“‘The problem with death is absence.’ – Roger Rosenblatt
After all our attempts to comfort ourselves and to make sense out of dying, we are left with a huge hole in the fabric of our lives – ‘I miss you. I miss you. I miss you.” And then what?…
[there is] perpetual danger of falling into the astonishing abyss of the person’s death…
Perhaps they become our guardian angels, our link with the other side. But to let them go initially is one of the compromises we are forced to make with life, and our longing for them sometimes makes the prospect of our own death almost right.”
from Funeral Blues, by W. H. Auden
He was my North, my South, my East and West,
My working week and my Sunday rest,
My noon, my midnight, my talk, my song;
I thought that love would last for ever: I was wrong.
It’s four weeks today since Larry died. I hate writing that because it feels like time is a river rushing me away from him. STOP! Bring him back! Is it possible he’s truly gone? He was here, smiling, chuckling, warm and cozy. The incomprehensibility of the loss hurts – even more now than at first. It hurts physically. It hurts mentally. So much so that I looked to make some sense of it and Googled how grief is impacting my brain.
I have trouble making decisions, even little ones. I have trouble remembering things. My brain feels like a hairball – all tangled and messy. I am exhausted, but not sleepy. I wake up not knowing what day it is.
My normal filters of what I say and how I react are warped. I feel overwhelmed by how much there is to do, and how little there is to do. I don’t know what to do next. Though I’m lonely I need to be alone more than I’d expect. Being with people takes so much energy – talking, understanding, looking interested, answering questions. I’m in a gray fog: grief brain, not depression.
What I read about how my brain is being impacted by grief made sense. That death is incomprehensible to us. We struggle to process it. We use up reserves. We use up the glucose our brain needs to function, just like our muscles. It makes no sense to us intellectually so we process it physically. Our heads hurt. Our bodies hurt. Our energy is depleted. A concussion of emotion. Just like concussions that don’t necessarily show on an MRI, the body, the physical brain, still needs time to heal to function properly. In fact, one neurologist, in her book Before and After Loss: A Neurologist’s Perspective on Loss, Grief and Our Brain , is calling for a definition of “emotional traumatic brain injury.”
Research shows that grief frequently leads to changes in the endocrine, immune, autonomic, nervous, and cardiovascular systems; all of these are fundamentally influenced by brain function and neurotransmitters. Rates of heart attacks and car accidents are elevated for people who are grieving.
Another article reported “that several regions of the brain play a role in emotion, including areas within the limbic system and pre-frontal cortex. These involve emotional regulation, memory, multi-tasking, organization and learning. When you’re grieving, a flood of neurochemicals and hormones dance around in your head. ‘There can be a disruption in hormones that results in specific symptoms, such as disturbed sleep, loss of appetite, fatigue and anxiety,’ says Dr. Jannel Phillips,” a neuropsychologist at Henry Ford Health System.
It’s helpful to know all that. It’s reassuring, in a way, to know my brain isn’t going to function well because it’s busy grieving. I should lower my expectations.
I should drive really carefully, or not at all. I should postpone decisions where possible. Everyone keeps asking me whether I’m going to stay living where I am. Who knows? Don’t ask me. Am I going to move west to be near two of my children? I don’t know – don’t ask me.
I tried to buy a car to replace our wheelchair van this past weekend. I didn’t want to buy a car without Larry. A car for one. My brother and his wife were trying so hard to help me but I couldn’t tell one car from another – couldn’t remember the details of each. Felt overwhelmed and exhausted. The pressure to make a decision when nothing made sense felt increasingly heavy. What do I do? Suddenly, yesterday, I realized I could keep driving the wheelchair van until I’m ready. Maybe the decision will get easier as my brain heals.
I am grieving not only the death of my husband, the loss of my soul mate, but also the end of my caregiving, the years of having to be strong every minute of every day. It is blindingly exhausting, confusing, draining, painful. No wonder the grief is impacting my brain. I need time, lots of time, to heal. To let my brain heal. It’s exhausting to think about.
The thistle connotes endurance and fortitude, as well as bravery, courage, and loyalty. It is said you should wear a thistle whenever the stage of your life seems overwhelming.
