Winding Down

The tremors in his hands have mostly ceased. This morning he worked to touch the side of his mouth as he’s been doing repetitively for the last week. A laborious movement this time, his hand heavy and slow to reach it’s destination. 

Then a boost of energy. His eyes open wide and locked to something above him on the ceiling or beyond it, with an easy movement he reached up directly overhead, held his arm suspended for a long moment then slowly brought it down to his side. 

Twelve hours later, he’s not lifting his hands at all. 

Last night I was alone with him. No music or television, just us and the air conditioner hum. Dad exhaled. I heard a click. I tilted my head closer to him. 

Click. 

I moved my chair closer to his bed.

Click Click, like fast tap dance steps. 

I listened to the cadence, to the air conditioner, to the train going by. I recognized the start of breathing changes. 

“We’re here now,” I said to myself. “Ok.”

His eyes are glassy tonight. His hands warm earlier in the afternoon, cool now. 

He’s winding down.

One of my forever friends came over today. Kelli, John, and I sat around Dad’s bed. We talked in our regular voices, not loud and not the whispered ones from earlier in the week, just regular. 

We laughed. We told stories about our families. We were silly and relaxed I imagine because we’re so damn tired and can feel the big tending of Dad is done. 

The hourly medications aren’t required. He’s not moving and working to get himself out of bed. He easing into his next step in the journey, as are we.

I kissed his head.

“Dad, I’m going to the motel. I’ll be back around nine in the morning. Suzette will be here by then and she’s bringing the pup. If you want to wait around for us, great. If you need to go on tonight, that’s ok, too. 

We love you. I love you. You’ve been working so hard. John will be here with you tonight. He’ll take good care of you. 

Rest well.”

I gave him another kiss and gathered my things to go. Out Dad's window I noticed a combine in the cornfield.

It's harvest time.

 

Martha Jo Atkins, Ph.D., LPC-S is the Executive Director of Abode Contemplative Care for the Dying in San Antonio, Texas. Dr. Atkins is a professional counselor, coach, and researches and teaches about the trajectory of dying. You can learn more about Abode Contemplative Care for the dying at www.abodehome.orgYou can learn more about Dr. Atkins at www.marthaatkins.com.

Contractions

Saturday I noticed a cycle. 

Noble lies in the bed on his back, stares overhead, unmoving, eyes still and away. His left hand begins to tremble, slowly at first then a rumble. Right hand follows. 

The rumble moves up his arms and shoulders. He raises his right hand to his mouth then to the bridge of his nose or eyes. His left hand scratches the crook of his right elbow. His right arm moves, left hand still in place, to scratch the back of his head. His right hand moves to fuss with a button midway down on his pajama top. His left hand lifts up and out toward something beyond him. Right hand follows.

He rises up off the bed just a bit enough to make the bed groan, talking to someone we can’t see, sometimes with gestures, sometimes not. Most of the time now we can't understand him. Last evening during several cycles, he smiled at what he saw. No words necessary.

He tries to clasp his hands together and can’t quite do it. As he his puts his arms down to rest, his hands tremble less and less until one stops. Then the other. 

His eyes become unfocused and he is still, mouth opens slightly, then wider. His head rests completely on the pillow

After many rounds of this I turned on a timer.

After two minutes thirty two seconds of rest or away-ness or whatever it is, the cycle started again. 

After 2:15, it started again. 

1:48

2:03

2:22

2:51

1:41

I timed the length of the trembling and connecting to whatever he's connecting to. Less than a minute both times:

46.79 

46.18

When my Aunt Betty was dying, her daughter said Betty would get frustrated, reaching her arms up above her and grimacing, then dropping her arms like she was mad because someone had left.

Butch had a similar experience. He was frustrated when ‘the men’ came to see him on ladders and upon leaving, either took the ladders with them or the ladders were too short for Butch to use. Curses.

Every once in awhile we can understand Dad as he reaches:

“Wait! Wait!”

“Help me.”

“Please, please, please.”

"Heyyy! Hey Heyyy! 

Like Aunt Betty and Butch, Dad seems to want to connect with someone or some thing and can’t just yet. There have been times when he has looked frustrated, as if he wanted to cry -  head and face red, his lip pursed. I suspect there would be tears if his body wasn't so dehydrated. 

I sat by his bed last night. He reach out looking beyond me, "Please, please.”

I held his hand. “Dad, they’re coming back for you. Just a little while longer.” 

Another time he reached and looked at me, “Hello, Baby.” I don’t know if he was talking to me or not. I'm gonna go on and believe he was. 

Many kind souls have asked if we, Noble's family, have given him permission to go. Yes, we've told The Papa many times we want him to go when he's ready, we're ok here, he's taught us what we need to, and other variations on the theme. Unfinished business? Not that we're aware of but who knows. 

