Dying is a lonely journey. Not only for the sick person but also for the family. As hard as we may try to avoid death, the truth is that we do a lousy job of it. Science and medicine will certainly postpone it, even staying healthy might seem to delay it, but the harsh reality is that death does not wait for you, it does not ask you, and it does not listen to you. Death ignores your feelings and wants; you do not matter to death…Death is the only certainty in life! We need to remember that our existence here is fragile, and we never have as much time with people as we think we do. If there is someone or someones out there that you love, don’t neglect that and don’t put off engaging with them because waits for no-one… Vic's Journey ended on 18 January 2013 at 10:35. She was the most courageous person in the world and has inspired thousands of people all over the world. Vic's two boys are monuments of her existence. She was an amazing mother, daughter, sister and friend. I will miss you today, tomorrow and forever my Angle Child.
The boys and I visiting Vic in hospital last year.
It has been a day filled with back to back meetings. I coped well (I think) and managed to focus. It was strange not checking my phone every couple of minutes to see whether Vic is okay or not.
I sent the boys’ text messages early evening as the meetings continued into the night.
Me to Jared: “Hi baby – you okay?”
Jared: “Hey Oumie. I’m okay thanks and you?”
Me: “Missing you”
Jared: “Missing you too Oumie. This house feels empty”
Me: “Will phone later just in a meeting”
Jared: “Owkay Oumie”
Me: “Sleep tight angel! Pse wake me so I can see you tomorrow”
Jared “Owkay mommy I will!!! Love you!!! Missing you too Oumie”
Breathe in, breath out, breathe in, breathe out…. I could not look up. I was petrified that that my colleagues would see the tears that formed in my eyes.
These poor boys! They are stoic in their grief. They carry on bravely at school and with all their extramural activities. They are so young to have gone through so much pain and loss. They lost their childhoods to Osteogenesis Imperfecta and doctor error; they have watched their mother suffer horrific pain, lose her dignity…Yet they witnessed their incredibly beautiful mother fight every second of her life to stay alive… She showered them with love and taught them independence. She was strict and her favourite words to them was “I am your Mother not your excuse”
The boys are brave like their warrior mother! A credit to her!
I wish I could wipe the pain from their hearts and memories. There is however no Ketamine Infusion for emotional pain, only for physical pain. I wish I could protect them for pain and loss but I cannot. I must continue with the phenomenal work their mother started in their upbringing. I must help them to continue growing and individuals on this path Vic put them on…
I miss my child more than I ever thought I would. I honestly thought, because of the extended “Anticipatory Grief” period, that we went through, the grief would be less after Vic’s death. That anticipatory grief is however NOTHING compared to the pain we are experiencing 17 days after Vic’s death. I don’t know whether I will ever get used to this void in my heart.
Will I ever be able to breathe without pain again? Will I ever sleep again? Will I ever laugh spontaneously with joy again?
I actually just don’t want to live with this pain…..
Tuesday brought an avalanche of visitors. It was a very, very emotional day. Vic was confused and seeing visions of angels and dead loved ones.
Vic’s friend Angela has been absolutely amazing. She has sat through many hours of Vic’s tears and fears. She has consoled and supported – at great personal expense. I have used Angela as a sounding board and dragged her into discussions with Siza. I discussed sedation and treatment options with her. She has hugged and messaged. She has been a pillar of strength.
Leigh, Jared BFF’s Mom, walked in on Tuesday with armloads of flowers. Vic’s room looked and smelled like a garden! It looked absolutely beautiful and Vic was thrilled.
Vic has refused to let go. She is holding onto life with every fibre of her being. She does not want visitors to leave and will try to get out of bed when they are here.
She cries and keeps asking “How do I say my final goodbyes?”
Esther visits every day. She picks up the boys after school. She is Vic’s guide. “Go towards the light. The light is good!” she keeps telling Vic. Esther is a ray of sunshine and like the Rock of Gibraltar. She is Vic’s sister in love.
It is heart wrenching!
Vic clings to her dad and the boys. She puts out her arms and says “Daddy don’t leave me…” When she sees her boys she cries “Please give me a hug…” and then “I love you more than life and then some more…”
Over the past 10 years I have seen my child suffer so much indignity and indescribable pain. I have seen the despair in her eyes, the helplessness in the eyes of her boys….I have stood next to her bed and physically pulled my hair in frustration – tears pouring down my cheeks. I have wept before God and prayed for Vic to die. I begged God to take away her suffering.
I advocated the right to die with dignity.
Vic has been in the care of Hospice for the past 3 months. In this time Vic has been given a new lease on life. Hospice cannot change the prognosis but they have given Vic quality of Life. For the past three months Vic has been able to occasionally get out of bed, go for milkshakes with her boys, she went to Jared’s confirmation and Jon-Daniel’s honours evening. She completed her photo albums.
Vic is in renal and hepatic failure. Her tissue is horrendous. Her pain is under control! As and when symptoms surface, Vic’s medication is adjusted. She is treated with compassion and respect. Her wish is the teams command….
