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.
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.
Vicky constantly says “sorry Mommy.” She says “sorry Mommy” when she vomits, when she is in pain, when she is ill…
Then there is a flood of “thank you’s”….. Vic says “thank you” all the time! It drives me mad! I don’t want her to apologize for being ill and I don’t want her to continuously thank me.
Vic’s situation, our situation as a family, is unfair, arbitrary, frustrating and so sad. Vic is blameless, helpless, a victim of poor sick genes and doctor error.
I know that Vic is sad about her situation. I know that Vic is sad for what the family is going through. She is sad because she cannot be the mother she wants to be. She is sad that she has a lonely, sad life devoid of partner love, physical love and friendships not based on pity. She sad because she does not have a social life and neither do we as a family. Vic is sad that she is dying in the prime of her life. Vic is sad that she has achieved so little in her life (by her standards only).
We no longer have lunches with friends, outings or holidays. Life has ground to a slow, agonizing halt… Vic floats from one pain filled day in bed to the next. When she has a good and busy day, like yesterday, she pays the price for weeks. Vic has not been out of bed today. She is deadly pale and drawn.
It is hard for her not having privacy. Vic is embarrassed that I hold her hair or wipe her face when she is vomiting. Yet she needs me with her….
We are however in this together as a family. It is a rough journey for everyone.
“I am so sorry Mommy…” …it echoes through my heart.
Today was another milestone for Vic and the family. Jon-Daniel turned 14 and he woke up to his loving mother’s birthday wishes and kisses.
I could not help but think back to the day he started “big” school. Vic was violently ill but refused to be admitted to hospital before Jon-Daniel was taken to “big” school and settled into his new class… Seven years ago she placed her own life at risk to take her son’s hand in hers and lead him into a scary new phase of his little life.
Vic kneeled next to his little chair and told him school was going to be one of the greatest adventures in his life. She told him she loved him and he was in good hands. His brother would look out for him at break. He had to concentrate and listen to his teacher. “Mommy will see you after school” she promised.
When we left the classroom Vic collapsed. Colin took her straight to hospital. Silent tears ran down her cheeks.
“Mommy, please bring the boys to hospital this afternoon. I promised Jon-Daniel I will see him after school.”
I do not remember the exact details of that particular hospitalization episode but I do remember what a milestone Vic reached that day…
Yesterday my little girl dragged her body out of bed. When Vic and the boys moved home a year ago I bought her a doughnut-making machine. She had not used it. Jon-Daniel loves baby doughnuts and keeps asking her when they are going to make doughnuts. So, Vic made baby doughnuts with Jon-Daniel yesterday afternoon. It wasn’t a big batch but she was absolutely exhausted and in terrible pain after she finished his “birthday doughnuts”.
I wonder if he will ever realise what a superhuman effort it took for his mother to make him birthday doughnuts….
Vic bought Jon-Daniel a sound system for his 14th birthday some time ago. It has been wrapped and ribboned for a while. I am so grateful Vic was able to give it to him, in person, this morning…. He was absolutely delighted! The boys had to go to their Dad this evening so Vic made the decision to take Jon-Daniel out of school early today. We did not have the normal “tea and cake” thing at home as we simply did not have enough time. We went to lunch and had a wonderful time! We screeched with laughter. The boys joked with Vic because she is so short…. (She loves being ragged about her (lack of) height) and the boys love humouring her!
“Mom can’t do a ‘high five’ Oumie – she is too short…” They just carried on and on joking with their mom.
Late afternoon, after the boys left, Vic and I quietly sat basking in the milestone day….
“It is so sad Mommy. I wish I could write to her and tell her what an inspiration she is to me…” Vic said. “I am so scared…. I have a hollow feeling on my tummy.”
We just sat in silence. I held her little hand knowing what she was saying. I did not have words for my little girl.
“I have such a good idea for your Christmas gift but I need the boys to help me.” she said
“Well, in 6 weeks’ time the boys will have finished their exams and they will have lots of time to help you.” I said
“I can’t wait that long Mommy. My health is too precarious. I must do it now…..”
With a hollow feeling on my tummy I wonder whether we will reach our next milestone….
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
Jared sent me the lyrics of this song. I walked to his room and said “These are beautiful lyrics Angel.”
“I think this is how Mom must feel Oumie” he said….
