The fire may be winding down, but there are still some good hot embers

I know everyone is worried about our dear, lovely Rita. She has been very weak. "I just feel so energy-less," she just said to me.

At the same time, she still has that spark of humor that has made her so beloved by us all. When the nurses asked her what she wanted for dinner, she said, "Bud Light."

I didn't even know she liked Bud Light.

Since the level of care being given to her has changed, just today at about noon, they moved her to a different type of room, still on the same floor, but, oh, SO much more comfortable for us.

The previous room was a single hospital room with a lovely big window looking west over Spokane. So it was definitely nice. But it was very crowded. When Peg, Bill and I were all there, two of us had to cram up against the window while one stood at the foot of the bed or on a chair on the other side. And the chairs were wood with no padding.

I didn't really pay that much attention to the situation; it wasn't that important. But now we're in a room meant to include family. There are two soft recliner-like chairs that evidently convert into sleeping surfaces, there's a small table with two chairs for eating at, and a small refrigerator and microwave. Now that the surroundings are so much more comfortable, I am realizing why we were each getting pretty tired as we took a turn at staying with Mom.

It has been a LONG two weeks.

Especially for her.

But even after all this, my brave, wonderful mother has a weak smile for us when we come in the door and manages to make the nurses laugh.

Don't tell anyone, but we're smuggling in some beer a little later. :-)

Final wishes

Yesterday evening, Mom was alert, chipper, and feeling very well. Peg and Bill were able to enjoy a nice evening visit (I was still in Pullman), and her doctor was talking about a release date.

Overnight, her condition changed dramatically.

This morning, when the pulmonary therapist came in to administer a treatment, she heard a lot of "crackling" in Mom's lungs, which is a sign of fluid build up. So the "Rapid Response" team was called in to get Mom stabilized. The members of this team are exceptionally skilled in their areas of expertise. Their efforts were successful.

Peg was called, of course, and she called me. She and Bill, who has been staying here in Spokane ever since last weekend, came to the hospital, and I drove up from Pullman. All four of us conferred as a group. Mom has been saying to many of us over these past two weeks that she is ready to die. She has said this so often, and to so many of us at various points, that we, her children, pursued with her a serious, end-of-life wishes conversation. Although she has been very weak all day, she has been alert and clear-headed, so we felt confident about having this discussion today.

We very carefully and thoroughly discussed what exactly Mom wanted to do at this point. We identified the options for her. These options roughly fall into categories of
• "do not resuscitate if pulse and/or breathing stop";
• do everything medically possible
• do some things but not others (do antibiotics but no artificial feeding, for example)
• do only what will keep her comfortable

After about two hours of talking among ourselves (Bill, Peg, Mom and me), going through the hospital's forms, and getting clarifications from the various medical specialists, Mom has decided to accept only comfort-level treatment and there is a "do not resuscitate" order if her pulse/breathing stops.

Over the course of the afternoon, several specialists who have been involved with her care have come in to talk with her and us. She has confirmed this decision with all of them.

She will continue to accept IV infusions that keep the fluid levels in balance, and she is accepting the pulmonary therapy, a broncho-dialator. She will accept IV antibiotics to address an infection. But that's it. No new medicines, no new treatments, no aggressive measures.

There is a wonderful hospice program in Spokane with a just-recently-built 12-bed facility, Hospice House. She has been accepted to be taken there when a bed becomes available. That will probably be Monday or so.

Peg was particularly comforted to know that a former colleague--a nurse whom Peg admires, respects enormously--is the director of nursing for this hospice organization. Mom could not be going into better hands.

It is very sad news, I know, for all of us who love her so much that we will soon be saying goodbye to this wonderful, wonderful woman. Peg, Bill and I are so grateful to have been graced by such a mother. She has truly taught us what love is. As one expression of our gratitude for her love and motherly care, we want to support her desire, which she has made clear to us many, many times over the years, for a dignified death, not a protracted feeble helplessness. Sad as I, my brother and my sister are right now, we know this is what she wants for herself.

Thank you to everyone for your thoughts and prayers.

Finally some good news! Another update from Bill

Both Peggy and I were in Mom's hospital room yesterday when the cardiologist visited to tell her some good news.

The cardiologist had been called in to help a couple of days ago because Mom had been retaining fluids that had moved into her lungs and had put stress on her heart.

The medical staff has been taking aggressive action to get excess fluids out. Over the last few days, Rita has excreted over 7 pounds--that's more than about a gallon, folks!-of excess fluids.

Rita is getting back into "fighting shape" as a result. Her chest x-rays look clearer, her oxygen levels are greatly improved and near normal, and her blood counts (hemocrete and hemoglobin) are also greatly improved.

The cardiologist actually told Rita he was signing off the lead role he had assumed when the fluid build-up was taxing her heart so much.


Her primary oncology physician has said that Rita will stay in the hosptial through probably Tuesday and then be dismissed to a rehad faciltiy or other nursing location.

This one is from Bill

Sunday was Bloomsday. Over the last several years, I have looked forward to this event as a great time. I’ve also looked forward to it with a bit of anxiety, knowing that I would need to be in shape to try to stay up with my mother.

