COMFORT CARE AND GIVING

Adapted from a friend’s email on 04.16.2009

Yesterday I went to a friend’s barn where a mare was struggling to give birth. The mare was old and the owners knew it would be a difficult pregnancy. I was there for 5 hours helping out alongside the vet and the owners. The foal was still born at 8:45 pm.

We took turns doing CPR, chest compressions and massage on the newborn. I still feel the tears oozing out of my pores. What a beautiful creature, a female, perfect in creation, red curly hair, big eyes, long legs and big hooves. Not able to breathe sufficiently on her own.

The mare is still seriously compromised. If we cannot get her to stand up she will die. For a large animal to be on the ground too long is not a good thing. It’s like a dolphin or whale being beached. The horse's organs will compress inside against her intestines and cause injury. It is best to get her up and stabilized.

Last night I held the mare's 50lb head in my lap while watering her, and thought ... God [life] is to be respected and feared [a reverence and power], and held in awe. I felt a solemn reminder that life is sacred. That it is important to help out All Life regardless of one’s own agenda or needs. To be able to grow old and still be able to love means that you must accept pain, death, anger, mess, fatigue, more death, struggle. Risk. It means that nothing can keep you from wanting to love because you will not stop despite the outcome.

I’ve dropped everything on my day's schedule to head over to the barn with a bag of apples to comfort the mare with soothing touch and sound.

MY REPLY AND JOURNAL
04.17 FRIDAY
Thank you for your words of wisdom ... that reverberate with what I am experiencing today. My mother is so much like both the mare and the foal alike. She is eighty-six years old and her body is tenaciously enduring the advanced stage of Alzheimer disease and rheumatoid arthritis.

She is frail, bony and lanky. She cannot stand nor walk on her own. She is bedridden and I fear that her organs are collapsing. I have to tell her to take deep breaths to get her to the commode by her bed. Her skin is transparent like a baby's.

Carol is coordinating her 24 x 7 x 7 care, and with the added assist of two CNAs mom is spending the last days of her life at home. Dad had a bladder cancer operation April 9th, so he needs our 24 x 7 x 7 help with a task he’s been managing for over ten years. It is wonderful to see how we as a family have rallied to help and make her final months, weeks, days, hours and minutes filled with comfort care.

In 2001 I got a call from mom. She said, "Judy, your father keeps falling down and I'm loosing my mind, I think we need help." That nudged open one of the portals that led me to move to the outer Cape in 2004. This is a mission and loving moment, as painful as it is.

A few weeks ago mom was refusing food. Carol said, "Chet, if you don't eat you will melt." She looked at Carol squarely and said, "I know. Don't worry. I'll come back." I know she will. She is still showing signs of the comfort care she’s given me all these years at a time when the departure of her earthly body that has carried her for almost 86 years is near. “I love you. It’s OK to say goodbye.”


04.23.09 THURSDAY
Mom is sleeping deeply today. Father Skaels from Holy Redeemer Church in Chatham made a house visit; we said prayers and he gave mom the blessing of the sick (formerly known as last rights) by anointing her forehead with oil and uttering words to invoke God’s mercy. Mom eyes were shut tight. Mom’s body is shutting down but her presence is still here, albeit in fleeting moments, like when I reposition her in bed and she feels pain. “Stop that, damn it. You’re hurting me.” I proceeded with gentle repositioning and soothing words, “I’m sorry. I love you. Let me move you up the mattress on the count of three … one … two … three,” and I pull the slip-sheet toward the head of the bed with an “Umphhhh.” “OK, is that better?” “Yes. Thank you dear, I’m cold.” I gently raised the covers under her chin and place the small, soft wool blanket on her lower torso. “Is that better?” “Yes, god damn-it what is wrong with me?” I utter gentle words, “Your body is failing. It’s OK. It happens to all of us. You are the best mom in the world and surrounded by love. I love you.”