It’s Not My Time Lyric – 3 Doors Down
Looking back at the beginning of this And how life was Just you and me and love and all of our friends Living life like an ocean
But now the current’s only pulling me down It’s getting harder to breathe It won’t be too long and I’ll be going under Can you save me from this?
‘Cause it’s not my time, I’m not going There’s a fear in me and it’s not showing This could be the end of me And everything I know, ooh, but I won’t go
I look ahead to all the plans that we made And the dreams that we had I’m in a world that tries to take them away Oh, but I’m taking them back
‘Cause all this time I’ve just been too blind to understand What should matter to me My friend, this life we live, it’s not what we have It’s what we believe in
It’s not my time, I’m not going There’s a fear in me, it’s not showing This could be the end of me And everything I know
But it’s not my time, I’m not going There’s a will in me and now I know that This could be the end of me And everything I know, ooh, but I won’t go! I won’t go!
There might be more than you believe (There might be more than you believe) And there might be more than you can see
But it’s not my time, I’m not going There’s a fear in me, it’s not showing This could be the end of me And everything I know
But it’s not my time, I’m not going There’s a will in me and now it’s gonna show This could be the end of me And everything I know
There might be more than you believe (There might be more than you believe) And there might be more than you can see But I won’t go, oh no I won’t go down, yeah
For true love is inexhaustible; the more you give, the more you have. And if you go to draw at the true fountainhead, the more water you draw, the more abundant is its flow.Antoine de Saint-Exupery
Love entails profound care for another person. Love is boundless. “One can never love too much….”
No! That is not true. Loving too much is as scary as lovelessness.
It is hard to see how positive care can be criticized. Even normal cases of romantic love tend to create a narrow temporal perspective that focuses on the beloved and is often oblivious to other considerations. In a romantic love situation loving too much means that one person in the relationship’s love is not returned in equal measures creating an unhealthy in balance.. Profound romantic love is not in its nature excessively wrong; but some cases of such love have a greater chance of being so.
With regard to parental love, some might claim that loving a child too much could be harmful as it can spoil the child. Others might argue that the problem here is not in loving the child too much, but in not understanding what is good for her in the short and long term. To this one might respond that it is precisely the nature of intense emotions not to realize the genuine nature of the given circumstances.
When a child is ill the balance of love becomes severely disturbed.
So I am actually going to rephrase the question – Can a caregiver “care too much?” My answer to that: Perhaps not emotionally — hearts are pretty boundless — but in practical terms, definitely, yes. It is possible to do too much for the person you look after.
Obviously, aging and ill members of family require different levels of assistance. Providing help is often the only humane thing we can do for our loved ones. I have researched this and discovered that sometimes well-intentioned caregivers overdo the role without realizing it.
The rest of your life suffers: A spouse grows resentful and distant, you’re less attentive or fall behind at work, your child feels neglected and your friends think you’ve dropped off the planet.
Your sick loved one, on whose behalf you’re working so tirelessly, is also negatively affected. He or she may feel resentment over what’s perceived as invasiveness, may become depressed over a lack of control in his or her life, or may develop “learned helplessness” and mental and physical skills suffer from lack of practice.
How do you know when you’ve crossed the line from good intentions to brink-of-backfiring?
You handle all the details of the person’s life so effectively that they complain of having “nothing to do.” Vic for a long time said “Mom I can do my own tablets…. I said “No baby, it is fine. Let me do it!”
You’re regularly in doctors’ offices – but they’re the doctors of your loved one. You can’t remember the last time you had a check-up of your own. True!
You can’t remember the last time you took a “day off” — that is a day in which you left the house, left your everyday life, and did not do the majority of caregiving yourself. Guilty!
Caregiving is pretty much your main hobby. Not by choice!
You prepare all the meals, even though the person could do some of the prep work or cooking – even if it took longer or wasn’t done quite the way you’d prefer. Vic prefers my cooking.
You’ll drop everything to take a call from your ill loved one multiple times a day and then resist bringing the conversation to a close once you realize it’s not an emergency. Guilty, Guilty, Guilty!!
You have more fixed appointments in your weekly calendar for the person you take care of than just for you –i.e. no lunch dates, standing walks with a friend, visits to a gym. True!
You offer to do things for others reflexively — but you’d really never think of asking someone to do something very specific for you. Absolutely!