I have buried my husband. We celebrated formally, as he requested. We euologized him, for the incredible loving man he was: the husband, the father, the friend. As mourners, we accompanied him to the York cemetery and a lone bagpiper played as the sun shone down on us. As mourners, we broke bread together. As mourners we drank together. As mourners we remembered him, and laughed and cried. Funeral and mourning rituals matter to me in a way I never understood before.
Now, as a widow in mourning, I have returned home alone. After being with family constantly since he died eighteen days ago, I have come home alone to our house. I have eaten my first meal alone. I have slept in our bed alone. There are black wreaths on our front doors, and in some ways I wish I could wear black all the time. But what would it mean today?
Victorian grief cultures of mourning were structured and intense with black symbolic of spiritual darkness. Now black is just a stylish color.
Widows wore their black “widow’s weeds” for life in some parts of Europe. I remember living in the Italian neighborhood of Silver Lake while I went to White Plains High School. I would see the grandmothers walking with their black skirts, black blouses, and black scarves covering their heads. I knew they were widows.
I remember reading Victorian novels where the widow would remove herself from public or social activities, and would graduate from heavy black to gray then lavender clothing as her loss receded and she moved into half mourning. People knew.
I took the dog for a walk at sunset yesterday, purposely avoiding the park where people gather. But one of the neighbors that I know only slightly pulled his car over and said hello. He asked “what’s new?” I just shrugged. If I had said anything, I would have started to cry. If we had a culture of mourning and I were wearing black he wouldn’t have stopped. He wouldn’t have asked. He would have known.
In the past there were mourning rituals which acknowledged that death impacted family members differently according to their relationships. Mourning customs for a widow were from four years to at least a year and a day, parents or children of the deceased were encouraged to spend six months, and grandparents and siblings were to spend three months in morning. Other family members should spend thirty days in mourning.
The hairdresser doing my hair several days before the funeral told me she knew what I was going through because her grandmother had just died. I nodded and said appropriate things but I wanted to yell “that’s not the same at all!!!”
Our culture today encourages us to “get on with life.” “Go back to work.” “Keep busy.” We, the mourners, are not expected to acknowledge our loss in a public way once the funeral is over. In fact, if we do, it can make some people uncomfortable. We don’t even allow ourselves to appreciate the significance of the loss, perhaps because it’s so incomprehensible. But also because we don’t have the ongoing ritual of mourning.
I’m not wearing black today, but my heart, my body, my soul – they are in spiritual darkness. The black wreaths on my door are my public acknowledgement that funeral and mourning rituals matter.
It’s a surreal feeling – today is your funeral, Larry. We’re all here to say goodbye.
It’s been gray and cold here in York, Maine, raining this morning – and matching my mood. The sun is supposed to shine for your graveside service. It would be nice if you could arrange that, please.
I’ve been wandering between tasks and tears. Although it’s a rather gross simile, grief feels like nausea to me. It’s constantly there. I try to breathe carefully and push it away, then without warning it takes over and I sob. There’s a moment or two of relief, then the same horrid feeling returns.
It was so hard to leave our house yesterday morning to fly up here. You were everywhere I looked and I just felt you wouldn’t be there when I came back, that I was leaving you behind in my life. I know you’ll always be in my heart but I wish with all my heart you were still in my life.
People told me I would feel some level of relief when you died, to be done with the caregiving. I feel NO relief. Just grief.
Today is your funeral. We will cry today – my waterproof mascara probably won’t last through the flood. We will laugh today. We will celebrate you.
You’d love the laughter. Just know that the tears are the salty evidence of our love.
Larry died at 9:02 last night, April 2, 2019. He was finally ready, but it was so hard to let him go, so hard to say goodbye.
His pain is gone, but the pain of loss is in every cell of my body.
Yesterday, he was with us and responding at 3 pm, surprising us all by saying goodbye to the CNA. He nodded his head when I asked if he loved Cody, again when I asked if he loved me, then nodding again when I asked if he thought I was beautiful. Hey, why not go for it?
My daughter and her husband sent beautiful messages of love and admiration which I read aloud to him. He was able to nod when I asked if he had heard them. My son called and told Larry he loved him on speaker phone. Cody read him Bible verses. I read from a book he used to read to me at night – a list of 10,000 things to love in the world, like morning dew, and ball games, and fireflies.
At five o’clock things started to change. Instead of days, we knew we had hours. We cancelled with dear friends who were coming to cook us dinner.
