The Transition
When discussing the ending days of a life on this blessed earth the word “transition” is frequently used. To me, transition always referred to a new political party taking over a presidency, and the replacement of one team of officials for another. This transition is not at all related to politics.
For many people who come to the final days of their lives, there is a period of time which has been labeled “transition.” This refers to one’s journey from this life on earth, to what lays beyond. It is a heavy subject. One that most people would be happy to avoid discussing. Of course, many people are blessed with an easy passing – a sudden heart attack or passing in their sleep. My father passed while watching television, which was a blessing beyond description after we had experienced my mother’s final days of lung cancer.
Hubby used to get dramatic every once-in-a-while (actually fairly frequently), and would announce:
“You don’t seem to realize that I am dying!”
My response was never what he was hoping for. It was usually:
We are all dying. It is just a matter of time for all of us.
“I am much closer than you are,” He would retort.
Yes, you are twenty years older, have had twenty more years on this earth and have had a wonderful life. Of course, you are closer.
Hubby was looking for sympathy. I felt that being sympathetic was not helpful. I wanted him to feel alive and not indulge himself that his end was near. He was not in pain or suffering, although his dementia was getting more severe, and I knew that at the age of 95, he was quite correct – his life was coming to a close. Still, admitting it to him served no purpose whatsoever.
I would read the accounts of others caring for their loved ones at the end stages of dementia, and truly did not know what they meant when they said their loved one was in transition. How did they know? What on earth were they talking about? Perhaps they were wrong?
In Hubby’s case, his brain and body began to fail more dramatically over the last few weeks. The brain tells the involuntary nervous system and organs how to function. It is not something we can alter at will.
Hubby began to fall into very deep sleeps from which we could not awaken him. That was the initial reason that I brought Dr. S. to our home to advise me as to what was happening with Hubby. There were times when Hubby went from fairly normal functioning to almost a state of fainting where his legs would no longer support him and he could not awaken from a sudden sleep state. Dr. S. thought it was possible that he was experiencing narcolepsy, a relative of epilepsy – all derived from brain issues. Dr. S. wanted to do a full blood work-up on Hubby and I was looking at a man so reduced and so thin and so tired that I was not anxious to comply. I asked the question as to what the purpose would be, and Dr. S. explained that Hubby appeared to be dehydrated and he needed to discover why. Certain tests could have helped unravel the mystery and perhaps result in good medical decisions. That was not to be.
After the initial recognition that Hubby could no longer swallow, drink, eat, or react to questions, he was put to bed with an IV of antibiotics to fight the apparent pneumonia which had set in. Pneumonia is probably the most frequent cause of death in dementia patients because when the brain no longer knows how to swallow, the food will be aspirated into the lungs where the pneumonia develops. That is what happened to Hubby.
Dr. S. told me that someone in Hubby’s condition would normally be taken to a hospital to be cared for. I refused. Hubby could not be saved even if he were to survive the pneumonia. He did not want feeding tubes to keep him synthetically alive with no quality of life, and I wanted him lovingly attended to as long as required.
As Hubby’s fever increased, we monitored his oxygen saturation. Once it dropped below 88 his doctor ordered an oxygen tank and a mask to ease Hubby’s breathing. Although his body was getting an IV of fluids and antibiotics 24-hours a day, the body was no longer absorbing the liquid, another essential life-saving ingredient. The fluids went right through him. The doctor constantly asked about whether the kidneys were functioning. It is not unusual for them to shut down completely in the final days of life. All of these shutting-down processes are part of the transition which I had not understood heretofore.
Now we were experiencing it all, up close and very personal. Hubby was essentially unconscious for five days in a row. He was breathing but with the pneumonia, his breathing was very labored and hard to witness. It would be fair to say that he was not aware of being in pain, but that his body was working very hard to breathe through the pneumonia.
Hubby opened his eyes once, very wide, looking at me sadly as if to say:
“Can you tell me what is happening to me?”
I told him that I loved him very much and that everything would be fine. Those last words haunt me. Nothing would be fine. He closed his eyes and went back to sleep. Days later we discovered that the oxygen machine was no longer helping Hubby and that he had stopped breathing. The transition was complete.
It would be fair to say that I did not fully understand that Hubby was experiencing his final days on earth, but I was very concerned that even if the antibiotics were somehow miraculously able to cure his pneumonia, what possibility could there be for his survival if he could not drink or eat? The doctor had kindly said that Hubby had a 50/50 chance of survival in this situation. I think he was just being gentle so we would not become desolate any sooner than necessary. One accepts any wisp of hope which is generously offered when it appears that none exists.
After caring for Hubby for the past ten years of his cognitive decline, through all the experiences which I have shared in this diary, it did feel as though what was happening was natural and inevitable. There was no illusion that the course of Hubby’s transition could be reversed or even improved.
The day before Hubby went into the five-day deep sleep, he would no longer even try to eat his ginger snaps, or drink his coffee. He no longer acknowledged that Frank Sinatra singing to him required that he should sing along. The joy of life had slipped away. It was clear that there was no remaining quality of life to be had. Acceptance embraced me when he passed, and I felt calm.
Today a dear friend called me to tell me that when she prepared to come to the funeral, that she packed some ginger snaps into her purse, planning to leave them on the gravesite. The idea was so sweet that I have vowed to do the same in the future.
It is Jewish tradition to leave a stone on the grave of someone you visit, so that others who come will know that caring friends and family have been to the site. I think I will place two ginger snaps on the grave with a beautiful rock from my gemstone collection. Hubby will know that it was me, and the birds will fly down for a snack and guard Hubby until I return again.