As the situation is now I am so grateful that my child is alive. I treasure every breath that she takes. We chat, laugh and cry. We dream of going to Italy in 2013.
So given the situation now what would I advocate – The right to die with dignity or the right to live?
I have no doubt that if Vic’s pain and symptoms got worse, I would want her suffering to end. If it remains as great as it is now of course I want her to live. But it is key that Vic is allowed to live with Dignity!
As much as I advocate the right to die with dignity I believe that the final decision lies with the sick person. It is not for family or physicians to play God. The patient has to be the only decision maker.
I must admit that if the decision was mine to make, my child’s suffering would have ended a long time ago.
We all have the right to Live with Dignity. There is a huge difference between breathing and living…
Hospice has just fitted a subcutaneous driver – again. Vic’s pain has spiralled out of control over the past couple of days.
Vic was in absolute excruciating pain during the night. She battled to breath.
“Help me Mommy! I can’t stand the pain anymore…”
I lay next to her and put constant pressure on the area that hurt most. It was just below her ribcage – liver. “Oh Mommy, it is so sore. Can you feel how sore it is?
As a little girl Vic used to believe that I could “feel” her pain…
“Feel how sore my toe is Mommy…”
As I lay there with my hand on her “sore” I wished with every fibre in my body that I could lay my hand on her sick body and soak up the pain and disease. It cannot be so I look for a new spot on her bum to stick in a needle.
Vic seems calm now and the pain under control. She is sleeping peacefully. She has not vomited since this morning and managed to have a sandwich for lunch.
Please God let the subcutaneous driver work. Please let the tissue hold up! Please God!
Aarthi wrote Vic another beautiful poem. Thank you Aarthi. We needed your beautiful words to encourage and remind us today. Vic is going through a particularly harrowing time. She is suffering from severe nausea and the injections are no longer as efficient as before. Poor little poppet! She also broke another vertebra on Saturday when she put on her bra….
For the first time in Vic’s journey I am running scared of the amounts of pain medication her body needs. This afternoon she was in excruciating pain – the pain was under the right-hand ribcage. That is the liver. Her eyes are slightly yellow and her skin a little sallow.
Over the weekend Vic walked into my TV lounge and I got such a fright when I saw her. Her face was ghostly pale. She actually looked like a geisha without the red lips and charcoal eyes. Her eyes were dark from pain.
I had to phone Hospice this afternoon and ask them for more pain medication. I am trying to work out what the effect of the increased medication will be to the toxicity levels in her body. Hospice said we are at the 50/50 level. The levels of medication can now be detrimental to her. What do we do?
A calm courage waits in them
like a belief that breathes in her soul
those black pearls of mysterious power
glow like a beacon of hope
it is as if she is saying
i shall continue the fight
her will is deeper than she herself knows
that lustre speaks so much more
she is a gem as i can see
she is a warrior in her ways
that strength that originates in the depths of her
flows out and gives her eyes a brilliant grace…
This beautiful poem was posted byAarthi – http://sickocean.wordpress.com on 24SaturdayNov 2012. Aarthi is an exceptional poet who often moves me to tears. Thank you Aarthi for sharing your amazing talent with us. I encourage everyone to visit Aarthi’s blog. It is filled with so much raw emotion.
The Weight In My Bones
like bridges made
of concrete ropes
ripping through my existence
keeping me earthly bound
so sturdy yet unchangeable a part
i am all heavy with matter contained
i try and bend yet
the break never happens
like a deeper strength holding me
pain prevents a shattering noise
the water in me weighs more
than what gives me a shape
this will is fragile
and a regret pulls me down
purposes unsolved
promises broken
a thousand images shattered
everything that i never said
all remains in unwalked places
the pores in my soul
each window was blocked
in persistent steps, in days and years and decades
leaving all weight like
ashes of a past trapped
so diseased i feel at times
lifeless like a fallen twig
and the feeling weighs me deep
deeper than skin and all the soft human matter
i feel it in my bones
like i am bond to a mountainous stone
so welded inside with a belief
perhaps i may never be able to sleep
Over the past 5.5 months I have received many messages of encouragement, prayer, support, empathy and an outpouring of love. Until now Vic’s final journey seemed so pointless and unfair ….
A million times I have asked myself WHY Vic? Why has she had to travel this horrifically painful journey? Why do her boys have to live and witness this pointless pain and suffering?
I realize now that Vic’s suffering has made us aware of the suffering of others. In my country we have a terrible poverty problem and only 5% of people dying have access to palliative care. Maybe Vic had to travel this terrible road so the world can become aware of the 95%’s plight.
Tonight I was reading through the comments I received on my latest blogs. I would like to share some of it with you. I randomly copied some of the comments for you to read:
Tersia, I am still with you, and so touched that you are so conscious of all that is going on around you. I hope that as Vic surrenders, as she is already doing,, so do you, so that this stage of both of your lives becomes an experience you couldn’t have imagined.
I hope as Vic begins to feel that gentle euphoria, you too get a share of it… the body and the mind are so complex and beautiful that not everything happens as we think it should, and I hope your grief is somehow eased and soothed. Thinking of you all, Valerie
PS I hope you don’t think this message is insensitive….
