Improving, Worsening, or Leveling Out?

October 31, 2014  Journal

I am beginning to wonder if I gave too much weight to the fears of Mom’s friends on Monday.  Mom said this morning that she had wondered what was going on, on Monday. Her friends may have been greatly affected by the suddenness of her decline, but would it continue at the same rate?

* * *

12:15p.m. Mom vomits, a lot. My heart sinks. She must get sustenance. She has kept down none since yesterday.

* * *

12:45p.m. After a hot bath, before she can even get her shirt on, she begins to vomit again. She finds one of the blue vomit bags on the floor. “It’s like a heart-retching,” she would say later. “A stomach-heart-retching. Deep down.” I bring her a shirt and a glass pipe filled with marijuana. In between her vomiting I light the pipe for her and she breathes in the smoke.

“This could be cachexia,” she says, nodding. She positions her mouth back over the bag.

Cachexia. The wasting disease. We worried that she had the dreaded cachexia earlier in the year, when she dropped over fifty pounds in a few months. It’s cachexia that usually leads to cancer’s fatal malnutrition. But my co-founder in Physician Cognition, a doctor, told us that cachexia is not present with a certain albumen score. Mom’s score meant she probably didn’t have it. We were relieved at the time. But what about now?

Later, she says that she thinks the culprit is the Ativan. “Every time I take that lately,” she says, “I vomit.”

The hospice nurse thinks the vomiting could be due to her cancerous liver. She uses the phrase “your liver involvement”.

I ask the hospice nurse if the IV painkiller could be a cause of nausea too. “A few days ago,” I said, “she thought she was getting nauseated right after pressing the button.”

“I may be just sick,” Mom says firmly.

“Yes, but if you’re nauseated right after doing something, that something may be a partial cause.”

“It may be just coincidence,” she says.

What was this? We have switched roles. I seem to be the voice of hope, and she the voice of reason.

* * *

A movie that Mom isn’t paying attention to has about 20 minutes left. “Hey, Mom,” I say. “Do you want to go for a wheelchair ride?”

“Not right now,” she says. But ten minutes later, she says she’s ready. She sits up to put on her shoes. Her gorge rises and she grabs a blue bag, into which she vomits.

“Oh,” she says. “I hope this isn’t going on all day.” She begins to cry. I hand her a warm towel with which to wipe her face.

Adam and I load her into the wheelchair. She doesn’t like that it’s out front. She hadn’t remembered it was there. A minute later, she says, “I saw that we have some madelines to eat, I wish I’d known that.”

“Do you want one now?” I say. We are still near the house.

“No, I just want to know these things,” she says. She is trying to reassert a semblance of control over her life.

The neighbor’s dog, Cassie, runs up to the fence. Mom has fed her bologna nearly every day for years, and this has made the shy, small, fat Border Collie my mother’s best friend. Mom reaches down and through the fence and pets Cassie. “I know, it’s all so different now,” she coos.

Magic Wheelchair Ride

Magic Wheelchair Ride

I push her for a while, but it is hot and I ask Adam to take over so I can take off my sweater. Mom puts it on her legs, which are cold. She takes my hand and we walk like that, to Main Street. There we stop to take in a tiny Latina girl dressed up for Halloween as a bee. Mom is pleased and watches her for a while, offering compliments, and then we cross Main. No one is talking much. I am thinking cachexia. She probably is too.

She spies a new store that sells kitchen supplies and asks if we can go. “Good afternoon!” she says, as her wheelchair crosses the threshold. The clerk says hello. Adam pushes her through the aisles as she points at and sometimes fingers various kitchen implements. I pay attention to my state for a moment and confirm that I am feeling miserable.

I imagine that I am in one of the dreams I know I will have some day – the dreams in which my mother is there, simply existing, or doing something mundane, and I am filled with the greatest happiness. Why can’t I feel that now? Why can’t I look at her as if her presence is the rarest, most precious thing? I try this, and it works – I feel a smile taking over my face, and joy fills my heart – but then it becomes too much and I have to stop for fear of weeping. There is no nostalgia without pain. The meaning of nostalgia, in fact, is a return to pain.

* * *

Mom said she had wondered what was up on Monday, with everyone acting as they were. She was too groggy to express any surprise that people would visit from so far off, and at the same time, but now she says, “I just don’t want anyone to know something I don’t know.”

“No one knows anything more than you, Mom.”

* * *

Silke, Berle, Monika, Peggie. They began arriving at around 5pm. Peggie brought necklaces with flashing lights. She was ready to give out treats. “No one ever comes to my house,” she said. She lives on a ranch outside of town. Mom said the last trick-or-treater to come here was 8 years ago.

Silke told a story about how her husband Gordon once rode along in a Lear jet that flew to San Francisco, where the three passengers had lunch and then turned around and flew back to Colorado. The assembled women all made different sounds about this fact. Mom said, “Someone is out there living my life.” She paused. “And I’m living theirs.” She said she was tired of “this cancer crap”.

* * *

“Cameron, you’re so calm,” Peggie said. She thought it was the cannabis oil she had provided me with.

“I thought he’d changed,” Mom said. “He’s been really attentive – well, he’s always attentive. But – and he was patient. I thought I must be dying.”

The women laughed.

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