I imagine it must be terribly difficult to leave behind the ones you love. He's journeying on his time. We trust him. 

I timed the rest phases in-between contractions yesterday afternoon. They were longer.

 

What does it mean? Ah, that's the thing. We're in a mystery. Some things are knowable. Some things are not.

This morning there seems no down time at all. One continuous contraction. Moving. Moving. Moving. Medicine is calming him. His eyes don't seem as open this morning as they were yesterday.  

I raised the head of his bed up so he can see around the room. He's looked at me several times. I waved.

He nodded two quick nods. "Hey, Sweetie." THAT I understood.

His friend came to see just now. She leaned in close. 

"Hi, Pastor."

"Hi, Debi."  

Debi had a quick follow up question for Dad. He didn't answer, already gone to wherever he goes. 

Eyes closed, mouth open, hands in his lap, breathing easy, he's resting comfortably now.

Onward.

 

 

Martha Jo Atkins, Ph.D., LPC-S is the Executive Director of Abode Contemplative Care for the Dying in San Antonio, Texas. Dr. Atkins is a professional counselor, coach, and researches and teaches about the trajectory of dying. You can learn more about Abode Contemplative Care for the dying at www.abodehome.orgYou can learn more about Dr. Atkins at www.marthaatkins.com.

 

Unchained

His eyebrows have grown long in the last three weeks. The tight pajama tops fit looser. We didn’t expect him to live much beyond the first weekend here. The hospice nurse mentioned yesterday she didn’t expect him to be here this long either. My father, bless his heart, has never done anything quickly in his life. He is deliberate and thoughtful even in dying. Of course he is. 

We’ve told him it’s ok to go. We’ve told him everything is taken care of, that he’s taught us what we need to know. He's beginning to change now.

Jasmine came to give a bath. “He smells different.”  I've worked with dying patients and smelled the smells. This particular parfume de Noble is unfamiliar to me. 

I asked Jasmine, “Is the smell a kidney failure smell to you?” 

“Could be.” 

Toxins build up and come out the skin or the breath. It's not terrible. It is distinctive.

Noble is itching a lot, something we attributed solely to medication until Linda pointed out that building toxins in the bloodstream cause itching, too. So much to learn.

When Dad offered a detached "Hi, Sweetie" several days ago, I realized he didn’t recognize me. This morning he smiled. Ever the polite gentleman, he nodded and said, “Hello, Ma’am.” 

He has been eager to be out of bed. “Can we go now?” “Can I get up now?” One leg has regularly been over the side of the bed.

When he’s awake, his hands tremble. When the pace of tremors quickens, we know it’s time for the magic trifecta of calming balm: Benedryl, Ativan, Haldol. A nurse encouraged us not to put it on his arm without wearing a glove or we’d be napping right along with him. 

I kissed his forehead and touched his arm when I arrived this morning. I could feel the heat rising from him and teared up. 

The heat, the away-ness of his eyes, droop of his mouth, and open mouth breathing are all signs I recognize. Until today, I’ve seen him come back to present time when he opens his eyes. He's slowly, slowly inhabiting a different place now. 

His language has changed, too.

Monday night he said, “Unlock the door”, a common metaphor of the dying. Once the door is unlocked, more exploration happens.

Tuesday night, “Dot, Dot, would you bring me…? I couldn’t understand the last part. I did understand the Dot part. My mom is Dorothy. She died in 2006. Dad called her Dot. This was the first comment he’d made about someone he loved who has died. I’ve been listening for more and have asked several times who is around. He watches and reaches. This afternoon he talked to someone beside the bed.

"Papa, who is here?"

"I don't know but he came by to us."

"Is he someone friendly?"

"Yes. Yes."

Then he was back asleep.

He wants up. Out of bed. To go. 

"Can we go now?"

“Where do you want to go, Papa?”

“Springfield, Missouri."

"Why Springfield, Missouri?"

"To see Jimmy.” (A deceased friend of his.)

“Ah, Papa. Jimmy will be along to see you soon.”

“Ok.”

He’s been checking his watch regularly and asking for the time.

Dad: “I have a meeting.”

Me: “When’s your meeting?”

Dad: “9:30.”

Me: “You’re late. You better get moving.”

Earlier he asked, “What time do we leave?” John said, “We can leave whenever you want to.”

As I left for the motel last night, Dad was working to relieve himself of his pajama top and sheet.  He wanted his pants off, too, though he wasn’t wearing any. Finally, he took off a prized necklace with a Huguenot cross. I'd never seen him wear it until three weeks ago, the night we discovered his kidneys were failing. He'd put it on the day before and wore it until last night. When he took it off, I knew things were changing. 

I got a text from John:

Early this morning there were questions in rapid succession:

"The doors are open?"

