Hospice is ....

You know, no one really wants to talk about going into Hospice. It almost seems like a dirty word. When I mention my husband is in Hospice I get that look. 

The look in someone's eyes that conveys sadness and curiosity at the same time. People who know me well don't do that, but a casual friend in the store may ask about hubby and when I tell them...I feel the temperature change in the air between us. And the look.

And then they don't know what to say. They do say the social polite thing.

"I'm so sorry." 

Then I freak them out even more and reply. "It's okay. He is happier now than he has been in 10 years."

Their eyes say --You must be smoking weed or something! 

Maybe I am supposed to be sobbing and tearful each time I talk to someone about it. But that would freak them out more. 

The truth is. We as a society do not talk about end of life. It is a tabu subject. There is an end for all of us and I understand that. It does not in any way make it any easier to loose someone.

If I mention this to someone who has experienced going through the end of life with Home Hospice most of the experiences are recalled as bittersweet but not horrible. Home Hospice is different than say Hospital or Nursing Home Hospice. 

It is face to face. One on one.

It can be frustrating. It can be funny. It can have moments of joy and deep sorrow. Worry, anger, sadness, and even wanting to quit are all things that run through the Caregivers mind. 

I've even thought 'Just get on with it already' when I've had a few days of little sleep and too much to do. Then the guilt with a capitol G hits me. Jeeze, did I just think that? How awful am I?

At first I was slightly annoyed by all the visits per week from Hospice. Now I look forward to them as they break up our monotony of daily Caregiving. They understand where the both of us are at mentally and physically. The social worker doesn't just care how Rich is doing. The social worker and the Chaplain are concerned with how WE are doing.

Sometimes it is just friendly visit and we chat about the things that are important to us. Other times the questions are more pertinent but not uncomfortable.

The nurses and workers come to our home. I am not trying to cart a wheelchair and endless supplies of oxygen to doctor visits an hour away. I can have his meds delivered by courier or pick them up at the local pharmacy [which I do].

In fact the pharmacy folks know me be now and greet me like a good friend. No sorrow in their eyes. Lots of smiles when they check me out.

Thursday afternoon hubby felt awful, I could hear his wheezing from another room. He had me call the Hospice Hot Line. I tried his regular nurse, but his phone was off [he was not on duty]. I was transferred to nurse Ashely who decided to come from her current patient an hour away...to evaluate Rich.

She came and evaluated him and spoke with the attending doctor. Med changes were given for a possible bronchial infection. Or the other reason he was feeling so poorly was that it was a progression of his COPD [worsening]. So we adjusted.

The next morning I got a text from Jason, his regular nurse that wanted to know how Rich was doing. He apologized for not having his work phone on. Rich was doing a bit better. Then Jason gave me his personal phone number. I said I never wanted to bother him on his day off.

His text back was pretty amazing. "Val, we've been friends for years, I want you to call me/text me anytime you need me."

Did I say that I've been friends with Jason and his wife for 7 years? As luck would have it, we were assigned a person we knew as a Hospice nurse.

So what is my insight right now?

Rich is living with a life ending disease and as he deteriorates slowly, he is enjoying his life by not rushing from one doctor appointment to another. He is getting people visiting him. Mostly it is the Hospice Staff, but they have become so important to him.

His good buddy Steve calls or visits often. Our granddaughter Ariel has come 3 times this year to see her Grandpa. 

A good gym friend of mine came out yesterday just to visit and drop off some potatoes so I didn't have to run to a store and get them for the supper I'd planned.

We sat on the porch and she told me about her granddaughter and how her own daughter was a 24/7 caregiver and how she has been for 17 years for Spinal Muscular Atrophy. It puts a different perspective on what I am doing. 

Her daughter and granddaughter have to be incredible people. Just saying.

We've been involved with Hospice now since the beginning of March. It was an adjustment for us. But I have to say that the years with Palliative Care [not Hospice but a great medical program] and now time with Hospice have given us a better journey through a life ending disease. I only wish we'd have known about this for my Father in Law and my Mother in Law.

