Wednesday, April 3, 2013

Wednesdays with Dorothy: Crossing the Threshold

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Dorothy having coffee and dessert
one Thanksgiving Day 
Dorothy had often surprised me over the years.  When my daughter was born and Dorothy got to see her, she made the comment, “I want to see Elaine when she gets her driver’s license.” I thought to myself that I was not at all sure that Dorothy would live that long, but sure enough, Elaine turned 16 and got her driver’s license while Dorothy was busy planning her 76th birthday party. On her birthday, when we went to pick Dorothy up, I asked Elaine to drive. We proudly announced to Dorothy that the day had arrived, Elaine had her driver’s license and Dorothy was there to witness it.

When Dorothy was in CCU, I didn’t think she would survive once the IVs were stopped, but she did. Once she was moved to the Palliative Care Unit, her condition remained stable enough over the next few days that the medical team ordered physical therapy to her build her strength and began taking about longer term care options such as nursing home care.  We all continued to take turns visiting with Dorothy.  She even talked to me about wanting to make another trip down to Sylagauga, her hometown.

A Gentle Downward Slope

It was on April 10, six days after her being transferred to the Palliative Care Unit, that Dorothy suffered a stroke.  Her right side was affected and her speech was slurred. Her speech and movement improved a little over the next couple of days, but she spent more and more of her time sleeping.  Sometimes when I came by to visit, she would be asleep the whole time. I noticed her breathing was a bit more labored. My professional nursing instinct prompted me to check her pulse and count her breaths: heart rate - 100 beats per minute, respirations - 30 per minute. A normal heart rate is 60 to 100 beats per minute and a normal respiration rate is 12 to 18 breaths per minute.

In spite of her stroke and he declining health, Dorothy remained mentally as lucid as ever. She recognized everyone who came by to visit, and she would smile and make some conversation.  Her stroke had been on Tuesday, and by the weekend she was sleeping much more. When awake, she could still take food and communicate, but those waking times were less frequent. Watching her sleep, I took note of her more labored breathing. Again, I checked her pulse and counted her breaths – she continued to maintain with a heart rate of 100 and 30 breaths a minute. When I left her room on Sunday night of the 15th of April, she had remained asleep the whole time. I was noticing more congestion with audible rattles in her breathing.

One More Cup of Coffee Before I Go

The next day I had to be at work at 6:30 in the morning. As had been my habit of the past couple of weeks, I left home a little earlier so I could swing by Dorothy’s room before going to my own floor to work. As I walked down the hallway on this particular morning, remembering how she had been the night before, I prepared myself for finding an empty room with news that she was gone.

When I arrived on the Palliative Care Unit, I saw Dorothy’s name still on the board at the Nurses’ Station. I asked the nurse on duty how Dorothy was doing. The nurse then became very wide-eyed and said, “We could not believe it this morning! She slept all night making no response at all – no signs of consciousness. We expected her to die at anytime. Then this morning as we were getting ready for shift-change, her light came on at the Nurses’ Station.  We looked at each other wondering, why is that light on in her room? Then Dorothy’s voice came over the intercom: ‘Could I have some coffee, please?’” We were all amazed that she woke up asking for coffee. but I said, “That's Dorothy!

The Final Hours

When I left work at the end of the day, I stopped by Dorothy’s room again on my way home. I stayed there until about 8:30 p.m. Dorothy’s friend Lona was there with her, but Dorothy was sleeping – heart rate of 100, breaths at 30 per minute (I had to check).  After I left that night, Dorothy’s friend Ros came by to see her. Ros was on her way back to Canada and had an early flight out the next morning. She told me later in an email how her visit went (you may note a bit of her Australian accent in her turn of phrase):

I had tried to visit on Monday morning but couldn't find a car park, drove off to do a lot of last minute errands and decided to see her that evening.  The day continued to be a little hectic so it was about 8:30 - 9:00 pm by the time I visited.  We had a lovely visit I think, she wasn't really responding, I sat and held her hand and rubbed it gently and sang some songs I think she liked (or tried!)... “All Things Bright and Beautiful,”  “Jesus Loves Me,”  “Amazing Grace,” etc., so I like now to think she was hearing that and was very much at peace those last couple of hours.   I was thinking I would have liked to stay with her until midnight...
In was in fact, very soon after Ros’s visit that Dorothy slipped from this life. We got the call around midnight from Lona who had been with her at the hospital. Dorothy had died at 11:35 p.m. It was a special providential grace, indeed, that Ros happened to have been in town at the exact time she needed to be to visit with Dorothy. I thought how fitting that Dorothy had been with friends throughout the process of dying, and that one of her very dearest friends, Ros, had been there in those final hours to assist her across the threshold between this world and the next.

Dorothy at one of her birthday parties
wearing her tiara
(Probably around 75 years of age)

(Next week I’ll talk about my last Wednesday with Dorothy.)

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