You cater to the person’s special diet needs (low salt, for example) but don’t pay any special attention to your own nutrition. Maybe…Ok guilty!
The last time you took a vacation was a long, long time ago!. Innocent!!! I went to England for a week in May 2012
A friend or relative slips and calls you a “control freak.” So? I don’t have a problem with it. Vic is my child and I know best. I love her more than any other person in the world loves her and only have her best interest at heart!
So what? I am guilty as is many, many other caregivers in my situation. We love so much that we want to protect, nurture and control. By caring we think we may extend our loved one’s life.
Tonight Vic showed me a birthday card that I gave her on the 31stof August 2002. In the February of 2002 Vic had her blotched back surgery that triggered 80 abdominal surgeries and years of pain, indignity and unbearable suffering…
I wrote “You are so special. You are brave, strong, resilient and caring. I love you so much! Baby, from now on we are moving forward. The end of all of this is in sight. Remain focused and continue to fight. I know things are getting better!”
3 October 2012 I would write: “You are so special. You have been brave, strong, resilient and caring all your life. I love you so much! Baby, from now on we are living one day at a time. The end is in sight. I am sorry I held you back for so many years. I am so sorry for the pain I have allowed you to suffer and endure seeking a cure. Know whatever I did was done in the name of love. Please forgive me. It is okay to let go now. Go in peace my beloved child. I love you more than life!”
So, in conclusion I must admit to myself, I have loved Vic with an obsessive, possessive all-consuming love all her life. From the first time she moved in my belly I loved her. When she wrapped her tiny fingers around mine I was lost…. I love you too much, child of mine, now and forever!
I sense a loneliness of the heart in Vic. I cannot imagine what it feels like to be aware of the fact that you are facing your last months of life, planning your funeral….No matter what we do or say – this is Vic’s journey.
The subcutaneous syringe driver was halted as Vic’s tissue is so bad. Vic is now on 100mg Durogesic patches and morphine syrup. Initially it appeared to be an okay solution. Then the nausea started…. The pain steadily increased to absolute intolerable levels by last night.
Yesterday morning Vic was great! She obviously still has some of the intravenous morphine in her system. (I also gave her extra morphine syrup as a precaution). She went to breakfast with her friend Angela and had a wonderful time. She glowed when she got back. Gill, my BFF, popped in for a cup of tea and was amazed (once again) at how well Vic was looking. Madam was even wearing a shoe with a little heel (which we made her take off).
In the afternoon Vic started looking grim. She was nauseous and suffering from abdominal cramping. Her tummy was distending.
By 10pm last night Vicky was sobbing with pain. By 11pm she was vomiting uncontrollably. She has severe intestinal pain and I believe she fractured a vertebra with the vomiting.
This morning I had an early meeting. Half an hour into the meeting Vic phoned sobbing uncontrollably. I was unable to hear what she was saying through her sobs. I just said “Baby, I am on my way…”
When I arrived at home Sr Ciza from Hospice was here. She had given Vic a morphine injection and an additional 25mg Durogesic patch. Vic was already looking so much better. Ciza encouraged me to get a night nurse to assist me… She had written a motivational letter to the medical aid without my knowledge. I don’t think I am ready for that yet.
Whilst she was vomiting last night I thought of how quickly she “crashes” and how the good times have almost disappeared. Yesterday morning Angela actually looked at me with a question mark in her eyes when Vic said she wanted to go out for breakfast. I nodded my “consent”. You see I had just read a comment from an incredible brave lady.
“my husband has expressed the same concerns you have over your daughter pushing too hard when she does feel better. it is so important to me when i do have a good day to get out or make dinner, even doing laundry makes me happy. it is a reminder that i am still me. whilei see your point and his, i know how vic feels and know that for me it is worth the price i pay afterward to have that time where i feel like the old me. the me before. My heart goes out to you all and say a little prayer for your continued wisdom and love. http://thedrsays.org/”
Today I would also like to quote my “mentor into the world of pain” Tracy Rydzy http://ohwhatapain.wordpress.com/author/ohwhatapain
The concept of illness as a way of telling you to slow down is frustrating, as I have always lived life in the proverbial fast lane. Since my first surgery, my life has basically come to a screeching halt. Any living I do is now in the slow lane, sometimes I never even make it off the shoulder. I think one of the most difficult aspects of pain, especially during a flare, is the comorbid (I have to use my expensive Master’s Degree vocabulary sometimes) depression and mood swings.