In the final stages dying is something we do alone. i have often thought i would like to enter that final sleep while my husband is out. maybe that is just me and my desire to spare him more pain. you and vic are so close and i don’t think there is anything that can be said to make this more bearable for you. my heart aches for you, your husband, vic’s boys, her siblings and extended family. just remember it is easier to be the one leaving. we know that our suffering is going to end. it is your suffering we despair. whatever is meant to be will happen and yet i can’t help but hope for you to have enough time to be ready to let go
November 14, 2012 at 07:29(Edit)My thoughts and prayers are with you and the family. I pray that you will all have peace in your hearts and minds as you await Vic’s release from this terrible suffering.
Amazing that you are sharing this difficult journey with all of us. This takes a lot of courage, and Vic is so lucky to have you (and the others) around her at this time. And we are so lucky to benefit from your sharing, should (or when) we find ourselves in comparable situations. But right now, my thoughts are with you and your family.
Ray’s Mom says: November 15, 2012 at 00:53(Edit) Tersia I wish you didn’t have this to bear, that your daughter could magically recover. God is with you and your daughter is so fortunate to have you near. Thank you for sharing this life experience.
optiesays: November 13, 2012 at 07:46(Edit) I am so glad that Vic has been blessed with these “extra” years but I am sure she is aware that they come at a cost to her and the family. We are never ready to say goodbye to those we love dearly. Vic’s suffering is terrible and my prayer for her is that the pain control will be well managed till the end. My heart goes out to you as a mother and grandmother, I cannot imagine what it must be like for you to have witnessed all that Vic has been through.
Gilliansays: November 17, 2012 at 07:02(Edit)That is brilliant idea, is there anything I can do to help you get the (Hospice) centre up and running.
I have to thank you for bringing a subject most feel they cannot talk about out in the open in such a loving way ~
I would wish too be able to move forward with your goal with a hospice there in your area know If you need a latter writing campaign, or anything i can do from here please never ever hesitate to ask me please. You are making a beautiful thing out of the tragedy of Vic;s life being cut far too short.
sbcallahan says: November 16, 2012 at 03:06(Edit) it is only normal to want to hold on to your beloved vic. i do hope with all my heart that you can let her go if that is what she wants now. at this stage you know that her suffering is going to go on and no one is served by her continued pain. this is the hardest thing you will ever do but you can find the strength to do it. wishing you peace of heart
Barefoot Baronesssays: November 17, 2012 at 17:38(Edit) My God Tersia. I was instantly taken back to my mom who had stage 4 lung cancer that we were aware of just 2.5 months after diagnosis. I know the fear of the low oy2 count. I do know the fear of the oy2 therapy. What I did not know is the long lasting journey that you & Vic know.
Every post you share and I read I am left with this love for you both that seems to wash away all those things in life that matter not one bit. I have stopped sweating ALL the small stuff. There is something so loving & giving in your sharing with us, but more importantly Vic’s children are always going to have this. your journal of their mom’s life. I cannot think of a more loving, tender and generous thing for a mother and grandmother to do. my prayers and wishes are that this cathartic in a good way for you.
Although I am still behind in reading posts I have devoted m, myself to missing one of yours. Just may put me behind in commenting and I am wondering and hoping this does not cause you more pain having to come back to a memory of a few days ago. You tell me if so because I will understand and honor your wishes.
My gentle hugs to you both, Please give my love too. ~ BB p.s. you will forgive me please..I cannot hit the like button on your posts.
Barefoot Baronesssays: November 17, 2012 at 19:41(Edit) My Dear friend, You have choked me up with tears. You, who is going through so much have the sight to see beyond. I am humbled by your kind and generous words. I’d like you to know that any time you need a cyber-shoulder to lean on I would be honoured if you chose me at times, or all the time. You can even email me, you have my permission.
I am grateful Tersia for your words. I mean what I said that the small stuff is not on my plate anymore. If it arises I am able to just kick it to the curb with no further attention. You & Vic are enforcing this belief in myself every day Vic should know that all she allows to be shared is the most loving gift any human can give to another at this time when real wisdom’s surface. It’s amazing to me that at a time when it would be allowed to let her withdraw she instead reaches out to her children, her mom, and via your blog even her words.
Thank you so much for this message~ My love & gentle hugs to you both.