His son Cody and I sat at his side, holding his hands, crying and making jokes. We continually were in awe that Cody, who lives a busy life on Cape Cod, was with us for this moment, for this final transition.
This is my third death bedside watch, Cody’s first. And the most intimate and irreverent. He would have loved it. I hope he did love it.
By 7, after canceling friends who were coming to cook us dinner, we were guilty to admit to each other we were hungry. I didn’t want to leave him for more than a minute so I ran to the kitchen, grabbed a few beers, and some cheese, and fruit, and chips and guacamole. We had a “deathbed picnic,” toasting him lying on the bed and passed the guac back and forth over him. He would have loved it!
By 8 we thought he’d left us but after a long silence – his head relaxed against the pillow and his breathing stopped. We started to cry with our foreheads against his. All we heard was our tears.
Then… he drew in a loud breath, scaring the heck out of both of us and started breathing regularly again. Really, Larry? Just like when he’d hide around a corner and jump out at me.
He did that repeatedly until finally Cody said, “I wonder if maybe they just don’t have his room ready so they keep sending him back.” We got a good laugh out of that.
Cody sang a song to him called “Nobody Knows.” The first line is ‘nobody knows how to say goodbye.’ Oh, &^^%%!
We felt all the love coming from all over the country, like those airport flight tracking maps with all the red lines of love joining in Osprey Florida. And yet it was perfect that it was just the three of us in the room, no healthcare workers, no strangers.
Finally, at 9:02 he was quiet.
I didn’t know how hard it would be to say goodbye. We had told him we loved him so many times over these last days. We’d told him the wishes of love that so many others had sent. What more was there to say?
Larry, you showed us how to live. You showed us how to laugh. You showed us how to live and laugh while dying. You were always you. As Sam said “you were just a good person all the way through.” You were an incredible partner, an incredible parent, “which will forever be a gold standard for me,” said Krista.
You fed us great food, you made us happy.
You loved well. You were loved. You will always be in our hearts.
I opened the refrigerator and there are leftovers of food he took a few bites of. Today it will be five days since he’s eaten anything.
I went to make coffee for Cody and me and there was cold coffee there from yesterday. I looked at it for probably two minutes. Normally I would have poured it in the carafe in the refrigerator to save for Larry’s iced coffee. I couldn’t pour it down the drain. That seemed like giving up. I couldn’t put it in the refrigerator. That seemed like relentless hope. So I left it there and walked away.
The laundry can blow me away. I did a wash and folded his shirts and shorts and wanted to cry. It’s not that I haven’t cried.
I finally slept til 6 am this morning after many nights of giving up sleep at 4 or 3 or 1:30 AM. I rolled over to put my hand on his heart and hold him. I didn’t realize I was crying but the tears rolled down my cheeks. I took a deep breath and tried to hold us both with quiet loving energy.
The hospice nurse came yesterday at our request. He gently examined Larry. He seemed sad. He confirmed what Cody and I had been talking about. The signs of the end are there. Larry’s has only had drops of water for the last few days. He is waking only for short periods. The nurse’s guess was within 5 days. He said if things got too hard for us to manage by ourselves they would send a full-time nurse. He suggested we stop all meds except for comfort meds.
As I suspected, this is what hospice does well. The last days. The active dying. Not the slow dying leading up to this.
Yesterday was April 1st. In the morning I wrote in my journal that maybe Larry would wake up and say “April Fools, just kidding.” I didn’t mention it to Cody. Last night Cody turned to me and said, “maybe he’ll just open his eyes and say ‘April Fools.'” Larry would like that we separately we thought that and got a laugh out of sharing it – a way too big laugh.
When he is awake, he does respond a tiny bit with small raises of his thumb or minute shakes of his head. He’s tried to say things to us but it’s so damn frustrating because we feel helpless that we can’t understand and we haven’t yet guessed right. We feel so helpless to help him communicate.
We know by thumb raises whether or not he wants pain meds – mostly not, but we do pre-treat him with morphine before we clean him up. Yes, unbelievably, he is still going. We finally gave him Imodium with the hopes of binding him up so we don’t have to put him through the pain of continual cleanings. Who would think of Imodium as a comfort med?
