Reflections on the death of my Mom

It was late in March when got the call at about 3:15 AM. It was a call we'd been expecting for over a week. The night nurse called to let us know that Mom was actively dying and the hospice nurse was with her. Mom had been decling before we got her moved to an assisted living facility back in August and the move only accelerated her cognitive decline. She tried to maintain some semblance of reason, but as time passed, those efforts simply vanished under the rising tide of her dementia. In January, it became necessary to move her to the Alzheimer's unit for continuous care.

She was a force of nature, with a short temper and no tolerance for fools. She made use of Dad's GI Bill benefits and got her ADN in 1977, and worked as a Med/Surg RN until 1992, retiring a couple years after Dad died. She had frieds she traveled with...to Italy, Mexico and Central America, The Carribean. But,the years of pounding the floors as an RN had taken their toll. Arthritic pain to her legs, knees and feet began to limit her mobility. She sold the house, which was at the top of a steep flight of steps from the street, to a single floor condo.

After the death of my sister in a tragic accident in 2010, she lost something, and began to close in on herself. Then, about 5 years ago she had a fall resulting in a broken hip and hip replacement, with another fall the following year and the other hip replaced. She tolerated the surgeries well, the rehab was another story. I talked with her ever day on the phone, and made the 90 minute drive once a week to see her, to be greeted by her raging at the rehab facility and it's staff for being "incompetent and unresponsive". During this period, she was becoming more and more isolated as her friends died, her fear of falling increased and her mobility decreased.

Her decline accelerated after she was admitted to the hospital with urosepsis. Her stay was complicated by a fall because no one answered the call light to assist her to the bathroom. She had been transferred from intermediate care to a step down unit. My discussion of the incident with the nurse caring for her at the time revealed that the nurse had not been informed of her confusion secondary to the urosepsis or that she was a fall risk. I restrospect, I should have sued.

Her cognitive and physical decline continued until it was simply no longer safe for her to continue living at her apartment even with a private duty nurse checking on her two ot three times a week and home health aids in on a daily basis. So, in August of last year, we moved her to an asssisted living facility. And there her decline accelerated until it became necessary to transfer her to the facility's ALzheimer's unit for continuous care by January, and we got hospice involved.

It was the second week of March when the facility called to let me know that she had stopped eating and drinking, and was refusing her medications. By then, I had retired, so my wife and I departed from our usual bi-weekly visits to begin driving to the facility to check on her every other day. That first visit, after she stopped eating, she was lethargic, but she brightened at our arrival and spoke with us briefly. It was "Honey" for me and "Sweetie" for my wife, as she could no longer recall our names. And, to me, that was as sddening as anything else that had transpired to that point. She, who ahd given birth to me, and put up with me, and supported me in what ever I turned my hand to...no longer remembered my name. As her remaining days passed, she grew more and more obtunded. My last visit, she looked up at me and smiled as I held her hand, then drifted back off. With my experience as an ICU nurse and hospice nurse, I knew the end was drawing near, and I was surprise she had lingered this long, a week and a half so far with no food or water. I returned home and prepaared my aunt, my cousins and her few remaining friends for what was to come.

It was a day later, at 3:15 on a Monday morning, that we got the call. We coffeed up, got dressed and started the 90 minute drive to the facillity. The hospice nurse was there, she'd been getting morphine intensol sublingually to ease any pain or air hunger she may have been having. My wife and I sat beside her bed, holding her hands, telling her it was alright to go...that we would be alright. Her breathing became more irregular...then agonal...and then stopped. I put my stethocope to her chest and listened, as her ragged heart beat slowed and finally...stopped...at 5:46 AM...less that 30 minutes after we arrived at her bedside. The hospice nurse auscultated for heart tones as well, confirming the time of death and pronouncing. This was a road that, in my 25 years as an RN, that I had travelled with many other families and now, it was my turn. That experience did nothing to lessen the pain of her loss, but I knew it was how she wanted to pass. It was an issue we had discussed over the years and she had provided advanced directives and made herself a DNR, when she still ahd the capacity to do so. She did not, as I have seen far too often, the deaths of those in the ICU whose families wanted "everything" done, whilst have absolutely no comprehension of just what that "everything" entails. She passed peacefully, my wife and I at her side...as it should be.