My Blogsays: October 20, 2012 at 00:43(Edit) I too wish your child could be pain free. After I read your post I logged on to Facebook. My daughter posted about her migraine, and how her meds aren’t working. I too suffer from migraines and blame myself for passing them down to her. I wish I could help. All I can do is love her and be there when needed. Keep up your strength. We’re with you and your daughter in spirit
thedarkest13 says: October 19, 2012 at 20:51 It’s amazing that you have that openness with your daughter and the living fear and pain is going to be there. We are made to feel loss and sorrow. Especially when it’s our children. I am truly sorry for what is happening and watching is not easy. Just enjoy what time you do have and make the most loving memories you can. You both seem amazingly strong and I don’t even know you. The love you have transcends these moments.
those moments between you and your daughter those drops of peace and happiness and joy save them like drops of pearls save them like diamonds rare that is a form of unending love that gives and gives and never expects be there like a rock for your child and i am sure she would win and survive our world is one of miracles too our world is an oasis rarities and your child too shall her courage prove just be there with a smile always give her the courage to stand taller than before she shall overcome her struggles soon prove all wrong and herself right she must win and win this time make sure you are there to know witness her strength, her wars, her fight love can kill the worst of fears and happiness shall soon return changing the way she views her life…
with love and regards…
Dedicated to Vic and her wonderful Mom. :)
Peter Wiebesays: October 22, 2012 at 01:14 I so appreciate your openness. I pray that nothing will happen while you are away. I pray that Jesus will bring you comfort.
Andrewsays: October 22, 2012 at 03:51 I always found the roller coaster metaphor powerful during my cancer treatment, recovery, relapse, treatment, and recovery again and I think you have captured it well with Vic. Good for you to get away for a week – caregivers sometime forget that they need care too. Best wishes.
Gillian says July 4, 2012 at 04:56(Edit) Dear Tertia, Do not be so hard on yourself. You have so much on your shoulders, you are allowed to have emotions, you are allowed to get irritated, What you need is a good, well deserved mental rest where you stop trying to work things out yourself …… A long much-needed look at the beautiful creations, topped off with some quality time with a friend. And trusting someone to assist with Vic for 2 days a month. She does not want to feel that she is the cause of you being house bound. Read Matthew 11:28-30. XXXXX
dlmchalesays: October 12, 2012 at 20:48(Edit)I only bookmark a handful of sites that I “need” to follow; sites that do more than convey information – sites that cause an necessary evolution of my own humanity. Your site is at the top of that short list. I have so much empathy for what your family endures on a day to day basis, so much so that there are times I can’t even read another paragraph because it physically hurts to watch you and your loved ones afflicted so.
I know there are times when you feel like giving up. That is more than understandable and you should not run from those feelings….these types of reactions actually keep you sane. But know this: in your darkest moments, when all else seems insurmountable, ….you are not alone, in spirit, in prayer, in thought. You need never edit your writing to mask this incredible pain. In sharing such a violent and honest summary of your families pain, you bring a sense of belonging to something bigger to all those people who are enduring similar challenges. I can’t tell you why the unfairness of it continues. But I can witness that you have been a champion of love and a gladiator of emotional support. You make a difference in this fight…a big difference. We….the people who experience this on vicariously through your written word…also have an obligation, one that I commit to and cherish…and that is to be here for you when you need us. You are an inspiration to me.
Dennis
micey says: October 23, 2012 at 21:12 Hi Tersia. I finally made it to your blog. I’m so sorry for the suffering your family is living through. I pray the Lord gives you strength to carry on each minute of the day. I pray He fills you with peace. I pray for miraculous healing for your sweet girl. I pray for the end of suffering. I pray you have a safe and wonderful trip to visit your family. I pray you receive many hugs from those you love. I pray you find rest for your weary soul.
in the final stages dying is something we do alone. i have often thought i would like to enter that final sleep while my husband is out. maybe that is just me and my desire to spare him more pain. you and vic are so close and i don’t think there is anything that can be said to make this more bearable for you. my heart aches for you, your husband, vic’s boys, her siblings and extended family. just remember it is easier to be the one leaving. we know that our suffering is going to end. it is your suffering we despair. whatever is meant to be will happen and yet i can’t help but hope for you to have enough time to be ready to let go
I am so proud of my beautiful Vicky who has made a difference in so many people’s lives. I am proud that is her most pain filled moments she can think of others who are less fortunate than she is.
I thank Vic for the vision of a Hospice in our city. I want to thank everyone who has sent us messages of comfort, support, encouragement and prayers… Thank you for walking with us on this difficult journey. Thank you for the love you have shown. Thank you for your prayers.
If this post does not make enough sense please forgive me. Today has been a very difficult one for Vic. She is so tired. I am just trying to make sense out of everything…..
The comments I extracted were absolutely random and does not minimize the value and comfort I experienced from the hundreds of wonderful messages I have received. Most of my readers/followers have life-threatening diseases, lost a child, suffer debilitating pain of their own and yet they care! Thank you.
Last night was a better night. The additional anti-nausea injections are working. I hope the antibiotics are working.
Hospice measured Vic’s SP02 levels today and it is between 84 and 88%. I don’t think that is a good sign. Lani, second eldest stepdaughter, phoned me last night and told me that she had chronic ill patients whose SP02 levels were as low as 70%. Lani is a physiotherapist. I felt better after our chat.
Vic is extremely tired. She went out for coffee with her best friend, who, very recently, was diagnosed with breast cancer. Vic is a compassionate and caring person and wanted to support her friend emotionally! When she got home she had a lie down – for the rest of the day.
Tonight I helped her bath and wash her hair. Poor poppet, she is so exhausted after her bath that she had to lie down and is taking a nap again. Her hair is still damp but we will dry it later. I hope she has a better night but I am not very optimistic.