"Is the door open, open, open?"

“Can you raise the floors?” 

“How can we get out?”

“How do we pop it out?”

Much of the day he’s been reaching towards things the rest of us can’t see. Sometimes his eyes are open. Sometimes he smiles as he does it, pulling himself up off the bed. Sometimes his brow is furrowed as though he’s concentrating deeply. 

He's resting now. No pain meds have been needed for more than a week. He’s peaceful. He’s making his way.

He asked John tonight, “Can we undo this connection?”

Yes, Papa. As soon as you’re ready.

 

 

Martha Jo Atkins, Ph.D., LPC-S is the Executive Director of Abode Contemplative Care for the Dying in San Antonio, Texas. Dr. Atkins is a professional counselor, coach, and researches and teaches about the trajectory of dying. You can learn more about Abode Contemplative Care for the dying at www.abodehome.orgYou can learn more about Dr. Atkins at www.marthaatkins.com.

Liminal Space

The Monday morning sun has come up. Just beyond the cornfield several north and southbound trains have gone by. Dad prefers being turned so he can see out the window. Suz and I took the late shift and The Papa was awake for much of the night. 

The big agitation has lessened. He doesn’t answer questions now or respond with the smile we've become accustomed to. He holds hands with us and we with him. 

When he started hallucinations a few days ago, we knew what they were and had the medicine ready to go. The pre-death visions have come, too, and they come whether the medication is onboard or not. They are different for him, not agitating, and he seems to want to engage with them.

I've been taught that hallucinations can be frightening for the dying person and easily controlled with medication. That's been true for Dad. He looked at something in front of him, moving his head away from whatever it was.  “Don’t help me. Don’t help me.” He looked at me, then looked back, “Carry them away.” Medicine carried them away and he was peaceful. 

The next morning it seemed to me he’d gone back in time, watching several scenes unfold and speaking to whomever was in the scenes with him. No fear there.

And before all that started, he wanted his pocket knife and a handkerchief, gathering items for his journey.

Grandson, John R. and I heard Dad say something about an airplane though we couldn’t quite decipher what. The next night Dad asked Suzette, “How do we get off this airplane?” Suzette said, “Parachute?” Dad was quick to say, “Nooo.” For your viewing pleasure, Chris Duel sent along this clip of the airplane scene from Heaven Can Wait. Thanks, Chris.

 

Saturday morning I put on a piece a music Dad has chosen for his funeral. The intro played and Dad, who’d not been saying much, clasped his hands together and settled into his pillow. He looked off somewhere beyond us.

“Dvorak.”

“Yes, Papa.”

There’s a stanza in the music,

Mother's there 'spectin' me,

And father's waitin' too,

Lots of folk are gathered there,

With the friends I knew.

With the friends I knew.

Home, home, I'm goin' home.

After those lines were sung he said, “Friends and family are gathering now.”

“Yes they are.”

Just before Suz and I got here last night, John was sitting with Dad. Dad said aloud, “When are we going over?”

John told him, “Soon.”

As he was reaching and reaching toward the window around three this morning Dad said, “Pull me further out.” 

Bit by bit he’s making his way. 

He can’t clear the phlegm from his throat now and he's not so interested in water. His breathing is coming more from his abdomen. Eyes are open sometimes, closed sometimes. He’s doing his work. 

Dad's not quite ready to go yet. We’ll keep playing music he loves and sit in this liminal space with him until he is. 

Martha Jo Atkins, Ph.D., LPC-S is the Executive Director of Abode Contemplative Care for the Dying in San Antonio, Texas. Dr. Atkins is a professional counselor, coach, and researches and teaches about the trajectory of dying. You can learn more about Abode Contemplative Care for the dying at www.abodehome.orgYou can learn more about Dr. Atkins at www.marthaatkins.com.

Octave Shifts

When I got to his bedside yesterday morning, Dad’s body was hot for the first time since his initial go at labor a couple weeks ago. Hospice patients are notorious for getting better before moving into different levels of experience. In retrospect, I see he did that. He wasn’t ready. He is now. 

The heat is an indicator. The change in the color of his pee, the way his eyes look and don’t see me sometimes, his movement, his language, all indicators of octave shifts (thank you for that language, FF) he’s made and will make over the next few days.

Wednesday Dad said, “I’m twisted up.” 

Thursday morning, “Martha, I’m scared.”

“Ah, Papa, what are you scared of?”

“Falling.”

He’d done several full body jerks up in the bed, wide-eyed each time. 

“Papa, your safe in the bed. We won’t let you fall.”

“Ok.”

Metaphorically, as John so eloquently put it, “He’s falling out of life.” Soon after he talked of falling, “I’m turned around. Martha, will you help me? I’m turned around.” He was lying in his bed just as he had been. 

