One of the reasons that I have stayed in the same job for twenty nine years is that it affords me the luxury of being personally and professionally involved in the healthcare of my family, and that has included the deaths of more than a few. Prior to my employment in 1979 I had never been really aware of what was going on during the last days, but I learned pretty quickly.

The first was my paternal grandmother who had cancer. In one of those freak timing things, Daddy didn't make it there before she died, so it was me and his sisters and the surgeon around her bed when she gave it up. It was a peaceful event for the most part. She was tired of fighting it and ready to rest. It wasn't until I started therapy in my early thirties that I realized that I had never really grieved that experience fully. I had stuffed all the sadness and fear back down so I could go back to where I had to work to pay the bills. A young uncle came after that, an addict who was a fairly intelligent Mama's boy and helped her run through the family fortune. His liver went quickly and so did he. I was there with my grandmother...my mother and her sister were awhile away. A paternal uncle with emphysema was admitted to ICCU on a ventilator against his wishes. He pulled that sucker out and died on his own terms, with my Daddy by his side. Luckily, the doc on call had some compassion and didn't put the tube back in. Both of these were ghosts that I dealt with during therapy.

My favorite uncle Jimbo had prostate cancer at the young age of 54. Even though he already had bone mets, the cancer responded well to treatment and he had four good years with a normal PSA before it turned aggressive. The last six months he was dependent on blood and platelet transfusions as tumors filled his bone marrow. The frequent blood counts between transfusions became too much for him so I would go to the house and draw his blood. He spent three days in the hospital at the end, still getting blood and fighting with all of his might to either stay alive or give it up. Dying is hard work, physically. In his hallucinations he would work his hands busily with his eyes shut "making platelets." Hospice was consulted at my request when he was admitted, which was way too late...and typical.

Gaga was my maternal grandmother and all I can is that I was "the shit" in her eyes. As the first grandchild on that side of the family, the whole show was mine for a year or so. Her husband died when I was just 3 and he was only 45, of heart disease. Today a stent or two would take care of what killed him back in '58. I never remember Gaga having a boyfriend, even though she was still young. She did fun things like bridge club and garden club and spoiling all of us grandkids rotten to the core. We adored her. COPD almost got her several times, but she soldiered on and quit smoking. Some time after she moved to assisted living, she got colon cancer and had a re-section. Did well..went to the nursing home for post-op rehab. About a week later, she started getting sick and was sent to the hospital for admission with peritonitis. Her large belly didn't tolerate the incision very well and had pulled it loose. A colostomy was next, with her belly left open for the peritonitis to drain. Her surgeon's partner was covering while he was on vacation. The narcotics that eased the pain of the peritonitis depressed her breathing to the point that the order was given to put her back on a venilator. My mother and aunt, decided against that and the anesthesiologist on call was very supportive and understanding. It would still take a few days. For some ungodly reason the surgeon on call decided to adminster Narcan in the hope that HE wouldn't have to take the mortality hit by the numbers crunchers. This little old LPN student came and got me and said "If it was MY grandma, I'd want to know!" I found her writhing and screaming in pain because the drugs were completely neutralized by the Narcan. *this is where Poopie goes apeshit wild nuts on everybody and their brothers* Long story short, a pulmonologist put her on a non-invasive thing and gave her back the morphine. She died the day her surgeon got back from vacation and he came to the ICU to be with us. Later that morning at church, he told me that he "felt like I thought he had killed my grandmother." That struck me as odd, since we worked together and I thought he knew that I respected him. I was sad, yes. But I had been through it enough to know that stuff happens. Doctors aren't gods ( even though they try to act like 'em sometimes ) and often, patients die. Guess you can figure out who was the good guy(s) in this little scenario. That one took me a looooooooooong time to forgive.

My aunt, with a strong family history of colon cancer, never scoped, was diagnosed a few years after that. She was on coumadin at home the last six months, so I was back to vampire making housecalls. I took just one shift during her last few days and my eyes were opened to what all is involved in caring for those who choose to die at home. That is also hard work, especially for the family members.

All of this happened within a brilliant timeframe, perfectly orchestrated by Big Ernie where I would be able to recover and learn from one experience before the next one came around. If I had not talked about it and sought help, I'd have never made it. That is where my initial interest in hospice and palliative care began...with my own family and friends. Babygirl wrote her senior term paper on the subject and we bonded like a mug during that time. I think that was beginning of her desire to become an LCSW. Sharing the family history has always been up front and center with us.

A week away from reality has prepared me to make a decision about what I need to do with this segment of my life. I'm not sure exactly how it will happen...or when. But it will.

Y'all have a good weekend.

^j^