On a side note, one of the caregivers on the Multiple System Atrophy Facebook discussion group said in response to my post about Larry’s extreme reaction to the enema that she had found that hospices were way too aggressive about treating bowel issues. We’ve found Mountain Sage Smudge Sticks a better air freshener than Febreze.
Our three kids are talking to each other. Mostly about how to best take care of me. My friends are talking to each other, and to my kids. Mostly about how to support me. One friend was going to pick up Mexican food for Cody and me last night. She texted the menu and asked us to choose. We were helping the CNA clean Larry so I didn’t respond. Shortly thereafter she texted back not to worry – that my daughter Krista, in San Franscisco, had chosen our dinners and she would deliver them at 6:00. Krista chose well. The food was great.
I’ve been an independent, take charge woman my whole life. It is so strange to have this back and forth between friends and family all going on behind my back. So strange and so wonderful.
They provide a safety net of love. In a different way, they blow me away.
There are not enough tears so why bother to cry! I was reading a book called Being With Dying and the author quoted a dying person as saying “It’s not death that’s hard, it’s the dying that’s a pisser.” Oh, yeah.
The last few days have been the worst. He hadn’t pooped in many days but had hardly eaten and had no discomfort. At first I wasn’t worried, but just in case, I asked the hospice nurse just to check him out Friday morning at 9 am. I so wish I hadn’t!!!!!
That check resulted in an enema that just hasn’t stopped giving. The nurse left at 10 am saying it might take til the afternoon. HA! Today, 53 hours later, we are still in a “go” mode. He’s spent his first days stuck in bed, mostly half or fully asleep, so very weak. In retrospect, this was too aggressive to do to an MSA patient.
Thankfully, his son Cody arrived Friday. I couldn’t have done it alone. The worse was not the messiness but the pain Larry was experiencing – stomach cramping, pressure sores being cleaned over and over. His face was in a grimace, the cords of his neck standing out rigidly.
And yet, because it’s Larry, there were still funny moments. When Cody and I did something incompetently in the midst of helping him and Larry snickered quietly. Or when we decided he really needed a shower but we couldn’t make it happen, and I suggested we strap him face down to the roof of the wheelchair van and take him through a car wash. Cody even promised we’d find a “Gentle Touch” carwash. Larry managed to raise his eyebrows.
Then last night as we sat waiting for him to finish his breathing treatment and clean him for the last time before we went to bed, Cody started exploring the Hoyer lift that hospice had delivered. I showed him how it’s supposed to be used and why it didn’t work for us on a carpeted floor and with Larry being so tall. Cody decided to try it for himself.
In he climbed, and up and down he went. Rides at Disney, right?
This all sure feels like one of those rides I have always hated that make your stomach drop out.
And yet, when I can pause and stop doing, stop problem solving, I am able to bring more open-heartedness.
This morning I was reading a quote by Lao Tsu about the value of emptying your head, of non-doing. The doing is the benefit, the being is what matters.
Someone said wiping his ass is CNA work, not a job for a family member. That may be true. And yet sometimes, just maybe it is an act of love. Thankfully, our CNA is as caring and gentle as a family member. Certainly more skilled. We’re learning from her how to help Larry better.
There is a messiness to all of life we like to forget, prefer to avoid. We like it neat and tidy, without pain. Coming into the world is a messy painful process. I guess going out of it is too.Dying is a pisser. And there’s a lot of messiness and pain throughout life, if we are really present to it.
I don’t know if this is Larry’s time to go. Or if he will revive and we will go through this again. I do know there is something for me to learn here.
I do know that I am a part of him and he is a part of me, and a part of many others in this world, who’ve known him, loved him, admired his grace and fortitude throughout his life and throughout this process. When his body goes, today, tomorow, next week, next year – whenever, he will still be within us, within our hearts.
So where are we now? I’m on this endless road that goes from paved to dirt, twists and turns, and has absolutely no signposts.
Yesterday was a good day, after a good night of sleep rather than the previous night from hell.
Yesterday, Larry was awake much of the day, rather than asleep most of it. He was able to help support his weight a tiny bit when we did the morning transfer. He wanted an English Muffin for breakfast (which he wasn’t able to eat because he couldn’t move it around in his mouth, but he still wanted it.) He asked for his glasses and the sports page of the paper, (although I’m not sure he read it). His breathing was relatively clear.