“Papa, I don’t know how to help you. Do you know how to help you?”

“Sweetie, I’m afraid I don’t.”

John asked, “Do you feel turned around in your mind or body?” 

“Body.”

We rearranged Dad on the bed and that seemed to calm him. Medicine for agitation helped, too. 

Unbound.

Falling.

Turned Around.

Then a new question. “How do I get out of my apartment?” Yes...Once he’s unbound, he can begin traveling. He's wondering how in the world to get out of here.

Early yesterday morning Dad begin to talk about the light.

"Would you turn on the light?"

"Can you get the light on? I feel helpless."

"Where is the light?"

"Would you make it brighter?"

“Turn on the light."

The lights are on now and Dad is moving into the next octave of work.

From The Google: 

Terminal - of, forming, or situated at the end or extremity of something. 

Restlessness - never at rest; perpetually agitated or in motion

Man it was a long night. 

Terminal restlessness is part of the experience.

Some folks only use words like delirium, agitation, and hallucinations when describing this juncture of the journey of dying. If that’s all they see, they’re missing out.

For Dad and me last night, terminal restlessness looked like: balling up the sheet between hands, nose picking, working hard to get out of bed even when there’s been no out of bed-ness for weeks, dropping every pillow, blanket, sheet, kleenex, towel, piece of clothing to the floor, all kinds of movement in bed, a red faced man whose is momentarily M. A. D. 

“You’re holding me.” 

I had my hand on his leg so he wouldn’t scooch of the bed.

“Yes, Papa, I’m holding you.” 

“Why?” 

“I want you to be safe. You haven’t walked in a long time. ” 

"The walls. How do I break the walls?"

"I don't know Dad. You'll figure it out."

"Ok."

I gave him medicine. Then more. After 45 minutes he slept a few hours. It started all over at 6 this morning. 

“Too small for me. Too small for me. Take this off please.” His body is too small for his spirit now. It’s about time to shake it loose. 

This part of the process sucks. It’s damn sure hard for me to watch and experience with him. I know it will pass. I keep reminding myself it will. 

Dad looked past me this morning. “Is that Britney behind you?” 

“No, Dad, it’s not. Is it someone friendly?” 

“I think so.”

As he looked out the window, “I don’t see a car there.”

“No cars, huh.”

“No cars.”

"I bet there will be some later." 

Around nine this morning I got six cheer me on text messages one after the other from different friends. Then a message from Betsy. No words, simply a link to Barber’s Adagio for Strings. 

Dad was finally still and I could be, too. I turned on the music. I held his hand. I cried from weariness. I cried for the men killed this week. I cried because each octave shift is a step closer to unbinding. I cried because my dad is dying.

Then back to the present. It's bath day. 

 

Martha Jo Atkins, Ph.D., LPC-S is the Executive Director of Abode Contemplative Care for the Dying in San Antonio, Texas. Dr. Atkins is a professional counselor, coach, and researches and teaches about the trajectory of dying. You can learn more about Abode Contemplative Care for the dying at www.abodehome.orgYou can learn more about Dr. Atkins at www.marthaatkins.com.

In-Between

Evenings bring out a different Noble. Repetitive movement with the kleenex, working to fold and unfold. Eye glasses off and on and off. Pulling the sheet towards his eyes to wipe them. Pushing sheets away then pulling again. Rubs right eye. Rubs left eye. Looks for kleenex.

As evening turns into night, Dad’s sentences come out garbled. He’s here then not, eyes present and in a flash, a look that tells me he’s far far away.

He’s back in the morning, greeting the loves who come to visit him. 

“Hi, Sweetie.”

“There’s John-o.”

“Hi, Liz.”

"Is someone at the door?"

"No, Papa. Well, maybe." He's beginning to hear things we cannot.

This morning, Doris and Dee, two of Dad's caregivers and friends came as they do each morning before starting their day. They were off shortly to give morning baths. “Help the ladies smell pretty”, he told them as he waved good-bye. 

He had coconut cream pie for breakfast and afternoon snack, along with orange sherbet. Perfection. 

His face is changing, cheeks sinking in a bit.

“Your arms are getting thin, Dad.” 

“Yes.”

More pain medicine yesterday and today than others days though still not much. He is comfortable and peaceful, and more present than I imagined he'd be now. 

Jo Buyske recommended a Tennyson poem, Crossing the Bar.

Last year I helped a client think about what he wants at end of life. He wasn’t dying though he wanted to be prepared for when he was. The Tennyson poem is one he wants read to him. I was unfamiliar with it so he sent it along. 

I was happy to see Jo’s recommendation of the same poem. She included a link to music and the poem combined. I remembered it this it afternoon. The meaning is rich for me in new ways now. 

Jasmine, hospice aide extraordinare, was giving Dad a bath. 