I'm glad we didn't wait too long to get in the program. It has made a world of difference to my husband and I. We feel more connected with what is going on with his health and our own well being. 

[Except for those days -- which are many -- that I feel overwhelmed]

Today. I baked a cake for him. The smile was priceless.

Charlie. The dog knows.

There is more than one reason to have a dog.

Charlie.
He has been acting a little different lately. He chooses not to go outside with me to do chores in the morning. He insists on staying in the house near hubby. He insists on getting up into the hospital bed with him during hubby's naps.

Does he like that situation much better than going out and smelling things? Or does he know that his master is not well.

When Charlie was under a year old, my MIL entered a nursing home. Charlie was allowed to go see her on a regular basis. He'd sit on her bed quietly while she petted him. In the hallway as we'd walk in or out residences would ask to pet him. Since he is only 7 inches tall, I'd lift him up so people could pet him.

Charlie would wag his tail furiously and make little soft noises. Sometimes a resident would give Charlie a ride in their wheelchair. Charlie would sit quietly and proudly as if he was a tiny king.

Charlie's nursing home visits stopped with Covid. I asked about going once more and since my MIL was no longer a resident [she died during Covid], they wanted Charlie to be a licensed Canine Good Citizen.

Poor Charlie. Sit, stay, down, are not in his vocabulary. 

Waggy Tails, Grunting with Pleasure, Wiggling, and being absolutely Cute are his strong points. Being silent and snuggling up to people are another.

Charlie now greets the hospice people with Wiggling and Happy Grunting [his Pekinese mom grunts with pleasure].

He will sit on his chair and take in all the conversation between Hospice and hubby.

When hubby gets his sponge bath, Charlie has to sit on the bed and oversee the process. He lays on the end of the bed and watches. Still as a statue.

Lately he is spending more time watching hubby. His every move is followed. Normally Charlie will take his place on the couch or his chair in the eating area and snooze while keeping a sleepy eye on the activity in the house.

Now he follows the wheelchair everywhere. 

I'd say that he is an exceptional Emotional Support Dog. Does he know what he is doing? Probably not. 

I looked up Emotional Support Dog and was surprised at how easy it is to get an animal certified without any special training.   Hmmmm.

That aside. Charlie knows.
He knows that one of his people needs his warm little body next to his and that somehow it makes that person feel better.

Seven years ago I brought home this funky little puppy and my husband said, "Well, what is he good for?" I handed the pup to my husband and he snuggled right in and made himself at home.

Indeed, what is he good for?

Charlie, you do not need a letter or a certification. We now know your purpose. 

And it is appreciated.

I figured it out...

 It isn't so much as being cranky and tired, although that will contribute to my current feelings.

I keep a paper journal. You know, one of those spiral notebooks with paper in it. The kind you have to actually pick up a pen and write with.

I use it to write down meandering thoughts and mostly the stuff I won't post anywhere on the internet. I can say what I really want to say about certain things without the danger of anyone being offended.

I can approach politics, religion, medical care, and people without any blow back. Well, I suppose if the journal is looked at after I am dead, somebody somewhere may be offended.

I finally realized the Why as to How I was Feeling.

I have run out of empathy and sympathy.

One friend who visited did nothing but talk about his 'situation' and his hardships and his struggles when he came to visit. In the past I offered empathy and listened intently.

My Respite girl who keeps showing up late has offered up her tales of woe without me asking for them. Normally I am the type of person that will listen and figure out if there is a way I can help or perhaps show verbal support. [Her tales of woe include 'excuses' for how and why she ends up being over an hour late]. 

[My thought on inconsistency is this. If I cannot depend on her to be timely, can I entrust her to care for my husband while I am not home? 

Hubby's thought is this. He is a Vietnam Veteran who fought in ground battles in country. IF a person did not have your back and did not act with responsibility, you could die. Pretty simple and direct views in my opinion.]

Here I had two people who came to 'give' me Respite and comfort [Shay's job is this] ... didn't. Instead they focused on their issues and problems and dumped them on me.

So while rambling and writing...this light bulb came on and suddenly I felt much better. I understood where my darkness was coming from and why it was bothering me. 

