiveness?

            What do I obsess about that I need to shed?

            Is there a dream I need to pursue before time is gone?

            Are there places on earth I’ve always wanted to visit?

            What is truly important to me?

            What do I need to stop doing?

What should I start doing?

            How often to I appreciate the specialness of each mundane day?

Where do I find joy?

Marilyn:BobAnswering those questions can be gifts to all of us, including Marilyn.  The key, then, is to change our lives accordingly, if necessary, so we can truly live out our days and not sleep walk through them.  Those of us who live in mystery of the end rarely take time to appreciate the daily spoils of life.

Meanwhile, my answers to those questions are still percolating around my system.  But I’m grateful for the wake-up call and send Marilyn ongoing wishes for healing while she processes those questions too.

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My column from last Sunday’s paper…

A living will is one of those documents you don’t usually think about until circumstances force you to, and then its piercing questions cut straight to the meaning of life.

How hard, and at what price, do you want the medical system to work to keep you alive? Therefore, what does it mean to be alive? This is not light Sunday morning reading, to be sure. For me, the living will took most of a Sunday afternoon to labor through on behalf of my elderly father, whose health just took a turn for the worse.

The first question asked whether he wanted CPR to be administered. He’s always said that if there’s a breath, there’s hope, so I guessed he’d say yes. But now I read that risks of CPR, particularly in the elderly, include broken ribs — one of which could puncture his lung and require mechanical intervention and a chest tube. He could also suffer brain damage because of less oxygen to the brain, and vomiting that might cause pneumonia if it aspirates into his lungs. Really? Call me naive but I had no idea, and, as it turns out, neither did he. In other words, he could be sicker than when he started.

Of course, the alternative is death. So there lies the question: How alive is alive?

Many physicians spend their days saving lives yet would not want heroic intervention for themselves; they well understand that it’s often futile and, worse, imposes suffering on the patient. Dr. Ken Murray writes about quality of life vs. its length in his poignant blog called “How Doctors Die.” (http://bit.ly/LP2d7g)

So many people wind down their lives in an ICU attached to tubes because traumatized family members tell doctors to do everything possible. They’re expecting a chance for the patient to resume a normal life again. Often that doesn’t happen; the patient may live, but not the life they knew. Family doesn’t realize, nor are they usually told, what’s reasonable to expect. And in the process, tens of thousands of dollars are spent every day.

As a hospice volunteer, I witness the process of dying each week. Patients experience their final days receiving compassionate care that minimizes pain and offers emotional, social and spiritual support. It’s usually not death that people fear, but rather pain and social isolation. Facing the end, people realize that it’s relationships that matter and spending time with loved ones takes priority. A book by Dr. Ira Byock summarizes four things he found matter most to a dying person: “Please forgive me. I forgive you. Thank you. I love you.”

Author and philosopher Joseph Campbell says that the real search isn’t for the meaning of life so much as for the experience of being alive. Nobody wants to end their days wishing I had, or hadn’t — we all want to live significantly and feel we’re making contributions of some kind to the planet and each other. We want our lives to have meaning until our last breath.

One of my favorite reads is by Rodney Smith, whose book “Lessons From the Dying” is, despite the title, more about living. During his hospice career Smith gleaned insights about what’s important in life. There are gems throughout this work, but his summary point might be, “It helps to live with the end in sight.” Each day matters, and living it consciously is a choice we’re all empowered to make.

Everyone is going to die. The question is how do we want to live and at what cost?

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Growing Old


Health

Health (Photo credit: 401K 2012)

It’s a bitch to get old and feeble.  None of us thinks about it while we’re busy with our lives managing careers, family, friends and the daily mundane chores of living.  Nobody anticipates the day when we can no longer take care of ourselves, relegating decisions about our life to others.

That rude awakening landed square between my eyes while now playing the role of parent to my elderly father.  He’s always been a ferociously independent, active man who supported a family of six, sent his kids to college and provided the religious education he considered to be important.  He ran a business and answered to himself about all matters.

As a renegade, my father felt rules were guidelines that he could follow or not.  He could run red lights if he determined there to be no traffic, but God forbid any of his kids do that if he’s a passenger in our cars.  If his customers were tardy on paying him, his bills could wait until cash flow improved.  Any imposed penalty for lateness didn’t apply to him because of his extenuating circumstances.

Now he sits in a wheel chair while his body defies his craving to walk and go and do.  Now he has to listen to us.  And his therapists.  And his doctors.  And eat food they want him to eat and drink liquids that are unappetizing.

Life is incredibly difficult for him these days and at 89 it’s damn near impossible to become a different man, a deferential man.

My heart aches for him and I wonder whether he will be me someday.

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People are usually wowed by my revelation that I’m a hospice volunteer, more than likely following that reaction with “boy I could never do that.”   They ascribe all sorts of saintly attributes to me which is uncomfortable, because they’re not true (ask my husband).  What is true is the following list … in no particular order … at this time of lists.

I receive much more than I give.