“Hey, Dad. Do you know a Tennyson poem with the phrase Crossing the Bar?”

Eyes closed enjoying his scrubbing. 

He opened his eyes and looked to the ceiling.

“Yes. Crossing the Bar is the title.”

He closed his eyes and recited slowly:

"Sunset and evening star, 

      And one clear call for me! 

And may there be no moaning of the bar, 

      When I put out to sea, 

But such a tide as moving seems asleep, 

    Too full for sound… 

When that which drew from…

When that which…

When that which..

No moaning of the bar…

Turns again home…

He couldn’t find the words, this man, who a few weeks ago could recall word for word poems he’d first learned in 1935.

Mouth momentarily dry, lips sticking to teeth.

“Let me get you some water, Papa. May I play a rendition of the poem for you?”

“Yes, please.”

While Jasmine finished bathing his thinning legs, I sat at the head of the bed and balanced my Macbook close to his good ear.

His tears didn't start until "when I see my Pilot..."

Mine started at "may there be no sadness of farewell when I embark..." Shooo. 

Then there was sleeping.

It's evening again and he’s stepped back to an in-between place.

The Shears came to visit tonight and I watched Dad pull himself back here for a few minutes. So much energy to do that. Then away again. Then back to bid me adieu. 

“I’ll see you in the morning, Papa.”

“Where are you going?”

“To sleep at motel.”

“Oh, that’s good.”

A kiss on his forehead for him.

An affirmative nod for me.

Goodnight.

 

Martha Jo Atkins, Ph.D., LPC-S is the Executive Director of Abode Contemplative Care for the Dying in San Antonio, Texas. Dr. Atkins is a professional counselor, coach, and researches and teaches about the trajectory of dying. You can learn more about Abode Contemplative Care for the dying at www.abodehome.orgYou can learn more about Dr. Atkins at www.marthaatkins.com.

Doors, Doors, and Metaphors

Courtesy of Enspire.deviantart.com

Courtesy of Enspire.deviantart.com

Fabeku Fatumnise, a friend and teacher of mine, taught me a phrase one his teachers taught him; Fire makes a way for itself. 

The heat and cool patterns Dad was experiencing last week ceased for a few days. 

Braxton Hicks contractions. The Google says they “can be first felt around mid-pregnancy and increase in frequency and strength as your pregnancy progresses.”

Dad’s full on labor, the pushing that will help him leave his body, has yet to come. I wonder though if the first wave of heat and cool helped usher in the place he’s in now, fire making a way.

He asked earlier today if he had a fever. “I don’t know, Papa. Do you think you do?” “Maybe.” I didn’t check to see. The conversation didn’t feel like we were talking about practical matters but something else.

Last night I saw a change in Dad’s connection to here. This is the first time in a few day that’s happened. He was fidgety, folding and refolding Kleenex and moving to and fro in the bed - two things he’s not done much at all. He was inside himself, not talking much. 

He’s been spot on the last three days, calling friends by name, calling staff by name, telling visitors about the beautiful flowers gifted to him from his church brought over by "my good friends, The Tuckers". He's had lots of orange sherbet and juice. So much juice!

He's giving us clues now that he is in process, slowly and surely making his way to full-on labor.

Yesterday afternoon he asked, “How did I get to this room?” This is a big signpost that things are changing. The present reality is giving way to another one. 

The metaphorical language has begun in earnest. 

"I don't want to leave to late." As John says, Dad was not talking about Texas Central Standard Time.

“Has the insurance man been by to see about fixing the car door?” This is a wiz bang metaphor as it encompasses travel and his ability to do it. Something needs change so the car can go safely, so he can go safely.

Dad has begun now, as many dying people do, to talk about doors. He started with the car door which is not not broken in real life. He talked about a swinging door this morning and wondered if someone would be behind if it swung open. He asked John, “How did you get in here?” John told him through the door in living room which Dad couldn’t quite imagine. He’s lived in this apartment for ten years. Doors and the language around them important to this process. 

Tonight Dad’s been moving his legs in the bed repetitively. 

“I don’t know why I feel so wrapped up.”

“You’re gonna get unwrapped, Papa. You’re gonna get unwrapped.”

“Ok.”

“I’m twisted.”

“You’re twisted. What can we do to get you untwisted?”

“Sweetie I’m not sure.”

He’s been restless for an hour or so tonight. He’s pulled the sheets and blanket off of himself. He’s checking his watch. Lifting his left leg again and again. I asked if he’d like some medicine to calm him. “I believe I would.”

Another metaphor.

"I wonder how to make my bed go up.” I dutifully raised the head of the bed. He responded, “Well, that’s one way.” Ha. 

The language of getting up and out will give way soon to physically trying to get up and out of bed, his external self trying to make sense of what his internal self needs.

