Death Comes Softly

Death Comes Softly

It had been decided. The old woman's family had gathered with the doctors and staff; her final wishes were discussed, and the decision made to discontinue her life support.

At the time of the meeting life support consisted of breathing through a large tube down through her mouth into her trachea and lungs. Oxygen at varying pressures and percentages was being pushed into them by a large, boxy machine covered with numerous dials, buttons, and gauges. Alarms beeped periodically in warning or as reminders that pressure limits were being reached and tubing possibly was kinked.

Life prolonging medications flowed by pump into her subclavian vein, placed there emergently when she arrived by ambulance, resuscitative efforts frantically in progress. Tiny, tortuous surface veins don't hold up well under high pressure fluids and CPR. Medications that sped up the heart rate, increased the heart's pumping capacity, hydrated her dry worn system, forestalled possible infectious processes.

A particular milky medication that sedated her into the land of dreams or unconsciousness...who could tell from the calmly reposed figure lying wan and frail, eyes closed, tiny on the large hi tech ICU bed? Whether dreams or complete unawareness, it was far superior to feeling sticky EKG pads on her tiny chest, the large plastic straw down her throat secured by fasteners around her neck and on her sunken cheeks with tubing branching off to hang from her mouth, the iv tubing strung along her neck and arms, the wrinkled sheets under her paper thin flesh. Peace, nirvana among the chaos of intensive care.

The woman's brother came first; tense, quiet, face drawn with grief. He leaned over, kissed her forehead, whispered his love and sorrow, and walked from the room, not to return.

The son and daughter sat by the bed, teary eyed; gently squeezing the hands that couldn't squeeze back, listening to the wheeze of the ventilator, the blips of the monitors, and the hum of IV pumps.

The doctor came in; the one who would pull the breath giving tube out and shut the machine off. A Respiratory Therapist came in behind her; a young, anxious looking woman, facing her first planned extubation to allow natural death.

Some words of comfort were offered to the family from the RN as he prepared to give additional calming medications through the IV. The liquid flowed into the vein, made it's way to the heart, relaxed the mind, in case of any consciousness needing to be calmed; and muscles in case of gag reflex at extubation.

The therapist snaked a built in tube attached to suction down the endotracheal tube to clear any secretions. The tube holder was detached. The doctor gently pulled the tube out. Life support medications delivered by IV pumps were turned off, the IV fluid for hydration stopped.

The children watched dumbly, with nervous anticipation. Everyone was quiet, waiting.

The old woman lay supine. She continued to breath without help. Mouth sagging open, eyes closed, body limp. Without apparent consciousness. Her thin chest barely rose with each labored, rasping breath. The daughter took a pink swab sitting in a cup of ice water and gently sponged her mother's dry mouth. Excess water trickled out of the corners onto her neck.

Her daughter gently wiped it up with a tissue. She ignored the tears on her own cheeks that dripped off her chin.

Monitors were turned off; the sticky EKG pads removed from the thin skin and the oxygen sensor from her wrinkled finger. Blankets pulled up and tucked around the old woman in a semblance of comfort. The son leaned against the bed while holding his mother's dry, limp hand.

Water, coffee, and tissues were made available. The family weakly nodded their thanks and returned to their grieving vigil.

The old woman's pulse was visible in her neck; bounding, pulsating in spite of the shallow raspy breaths. Son and daughter squeezed her hands; reminiscing, telling her of their love and gratitude. No response from the woman lying on the bed; could she possibly hear them in another soul dimension? They hoped so.

Hours pass in a surreal deathscape. The room is darkened. Pillows and blankets are piled in a cabinet and used for the son and daughter to sleep on the fold out chairs. They agree to take turns sleeping, not wanting to miss any sign of arousal or the moment of passing to the next world.

Nurses and techs come in, check the old woman, reposition her gently; even if dying, good care demands repositioning, moisture for the dry mouth, assessment for pain, air hunger, or restlessness. Family is asked if there are any needs. They decline any assistance.

Various friends and distant relatives peeked in briefly, unwilling to disturb the quiet atmosphere as they gave their whispered blessings, prayers, and good wishes. The hospital chaplain offered spiritual comfort.

The son and daughter smooth the old woman's hair, stroke her forehead and cheeks, smiling through their grief. They think of years she gave her life to their care; the sacrifices made, the times of incredible joy, the times of sadness, anger, misery, happiness, and contentment. They recall the shared heartbreak at the death of their father two years before with her subsequent loneliness and stubborn determination against burdening her family.

They reminisced on memories she shared of her life before marriage and children; the helping with multiple young siblings, moving in with her grandmother to escape her unending family duties after her own mother's death, her bold enlistment in the Navy in spite of her father's severe disapproval, her experiences as a young Navy medical corpsman. Less discussed was her planned escape from her abusive first husband. A life well lived and reflected on. Not always enjoyed, though she seldom talked about that.

The daughter was dozing fitfully when her brother softly tapped her shoulder, telling her he thought it was time. She immediately went over to the bed.

The old woman's breathing was extremely shallow; scarcely any air was moving in or out of her mouth. Her chest barely moved. The pulse in her neck was no longer visible.

Suddenly her eyes opened slightly; they appeared rheumy, dry, and glazed; her voice rasped, nearly inaudibly; 'I see him..'. The children bent over her, trying to hear.

'Who do you see, Mom?' the daughter whispered.

The old woman had no breath left for words. Her dry lips curved in a slight smile. Her eyes startlingly grew bright and glowing...then closed for the last time.