Time and receptivity is all that’s required and in return I learn about life and what it means to be human.  There is no other time in a person’s life when the need for true connection is greater.  To be invited into someone’s ultimate personal journey is a gift not to be taken lightly.  It holds great responsibility for truthfulness and vulnerability with its attending need for confidentiality.  Life’s lessons can be transmitted in just a few final months and I’m awed by the opportunity.

Hospice care givers are selfless heroes.

After a certain point a person in hospice care can no longer go and do.  All that’s available is to Be.  It’s the caregiver who is their loved one’s wheels, hands, utensils, hygienist, eyes, ears and task accomplishers.  They become housebound, leaving only when someone’s there to sit vigilance in their stead.  Life can exist that way for months, depending on the nature of the illness.  And it’s they who experience the deterioration of the person they knew and loved who’s no longer the person they remember.  They give selflessly without complaint – the greatest gift of love.  They lead invisible lives until theirs can once again resume.

Live life the way you’d like to be remembered.

This lesson can be sobering for someone on a deathbed.  One of my patients was postponing her death as long as possible even though its extension caused her suffering to be prolonged.  When we learned that she was afraid to die because of her shame about the pain she had caused others in her life, and her subsequent fear of retribution after death,  we called in her pastor to pray with her, allowing her to ask for the forgiveness she believed she needed.  And that included a necessary plea to her husband.  The next day she died.  No-one wants to be haunted on their deathbed.

Two friends

Authentic relationships are the only kind to have.

Once I experienced a true human connection I realized that it’s the only type I want.  Life is so short, putting on airs and pretending to be someone you’re not is foolhardy and a waste of precious time.  Being invited to peer into someone’s soul can be profound.

Friendship

It’s gratifying and enriching to be of service.

My time, until now, has been paid for by a number of companies who determined the value I brought to their organizations.  Doing what I did had market value and its commensurate performance standards. So most of my waking hours were spent performing to expectations – theirs and mine, tying my definition of value to size of paycheck.  Today I know differently and it’s had a profound effect on my life.

Day Hospice

Love comes in many flavors…

and romantic love might be the most shallow.  Relying on a family member to perform hygiene needs can force the final release of dignity.  And yet it’s part of the dying process.  Attending to people during their greatest time of need requires true unconditional love.

Friendship, Göteborg, Sweden

Image via Wikipedia

Shedding a facade makes room for intimate connection.

There are no more airs during the dying process, only naked humanity.  When I walk through the doors of a patient’s home I leave my defensive walls behind and open my heart to anything that might transpire for the next few hours.  I was privileged to attend to one elderly patient during her active dying phase with her equally elderly husband by her side, over wrought with grief.  With fever raging and her husband helplessly watching, I applied cool, damp wash cloths to her head, chest and arms, speaking soothing words as her breathing changed.  I witnessed her husband’s tears and last words of love and kiss goodbye – an unparalleled moment of intimacy that I’ll never forget.  Even her children didn’t experience this exchange between their parents; by the time they arrived she’d lost consciousness.

Change is the only constant.

Spending time with the dying certainly drives this point home.  Photo albums, pictures on the walls, stories from family members – those are the only ties to who this person was – his likes, her dislikes, their careers, their passions. This new person only shares the same name.  Most of the time I’ve never met the person they describe.  Life represents one changing moment after the next.  Might as well embrace it and enjoy it.

Patient

Trust defines our human-ness.

When you’re dying all there is is trust.  Trust that those who are there will do what’s right and take no advantage.  The dying slowly lose all control over their lives, leaving it in the hands of those around them, trusting that their wishes will be honored.  It’s heartwarming to watch adult children assume the role of parents and caretakers.  And the process reveals the true character of people.

Original caption: Ne ties a friendship bracele...

Image via Wikipedia

Listening without judgement is vital.

My role as a hospice volunteer is to do whatever the patient needs at the time.  Some like to be read to, others enjoy playing games.  One patient just wanted to watch old movies.  And one gentleman waited until his wife left to break down and grieve that he wouldn’t be around to counsel his grandson into manhood.  This man’s son died the year before and now his son’s son wouldn’t have a grandfather.  It was more than he could bear and it took all his energy to stand strong in front of his family.  Many patients need the ears and hearts of people who come with no family baggage.  Holding hands and simply nodding provides comfort.

Hospice

Friends show their true colors in time of need.

And many walk away, never to be heard from again.  It’s easy to be friends when life is humming along; it requires much more mettle when there’s nothing to be gained in return.

Mother and Child watching each other

Image via Wikipedia

Recognizing mortality energizes living.

Working in hospice is not depressing.  It’s not morose.  It’s not morbid.  It ends in sadness but inspires vitality.  When we recognize that life will end – for all of us – then we’re compelled by an urgency to appreciate each day and be aware of it.  Awareness of the present is a Buddhist tenet and that lesson stands front and center in hospice.

Hospice

Hospice is a gift.

It offers the dying a chance to end their days in comfort.  Without pain.  Without tubes attached.  Outside the beeping noise of an ICU with its antiseptic smell and sterile walls.   And it teaches the greatest lesson to accept that which you can’t control.

Yes, hospice inspires living.  May be we all be so inspired.

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