He's doing his work. We're supporting him as best we can. For the record, my brother's a rockstar caregiver. 

Thank you for coming along and witnessing this time with us. The writing will help me remember, synthesize and teach. For now it's helping me make sense of what's happening in these moments. The stories you all are posting and sending me about your own experiences are wonderful. I can’t respond to them all. I am reading them and I do thank you. 

Time for hand holding and ice cream eating.

Happy 4th. 

 

 

Martha Jo Atkins, Ph.D., LPC-S is the Executive Director of Abode Contemplative Care for the Dying in San Antonio, Texas. Dr. Atkins is a professional counselor, coach, and researches and teaches about the trajectory of dying. You can learn more about Abode Contemplative Care for the dying at www.abodehome.orgYou can learn more about Dr. Atkins at www.marthaatkins.com.

 

 

Inside Out, Outside In

Albert and Dad.jpg

I don’t know if the Right Reverend was rallying today or what. Mercy he was with it. 

For the last week he's mostly been inside himself doing his work. Today he was more with us. 

He woke up with “one matter to think about”, wondering if the his insurance company been called. Not yet. We will. All is well. John and I did the wide eyed look at each other when Dad started talking because really, he's been wayyyyy away.

Then Dad looked at me. “I had a dream.”

Now I’ve been asking him about dreams for the last few months. I was Delighted with a capital D to hear he’d had one worth mentioning though he couldn’t tell me about it. (If you want something interesting to read, look up the Buffalo hospice research about dreams and the dying. Good stuff.) 

Then, “Has the insurance man been by yet?” “Is there someone parked outside?”

We told him we hadn’t seen the insurance man and suspected yes, someone was parked outside.

When my friend Laurie was on hospice she talked about people in the hallway having a party. And she fretted over not being able to get a ticket to the big show because she didn’t have her purse. Michele and I reassured her the ticket would be ready and waiting when it was showtime.

Dad’s in a similar place, waiting for the folks outside to start coming in. They’ll be along shortly. 

This afternoon he closed his eyes for a bit. He woke himself up (and scared the crap out of me) looking to the left of his bed speaking with vigor, “Hello, hello, helloooo” as though trying to get someone’s attention. 

There was grief today, too. He cried a couple times. No words spoken. Much emotion. From all of us. 

“This is a sad time. It must be so difficult to leave. We’re sad, too. We’re going to miss you so much.”

Dad's asked quite often, "How are you feeling?"

Not bad and better are his two favorite replies.

He offered a new one today. "I feel like I'm getting closer to going home. I'm feeling alright."  

I had a ball of anxiety in me the size of Kentucky this afternoon. Rachel showed up at the exact right moment and took me to Wal-mart for a walk-about - as good friends do. Anxiety dissipated. July 4th T-shirts purchased. Reset complete. 

Tender moments. Sweet moments. Smiles. Many pieces have came together to make a good day:

John feeding Dad a wee bowl of orange sherbet. 

7 Brides for 7 Brothers. 

Nonagenarian Vi stopping by to cover Dad’s toes.

Nonagenarian Albert getting a greeting from Dad by name. “Hello my friend, Albert.” 

“Glenn, let me shake your hand.” (Glenn is not a nonagenarian. He IS a contrarian and we like that about him.)

A prayer shawl received from Cousin Carolyn and a group of loves from the Church of Reconciliation in San Antonio.        

Our 3rd Louie Mueller BBQ lunch. 

Blue Bell, John, and Erica came visiting and Blue Bell got on Dad’s bed for few minutes. 

More Masonic brothers.

Talk of Jim and Dorothy, brother and mother we imagine are around.

It's been a good day.

“Dad, Suzette’s staying with you tonight.”

Big grin...“Well that’s alright.”

“We love you.”

“Goodnight Sweeties.”

“Goodnight Papa.”

 

 

Martha Jo Atkins, Ph.D., LPC-S is the Executive Director of Abode Contemplative Care for the Dying in San Antonio, Texas. Dr. Atkins is a professional counselor, coach, and researches and teaches about the trajectory of dying. You can learn more about Abode Contemplative Care for the dying at www.abodehome.orgYou can learn more about Dr. Atkins at www.marthaatkins.com or find her on Facebook here or here.

Labor

When Mother was dying, I didn’t understand about the dying process the way I do now. Jane Marie reminded me there's hard won knowledge we can only get through living. I've surely learned much through my work. The nuanced learning though, has come from family and close friends.

Jim helped me learn. Mom. Laurie. Gloria.

Dad helped me a couple years ago.
He’s helping in a new way now.

Dad felt warm to me yesterday. Slight fever. Nothing to do about it.

Linda, his hospice nurse came for her visit. Vitals were fine. No fever. Took me an afternoon to understand what was happening. Linda helped me see it.