On Monday, we checked the race statistics. According to their records, Mom has done Bloomsday 27 times. She has walked with many family, friends, kids and grandkids, and she has made a lot more friends along the way.

Mom could have had more fun on most of the walks, but she did Bloomsday just like she has done her life-- not as a race, being concerned with where she placed, but more as a journey to connect with family and friends. To be part of a parade, not to be in front, but just to be with it.

On Sunday, she had visitors from her husband’s side of the family, the Williams family. I haven’t spent much time with Ron, Ingrid and their kids in the recent past, but I got to be there for some time while they visited Mom. They had many fun stories and memories of spending time with Mom and Jim at their Asotin home; it was great to hear about all those good times.

Grandma Rita and Grandpa Jim were legendary for their welcoming, kind treatment of kids and grandkids at their Asotin home. It was a tradition every summer to take the kids across the street to swim in the Snake River, to fish and to have picnics.

Grandma never let the fact that the "fish weren't biting" dampen a kid’s joy of bringing in the big one.

One such summer day when grandson Chris was disappointed at catching nothing as he, Mom and Jim fished in the river across from the house, Grandma Rita snuck back across the street to the house and pulled one of Jim’s fish from their freezer. While little Chris wasn't looking, she slipped it on his fishing line, threw it back in the water, and then yelled with joy, "fish on, fish on!"

Even a young kid knows that you don't pull fish from the Snake River frozen, gutted and all ready for the pan. But it was fun, and the memory of Mom’s kind joke still lives. Just like the Bloomsday race, it wasn't about the race or the finish, it was about the experience.

Hearing this fish tale recounted again with Rita in her hospital bed brought laughter from everyone in the room. And there was a gleam in mom's eye, knowing that she was able to impact us in those ways throughout her life.

From a medical standpoint, the last few days have been tough. Fluid has started to build up in her lungs, which is somewhat common during chemotherapy. Mom’s heart is not pumping as rhythmically as it should, while the demands on her heart are greater than normal for an 88-year person’s heart.

She remains in the hospital. Her blood statistics, which were the medical issue that first brought her in, are in decent shape. The priority now is to deal with the fluid build-up and retention.

She is noticeably weaker physically as she fights the fluid retention.

Her spirits are guarded. When family and friends join, she smiles and jokes with what energy she has, but she is easily tired. Her room is well decorated with cards, scrapbook pages, and mementoes and memories from family and friends. And she continues to harass and hassle family and friends with the glow and smiles she is famous for, even though the glow is dimmer and the smile is not quite as big.

Rita sends her thanks and love to all those who have reached out, and she gratefully accepts your faith and prayers as she walks a tough section of life’s "Bloomsday."

Two steps forward, one back.

The Bloomsday weekend has come and gone. This was one of the few Bloomsdays in the past 28 years that Mom has had to miss. But Bill and I carried her banner. Bill even managed to get a t-shirt for her. She’s hiding behind it in this photo.

Over the weekend, her son-in-law and daughter-in-law Ron and Ingrid Williams, along with her grandson Chris and his bride visited Mom. Surprisingly, they managed to get hotel rooms even though the town was full of Bloomsday participants and volunteers. They visited with Mom Saturday night and watched the live coverage of the race’s start and finish on Sunday.

Since Bill and I were not featured runners enjoying live television coverage, we kept Mom up-to-date on our progress on the Bloomsday route by calling Ron on his cell phone and having him relay the information to her. Her hearing isn’t working well enough nowadays to get on the regular telephone, much less those silly cellphones.

I must say, though, that this past week has converted me from cellphone-resistance to cellphone enthusiasm. I’m sure that Peg and Bill would agree that we all would have gone abso-freaking-lutely insane if we hadn’t been able to speak with one another at a moment’s notice.

Note: the following may fall into the category of too much information. If the details of medical treatment don’t sit well with you, you can skip this paragraph. About Mom’s physical condition: the weekend has her continuing to improve. Her blood count and blood oxygen levels have gradually gotten back to near normal, her temp frequently has gone below 100, and her infection has almost cleared up. She has been retaining water, though. The heart and the lungs have been working extra hard as a result. The diuretic they’ve administered really kicked in yesterday, though. She’s probably lucky that she’s on a catheter. The water retention has also included pulmonary edema, so they’re tweaking the treatment plan for that, too.

Although she has definitely improved since she was admitted, it has been a case of two steps forward, one step back.

Recently, since the fever has gone down so much, she hasn’t been delirious, but she has been very sleepy. I stayed with her for three hours Sunday afternoon; she was awake for only 10 minutes. I packed a lot of news into that little bit of time, let me tell you, before she told me that she wanted to go back to sleep. Bill has been staying with her at times over the weekend and then all yesterday and today. When he told her that he had to go back to Wenatchee and asked whether Peg or I should come back in and hang out with her, she said, “Please, no!” She’s really tired and just wants to be left alone to sleep.

She may not realize that we hang around as much for our own peace of mind as for her wellbeing. But I guess it’s time to stop hovering and let her be taken care of by her wonderful nurses, nursing assistants and docs. So thanks Evelyn, Patti, Sandy, Linda, Amanda, all the other nurses and aides whose names I can’t remember, and thanks Dr. Rosales. We're counting on you!