Is this an improvement or a momentary blip? He said he was a 5 out of 10. Several days ago, with awful symptoms, he said he was a 5. Perhaps the symptoms don’t determine his state of mind. I almost felt like yesterday was worse for him in the sense that he had more awareness of what he was going through.
I don’t know whether to be cautiously hopeful or worried about what’s coming next. As I type this I think, “just stay in the present, Nancy, you will never know what’s coming next.”
Adjusting to a “new normal” has always been hard, throughout this disease. Emotionally and logistically. Are we in another damn new normal? Are we at the end? How many new normals can I stand?
The impending symptoms of death listed in the book given to us by the hospice are all symptoms of Multiple System Atrophy, things he’s experienced on and off for several years – breathing irregularity and congestions, urinary and bowel changes, body temperature fluctuation, difficulty moving food in the mouth. A visiting friend experienced in hospice commented on his glassy, almost non-blinking eyes and said that’s often an end of life sign but its another symptom of this disease, one that we’ve experienced almost a year.
Moving right along…
Yesterday was a good day in other ways. The new hospice nurse was great! He’s got lots of useful experience and had already read a bit on Multiple System Atrophy before he came. Hurray! He arranged for me to have a liquid version of the Xanax so no more crushing pills in the middle of the night. He lives not far from us so said it would be easy to stop by.
The awesome CNA started five days a week. She can help me get him cleaned up, dressed and moved from the bed to his wheelchair. I’ll hire the same person I had before for at least one weekend day.
Friends came over yesterday. She took me out of the house for a little window shopping in Venice. Her husband stayed with Larry. He also fixed a bathroom faucet and ordered a part for a kitchen faucet. They kept Larry company while I napped, then showered. They cooked us dinner and helped me get Larry into bed.
Larry’s son Cody arrives tomorrow for the weekend. I’m so glad!
I have a patchwork of support that has worked this week. What will I do next week?
We give love, we receive love. We keep breathing in and breathing out, putting one foot in front of another in this very long journey.
We were alone in the house and had a quiet evening watching a Hallmark movie. A friend came over at 9 and helped me get him into bed. We fell asleep around 10:30. At midnight he woke me with gurgling gasping breathing.
Breathing treatments. Gurgling, gasping. Morphine. Gurgling, gasping. Meditating and praying. Gurgling and gasping. More morphine. More breathing treatments. I thought perhaps this was going to be the end. I wasn’t in panic. I just wanted him more comfortable. I held his hand and leaned my head against his. He was hot.
I thought of calling a friend. But what could they do? I didn’t worry about disturbing them. I didn’t call because I wanted to just be quietly alone with Larry in the intimacy of the night.
At 2:00 AM I called the emergency hospice line to see if they could offer any other treatment ideas. I was calm. I got a recorded message and was put on hold for 2 minutes. I hung up. I wanted to just text my questions.
I put Larry’s Bi-pap mask back on him and brought the dog to cuddle under his hands. The breathing problems had escalated by now to moaning in between gasping and gurgling. I called hospice again. More recorded music on 2 more minutes on hold. I hung up. I sang to him. I played music on my phone.
Finally I called hospice again and reached a person who apologized that they were having phone problems. Asked questions. Suggested I crush a Xanax and put it under his tongue. Said they’d call the triage nurse.
I crushed the Xanax. I got a tiny funnel – I have two and had the presence of mind not to use the glass one even though it was a better shape because of the possibility he’d bite it. I brought the crumbled pill and funnel into the room and took off his bi-pap and just stood there feeling helpless.
His body was restless, his teeth clenched. It would have taken several people to get the crumbs under his tongue. I should have asked how the hell I was supposed to accomplish this task? What other ways might I do it. I wanted to text back and ask. I didn’t want to call and be put on hold again.
As I waited the 30 minutes for the triage nurse to call, his breathing finally slowed and his body calmed. I figured the morphine was finally kicking in.
I told her we were okay and she started to ask questions to understand what might have happened to start the episode. Had I just given him liquids? Had he aspirated? She clearly didn’t understand that it was just his Multiple System Atrophy.
So what will today bring? We have a nurse coming soon to check his pressure sores. A new nurse who is replacing the nurse we met last week and told our story to and explained Multiple System Atrophy. This nurse is brand new to hospice. Any hospice. Hmmmm.