Once upon a time I was visiting with a pregnant friend when she started having ‘cramps’. I’d never had a baby so I didn’t know what was up. The women sitting on either side of her, whose faces my friend couldn’t see, glanced at each other with knowing looks.

Labor. My friend was in it.

My father is in it now.

Dad’s experiencing a waxing and waning of heat and cool as his body works to release his spirit. Just like labor pains, the cycles are far apart first, then get closer and closer together until the cool stays.

As Dad gets further into the laboring, he moves farther away, especially in the warm cycles. He spoke few words yesterday. He's a bit more present this morning. It’s easy to assume our beloved dying are not with us - can't hear us, aren't present -  in this process. Not true.

See the picture at the top? John showed it to Dad. Dad’s response, a smile and “Woof!”

Most of the time there’s a far away look when Dad’s eyes are open. Ester or Debi’s voice or Helen or Gloria’s touch have brought his focus to present time. He doesn’t stay long - 10 seconds, 20 seconds if we’re lucky.

His eyes were wide open and he was away when Rev. Clifton Howard made his second visit late in the afternoon. He came back for a moment.

Rev. Howard took Dad’s hand and stood there. A strong tower of peace. He didn’t talk. He didn’t move. He didn’t fill the space. He was utterly and totally present. In his silent steadiness Dad closed his eyes and went to sleep. Then the 23rd Psalm. In that container, I had space to cry.

I read Agatha Christi to Dad last night, right up until his brow was furrowed.

"Dad, are you hurting?"

"What?"

"You’re frowning. I wonder if you’re in any pain?"

"No."

"Do you want me to keep reading?"

"NO".

I closed the book and found music. Debbie Gordon sent this version of the Lord's Prayer with Andrea Bocelli and the Mormon Tabernacle Choir. It’s glorious.

I wondered what was next. I remembered a conversation at the hospital Saturday morning. We talked about his funeral.

“Dad, I’m so sorry you’re going to miss it. It'll be a beautiful service.”

I decided as we sat together last night I could play the pieces he’s chosen for that day, ones he loves so much.

First, Panis Angelicus.

Then as Sancta Maria was playing, Dad turned his head to the window and reached out toward someone or something.

“Ahh, Papa.... They’re here.”

He closed his eyes around midnight. I closed mine.

This morning when he's awake, Dad’s been present - smiling, drinking a little juice, saying ‘hi sweetie’…. Jasmine is washing his hair and we’re listening to Bocelli again.

Grandson and Great Granddog have arrived for the day.

Rev. Steve Langford came by. John encouraged Steve to talk to Dad.

"No, let's let him do his work."

Yes.

 

Martha Jo Atkins, Ph.D., LPC-S is the Executive Director of Abode Contemplative Care for the Dying in San Antonio, Texas. Dr. Atkins is a professional counselor, coach, and researches and teaches about the trajectory of dying. You can learn more about Abode Contemplative Care for the dying at www.abodehome.orgYou can learn more about Dr. Atkins at www.marthaatkins.com or find her on Facebook here or here.

Oh Yes I'm Nigh to Dying

He’s wearing a blue checkered pajama top this morning. Suzette reminded me about cutting it up the back, right to the collar and slipping it on over his head. Worked like a charm. He’s been dressed in something he loves and we’ve not had to wrestle his body to get it on him. 

My brother John trimmed the bendy straw to half size so Dad wouldn’t have to work so hard to get the juice into his mouth.

Simple things that makes this hard thing a little easier. 

John, the Grandson and Blue Bell, the Granddog have been steady presences. 

Dad's beloved niece and nephew drove from New Mexico to sit with him a few hours and tell him how loved he is. They left and things began to change.

He offered one word answers to questions or repeated some of the words we said.

"Let's move you up in the bed, Papa."

"The bed." 

He asked for a white pill for the pregnant male dog (not a typo) at which point I found a thermometer. He had a wee fever. John and I stayed with him until he fell asleep. John sang to him. It was a tender a beautiful evening. 

I wondered if he’d talk again. If he was gone from us. He slept. 

Before the birds were up, I closed a door in his room.

“Who is there?”

“It’s me, Papa.”

He did his crinkly eye smile and said, “I'm a lucky man.”

I'd clipped a microphone on his collar the night before. I turned on the voice recorder. 

In the dark of the morning he recited a poem, starting then stopping then starting again, his voice rising and falling as it does when he’s reading poetry or scripture. 

My master bid you come with me if your name be Barbry Allen. 

Slowly slowly she got up and slowly she drew nigh him.

All she said when near she got was young man I think you’re dying

Oh yes I’m sick I’m very very sick

Oh yes I’m nigh to dying.

Oh yes I’m nigh to dying. 