It’s hard to deal with the slow down. I mean, generally, this is something that comes with age and is a natural part of life, but when it happens at 33, how the heck do you reconcile that? Before “all this” I felt so strong. I felt like I could take on the world. I used to be busy everyday, all day and the craziness of my schedule was like a high. Now, I have maybe a quarter of that activity, some days, I have none. The worst part about slowing down is that the pain slows down my body, but not my mind (thankfully), so in my head I still feel like the woman who can go all day, do it all, run around all day and still have energy left to cook dinner and clean the house. Nowadays I get up at 1030am on a good day, workout and do maybe one chore, and by the time I am done I want to cry from pain and exhaustion. But I am still me. I refuse to let the pain change who I am.
I still feel like I can do it all, but I can’t. The constant drive to push and do more is, at times, a gift and a curse. I still push myself to do more, even if it comes with the cost of a day in bed. When it comes to physical therapy (and the accompanying weight loss), I know that I push myself too far, too often. That part of my brain that refuses to accept this “new normal” can’t give up certain things. One thing I can do is physical therapy, so I will do it as hard as I can and push myself, regardless of the cost to my body. A couple of weeks ago I hurt my back (more) while driving and the surgical nurse, who knows me well by this point, actually said, “I tell most patients to slow down for a little while, but I won’t bother telling you that, I know you won’t.”
Sometimes the slow down causes resentment. I get angry that those around me have a life and are busy and that adds to the mood swings and depression. The weekends are the hardest because I want to do so much more than I realistically can, yet I watch friends and family run from event to event with no need to stop and rest. For me, a trip to Wal-mart requires a rest.
Flares do bring up an interesting realization, though. Until things get as bad as they are right now, I didn’t realize that I was in less pain before. So, in essence, flares tell your body to slow down and take it easy, but at the same time, for me at least, it takes something bad to make me realize that before this, I was feeling a little better, at least by comparison. Now if only I could return to feeling like crap instead of complete crap…
On our way to Hospice Jon-Daniel sat with his arms crossed muttering “I don’t need to see anyone” under his breath. “I am like you Oumie. We don’t talk…”
“Yeah” I said. “But I really think the time has come for us to talk to someone. Besides it is part of the Hospice thing. We have to do it!”
“The whole day I was thinking of shrink jokes” Jared said. “Do you think I can ask him ‘how does this make you feel?‘”
We all laughed.
“Guys if we don’t talk to the counselor we may have to come back…. Let’s answer all the questions and get it over and done with….” I cautioned
Alan is a short young man. I think he is in his early thirty’s. We shook hands and he asked us how we wanted to “do it?”
The boys went in on their own. I sat in the waiting room saying a little prayer that they would open up to this professional stranger who is an expert in dealing with death. Thirty minutes later I was invited in.
“The boys tell me they are coping well. They don’t see the reason for seeing me…..What do you think? Are you guys coping?”
I was truly taken aback. “Yes, I think we are coping. ”
“So Tersia, why do you think the boys need to see me?”
I did not speak for a couple of minutes. I was grappling with my brain as to how much I should tell this stranger.
“I think the emotional roller coaster is getting to us. We have said our goodbyes so many times and Vic always bounces back!” I eventually said.
“Yes, Jon-Daniel said so” Alan replied.
“I worry that the boys live in a home where death lingers. There is not enough laughter in our home. It saddens me when they stand next to their Mom’s bed and I see the helplessness in their eyes!” I mused
“I get impatient with Vic. When she has half a breath she will organize a party. When the pain medication works she will not pace herself. She will hurt herself and then I have to pick up the pieces. Sometimes I am scared that her suffering will not end. ” I continued.
“What type of party will she organize?” Alan asked.
The boys and I laughed!
“It is only a figure of speech….” we explained. “She will try and do things with the boys and hurt herself.”
“What type of things?” Alan asked
“Drive and take us for a milkshake” Jared replied.
“Mom forgets things and she thinks we are all against her… Yesterday she said to me that I must not feel guilty if she dies and I am cross with her…Mom always thinks we are fighting with her….” Jon-Daniel said.