Here were two people over a period of days expressing all their challenges. They forgot that they were expressing their challenges, issues, problems, to someone who is caring 24/7 for a person who is dying.

They seem to forget that I am having daily emotional mountains to climb. Every day, I watch my soul mate disappear little by little. I am putting everything in my life on hold for his care. I am giving up the things I love to do and things that give me strength and emotional release for him.

My inner self has built a wall that never shows really how I feel on the outer self. 

[It's complicated--> that is how I grew up--> some day I may explain that ... just say, that is how I survived an abusive childhood with mom.]

I'm done feeling empathy and giving support right at this moment for those who need and crave it at every turn. 

Shay did show up on Tuesday and offered up some incredible 'reasons' for being late. She claims they are not excuses and said sorry sorry sorry about 100 times. 

I was chilled to the bones, I just raised one eyebrow as she dug herself deeper into a hole with me. Could she not read my face? Was she so wrapped up in her issues that she could not see how stiff I became? Did she not feel the cold air wafting off me?

She begged to let her come on the 4th where she could make Holiday pay and I reminded her that my Granddaughter would be here and that it would be family time. She asked to come another day [to make up for her loss of pay]. I stated that I'd see her Tuesday the 8th at 9:30 sharp. 

I'm giving her Tuesday because I have a car appointment that I need to get to. After she is done with her shift ...if she shows, I am calling her company and the VA to let them know that she is not living up to expectations. 

This issue changes the dynamics of trust which is a very big issue for hubby and I.

July 1st and Exhausted

 I won't lie.

Caregiving is exhausting. It can be Caregiving as a mom to kids, a mom to a disabled child, a young child caring for a parent, or a spouse caring for a spouse or elderly parent or relative.

I watch the latest PBS program on Caregiving which is a 2 hour program. Our Chaplain suggested I watch it as she felt it was interesting. It tells the stories of a few families along with the history of Caregiving and how hard it has been fought for by advocates over the years.

Francis Perkins served in the cabinet of FDR as Secretary of Labor. She was a powerful voice for not just Caregiving but the Implementation of Labor Laws to protect children, and so much more. If you are interested you can look her up.

So, right now I am exhausted. I my insomnia this past week was well used in visiting the night skies and watching the Fireflies mating dances. It eventually catches up and Sunday night I went to bed at 8pm and did not wake up until 5am.

It isn't just sleep deprivation, it feels like my soul is being dragged through a fog. When I am tired like this, everything is ugly. I am ugly. I am short tempered and have to bite my tongue.

What has not helped at all is that the Respite person has become unpredictable. I had a car appointment. As I am waiting for her with keys in hand to leave.

Text: Sorry hon, is your appointment today? I'm running late.

Me: Yes.

Now if anyone knows me, they know my work ethic is extreme. I always showed up before my shifts, was never late, and never had excuses.

Text: I forgot my medicine I have to take twice a day and had to go back for it.

Me: Hmmm.

I was not amused at being referred to as hon. 

Other reasons for being late. Overslept. Traffic. [on rural roads? plan for it!] Can't find childcare. 

I give her the benefit of doubt but it seems more and more that poor planning is the issue. None of the 'excuses' are valid. Not if she would plan ahead.

I'm going to combine that with the stress from the long weekend stay of my friend. I like him, I enjoy his company. I don't mind his pets. But more than one overnight stay is my new limit. And I am not available to waltz around in the woods and watch out for him.

I am going to set boundaries. I need to. Granted he helped weed my gardens, however I told him not to drop the weeds in the grass I just mowed.

See? When you lose sleep and are burned out, every, little, thing, matters.
Muddy dog prints on the floor. Talking when I need silence. Oatmeal on the table. Spilled coffee. 

None of those things normally bother me. 

However I seem to have become a nit picking freak. I tolerate the messes I continue to clean up [endlessly] from my husband as he loses control over some functions. I remind myself he cannot help it.

Then someone comes and adds to the 'burden'. In reality, they aren't really. But in my mind, it is so.

