Final vigil for Maggie

Maggie’s sister called me around 6:30 am to tell me that she and Maggie’s brother had been called and told that Maggie does not have much longer to live. They had gone to their respective homes for the weekend on Friday afternoon to get chores done, based on assurances from the doctors that Maggie seemed stable and they would call immediately if that changed. They had made the two-hour drive back to Lexington to be with her before calling me. This is my death vigil post for Maggie. Please pray for Maggie to feel loved, forgiving and forgiven, divinely protected, divinely guided and to be blessed in every way for her highest good now and always.

Maggie got a CT scan on Thursday to see why she was having hallucinations and check on her heart and lungs. The CT ruled out physical causes for the hallucinations and the doctors did not say they are a symptom of dying in addition to being a side effect of chemo — if hallucinations like Maggie’s even ARE ever a side effect of chemo. However, the lung scan showed Maggie had pneumonia, so she was started on IV antibiotics. She also got a Dobhoff feeding tube, which is a type of naso-gastric tube. That is, it goes through the nose and esophagus to the stomach. (Other types of feeding tube require a brief surgical procedure to create a hole through the abdomen into the stomach.)

Maggie weighs 98 pounds now — which reminds me that I should have mentioned a week ago that she had developed considerable edema from being on IV fluids, which were prescribed for reasons including the fact that she had no desire to drink or eat and therefore was not doing either. When your body is shutting down as part of the dying process, it can’t process food or drink and therefore you are not hungry or thirsty. In that situation, if you are forced to eat or drink anyway, you will vomit. Also in that situation, when you vomit you are likely to choke and aspirate your vomit, simply because you are weak, have poor coordination on account of being weak and because you are lying down. Aspirating liquids or solids into your lungs leads to aspiration pneumonia. This is why your advanced directive allows you to refuse food and fluids at the end of life and why those wishes are followed in hospice care.

Anyhoo, thanks to the edema from not being able to process the IV fluids, Maggie weighed 122 pounds last weekend. The edema was squeezing her heart and lungs — did I not mention edema does that and it’s uncomfortable and frightening? — so Maggie was started on lasix, a diuretic. She lost 24 pounds in three or four days. That’s three gallons of fluid — a gallon of water weighs 8.3454 pounds.

Maggie also received a very frank lecture mid-week from a doctor regarding her final wishes about CPR and ventilation (intubation and connection to a breathing machine called a ventilator). The doctor explained that when CPR is performed properly, it breaks ribs, even in healthy people with strong bones. Maggie is frail and her rib cage would be crushed by CPR. CPR and defibrillation — which someone who’s had it told me feels like a mule kick in the chest — under ideal conditions fail completely most of the time and when they succeed frequently leaves the patient brain-damaged or in a vegetative state. The doctor also told Maggie that in her condition, if she needs ventilation, it will not give her a bridge back to life. Maggie decided against CPR and ventilation.

Maggie’s sister told me that Maggie had a visit mid-week from a group of doctors that left her and her nurse astonished and asking, “What just happened?” That’s because after days of hallucinating, as soon as Maggie saw the doctors in their white coats, she became oriented and lucid and was able to converse with them. As soon as they were out of the door, Maggie was back to her hallucinations and lethargy. So the doctors saw Maggie in a completely different state than anyone else attending her.

On Friday, before Maggie’s sister and brother left, Maggie got a session with a physical therapist to see about getting her strong enough to walk. Maggie is very emaciated and has no muscle tone. (The emaciation of her buttocks led to a pressure sore there.) However, after tearing out her IVs and chemo port on Wednesday — because she was determined to get up and go — I think it was an occupational therapist who came up with a solution for Maggie’s restlessness and gesturing at tasks visible only to her: a large apron with lots of buttons, zippers and different textures. Maggie found it very satisfying. (I guessing an OT came up with this because hands are their domain.)

Last night dear Mark Koenig asked me how I know that some people’s end of life experience can be angry and frightening. The answer is that that is how my mother passed, although I was able to lift a great deal of her anger, fear and pain while surrounding her with friends and family members who loved her and got to say so when she could appreciate it. So in the end her passing was peaceful. Margaret’s passing was peaceful all the way through, probably due to both of our personalities.

At the very end, I tell my dying loved ones that they are having the experience of dying, so they know what is happening. I tell them that their guardian angels and angels of love and healing are with them and will take them to heaven when it is their time, so that they feel there’s a proper procedure for their passing that is being followed so they can feel safe about it.

I told Maggie’s sister to tell Maggie that she is dying, and that we love her, the kitties love her and her guardian angels and the Angel of Love and Jesus are with her and will take her to heaven when she is ready to go. Maggie’s sister said she would tell her.

Maggie, I send you my love and gratitude for all the good things you have done for me, Margaret and my family. I forgive everything that needs to be forgiven and I pray you forgive me for everything that needs to be forgiven. You have had a life to be proud of. Your guardian angels, the Angel of Love and Jesus are with you to take you to heaven when you are ready to go. You are safe and loved. May God bless your soul in every way forever and ever. Amen.