04.25.09 SATURDAY
Mark is manning the house today and I arrive after work at 7 pm. Mom is agitated. Her cheeks are red even though her face is more sallow. After assisting with a commode void and administering her evening medications I lie down on dad’s bed next to her and we say a few Hail Mary and Our Father prayers together. She remembers the words if I start the sentence. In fact, she knows them better than me. Her faith comforts me and I hope it comforts her. She frequently cries out “God why don’t you just take me. Mary, help me. Jesus, please.” Those words upset dad. To me it is a sign of her faith working to ease her suffering. Finally mom drifts off to sleep. She is sleeping so soundly I cannot rouse her in the very early morning hours the next day to go to the commode.

04.26.09 SUNDAY
Mom’s breathing is really labored. Five deep sucking breaths followed by between 18 and 60 second intervals of not breathing. Apnea. Her tongue is caked with the applesauce pill mix I gave her last night. Shit, she’s not swallowing it. I call hospice and the nurse instructs me to open the comfort pack and administer .25 mg of liquid Roxycodone and 1 tablet of Lorazapam under her tongue. The pill does not melt like she said it would and mom wants to spit it out. Her breathing improves in about 15 minutes and she is resting more peacefully when I depart for work two hours later. Carol administers her medicine in her usual punctual manner and comfort care throughout the day, with me joining the effort that evening and throughout the night.

04.27.09 MONDAY
Bev, wonderful Bev, is the care provider today and Lori, amazing Lori, tonight. I can relax when they are assisting mom and being good company for dad who is really sad. Bev told me the appearance of foam under mom’s nose and around her lips is a sign she is progressing to another stage.

4.28.09 TUESDAY
Carol cares for mom and dad all day and night. Mom continues to struggle to breath. The daily hospice CNA helps with bed-bathing mom and changing her bedding while she is in bed. Carol struggles to keep the daily CNA support on schedule and tells me dad had blood in his urine and I breath a sigh of relief, “Thank goodness his doctor’s appointment is tomorrow.”





4.29.09 WEDNESDAY
I arrive in Harwich at 2:30 am in the morning. Carol is in the kitchen writing on the yellow legal pad we use to record mom’s hourly care activities.

Later that morning mom is in a restful state. Not in pain. Not agitated. She is still not accepting food, nor drink. Dad and I go to his 2 pm doctor’s appointment for follow up on his bladder tumor biopsy. The prognosis is sobering. The best course of action is to remove his bladder completely if that’s the only organ involved AND his is physically able to undergo the procedure. The other option is to place radioactive isotopes in the bladder to slow tumor growth. That’s not a cure, but it may prolong his life for another five years, if other organs are not involved.

That evening mom’s breathing is getting more continuously labored with the gurgling sound increasing. We administer Atropine regularly to relieve that symptom. It doesn’t work. The Lorazapam seems to be the best of the three medications at easing her struggle. I know her body is shutting down.

4.30.09 THURSDAY
I’m having a difficult day.

5.01.09 FRIDAY
Mark calls to say he has an inner ear infection and is in a lot of pain and won’t be coming tomorrow. Carol scrambles to accommodate the gap in the 24 x 7 x 7 care schedule and straighten out medicine ordering foibles by our care providers. It’s Friday and hospice was late ordering the liquid pain medicine, the doctor’s office was late signing off and faxing the form to hospice, yadi-yadi-yada. We pick up the medicine at the Stop & Shop in Orleans, and go to Harwich. Mom is so thin and frail I hear her bones crunch when we roll her on her side to change her brief in bed. It pains me. Lori is on duty tonight so Carol and I retreat to Eastham to get some much-needed sleep.

5.02.09 SATURDAY
Bev picked up the Saturday daytime comfort-care-giving shift, and uncle Red and aunt Winnie came to visit and go out to lunch with dad. He was happy to see them. Winnie said mom looks peaceful. Those words comfort me. Mom is struggling to breath when we arrive that evening and we religiously administer the Lorazepam, Roxicodone and Atropine drops to ease her struggle. I listen to her breathing pattern on the baby monitor all night.