Jason finally got the idea I didn't want him in my way. He left. Rich will miss his company, but right now I won't. I want silence. 

Rich went to nap, and I decided to put off everything else after scrubbing the house and the rugs...

to dive into a place of divine pleasure. Getting lost in some creative endeavors.

 

After all, what really waited for me outside was storm damage that I needed to attend to.

When Respite shows up today, I use my 4 hours to run errands and then come back and start working on the fencing damage. See, the work doesn't stop just because one is tired or angry, or frustrated...

It still is in your face when you step out the door.

I am looking forward to NOT doing anything Hospice or visit related until Ariel comes to visit on the 3rd.

I may pull out chunks of bark and branches and create a fantasy world [all while tending to my husband's needs].

A final note.
With Caregiving like mine, it can be horrible and beautiful at the same time. It is tiring, it is hard, it is worth it.

We are lucky to have support where other folks don't. So I have to count my blessings as well as my gripes. 

But the mood of the Caregiver goes up and down with stress, anxiety, and fatigue. I am human, so I will have human moods good or bad.

And then this...just minutes ago.

Text: Hey hon, I'm sorry but I overslept, these new meds make me sleepy are you okay with me coming at 10:30 and staying until 2:30?

My response...slammed the phone down on the table.
I should have said no but I didn't. 

Me: I'm not pleased at all. I had to cancel the appointment I had for 10:30 and make it for next week for my car.

I told her to come. I have to get sweet feed, fly spray, wormer, groceries, and medications, along with other errands. 

How else am I going to get these things taken care of? 

I will be reporting this to her bosses and to the VA who contracts her company.

I am done with people who do not have a work ethic.

The conundrum? Rural health aides? Few and far in between and very unreliable. Those folks should be paid good salaries and be strongly vetted.

My last thought. If she can't be trusted to show up on time.
Can she be trusted to be a caregiver for 4 hours with my precious husband?

Not to be a downer...

 

Finally last night the dam broke in my heart and I had a long long quiet pity party for me. I realized that the house was going to be so empty when he is gone. The concentrator which has been a part of our lives for the past 10 years will be gone and quiet....
I won't get the tapping of the coffee cup in the morning and the question...

"Coffee made yet?" It used to irritate me so much as he'd say that before he'd say Good Morning. 
or "Hey what's for supper? Did you make it yet?" each afternoon. He knew how much that would get me going.

I'd laugh and threaten to hire a real cook. Our tiny house will feel empty after 30 years of the two of us knocking about inside of it.

Then I started thinking of all the paperwork I'd need to do. I mean, why not? These are things one thinks of at 1AM. 

I did decide to start a memory book though. I've taken years of photos of him. Mentally, I started to organize them in my head. To provide a distraction, I put on my headphones and turned on some 'Chill Out Music' to relax me.
So when this song came on unexpectedly .... 

Yeah so I totally lost it...but silently ... with salty tears dripping down my cheeks. 

The first few lines just slayed me...I've heard this song before and I know how it effected me then....

I know it hurts
Its hard to breathe sometimes
These nights are long
You've lost the will to fight...

And we all know how You tube works, they find this song in a play list and the playlist just kept on beating me up with songs of love and loss. But I needed it so I felt it in my heart.

As I listened and let my heart open to the emotions, I mentally started to list what I'd need to put a book together. I started smiling through those tears in the dark. Our memories, how we met, what we did...our crazy chance meeting. The instant knowledge that I'd met my once in a lifetime soulmate.

Handsome, funny, truthful, very OCD, PTSD'd veteran, all male, all full of himself, kind, honest, trustworthy, intense, fierce, difficult, loving man. 

In truth, he was a difficult father and husband in the first years he came back from Vietnam. Demons chased him constantly.  He didn't understand what was happening to him as so many veterans suffered the same unimaginable issues.

Perhaps he wasn't the best dad in the world but he sure tried hard when the grands came along.

There was nothing he wouldn't do for all of his grandkids. He still feels that way.

So now I am concentrating on a project. A photo book. Something that I can look at and remember.