Whilst I was rinsing Vic’s hair she said “Mommy what do people do that don’t have a family like mine”
“Oh sweetie, it must be very hard for them…”
“Sometimes I feel guilty because I take up so much time, money and attention from you. I have taken up your entire life…” Vic said
“But sweetie, we love you! What do you want us to do less for you to feel better? Tell me and we will do it!”
We both laughed and the moment was over…
A while back I made a decision. We do not have our own Hospice in our suburb. We fall under the auspices of the Houghton (Johannesburg) and are literally the orphans of the system. I am going to start a Hospice in Alberton.
This Hospice will focus on palliative care and will bring purpose to Vic’s suffering. It will be a monument of her suffering and her compassionate nature.
This is a subject very dear to my heart. Vic has been saved from the claws of death so many times in her little life. I often lie in bed thinking how much physical pain and discomfort I have imposed on Vic by not allowing the doctors to not give up. By cajoling her into living. Twice this week I begged her to allow me to take her to hospital. I promised earlier this year that I would respect her wishes. https://tersiaburger.com/2012/05/18/6-5-2012-3/
My BFF, Gillian, sent me this email message:
Morning, you summed up “Where did the time go” perfectly. I cannot believe that 8 years have passed so quickly. Jon Daniel was 7 and Dr said he would not understand about death, but Jared 9 would be able to comprehend and mourn. You wonder what is better……. When they are little or older. Vic our miracle child has hung in there for her Angels. She can only be commended on her will power to add another day to their lives. She has no life. Except to smile with sad eyes every time she sees the boys for another day. As hard as it is to nurse your child, you are also spared Another day good bad or ugly. God has sent Vic to us give each one a lesson – not to complain or give up – the Power of the mind. Be grateful for what we have body mind and soul. Love you all with all my heart
What Gillian wrote in her mail is so true. If I had allowed Vic to die earlier she would of been saved incredible amounts of raw, undiluted suffering and indignity! A couple of posts ago I wanted to include a photo of Vic’s abdomen so people could understand what a person looks like after 81 abdominal surgeries. I decided against it as it is too horrific to post. But we have been blessed with some wonderful times. The boys are now old enough to understand the extent of her suffering. At this stage I am focused on her pain. I remember when I was stressed that she was taking a couple of hundred milligrams of morphine a week. Now it is a couple of hundred per day…
During an internal medicine residency, newly hatched doctors are responsible for some of the sickest patients in their teaching hospitals. This is because those patients often don’t have private doctors to attend them and are poor and sometimes self abusive, with the complex problems that go with smoking, drug and alcohol abuse and lack of regular medical care. These patients often present with their diseases late in game, when much must be done quickly.
There is little or no time to discuss end of life issues and so the assumption is made that these folks want “everything done” which includes machines and potions to support organs and bodily functions as they cease to work right. A scenario might look like this: 48 year old heroin abuser comes in with fever of 104 and symptoms of a stroke. He is admitted to the intensive care unit with low blood pressure, becomes gradually delirious and his heart rate increases, he is sedated for trying to crawl out of bed and run off, he becomes lethargic and is unable to breathe for himself, a central line is inserted and he is intubated and put on a ventilator, his blood pressure is supported with pressors and fluids, his oxygen level cannot be supported despite high ventilator settings. His kidneys cease to work and his heart goes into a rhythm that produces no blood pressure at all, he receives CPR with chest compressions, he is resuscitated, but barely alive, unable to communicate, obviously brain damaged beyond repair, placed on dialysis, eventually succumbs to overwhelming infection. We call this a “flail.” It is horrifying and time consuming and ultimately a colossal waste of human and monetary resources. Repeated experiences of this type sour most of us on the idea of being resuscitated, so many doctors consider themselves “DNR (do not resuscitate).” We don’t want to be resuscitated ever, no matter what. There are some things that are worse than death.
Some resuscitations go well, though. A patient arrives in the emergency department with chest pain, develops an arrhythmia, has chest compressions briefly and electrical cardioversion and is conscious within minutes or hours. Some people briefly can’t support their own needs for respiration and require a few days of ventilation before being able to breathe adequately. Although they are weak and puny for awhile, they go home and live to tell the story, go back to work, raise families, climb mountains. These successes usually happen to people who were vital before they became really sick, the younger folks, without multiple or terminal illnesses to begin with.
When someone is admitted to the hospital, the physician responsible for their care (which is more and more often the hospitalist) determines, if possible what their wishes would be regarding life support should their breathing or heart stop. These discussions are very difficult if the patient has not thought about resuscitation and has not talked with a physician who knows them about options.
Often patients have reasonable hesitance to make potentially life determining decisions with a doctor who they don’t know and who doesn’t have time to talk with them about the implications of these decisions. In our heads we have a pretty good idea of which patients would do well should they require cardiopulmonary resuscitation, and we really want people whose chances of recovery are lousy to tell us that they are DNR. A DNR decision means that will not flail them. We will not get into a situation in which failure is likely. Should this patient become so sick that medicines, hydration and appropriate surgical procedures cannot save them, we will transition to a strategy that makes death peaceful and painless.