5.03.09 SUNDAY
Carol is on duty all day and night. I go to Eastham early to do an image capture for a Provincetown artist, and am listening intermittently to the voices on TV doing the derby pre-race program. Carol is caring for mom and dad until 9 am tomorrow. Mom is primarily unresponsive. Occasionally I see her looking through a slit in one eye, tracking my movement, perhaps. We continue to keep her comfortable, breathing with relative ease and speaking to her about how much we love her, are grateful for everything she has given us, and how it’s OK for her to go.

I go to bed early so I can wake up around 1 am and listen to her breathing again. A few weeks ago she would call “Wally, I need to go.” Carol and I would spring from our beds and scurry to lift her and move her onto the bedside commode, put Balmex on her bedsore, change her brief, gently place her back in bed and position her for comfort. The hospice air mattress hospital bed, bedside commode and help made mom’s wish to pass in her home possible.


5.04.09 MONDAY
First thing this morning mom’s breathing is more labored. She is gurgling in spite of the Atropine drops. She has a temperature of 102 degrees. The nurse comes early and administers a Tylenol suppository to stem the temperature. I go to work and Carol to the studio.

Dad calls me at 4 pm and says Bev said to call and tell me I should come over. I leave work and Carol leaves Eastham quickly and we each rush to Harwich. When Carol arrives mom’s eyes are wide open and she is yelling “momma, momma, please take me” with her arms and legs moving and reaching outward. When I arrive shortly thereafter her eyes are closed and she is unresponsive. I continue the comfort caring stream of soothing words and pray. Lori the evening CNA arrives at 7 pm, and we retreat to Eastham for much needed rest. Mom’s temperature is normal, her breathing is still labored, and her eyes are closed.

Lori’s entry into the CNA journal notes that mom was in bed with her eyes wide open in a very peaceful state at 2:40 am, Tuesday morning.

5.05.09 TUESDAY
Carol and I arrive at the house at 7 am. Mom is unresponsive and her temperature is elevated to 102.7 degrees, and climbing. Her shoulders are heaving as she tries to suck in air. This is not the apnea pattern. I call hospice and the nurse assigned to manage her care comes at 8:30 am to help relax her breathing. She administers another Tylenol suppository. It is not working. Her temperature continues to climb and tops out at 106.7 degrees just before she is released. She increases the dose of Lorazepam from .25ml to .5ml and the same with the Roxycodone. We continue to administer the medication as proscribed.

Mark calls and says he’s coming down tonight. I am happy he is. Mom can’t let go if he is not here. She is unresponsive and her eyes are small slits. I know there is still a light inside because the artery in her neck is throbbing. At around 4 pm that day Carol and I thought we lost her again. Her breathing pattern is changing again. There are fewer breaths (one not five) and long intervals between them. I make dinner for dad and Carol, tuck dad in and watch the first few innings of the Red Sox game.

Mark arrives at 9:30 pm and I retreat to the bed upstairs to get a few hours sleep. I know I’ll be up from 1 am on, the next day. Mark helps Carol administer another (4th one today) Tylenol suppository by embracing her and moving her on her side. He speaks words she needs to hear and returns to his home around midnight.

5.06.09 WEDNESDAY
I awake at 1 am and go in to check mom. She is breathing gently. Thank God. I pull a blanket over my body on the small couch in the living room, close my eyes and drift off to sleep. Carol is asleep on the other couch. Mom is due for more medicine in an hour. I check her at 2:30 am and there is no sign of breathing, nor a pulse. Dad is in the bathroom. I wake Carol and say, “I think mom’s gone.” She gets up and can’t find a pulse. When dad exits the bathroom I say, “Dad, I think mom’s gone.” He squints at me and says, “No. She isn’t.” I calmly say, “We can’t find a pulse, dad.” He starts to shake and I grasp both of his hands and guide him to sit on the edge of his bed. I can feel his heart sink and know he thinks he cannot go on without Chet. “I promise you, I will do everything in my power to care for dad, mom.”