It gives me a sense of direction and distraction right now as I watch his body deteriorate. This too is a process of living. I won't ignore it, I don't want him surrounded by strangers.

He is comfortable even though his body is showing signs of organ failures. He is home with his silly dog and his nutcase wife. His edema is beginning to rage all over his body but he is concentrating on the things he loves and holds dearly. He is not afraid, he is not in much pain. And he still taps his coffee cup for me and grins like the devilish fun guy he has always been.

And that is good enough for me.

Audacity

 I rarely get really irritated. 

But when questioned as to the 'why' I need Respite Care ... 

I'm sure the question was meant to be innocent but what I wanted to spew back out could have been rather nasty. I bit my tongue and just pulled my phone away for a moment...

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~`

Do you need rest from someone calling out your name at all times of the night for one reason or another.

Oh sure. Those of us who have been parents understand this. A baby cries in the middle of the night and you are up to see what you can do to stop the crying. It may be a messy diaper, hunger, tummy ache, or something else. 

I was a young mom and could handle that rather easily. I mean come on, when you are in your 20's as I was, a sleepless night was nothing. I simply handled things and went on about my day. After all, that beautiful crying baby was so amazing and I was so full of love and adoration.

Fast forward 45+ years. Sleep. Oh for wonderful uninterrupted sleep. That sleep that evades us as we get older.

Things happen in the middle of the night. Things like the commode being missed, or a wardrobe failure. Or even the malfunction of the oxygen concentrator so the large 02 tanks had to be brought out. Then hubby was afraid to go back to sleep for fear that the 02 tank would run out. 

Can I have a glass of water?
Can you make me a snack?
Can you help me [pick something, anything. Pull up pants, put on shoes, button a shirt, become a short order cook, change the concentrator hoses, help with the wheelchair, socks, shoes, ~~ well, the list goes on with about anything one can think of.]

That is not to say that I can stop mowing the yard, cleaning, doing laundry, chores, and all of the other little things that have to be done on our small place. That includes juggling a schedule of the weekly bath, and other visits from the Hospice Team.

However with 4 hrs of Respite [twice a week], I can leave a load of laundry to be washed and dried, the dishes are done from lunch and often there are fresh homemade cookies on a plate or in a zip lock bag when I return. Sometimes, if I remember to put something else out, there can be a cake made also!

Last week Shay made a cold Italian salad that I'd laid out to make when I got home. Goodness. My supper was made!

She'd also swept up Charlie hair and cleaned the bathroom and organized my messy cabinet drawers.

On Sunday evening my neighbor Justin came down as promised and mowed down two large thistle patches that he'd promised to help out with. Last year it took me 3 or 4 days to chop it down with our scythe. He finished that job in an hour and said he'd be happy to do it again. Of course he was having a man and machine moment. Guys love their gadgets and he has a brush mower that he pulls behind his ATV.

Thistle patch Sunday morning before I asked Justin to mow it...I was using the scythe once more and decided I just didn't have the time...

I related this to a certain person. Apparently she felt that I didn't really 'need' Respite or all of those nice things that were 'given' to me. Why did I need that? After all, .... YOU are retired! What else do you have to do with your time??? Make HIM do more! He is just faking some of it. 

This person has never been with my hubby when he is getting dressed. Nor has she been with him for a 24 hour period. She has not seen the daily struggles.

For example, getting dressed seems like such an easy thing to do. Except when it isn't. Baby steps to get dressed. Simple things become mountains.
Yes, this is part of a life ending disease and that is what Hospice is for along with Respite care to give the Caregiver a break.
AND...I love my breaks.

So when someone doesn't understand why I need them...

Well, perhaps they might if they were to walk in my shoes for a couple of days.

Anyway this was my rant and my rave. 

I pushed the end call button and stared out the window.

Audacity: rude or disrespect behavior.

Ignorant: lacking knowledge or awareness in general.

I think I'll go with Ignorant. It fits better.

The hardest thing I did was to ask for help. 

The person not understanding my need for Respite? His daughter.