“It is not about the final moments. It is not the final words or even the final disagreement. It is about the life and all the years of loving before death and dying…. You must not ever blame yourself for anything. Life is hard for all of you right now. It is okay to be scared and to get irritated. You must tell your Mom how you feel. I am not saying you must back-chat. What I am saying is that you must tell your Mom how her actions and illness makes you feel. The household consists of more than one person…. You all have the right to living…”
The boys asked to see Alan for another session…. Thank you God for another angel!
“You matter because of who you are. You matter to the last moment of your life, and we will do all we can , not only to help you die peacefully, but also to live until you die.” –Dame Cicely Saunders
The Hospice doctor that called to see and evaluate Vic was a tall, slim young woman. She has a gentle voice and long fingers with short nails. She drives a Jeep and keeps large dogs. She looks like a naturalist.
“I am Dr Sue Walters from Hospice. The Pain Clinic asked us to see you. Is it okay for me to examine you?” she asked Vic in her gentle voice.
Vic’s abdomen was severely distended and very tender. She was running a fever and her resting heart rate of 103 indicating severe pain despite the fact that she had already taken her pain medication. Vicky’s vitals were poor.
Sue administered a strong morphine injection.
“Vicky, you appear to have an abscess on the right-hand side of your abdomen. The skin is hot to the touch and distended. I think you have a partial obstruction.” Dr Sue said to Vic.
“I am here to see if Hospice can help you. Do you realize that you are very ill my love?” Dr Sue asked Vic.
“Hospice will not hasten your death my love. It would be our aim and purpose to provide you with pain relief and quality of life. We will treat you and not the disease. It is exclusively your decision whether you want us to help you and how you want us to help you.” She explained to Vic
Hospice is a philosophy of care. The hospice philosophy or viewpoint accepts death as the final stage of life. The goal of hospice is to help patients live their last days as alert and pain-free as possible. Hospice care tries to manage symptoms so that a person’s last days may be spent with dignity and quality, surrounded by their loved ones. Hospice affirms life and neither hastens nor postpones death. Hospice care treats the person rather than the disease; it focuses on quality rather than length of life. Hospice care is family-centered — it includes the patient and the family in making decisions. http://www.cancer.org/Treatment/FindingandPayingforTreatment/ChoosingYourTreatmentTeam/HospiceCare/hospice-care-what-is-hospice-care
Vic was in so much pain that she was barely able to speak. Tears welled up in her eyes and she softly said “Please doctor”.
“My love, you need to tell us how you want us to treat your symptoms such as obstructions?” Dr Sue asked
“I want no life extending treatment. I am so tired doctor” Vic whispered. “I can’t do this anymore…..”
“That’s fine my love. We will try and relieve your pain and give you some quality of life.”
“Mommy I thought I had more time…” Vic said with tears silently running down her cheeks…… Then the injection kicked in and she drifted off to sleep.
Dr Sue said that the responsible sister would collect the morphine from the Hospice pharmacy and she would set up a subcutaneous morphine syringe system by that afternoon. Hospice would arrange for counseling for the boys.
She hugged me and left. All of a sudden I felt so alone again!
Subcutaneous, or under-the-skin, injections use a needle to deliver medications into tissue just under the skin. An infusion of morphine, anti-nausea medication and Dormicum is now administered 24/7.
The first couple of days Vic slept a lot. She was tired but there was immediate pain relief.
The nausea subsided and the partial obstruction cleared two days later!
The first infusion site was in her leg. Within a day and a half the area “tissued”. A common side effect associated with subcutaneous injections is injection-site reaction such as swelling, redness, and pain. We phoned Hospice and the Nurse promptly came and the needle was reinserted into the arm. Within two hours the needle came out again and the morphine was running onto the skin. It was too late for the Hospice Nurse to return and to re-insert the needle so Vic went to the doctor and he relocated the needle into the abdominal area.
Last night the tissue in the abdominal area had tissued again. It was also bloody and the morphine was running onto the skin and not into the tissue. Vic was nauseous with pain. I had no option but to remove the needle and re-inserting it into a different site.
“I think we should put it into the other side of your tummy” I said
“Mommy, I will insert the needle if you help me…” Vic replied
“No sweetie” I said. “I will do it”
My heart was in my throat. I removed the needle and cleaned the injection site. I disinfected the new site that I had identified. I took the needle in my hand and lifted the skin. I pushed the needle against the skin. I assumed that the needle would just slide in… It did not just slide in! There was resistance!! I let go of the skin and changed my position. I could hear and feel my heart pounding in my ears! I again took my child’s skin between my fingers and pulled it upward.
