I purchased a weight scale, last night...
...for my mother at the urging of Hospice, to track her weight through this period. It is typical for cancer patients who are dying of the disease to lose weight as the disease develops. So far, my mother probably hasn't been losing weight. The Hospice RN, for the last three weeks has been measuring her bicep to determine if there has been any weight loss, since we didn't have a weight scale. Between the first and third measurements, she appeared to have gained a little weight, according the measurements. This doesn't surprise me. In order to keep her blood sugar from dropping below normal without eliminating one or all of the two 10 mg glipizide tablets she takes for blood glucose control (and which are still necessary; her diabetes is still operating, even though it's becoming easier to control) I've been adding desserts to her evening meal. In the way of experimentation, an experiment which surely pleased my mother, for three days during our Stat Vacation I even added her favorite sweet rolls to her breakfast while eliminating her morning OJ, substituting her preferred watered down instant decaf coffee. Although I didn't take stats until the evening of the day after the last sweet roll was eaten, then resumed full stating in the morning following No More Sweet Rolls Day, from those two stats I could tell her blood glucose was having a good time. Not a great time...I doubt that she rarely, if ever, went well over 200. But, it had a good enough time.
    The problem with expected weight loss is that my mother rarely loses her appetite when very ill. She continues to eat heartily; she just vomits in the middle of the night or a few hours after eating a meal, whichever comes first. Since 2004 we've had a PRN prescription of metaclopramide to deal with this problem when it occurs and it works beautifully. I'm also sensitive enough, now, to the conditions which may initiate vomiting so that I can often accurately prefigure that this might happen and get the metaclopramide going before the first time she vomits. So, as long as the metaclopramide works (and, it may stop working when she becomes very ill), she probably will not lose weight.
    It's funny...in a conversation with someone last night in which the discussion up for grabs was my mother's suitability for hospice, I mentioned that I take such excellent care of my mother that "she will thrive on her death bed". This doesn't mean she won't die, or even, necessarily, that she'll die later than predicted. What it means is that her quality of life will be very high right to the end and death will, truly, have to dance her out of this life in order to tempt her into The Great Beyond. This is good. This is how her life has been, in her mind. This is how her death should be, if it is at all possible, and my intention is to work toward this goal. It's not a matter of keeping her alive...it's a matter of seeing to it that the death that suits her has a chance to happen. Although Final Gifts makes it clear that my mother's death preference doesn't often happen (as far as I can recall, "a good death", in that book, always meant a decline in quality of life toward the end, taken as the signal that death is near), it also asserts the power of the individual to design one's own death. I suspect that when the caregiver and the dying one are working in concert to accomplish this, even more power is available for individual death design. At any rate, we're certainly in the pipeline to learn whether this is true.
    Here's a salute to death in life...a salute to death as life. Perhaps it's possible that if we befriend death as we have befriend life, death befriends us, as well.
    One sad note: A few months before my mother was diagnosed with lung cancer, the sister of a very dear local friend of mine (who is probably about 15 years older than me, thus, her sister, although younger than my mother, was probably much older than me, somewhere between my age and my mother's age) was also diagnosed with lung cancer. The cancer had fully metastasized before it was discovered. Nonetheless, the sister decided on a full course of chemotherapy and radiation in an attempt to stay the cancer. Over the last few months, in some conversations with my friend, she said she wished that her sister had decided against treatment, as she was clearly the worse off for it. She was in no pain and no discomfort prior to therapy. She experienced much pain and much discomfort afterward. My friend often expressed her feeling that a "no treat" course was definitely best for my mother. I just learned this morning that her sister died recently. Although her death saddens me, I'm philosophical about that part. I'm not so philosophical about contemplating what her experience of the rest of her life might have been like had she not opted for aggressive cancer treatment. I, too, am grateful that we chose a "no treat" course for my mother. All things considered, it is the right course. Unless I'm completely missing my mark on this, I think this choice, too, will allow her death to be the "right" death.
    I'd better figure out how this weight scale works before it's time to awaken my mother - early, today, for her.
    Later.
- posted by Gail Rae @ 09:51   email  this post