I’m glad the pressure wounds will be checked. They are awful now that he’s sleeping so much. At this point, it’s not their medical answers I need. I ordered a medical grade sheepskin to see if it would help. We’ll try that today. But I want not to have to change bandages on his butt. At all!
So many of the caregivers who remain active in the discussion group after their loved ones die talk about the PTSD they experience before and/or after the deaths. What was interesting to me was how many mentioned the pressure sores as a trigger.
Why does treating pressure sores stand out for these caregivers in the long list of horrors we deal with? Is it the intimacy of it? Perhaps. Is it the ugliness, the odors? Is it how painful they are for the patient? Perhaps. Maybe it is also the absolutely tangible visceral evidence of the the deterioration of the body.
Someone asked me whether I was dealing with my emotions. Which ones? Should I be grieving his impending death? But according to the Multiple System Atrophy discussion groups, these symptoms could go on for months. And months.
I can only stay in the present. I’m calm. I’m accepting. I’m exhausted. I’m grateful for my family and friends. To everyone of you who is reaching out by text or message or phone or cards.
In a few minutes I’ll go wake him up and figure out what will today bring.
So many emotions. We’ve completed the re-entry to hospice. My daughter flew in and has managed all of the details, given so much loving care to both of us. I had to make her go home to her husband, her two year old son, and her consuming career. Now a dear friend is with me. It’s early hours, still dark. I’m so tired.
Larry’s been sleeping or half-sleeping most of the day, some hours in bed, many hours in his wheelchair. He’s drinking a lot, eating almost nothing. He seems calm, only in pain when we move him, and can respond with head nods or finger raises.
Thursday night he had a horrible breathing/gasping/gurgling episode so we were up for hours, then I was up for a few more hours, unable to sleep. Somehow, my anger at hospice started to work its way from the forefront into the background and I felt acceptance seeped into me.
In those dark hours I started to feel part of the web of life, and death. To accept him gradually, slowly leaving his body, over years, now over weeks, days, and hours. I held his hand, I meditated with him. I tried to say the Lord’s Prayer but my muddled brain couldn’t remember the order, so I sang it to him instead – the song a memory from my high school choir years.
The process we’re going through felt bigger than both of us. I felt peaceful, surrounded by the love of our “community of caring” – all the family and friends, old and new, that were supporting us in their hearts and their actions. People reaching out by text, phone, cards, or comments on this blog, people showing up at our door with food. A neighbor I don’t know all that well came over with a list of all the days and times this week she could sit with Larry if I wanted to get out.
My hand made wedding ring broke this week. Such irony. It was so tight I had to have it cut off. That felt like a horrible symbolism, seeing the tool cut my rings in half and I cried. But this wonderful local jeweler fixed it overnight and they are back on my finger, looking all shined up and beautiful.
Many people with Multiple System Atrophy die sudden deaths, their breathing just stops. I used to think that would be a blessing but now I’m not so sure. If things continue as they are, this will be a gentle death for him, and yet not sudden – we get to say “I love you,” many times over.
And of course, he many rally for awhile and we’ll go through this process again. And perhaps again. Multiple System Atrophy is such a cruel disease!!!!!
His needs have increased so much in just this week. He’s thirsty. He reaches for the cup or tries to roll his wheelchair toward where it sits on the counter. But he can’t drink alone and needs to be given sips of water. Sometimes he can sip through a straw. Sometimes he needs the cup held to his lips. He needs his position changed in his wheelchair. He needs his wound bandages changed. He’s thirsty and wants sips of orange juice. He needs medicine. He wants something but can’t tell us. He’s thirsty. He’s thirsty.
One day a symptom gets better. Another day, there’s a new symptom. Where are we on this journey? No one knows. There is no knowing. There is no control. Only his needs.
At times I feel such love and such sadness. When someone arrives that hasn’t seen him recently, I see his decline with their new eyes, and am almost stunned by it and want to cry. Other times, I’m angry at him for being so needy. Can’t I just eat my own dinner, instead of giving him sip after sip of water? I’m tired! But he keeps reaching for the cup.
So many emotions. And then there’s a moment in the day where I see the faint glimmer of a smile, the tiny mischief in his eyes as something absurd happens.