We rarely succeed in communicating this to patients and many who will not benefit from cardiopulmonary resuscitation say “Oh yes, doctor, I want everything done.” Some say this because their experiences are different from ours, they have seen doctor shows in which resuscitation was successful, they think that withholding resuscitation means getting substandard care, and sometimes they think that we just want to spare ourselves the trouble of saving them. And some of these concerns are valid. A patient who is “DNR” may not be watched as closely or treated as quickly if they decompensate. Some people with horrible prognoses do get better after being resuscitated, though this is pretty uncommon and usually involves a pretty significant decrement in quality of life.
Even though it is hard to establish trust with patients or their families in the context of being a hospitalist, I think it is one of the most important discussions to do right. It is everso tricky, though. Even asking the question can make a patient frightened or hostile. They wonder if we are asking this question because we secretly think they are going to die soon. They feel that the subject is too private to broach with a near stranger. They have never thought about it and don’t want to start now. They think that if they make a decision not to be resuscitated that their family members will think that they don’t love them.
But sometimes patients have been waiting, oh so patiently, for someone to bring up the subject and be willing to take enough time to answer the questions that they have been afraid to ask. I find that a discussion of resuscitation is best started after I learn about who a patient is and what they have done for a living and what they spend their time doing at home. What were they good at when they worked? Do they have kids or grandkids? Where do they live, do they travel, do art, take care of other people, have pets? It is hard or impossible to help a person navigate the end of life if I don’t know them.
Even though I am a bit biased against intensive and technological medical care, I love actually doing it. The tools of this trade are really clever and the immediacy of the practice is inspiring and brings people together. I have seen beautiful and compassionate intensive care, which makes patients and families feel valued. Nevertheless, there are always the unintentional and casual cruelties of disturbed sleep, needles, boredom, prickly heat, bowel indignities, physical pain and nausea. Death following chest compressions and electrical cardioversion is not peaceful.
When I sit with a person and hear that, no, they don’t want intensive care or cardiopulmonary resuscitation should their heart or lungs cease to work, and it is clear that resuscitation is not in their best interest, my heart feels lighter. I can focus more on what the patient values rather than what procedures are most likely to keep them alive for the longest time.
Aarthi Raghavan, http://sickocean.wordpress.com, http://mysticparables.wordpress.com, a very talented poet, whose work I enjoy immensely, has written a beautiful poem and dedicated it to Vic and I. We are so honored and blessed with the gift of your words and your heart! Thank you so much Aarthi!
the love you share the words that say you care those moments between you and your daughter those drops of peace and happiness and joy save them like drops of pearls save them like diamonds rare that is a form of unending love that gives and gives and never expects be there like a rock for your child and i am sure she would win and survive our world is one of miracles too our world is an oasis rarities and your child too shall her courage prove just be there with a smile always give her the courage to stand taller than before she shall overcome her struggles soon prove all wrong and herself right she must win and win this time make sure you are there to know witness her strength, her wars, her fight love can kill the worst of fears and happiness shall soon return changing the way she views her life…
Vic could live like this. We could live like this. Please let this continue! Today I pray that this is the case. I pray for a miracle. I pray that Vic is in remission.
On the 17th of September Vicky was accepted onto the Hospice program. Dr Sue Walters, the Hospice doctor and Sr Ceza, Hospice Nursing Sister, thought she would die within days. Vic was barely conscious and too weak to walk. Vic was breathing but had already ceased to live!
In two days’ time we celebrate Vic’s “One Month with Hospice” and I think she is getting stronger every day. We still have bad days but her pain control is great! Vic is reasonably mobile; she laughs and spends constructive time with the boys and the family! She is sorting out photos and all sorts of things that she has neglected for months. She is spending less time in bed. She is sleeping less and eating more.
It is as if she has a new lease on life!
Could it be possible that the pain was killing her? Is it possible that the adhesions have stopped their devastating path of destruction? That just maybe the sepsis has cleared?
Vic still needs assistance with basics. Vic could live like this. We could live like this. Please let this continue! Today I pray that this is the case. I pray for a miracle. I pray that Vic is in remission.
Two days ago I reblogged a post “Is there pain after death” written by a Dr James Salwitz. This post elicited some comments – mainly from Vic. Vic has started reading the odd post of my blog. In a way I am truly okay with it but on the other hand I find it difficult to blog my fears and emotions knowing that Vic may read the post. I find that I have become guarded in what I am writing. I am thinking that I should blog about stuff that may allay Vic’s fears….
Yesterday Vic asked “Mommy, I know what we believe in but what if there is more pain after I died?”
“You read my blog?” I asked.
“Yes” Vic replied.
“Sweetie, I believe that when the time comes our loved ones will be our guardian angels and hold our hands whilst we cross over….”
“I know that Mommy but what if I am still in pain… What if the pain does not stop?”
“Sweetie, the pain that continues after death is the emotional pain that belong to the loved ones that are left behind. That is what the post is about…..”