Has caring become fainter in the 21st century?

The most important lessons I’ve learned about caring are this. Give more than you take. Empathize. Observe and listen. It is one of the most giving of our natural inclinations.

Caring is professed by the lessons of most religions, and guided by their principles like not hurting others, not seeking retribution and not always looking for greener pastures. Honoring life beyond one’s self.

I often wonder if caring became fainter in the early 21st century when communication and (some) information is pervasive, and when people can touch people of like (and unlike) minds across the globe.

In 2006 I noticed two men waiting for their wives who were shopping and sharing pictures that put smiles on their faces with a phone. That started an observation about how a lot of people are focusing as much on what’s on their portable media device as what’s going on around them. Today’s world of “always connected” distracts me from thought processes and observation.

Today, people are always connected, albeit selectively. When the cell phone buzzes one does not always answer it immediately. That selective function is needed to winnow out the fire hose effect of instant messaging, phone calls and getting things done. There is little to no time to consider that across the street Mrs. C is tipping over into her climbing-rose bush, let alone to pause and help her.

That selectivity creates too narrow a focus on affinity. Seeking others of like mind is a natural inclination. Accepting that which is not your affinity is necessary for caring. Religious silos have failed miserably at making this happen. Churches find it easy to attract people of like mind. Many teach tolerance in too few lessons. Some ignite the fire of fear and loathing of others to build a following. Still.

The reflecting pool is too shallow. The more layers, the deeper the pool. Relating via a plastic device in hand or megaphone or the whispers of narrow-minded voices is each a layer. Not seeing beyond and between the layers of selective consideration in today’s always-connected world stifles caring.

Give more than you take. Empathize. Observe and listen.

© US Copyright 2009. Judith A. Jalbert. All rights reserved.

Torn across the middle

48% of the Republican and 30% of the Democrat members of the US House of Representatives voted NO on the first Y’08 credit “rescue/bailout” package yesterday.

The high-wire act of getting the US economy back on track leans either toward uber-privatization concerns about “too much” governance on the conservative end of the stick, or protecting the people that are hurting the most (including prosperous friends) on the liberal one.

Today’s polarized picture of workers compensation, e.g., executive benefit packages vs. compensation packages of the vast majority of US citizens, plus the constant flow of US jobs overseas the past six years, makes the pendulum swing even more wildly above the stagnant pool of joblessness, gross domestic product decline, credit crisis, and the decline in micro businesses that benefit local communities.

Market corrections take years to make. So get comfortable. If you are approaching retirement age and have a 401(k) heavily vested in mutual funds, ask you doctor about Zoloft (then buy stock in Pfizer while the market is down).

I believe the job of both houses of Congress and the President is to make certain budgets are sound, to create laws to oversee and promote sound economic growth, and to support the free market needs of their constituents. Free market does not mean unfair business practices, i.e., allowing the Hedge Fund type short selling and unrestricted use of the media that drove company failures to benefit a few investors. That’s why “Wall Street” stepped up and suspended short selling a few weeks ago. Why didn’t Congress via the SEC chairman stop it long before the credit crunch train wreck?

Today, banks say take this piece of plastic, borrow up to $ XXX,XXX.XX dollars with it. Don’t worry, you get a free one-way retirement package ticket to … Timbuktu, to … work on a Sino-Euro farm without health care, fair compensation or family benefits to pay off your debt, especially if our asset based security is at risk. Oh yeah, and there is an Internet fee.

Shoring up the existing credit infrastructure is not enough to right this ship. A bi-partisan agreement to invest in all American citizens, create jobs and extend free health care benefits to everyone will turn the fuel of the economy on: the livelihood of its citizens, and create a sustainable alternative to the one way ticket to Timbuktu that a short-sighted “rescue/bailout” package seems likely to promulgate.