“Maybe I should relax my hold onto the skin…maybe the skin must more relaxed?…..” I thought.
I exerted pressure on the needle and it slid in… Sweet success!!!!
“Oh Mommy you are such a star! Thank you. That did not hurt at all!” Vic gushed.
I do not believe her. I had felt her little body tense up as the needle went in. It hurt!
My entire body shook. The bile rose in my throat and I slowly let out my breath.
We have all come such a far way. Until last night I could not watch anyone stick a needle into my child. Now I have stuck a needle into my child’s flesh. I fear that Vicky’s tissue is too poor for us to continue on the subcutaneous route…… If we do I will have to do this many more times in my life.
The good news is that I was actually able to work the whole week. It was the annual African Air and Defense Show and we exhibited. Normally I would be absolutely frantic about Vic. But I was okay with the fact that she is relatively pain free and the nursing sister visits every two days.
Vic is far more active. She is truly so much better. The partial obstruction appears to have cleared! She spends time chatting to the boys. On Saturday she took Jared shopping for a new shirt and shoes!
On Sunday morning Jared lit candles “For those we have loved and lost but will forever be in our memories♥..Gramps, Oupa Tienie, Ouma, Nan and Oupes♡” Vic handed him his baptism candle that she received 15.5 years ago at his christening. He lit his candle as he took responsibility for his own walk with God. Vic and I laid hands on him and prayed for him. It was so touching.
Joyous day!
Vic attended Jared’s confirmation service. I have never seen a more radiant and proud mother in my entire life.
She explained to us that Vic’s pain is what is keeping her alive. ”An adrenaline rush is the fight or flight response of the adrenal gland, in which it releases adrenaline (epinephrine). When releasing adrenaline, one’s body releases dopamine which can act as a natural pain killer. An adrenaline rush causes the muscles to perform respiration at an increased rate improving strength. It also works with the nervous system to interpret impulses that trigger selective glands.” http://en.wikipedia.org/wiki/Adrenaline_Rush
Vic has been accepted into the Hospice program. The doctor evaluated her at 07h00 this morning and immediately gave her a strong pain-injection. She also put on a 75mg Durogesic patch. Vic will remain at home. We now have access to nursing professionals 24/7. A subcutaneous infusion will be set up this afternoon for the administration of all further pain medication . Vic will no longer drink any tablets.
Vic has a partial obstruction and an abscess in the abdomen.
The continuous subcutaneous infusion of drugs by a small portable pump (sometimes called a “syringe driver”) is a major advance in terminal care, particularly for symptom control in the home. It has a number of advantages over intravenous therapy. It is safer (much less risk of infection and no risk of air embolus). The patient can remain fully ambulant. Tolerance does not develop to subcutaneous morphine as it does occasionally to IV morphine. (see Morphine)
The main indications for continuous subcutaneous infusions are vomiting, dysphagia, severe weakness or unconsciousness. They can be particularly useful for patients at home, either to control nausea and vomiting, or during the last days of life if the patient is no longer managing oral medication.
In the words of Dr Sue Walter, MBBCH/PALLIATIVE MEDICINE, “Vic’s suffering is inhumane”.
She explained to us that Vic’s pain is what is keeping her alive. “An adrenaline rush is the fight or flight response of the adrenal gland, in which it releases adrenaline (epinephrine). When releasing adrenaline, one’s body releases dopamine which can act as a natural pain killer. An adrenaline rush causes the muscles to perform respiration at an increased rate improving strength. It also works with the nervous system to interpret impulses that trigger selective glands.” http://en.wikipedia.org/wiki/Adrenaline_Rush
Maybe this is the final part of Vic’s journey. I do however expect her to bounce back!
Today, having a loved one live with a terminal diagnosis for an extended period of time is fast replacing sudden and unexpected death as the norm. Ultimately, many will reach a point where medical technology may be able to keep them alive but can neither restore their health nor even improve their condition. In actual fact they are merely kept breathing…. More treatment will only prolong their dying.
It is at this point that patients and families face difficult choices about the kind of care they want….
I have seen studies that clearly show that patients who access Hospice, earlier in the disease process, actually live longer than expected. Ironically it seems that Hospice, with its emphasis on quality of life, actually keeps people going. When people who are ill have good pain and symptom control and their caregivers are well supported, they don’t want to give up; they want to live longer.