Tears welled up in Vic’s eyes and she said “I know that Mommy but what if I am still in pain… What if the pain does not stop? What if your pain does not stop?”
Andrew, http://lymphomajourney.wordpress.com/, commented as follows… “Even before one leaves, I always thought it more difficult on my family to watch me go through what was pretty aggressive treatment than on me.”
sbcallahan, http://thedrsays.org commented…”this is one of the difficult things about being the one who leaves. to know that your loved ones are going to suffer more than they already have is heartbreaking.”
“how to die? I have watched many die over the years and the range is as you would imagine. there were those that just could not let go and suffered every indignity to their body and soul. of course others went quietly with love around them. I have not decided if I want to be alone or with loved ones by my side. is there a way to make it easier for them? would they rather receive a phone call with the news or be at bedside? either way it will hurt them, not me of course as I am the one leaving. I would be lying if I said I don’t think of how I will miss so much. the thing is I have had so much, so much more than others and it seems selfish to complain. what they will go through is tremendous compared to what I will go through. I will sleep eternally and they will live. the best I can hope for them is peace of mind and future happiness. I want them to think of me and smile as I do now thinking of them.” http://thedrsays.org/2011/03/
I am beginning to think it is easier to be the person leaving than the one being left. I have always known that about relationships and breaking up but now realize that it is the same when someone you love is dying. My husband became suddenly angry and I knew there was something wrong. it is so unlike him to get angry over nothing that I was completely off guard. we had been watching the movie “steel magnolia’s” and he asked me what Julia Roberts was dying from and I told him kidney failure. later when he was able to talk, he shared that it had reminded him of my own kidney failure and near death. we live in limbo waiting each week for blood tests to know if I am back in failure or good for a few more days. I don’t really think about it and when he shared his fear my heart ached. The sad thing is I have no fear and realize more and more how hard this is for him. I know that he will be fine in the end but it is hard for him to imagine he will be fine without me. It is so much harder to be the one being left behind.http://thedrsays.org/2011/03/25/the-one/
Vic so often tells me how worried she is about the family. She worries about how the boys, her dad and I will cope. Whether we will cope…. whether we will be able to get over her eventual passing…. Andrew and sbcallahan write about their fears… for their loved ones. It is a fear that all terminally ill people appear to have.
My Mom died a bad death! Two weeks after major surgery she died an agonizing death from septicemia We could see the gangrene spread…. She was burning up with fever and no amount of pain medication could dull or relieve the pain. God alone knows what went through her mind because she was ventilated. When my Mom finally died we were so relieved. We were relieved that her suffering was over. We were traumatized by the dying process not her death.
As a family we have lived with Vic’s pain and her excruciatingly slow journey towards death for the past eleven years. For eleven years we have heard her scream with pain, moan with discomfort, we hold her hair back when she is doubled up over a toilet bowel, vomiting until she fractures a vertebrae. We have nursed open wounds, changed colostomy bags…. We have watched our daughter and mother suffer the most horrendous symptoms.
So baby, if you read this post, know that we will miss you. We don’t want you to leave us behind but we want your suffering to end. We will continue to love you until we are reunited one day. You have to trust us that you will always be “my baby” and the boys’ mummy. But know that we will be grateful when your little body is freed from its pain and suffering. You will be at peace… You will not suffer more pain after death. We will mourn you but we will also be at peace… We will think of you and smile…
He eased his body onto the mattress while pulling up the covers and rested his head on the pillow. There are far too many memories of his selfishness, but he will not deny them; he will learn from them. That is both his prayer and his hope. Mercifully, the memories were not all bad. He smiled as another one surfaced.http://thresholdofheaven.com/2012/09/27/now-i-lay-me-down-to-sleep/
This is an extract from a blog of a father’s journey after the death of his young son. Like all parents he is wracked by feelings of guilt and inadequacy.
Shortly after her third birthday Vic developed a bad cold. Her nose was running and I asked her to go wipe her it. She looked at me and in her most defiant tone of voice said “No! I won’t”. I gave her a light smack on her bum. She moved her little arm in front of her bum in an attempt to stop me … three of my fingers struck her arm. She screamed! I immediately knew I had broken her arm…
The x-rays showed that the ulna was broken in three places…. Imagine my horror, guilt, feelings of inadequacy and self-doubt!
I worked hard as a young mother. I was young, divorced, a single parent climbing the corporate ladder. My child had been diagnosed with Osteogenesis Imperfecta (brittle bone disease) and I needed a lot of money to keep Vicky alive and living a fair life. She attended a private school. Did I neglect her at times as a child? Yes, I am sure I did. Not because I wanted too but because I had to work extra hard for that bonus or the next promotion!
Did I abuse her as a child? Absolutely not! My neighbors and some emergency rooms did however think I did… By her 3rd birthday she had had 40 fractures…
When Vic was a little girl there was no internet and Osteogenesis Imperfecta was a “new and extremely rare” disease. I spend many hours, days, weeks even months researching OI in libraries. I went from doctor to doctor. I tried alternative medicine, physiotherapy and hormone treatment! I have spent thousands of hours on the internet researching every single medical report, diagnoses, blood test result that Vic has ever received. I have bullied doctors, nurses and anyone who ever dared cross our path. An ICU sister once told me I am a control freak and that I feed off Vic’s illness!