Pain at the pump, wallet and lungs

Efforts to quell the 21st century oil glut/profit gloat includes thoughts about disrupting the supply and demand with a boycott. We need a new approach. While a boycott when done by millions will put pressure on the "free" market, will it help to eliminate dependence on fossil fuel? Will lower prices increase our use of fossil fuel and encourage car manufacturers to make even bigger gas guzzlers?

We need to pressure our government to look at more radical approaches like establishing a network to support the distribution of hydrogen made from electrolysis at the pump rather than gas. Better yet, fund local electrolysis generation plants that employ people in lots of communities, minimize the distribution and storage costs, and boost the local economy. Once the distribution system is in place, the mass production of vehicles that already exist will follow (http://en.wikipedia.org/wiki/BMW_H2R).

So while, for personal economic reasons, I will purchase gasoline for my glug-glug car from lowest price pump to ease my pain, we can forge a path that eliminates noxious emissions from gasoline and ethanol (carbon dioxide, formaldehyde)and our dependence on the oil and fuel distribution cartels in the US and abroad.

Age of Aquarius

When I was in my twenties, thirty years ago, it was my extreme hope that there really would dawn an Age of Aquarius when peace would guide the planet and love would fill the stars, and I hoped that would occur by the turn of the new millennium. I dealt with the cold reality that over the span of our earthly recorded history there have been few years when there were no wars by embracing ideals like peace, hope and charity in my work and activities.

Now, seven years after the turn of the new millennium I realize that the dawning that happened was actually the Age of the Internet. Written, picture and video information sharing has extended our daily experiences to an audience that lives all over the globe. The connections are there for all types of intent, some of which I embrace and some which I abhor. I do not believe in jihad, for example, but I believe people who do should have a voice and an Internet place to vent their ideas, and where they can see opposing views.

What did not end is the warring. Tribal barbarism is still rampant on all continents with murder, rape, and the mutilation of human lives stuck like a bad staph infection in the body of our collective soul. I find it particularly poignant that wars are fought for “religious” reasons when all of the great prophets of God – Allah - Yahweh professed the real breath of the spirit of creation, that of love and a commitment to ideals that are the antithesis of killing and the mutilation of life.

So, what is the root cause? Is it jealousy and infatuation with the self? We need to look at the genetic code of our social fabric to figure out why a small piece of land in the place of our ancestors, Jerusalem, has become the firebrand for wars still raging in the Middle East, and how modern day profiteers are driving ill contents that fester in the wounds of too many wars, too many scars on the face of our mothers and too many daggers in the hearts of our fathers.

I still hold hope for a period of time on Earth when there will be peace and love for all.

Another school massacre

The availability of 9mm guns and assault type weapons and ammunitions clips is a root cause of the murders in Virginia this week. Our failure to regulate the distribution of firearms is to blame for the deaths of too many innocent people. The availability of guns from unlicensed dealers, and failure to use the technology at hand to share information about the purchase of human assault weapons like 9mm guns and multiple rounds in a timely manner with school and local law enforcement, raises a red flag in my mind. Sharing that information with the broader population via the Internet would really help to quell the violence.

Is anyone looking at gun purchase stats (from legitimate vendors) and helping communities deal with the too oft’ times dire consequences that our present approach to gun regulation creates? I firmly believe everyone has the right to bear arms, but regulating the who, what, when, where and how of arms distribution is important to the health and well being of all citizens. After all, that’s what our state and national elected officials are charged with doing, creating laws that support the health and well being of their constituents.

Now entering the blog-osphere

Welcome to my journal about what inspires me to communicate visually and verbally. Using the Internet to reach out and communicate about the work, people and events that shape my existence is very exciting. You won't find rants nor raves on this site. Just observation, reflection and measured conviction about what I feel is important to share with my friends, work associates and family.