I'm changing the Ignorant...to

Willful Ignorance:
the act of intentionally ignoring or avoiding
information that could be inconvenient
~~ a conscious choice to remain
uninformed especially when
--my words--
when the information could be 
uncomfortable

[as much as this sounds like complaining, I want to state, that this is very valuable time between my husband and I. At the moment his condition is deteriorating and his edema is beginning to become a huge concern. I do get tired of the endless responsibilities. I don't hate our time together. I cherish it. Sometimes I get very cranky from lack of sleep and frustration of always being the adult. 
Yet I still strive to make his time left with me as comfortable as possible.
He is my soulmate after all.]

Paradox of Hospice

So our  plan is one of no pain and a lot of comfort and time spent together. 

I'm a pragmatic person. When Doris [another Hospice nurse] visited this past week she had some incredible advice and pointers. She has been a Hospice nurse for 30+ years. She is full of cheer which seems odd in her profession. 

Her advice. 
Visitors should be one at a time and only those who actually matter to you. If someone you don't really care for wants to visit...don't be polite, just say no.
If you have things you wish to do, do it if you are able. 

Watch the birds, enjoy your mules. Sit on the porch and drink coffee.

We are going to attempt--- with some help, a last fishing trip for hubby. One of Rich's lifelong friends is going to help us. He will provide the equipment, the car ride and the poles. He will even bait the hook for hubby.

We are getting a hospital bed for hubby on Tuesday. He will be able to elevate his legs to reduce the edema he is suffering from. Since he is unable to walk much fluids do build up in his legs. 
I've become and expert at putting his compression socks on.

One of the most important things we did this week was go to the cemetery where his folks and other family members are buried. It was quite the production just to get him in the Subaru for the ride, but we did it...one slow step at a time.

He wasn't able to get out at the cemetery to visit his parents' grave, but I was able to pull up close to the fence so he could watch me take care of the flowers.

He got confused as he said "No one has a flag for me out there."

I pointed out that he was still alive and he shrugged and said, "Oh yeah, I guess I am."

I put out the flowers and as is tradition, put a pouch of Grizzly Wintergreen Tobacco in the ground in his father's spot. 

Me: Do you miss your dad?
Him: Yes. A lot, every day. He was my best friend. OH no! I forgot to bring him chew!"
Me: I brought some and took care of it.
Him [he teared up]: Thanks sweetie. I just miss him so much.

We sat for a while and I pulled the car up where he could see his Great grandparents and Grandparents stones. He was pretty quiet. 
The cemetery is located on a road called Old Buzzard Lane. To get to the cemetery one has to drive through a dairy farm with cattle and round bales on both sides of the road. We waved to the farmer.

Rich had me drive the backroads to the cemetery and then gave me directions [I pretend I don't know the way so he can guide me] to drive another way home. He pointed out the different farms members of his family had on the way. 

So what is the Paradox? Before Rich entered Hospice we rarely had any visitors. Once the 'word' got around we started getting calls for visits. 

We pick and choose and set the rules. Only those who are very important visit. The looky-loos are turned away. 

Good neighbors text and drop by for a wee bit. The visits are nice. We set most visits at about an hour. But Rich enjoys them so much.

His Home Aide brings so much joy when she comes. His face lights up when she arrives. 

This week his regular nurse drove his classic muscle car on his rounds. It was a 1970's Chevy Nova SS which sparkled and growled.  Rich was beside himself. He offered to trade off our car for the Nova. 

So does this Paradox work? Rich is happier now that he is in Hospice than he has been in 10 years. He smiles more, chats more [still has aphasia which makes conversations more fun] and seems to have more light in his eyes when people come.

Hospice is often mistaken for a horrible time of life for many and eventually it is as the patient is expected to expire. 

However, being pain-free and comfortable and ... the extra care from the Social worker, Chaplain, Nurses, and Home Aides has improved his quality of life for the time he is still here.

No, it isn't a cake walk with love bubbles floating about in the air, but we are making our time together count as we have throughout our marriage and time together.

Oddly enough, his daughter has visited once in April. She called once this month to talk to him. I don't quite know how to take it. Rich just says that she is "Too Busy". I guess I'll take that as an answer.