I can however honestly say that I did my best. I cannot apologize for the mistakes I made as a mother as, at the time, whatever decision I made, I thought it was in Vic’s best interest.
Am I special? Absolutely not! I only do what any other mother would do under the same circumstances. I cringe when people say “oh you are so brave” or “Oh you are so special” or “What an exceptional mother you are. Vicky is lucky to have you as a mother”. Nothing could be further removed from the truth… I am the one blessed with an incredibly brave, compassionate, brilliant child! Vic has enriched my life so much! If I could choose a life with a healthy (different) child where I could have a life of my own, I would not. Vic is part of my journey.
I come from a long line of very good mothers…My Mom taught us the values of being a “family”, honesty, unconditional love, caring and nurturing… I am surrounded by good mothers. Vic is a good mother to her sons. Esther, Lelani and Michaela are good mothers to their children! All my grandchildren have good mothers.
Mothers love the way love is needed. If the child needs caring they get caring, if they need nursing they are nursed. A mother’s love is love in its purest form.
When Vic was 10 years old she lied to me about a school test. It was not the first time she had fibbed and I knew I had to punish her. Lying is an unforgivable transgression! I always told Vicky that it is better to face my wrath for 5 minutes than to lie to me and destroy the trust that we had forever. If she lied I would ALWAYS doubt her…Remembering the broken arm episode and knowing that she knew that I was a pacifist at heart, I decided the worst punishment I could give her would be a smack on her bottom. I made her lie on her bed, on top of her arms, and gave her three smacks with my slipper. (It sounds so barbaric!)
She smirked “It did not hurt at all” and I sobbed….
I phoned my Mom and sobbed “I am such a failure. I am such a lousy Mother! My child is lying to me. I failed as a mother AND I GAVE HER A HIDING!”
Mom quietly asked me “What can you do to be a better Mom?”
I replied “Nothing! I don’t know what else to do! That is why I am phoning you! I need guidance and advice! Please tell me what to do!”
My Mom gently replied “You can never do better than your best!”
These wise words have remained with me all my life.
Andrew, (http://lymphomajourney.wordpress.com ), suffers from mantle cell lymphoma (MCL). Andrew says “I am a husband, father of a teenage son and daughter, brother, a Canadian government executive with a wide range of international and domestic experience, who likes reading, film, music, walking, cycling, skating, being with family and friends.” Andrew is a phenomenal source of information. I sometimes think he has a full-time research team constantly researching all aspects of lymphoma and terminal illness. I often refer back to his blog. Please take time to visit his blog.
Andrew posted this earlier today. You may know that palliative care is my favorite hobbyhorse. I have fought for my child to have a “good death”. Thank you Andrew for sharing this article with us!
A grandfather-father-husband-salesman-cook-gardener-hiker-gentleman, adored by many, is struck down by cancer. His disease is particularly horrible, spreading quickly though his body causing damage not only to bone and organ, but to sinew and nerve. He suffers terrible pain for weeks, relieved poorly with inadequate doses of inferior medications, thrashing in misery witnessed by his kin, always at the bedside, ages seven to seventy. Finally, uncomfortable and agitated until the end, he dies. Does his pain continue after death?
Pain that is not relieved in a person’s life continues after they are gone, held as a sordid memory by loved ones. Just as we retain treasured thoughts of joy, wisdom and warmth, we preserve images of pain. Unrequited suffering contaminates memory, preventing healing, healthy grieving and closure. This pain in turn flows across our communities, touching many who may never have met the patient.
This does not have to be somatic discomfort to be treated with pain medication. Shortness of breath, seizures, nausea, wounds and bleeding cast intense images that last more than one lifetime. Uncontrolled anxiety or fear may contaminate a family and corrupt its fiber, as can loss of spiritual path, loneliness, or guilt. Failure to settle past wrongs or mixed intentions results in a loss of opportunity, a psychic wound that will never heal.
A poorly managed end-of-life experience can transform families for generations. I recently heard of a young man who suffered a miserable protracted death from cancer. This resulted in his wife becoming chronically depressed and isolated from her family. She committed suicide, leaving their son a life as an alcoholic and drug addict. The ripples from that one cancer spread out and, through the network of that family, caused pain for many more.
When we think of end-of-life planning, we focus on those immediate moments for the patient and family, as well we should. The opportunity to live one’s life well, even at its end, should not be denied, and must be the first goal of palliative medicine and hospice. However, we cannot overstate the need and potential to protect and even nourish future generations by treating pain of all types in patients with terminal illness, and in families sharing that passage.
There is pain after death, and I suspect it is the cause of much waste, anger and tragedy in our society. We must strive to prevent that suffering. Good things are possible, loved ones can be together, memories shared, and solid foundations laid. Patients, families, doctors and caregivers must protect and treasure even this difficult time of a person’s life, because as one life ends, others are beginning. http://sunriserounds.com/?p=920
Vic's Final Journey 