thin places

A while back, I got a text message from a friend that read, “My mom has the “O” sign”. I was reminded of a phone call from this same friend 20 something years ago, which read, “My water broke and I'm going in, letting me know about the imminent birth of her second son. One message indicated the end of a life and the other signaled the beginning of a new one.

The “O” sign is not a good thing. It is an unofficial, and maybe somewhat irreverent term used by medical professionals to describe the last stages of a dying person's life. The person is not there anymore but their body is – breaths go in and out, the heart beats, and the mouth is open in an almost perfect “O”. The eyes open but don't see, or at least don't see what we see. Another even more irreverent term used by medical professionals for this phenomenon is “circling the drain”.

Of course, you can see the “O” sign on an airplane when you walk back to the bathroom and everyone is sleeping with their heads lolling back and forth and their mouths wide open, unaware that they are breathing, unfiltered, the stale air laden with unknown germs of the other 80 some passengers. But these people are still present and you know they are still there in their bodies – just trying to tolerate the uncomfortableness of today's flying experience. When I see these multiple “O”s, on my way back to the tiny and stinky airplane bathroom, I think of the Stephen King short story called “The Langoliers".  In this story, all the sleeping passengers disappeared from the flight and those who were awake landed in some strange place – or maybe it was the other way around.

This same week that my friend notified me of her mom's sign of impending departure of this life, I got a call from a good friend, who is 96. She needed help getting her husband, (who was 97) out of bed. It seems he could not move his legs enough to help himself.

I went over and helped her, with a lot of difficulty, to get him out of bed. We got him in the bathroom, but still he could not move his legs or stand to pivot onto the toilet. Under protest from both of them, and partly because I did not know what else to do and partly because I worried he had suffered from a stroke, and mainly because we couldn't leave him in the bathroom, I called 911. I could see in both their eyes, that they knew this was the beginning of an end of the life they were used to.

After a visit to the ER, we were sent home with a diagnosis of dehydration, a home health referral, and very little support other than, “Well you will need to have some help to get him out of the car”. It was indeed the beginning of the end of this life for him – or maybe the end of the beginning of existence depending on how you looked at it.

It became apparent that she, who had taken care of him and had been married for 73 years, could not handle all of the care he needed on his own. He soon got placed on hospice and their home was inundated with chaplains, hospice nurses and aides, equipment, and forms to fill out about end of care treatment. My friend had to deal with saying goodbye to her husband of 73 years. It wasn't easy but she, like me, had been a nurse and knew what was to come and also knew that despite knowing, one is never ready. I was reminded of what grief, even anticipatory grief, does to a person.

I have been volunteering for hospice for the past few years and have always viewed it a privilege to share the death experience with someone. I have always felt that dying is a process much like being born – only in reverse. Dying is a part of living and as normal in many ways, as birth.  He was okay for a few days after being on hospice care, even getting out of bed several times and to the bathroom by himself. He ate scrambled eggs, read the newspaper (although he was holding it upside down) and had coffee and cinnamon rolls with us. Of course we had some hope that it was just dehydration and he might rally and live a little bit longer. This was not to be.

The next day he was exhibiting the “O” sign. It occurred to me that the “O” could stand for ominous. I was sad but glad he would not have to suffer and that she would not have to watch him suffer. I went and ran a few errands for her and came back to her house to find him awake and sitting up...one more rally. He talked for a long time about his mom who lived to be 103, and his sister who married a man he had never approved of and who ended up cheating on her. He drank some water and was still talking when I left to go home. The hospice aid told me she had never had a patient die on her shift and wasn't about to start now. She went into the bathroom and said a prayer for him.

The next day he was back to the “O” sign. He would occasionally sit up and stare at something we didn't see. He kept saying to his wife , “Hon, I gotta go”. She thought he meant he had to go to the bathroom. I thought he meant he had to go – to leave her for hopefully that better place we hope is there.

He lingered for three more days. He did not say any more but we watched his body shut down. For three days he had what is called cheyne stokes respirations – periods of apnea spells that are followed by periods of breathing. Sometimes he would open his eyes and stare at something beyond us, it seemed. I was reminded of a sermon our minister gave about what she called “thin places” where one feels closer to God, or to those on the other side or to whatever higher power one believes in. I believe that when people die, they are in one of those thin places and maybe they see those who have gone on before them and who might be waiting. Sometimes dying people seem to be talking to family members who have died.

The nurses aide, another friend, and I sat in the bedroom, in this thin place, with him for one entire afternoon just talking quietly. Olive asked me to time the apnea spells. She had been an OB nurse and I was reminded of how my timing the apnea spells was similar to how she must have timed contractions during labor for her patients. It was a sad afternoon, but we all felt very close and were sharing something very special.

Sitting in the room that afternoon reminded me of the cycle of birth and life. After birth, a baby takes a deep breath and hopefully the alveolar sacs in the lungs open. Circulation independent of the mom's placenta starts and if all goes well, the blood circulates to these newly formed and completed organs and they begin their 70 – 80 year journey to carry that person through a life that is to be determined. When a person dies, it is just the opposite. One by one, the organs shut down. Hands and feet become cold to the touch, urine output decreases and the length of the apnea spells increase until they cease. Life leaves little by little from a body that usually has served a person well and all that is left afterwards is the container which maybe is recyclable.

I wasn't there when he took his final breath,but his wife was.  She rarely left his side the entire time.  The best and final gift she gave him was letting him die at home, in his own bed with her next to him.  I believe he was grateful for that.