The grind

Every morning I make a pot of coffee. Over the last year, I've become a bit of a coffee snob, though, so I grind my beans with a manual burr grinder and use a French press for exactly four minutes. 

While the water is boiling in my kettle, I have to grind the beans. I use a manual grinder because it makes a far superior grind than any electric grinder I've used. Also, because I'm doing this while other people are still sleeping in my living room, I try to avoid the cacophony of an electric grinder before 8am. 

It takes almost exactly the same amount of time to grind the beans as it does for the kettle to boil. Logic would say that I should turn the kettle on and then get to grinding. But as I walk around the kitchen grinding beans, my mind thinks of everything else in the world I should be doing besides grinding beans. 

Put the dogs out. Check the weather. Check the fridge for breakfast items. Empty Rich's foley bags. Look up how to spell something. 

And when the water has boiled, I have no coffee grounds. And it screws up my whole morning routine because I have to keep going back to the grinder and end up with cold eggs, cold coffee, and a harried breakfast experience. 

My mother used to talk about getting her nails done for an hour and wishing she could just hand over her hands but still be able to do things during that hour. Apparently, I come by this naturally. 

As uncomfortable as it is, I'm forcing myself to stick to the task at hand without distraction of what comes next. I'm not so great at it, but over the last year I've seen the pros and cons of each method. 

This portion of hospice is a grind. My hands and mind and heart are busy now with the most mundane of tasks. Changing chuck pads. Dosing Ativan. Cleaning Rich's lips and teeth. Doing laundry. They have to get done. Trying to do several things at once just leads to confusion and cold eggs. 

It's hard because a dying man reverts back to infant stages but without all those features that make babies great. Newborns smell amazing because the survival of the species depends on it. Dying people do not smell amazing. They do occasionally call out "Mom" or smile, but it's not quite the same. 

I need to just keep grinding until the handle turns freely. 

burr grinder 

Contracting

I've only witnessed one death before - Rich's mom. I do have first hand experience with a birth from the mother's perspective, though. I'm seeing parallels I hadn't expected. 

I took two months off of work when I brought a person into this world. I should allow myself to take at least a few weeks to escort someone out of this world. 

Things are different now than they were a few weeks ago. For me, when Rich went into hospice, it was like the difference between being pregnant and being in labor. Yes, everyone recognizes that pregnancy is a thing and there are some limitations to it versus being decidedly not pregnant. But being in labor is more intense.

"Why are you being so dramatic and noisy? Yesterday you were pregnant and you weren't like this. Geez. If it's so unpleasant, just stop doing it." 
"Yes ... I am ... technically still ... PREGNANT ... as this person has not ... EXITED ... my vagina yet ... but this TRANSITION is much harder than him just ... hanging out on the inside. Now go away and make me a sandwich!"

Yes, people visited you when you were pregnant. You went to work when you were pregnant. You had sex while pregnant. You traveled. You tried new things. You laughed. You took care of yourself because there was a person growing inside of you. 

But when you are in labor, you don't give a shit about anyone else but the person you are escorting into the world. You don't even really care about yourself. Lady parts are getting straight up ravaged and your only concern is that other person making it through safely. 

So it is with hospice. Only instead of a few hours, it's weeks or months. And it's important. And there are no do overs. 

Like a birth, there are circles of people this affects. Right now, the Stryker clan is collectively going through a joint labor of escorting a loved one out of this world. We all handle that situation very differently. And just like nine women can't make a baby in one month, adding people to this process doesn't make it easier. 

While most of this will just be a blur once it's over, there will be sounds and smells that trigger memories. The hospice nurses make great death midwives but they're not living it. I've been with Rich over 15 years. His father and brother have been with him over 40. Ian has been with him his whole life. Yet everything is different once the walls start thinning. 

Rich talks about "going" a lot. It's hard to softly walk him to the moment when he can leave us behind and not use ourselves up in the process. I hope that once Rich is gone, we will be able to enjoy the peace he will have. And while we may be a little beat up from the ordeal, I hope we can all be proud of how we got him through safely.

Just born

TPN

There was a lot of discussion about how to handle Rich’s nutrition as he moved into hospice. Both hospice organizations we worked with don’t offer TPN as part of their services. It’s not part of their philosophy. Hospice is about escorting someone peacefully through the end of life, not extending it. 

Because of the emotions involved in all that, our hospice group agreed to step down Rich’s TPN over the course of two weeks. Rich was receiving 2500mL of milkshake intravenous nutrition. We stepped him down to 1800, 1600,  1400, 1200, 1000. And we kept him at 1000mL through February 1. 

Ever since Rich left the hospital at the beginning of December, he had horrible edema (swelling) in his feet and lower legs. His calves and thighs were the same diameter. We tried raising his legs and using compression socks. There wasn’t a medication the doctors were willing to use for fear of it causing other issues for Rich with his heart or blood pressure.

On Wednesday, February 1, the hospital bed arrived. That was the last morning that we hooked up Rich’s 1000mL of TPN. It was still an emotional thing for those not dying. I’m not sure that Rich said anything about it himself. I was on the phone with my mother and she started crying, “So now he’s going to starve to death?!” 

“No, Mom. He’s going to die of cancer. Because he has cancer. He’s going to die of sepsis. That’s how this works.”

I’ve mentioned before that Rich has had wild fluctuations in his temperature. It would roll between 94 and 107 every day. It was miserable and stressful for all of us. 

We hooked up Rich’s last TPN at noon on the 1st. His temp went up to 107.3 at 2:15pm. And ... That was the last time he had a significant fever. He took 1 Tylenol on February 2nd to bring it down from 100.6. All day yesterday (the 4th), his temp was between 96 and 98. 

Also, Rich’s feet are back to normal! They look like his feet again. They don’t hurt for us to touch them. I could actually put lotion on them yesterday without it bothering him. 

Rich is only getting 500mL of IV fluid a day. No more TPN. And yet, his health has significantly improved. He agreed to the bed and he’s sleeping better. As living people we all assume that we need to “keep Rich alive” as long as we can and that taking things away is giving up on him. But all that protein and sugar in the TPN was literally poisoning Rich because he couldn’t process it anymore. The fluid pooled at his feet and the sugar fed the bacteria for his infections to make them go crazy. 

I was in the kitchen this morning and Rich called out to me. I walked in and he said, “I just wondered where you were.” I told him I was making bacon for breakfast and I’d give him some if he wants it. Extra crispy like he likes. 

“Ooo, yeah.  .... Hey, can I have a piece of toast?”
“Do you want plain toast or cinnamon raisin toast?”
“Ooo. Cinnamon raisin please.”

Rich's breakfast

He ate it all, napped for a bit, and then picked up his phone to try to read messages. Look at him, all not starving to death.

Up next, we’re gonna watch “Blazing Saddles” while we wait for hockey to come on at noon. He also just asked for something else to eat for lunch. I offered strawberries. 

"I will have ... one ... strawberry."

He's eaten a whole bowl so far.