Vic has reached a stage in her life where she wants to die. She has absolutely no quality of life and is growing weaker by the day. Everyday Vic loses a little more of her independence and dignity. Vic needs help with almost all her day-to-day activities.
Opinion polls decisively show that most people would prefer to die at home, free from pain and surrounded by their loved ones. Sadly people often die alone in hospitals or nursing homes, attached to life support machines they do not want. It is also a fact thatmany terminally ill people die excruciating painful deaths because, even in death, their doctors suffer from Opiophobia…
“Opiophobia is the syndrome of failure to administer adequate opioid analgesics because of the fear of producing addiction or toxicity. The etiology of opiophobia is multifactorial: Peer pressure (provider and patient), regulatory agency pressure (real or perceived), and lack of education on opioids and the fundamentals of pain management all contribute to its persistence…. All of these factors contribute to the underuse of these relatively simple and very effective medications, due to no fault of the patients. ” University of Wisconsin textbook on pain medicine, Bonica’s Management of Pain, 3rd edition:
I promised Vic no more surgery and no more hospitals. https://tersiaburger.com/2012/06/01/1-6-2012 The only humane option left is Hospice. I have been fighting for Hospice to get involved with Vic’s palliative care not to hasten her death but to enhance her quality of life!
WHAT IS PALLIATIVE CARE
Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:
provides relief from pain and other distressing symptoms;
affirms life and regards dying as a normal process;
intends neither to hasten or postpone death;
integrates the psychological and spiritual aspects of patient care;
offers a support system to help patients live as actively as possible until death;
offers a support system to help the family cope during the patients illness and in their own bereavement;
uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
will enhance quality of life, and may also positively influence the course of illness;
is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications. http://www.hospicepalliativecaresa.co.za/What_is_palliative_care.html
WHAT TO EXPECT
Should the patient be accepted onto a hospice programme, the Hospice team together with the patient will develop a tailor-made plan care plan. Usually patients are visited by the hospice staff in their own homes. The care and support of the hospice team will help the patient and family as they navigate their way through the challenges of living with a life-limiting condition.
The main things hospice can help with are:
pain and symptom control
psycho-social support and advise
spiritual support
emotional support
bereavement support
equipment (wheelchairs etc)
The challenges that we as a family must face with Vic’s terminal diagnosis is complex. It includes evolving new structures and dynamics as the person we love very, very slowly slips away.
Last night and again tonight, Vic said to me “Mommy, I know you think I will live forever but you must prepare yourself because I know how my body feels…”
As a family we have learnt to cope with setbacks, Vic’s health steadily deteriorating and periods of seeming remission. This “extended grief”, wears us down and leads to the horrible realization that we sometimes find ourselves wishing that the process would end…. I have often said “Sometimes I am scared Vic will never die…” I do not want my child to die. I merely want her suffering to END!
As a family we have moved into a phase where the stress of the situation can no longer be ignored. It is making all of us ill.
This week has been an emotional roller coaster! On Tuesday I cried in front of a strange doctor. Wednesday I felt that I was losing the plot. I was unable to function on a professional level. My mind was absolutely fogged over. Thursday an angel named Christa evaluated Vic and I went from absolute despair to exuberance when I heard that Hospice’s Doctor would evaluate Vic on Monday morning…
Today when Jared and I were waiting to see the doctor after his CT scan we had a long chat…
He said “Oumie I can see when you are stressed. You zone out… You have been very stressed this week….”
“Yeah” I said. “I have been a little stressed this week.”
“Since you starting writing your blog you no longer wear a mask Oumie…You handled the stress better before! You always smiled.”
OMG. What am I doing to the boys? I realized today that I have to be more careful. The mask has to go back on. I scare them when I show my stress. Imagine what it would do to them if they read my blog….. Thank God they don’t!
I left the best for last though – no immediate lymph biopsy will be done on Jared. The lymph nodes are definitely enlarged but there has been no adverse change in the past two and a half weeks. We will give his kidney some time to heal and the CT scan will be repeated again in two months time.
I am feeling so positive!
There is a God and I thank him for Jared’s outcome, Hospice intervention, Baby Isak and my wonderful, loving family. I pray that He will enfold Vic and the boys in His Mercy and Grace. I pray for my mask!
Vic's Final Journey 