As cruisers we choose to live our lives a different way, many times that choice puts us in areas that are far away from family. Emergency trips home will happen to us all at one point or another and it helps when you are prepared. Knowing who will go home, when you will go home and how you will get there are all important parts of planning that will make the inevitable less stressful. It's hard to make the choice to leave family and go cruise, and having a long conversation with family explaining your choice is important. My Grandparents were understanding and knew the life we were giving the kids was full and one that would help them grow into wonderful adults, they could also see it in the way the children interacted with them and others. We were fortunate to have family that understand, but I think the way it was explained and shown to them helped.
Growing up I didn't have the best childhood, however I admit I probably wasn't the best child either, but the one thing that was always constant in my life was my Grandparents. You see, every summer was spent in Michigan being spoiled with Twinkies, bb guns, 4 wheeling and summer nights. After the summer was over it was back to reality. I would fly back to wherever it was we were living (military brat) and I would readjust to normal life. When I turned 14 through a series of events I was fortunate enough to move to Michigan to live with them. At an age when they shouldn't have to, they took me in and raised me. They were always there, always my safety net, my refuge, it was almost as if they would always be there, however in the back of my mind I knew this wasn't the case.
Growing up I didn't have the best childhood, however I admit I probably wasn't the best child either, but the one thing that was always constant in my life was my Grandparents. You see, every summer was spent in Michigan being spoiled with Twinkies, bb guns, 4 wheeling and summer nights. After the summer was over it was back to reality. I would fly back to wherever it was we were living (military brat) and I would readjust to normal life. When I turned 14 through a series of events I was fortunate enough to move to Michigan to live with them. At an age when they shouldn't have to, they took me in and raised me. They were always there, always my safety net, my refuge, it was almost as if they would always be there, however in the back of my mind I knew this wasn't the case.
After working for years as a Paramedic, working in ER's and my personal battle with cancer, I became acutely aware of not only my own mortality, but those around me. I hesitate to say I became comfortable with death, but I definitely had a different perspective. You see death is the one common thing we all face, the one common destination we all share, the differences lie in the way we make the journey.
I was aware of the severity of her injuries when I got the phone call that my Grandmother had fallen during the night and broken her femur. I knew that injury at her age (85) was almost always the beginning of the end, I also knew that one of the big risk factors would be stroke. However as the months passed and Grandma did her rehab she sounded great. I remember the last time I talked to her on the phone I actually thought to myself "maybe she is the exception". It was only a couple days later when I would get the phone call that she had a stroke. Still I thought she might recover, from the description my Grandfather gave it didn't sound bad, I struggled to find out more information and had a hell of a time getting the hospital to tell me anything. Finally around 9pm I got a phone call. We were in the middle of 35 knot winds, lightning and rain pouring down, when I answered and heard the voice on the line introduce himself as her Dr. I made sure to ask him to not sugar coat things. I asked how bad it was and he gave it to me straight. From that moment I began to prepare myself, and that night I booked a one way flight home to be by her side. I was there the next day, arriving just after lunch and we went straight to the hospital. There was no preparation for what I would see when I got there. Her stroke had been extremely bad, she wasn't responsive, could not follow any commands and for the most part could best be described as in a vegetative state. I could not believe what I was seeing, something I had seen hundreds of times with patients was now my Grandmother. As she laid there helpless, with tubes, IV's and oxygen helping keep her breathing, I came to the shocking realization that a chapter in my life was about to come to an end.
I had seen the effects of stroke at work, how debilitating, how life changing it was. I also knew the reality and likelihood of her recovery was slim to none. My Grandmother and I had several conversations about end of life matters. She voiced her dislike of nursing homes and her desire to never end up in one. She had talked with my Grandfather and instructed him to never let them put tubes in her, ventilators, or any life support. If it came to that point, it was time for her to go. As much as it tore me apart I would have to step up and become her advocate, her voice, to make sure her wishes were followed. Many times the things we do for patients aren't really for the patients, they are for us the family. We do our best to hold on under the guise of doing what's best for the patient, even when the outcome is certain and the suffering is obvious.
The next day my Grandfather and I arrived at the hospital and were told there was no change. I leaned in and called her name and was shocked when she grabbed my hand, opened her eyes and began to cry out loud. She raised my hand to her lips, pulled me down and held me close to her. She was in there, she could understand and I was able to ask her questions and she was able to answer them. There was a swallow test the following day to determine the next step, deep down I knew what the results would be. We were told the next morning when we arrived she had failed and would have to get a feeding tube surgically placed, something she always said she did not want. I noticed tears running down my Grandmothers face when the Dr was talking about the procedure, and after he left I leaned in to ask her what she wanted. My Grandmother wanted everything off, she wanted no part of it. I asked her if she wanted to come home, and if she did I made sure she understood it was to die. Without any hesitation her head nodded emphatically and began to talk to my Grandfather.
I asked the RN to get ahold of hospice and her Dr to let them know we were going to take her home. We had equipment delivered the next day and she was brought home the following afternoon. My next step was to get my children here and we booked them on a flight home immediately. The following day after picking my children up at the airport I prepared them for what they were about to encounter, at least I did my best. I explained Grandmas choices and her wish to die at home. We talked about how important quality of life is and the difference between existing and living. When they arrived at the house they spoke to her, and even though she was more distant then she had been she was able to acknowledge them and let them know she knew they were there. That night my cousin Lee and I took turns every hour giving her medication to keep her comfortable.
At 5am Lee woke me and it was obvious the end was close. We woke those in the house, including my Grandfather and called those that weren't there to come now. My Grandfather still had not accepted the certain outcome and left the room to make coffee and offered to make breakfast. As I felt her pulse weaken and her breathing slow I went into the kitchen and told my Grandfather it was time to say goodbye.
I asked the RN to get ahold of hospice and her Dr to let them know we were going to take her home. We had equipment delivered the next day and she was brought home the following afternoon. My next step was to get my children here and we booked them on a flight home immediately. The following day after picking my children up at the airport I prepared them for what they were about to encounter, at least I did my best. I explained Grandmas choices and her wish to die at home. We talked about how important quality of life is and the difference between existing and living. When they arrived at the house they spoke to her, and even though she was more distant then she had been she was able to acknowledge them and let them know she knew they were there. That night my cousin Lee and I took turns every hour giving her medication to keep her comfortable.
At 5am Lee woke me and it was obvious the end was close. We woke those in the house, including my Grandfather and called those that weren't there to come now. My Grandfather still had not accepted the certain outcome and left the room to make coffee and offered to make breakfast. As I felt her pulse weaken and her breathing slow I went into the kitchen and told my Grandfather it was time to say goodbye.
There at home, surrounded by an entire roomful of her grandchildren and great grandchildren she was gasping for air. My Grandfather leaned into her, kissed her gently and told her "I'll be ok Grandma, it's ok" it was at that moment, almost like the scene from a movie that she took her last breath. I felt her pulse and her heart beat just a couple more times and then nothing. She left this world the way she wanted to, comfortable and surrounded by those she loved the most, including her husband of over 51 years. In an odd way it was a beautiful moment, we watched the end of a beautiful life. We witnessed the end of an 85 year old story, better than any Hollywood script. We were fortunate and blessed to be part of her life and we were lucky enough to be there for the end.
Edith Malvitz
March 23 1928
February 19th 2014