And all because I love you so, hard hearted Barbry Allen. 

He went back to sleep. I held his hand. 

Out his window I watched the sun come up over the cornfield. Three canine escapees from the neighborhood paid us a visit outside. I took them treats on Dad’s behalf. A train goes by every now and again. The days are fast and slow.

Two Masonic brothers visited. I mentioned the steady stream of Masons coming from surrounding communities to see The Right Reverend, as one calls him. 

“There are so many of you showing up here.” 

“Ma’am…. he always showed up for us.”

I read to Dad from his prayer book. His eyes were closed and I wasn’t sure he was with me until I got to the end of a passage and heard, “Amen.” Made and makes me smile.  

Yesterday Dad could put his lips around the little straw. He’s having a harder time with that this morning. There is fever and a little fidgeting. I asked for the kitchen to stop sending food. Steps in the process.

Nothing to fear as he draws nigh.

 

Martha Jo Atkins, Ph.D., LPC-S is the Executive Director of Abode Contemplative Care for the Dying in San Antonio, Texas. Dr. Atkins is a professional counselor, coach, and researches and teaches about the trajectory of dying. You can learn more about Abode Contemplative Care for the dying at www.abodehome.orgYou can learn more about Dr. Atkins at www.marthaatkins.com or find her on Facebook here or here.

Village Making

After the burly guys from the ambulance shifted Dad from the hospital bed to the stretcher, one asked how he was feeling.

“Well, after receiving my diagnosis last night, we have clear answers and that's good. We’re glad we came to the hospital. I have the peace of God in my heart.”

In the emergency room the night before, Dr. Farmer deftly lead my father to understand he was dying. The words he chose were kind and sure.

Dr. Farmer looked at Dad. “Earlier this year your kidney function was 1/2 of what it should be."

Dr. Farmer looked at me. “Then it went to 30%.”

Back to Dad. “Now it’s at 10%.”

I moved my chair next to the head of Dad’s bed so the tennis match head moves could stop.

“This condition isn’t reversible. You can start dialysis or you can tell me to go to hell. If you were my grandfather, I’d want you to go home and have time with your family.”

Silence, and tears rolling down Dad's cheek and mine.

“Mr. Atkins, these decisions shouldn’t be made in the emergency room. Let’s keep you over night.”

Dad wanted me to go home for awhile and I understood his introverted self needed time to process. I asked if he’d like to talk to a chaplain. None were on-call that night so the house supervisor came, a woman who does hospital visits for her church. She and Dad had a good talk.

I was back before the sun came up Saturday morning. When the tech arrived to draw blood, after much tapping, she couldn’t find a good vein. “Dad, if you don’t want to have your blood drawn, you can tell her.”

In his basso profoundo preacher voice he told her politely and deliberately, “I don’t want to have my blood drawn.”

With that all medical interventions for curing ceased.

We are at Dad’s assisted living now, in the apartment he moved to in 2006 soon after Mom died. These people, the residents and staff, are family.

There’s been a steady stream of oldsters coming in to kiss him or hold his hand or cry. I’ve noticed they park their walkers outside the door and come in on their own power. It’s quite something to see.

A staff member came and held his hand yesterday, then asked for ‘her blessing’. Dad put his hand on her head and proffered a prayer for her to be a light to the residents she’d see during her day. I learned this morning he has done this for others here for a long time.

Dad’s mind is sharp. His funeral service prepared. Burial instructions given. He’s considering how much time he has left. He’s sad. He's thoughtful. He’s peaceful. He’s grateful for his life. Forgiveness has been ask for and given.

With Dad’s permission and full understanding, I started making videos yesterday. He wants to help me teach, an astounding legacy I will hold with great care.

I said to Dad Saturday morning, "this is so hard, and so good that your mind is clear and you can give and receive love and tell people goodbye and they can tell you good-bye... And my goodness I'm going to miss you."

An extraordinary village is coming together to walk Dad home. Such a sweet and tender time for which we are incredibly grateful.

 

 

Martha Jo Atkins, Ph.D., LPC-S is the Executive Director of Abode Contemplative Care for the Dying in San Antonio, Texas. Dr. Atkins is a professional counselor, coach, and researches and teaches about the trajectory of dying. You can learn more about Abode Contemplative Care for the dying at www.abodehome.orgYou can learn more about Dr. Atkins at www.marthaatkins.com or find her on Facebook here or here.

 

 

 

Let's Get Started

At dinner last night, a well tequila'd woman was talking with high volume and animation about her father. I turned in time to see her eyes well with tears, a signal to me of an important story.

She shared with all of us in earshot, "The night he died, he saw my mom and his sister on the couch. I told him he was hallucinating." I smiled. My beloved smiled. We knew there was more to story. I want you to know, too.

I'm Dr. Martha Jo Atkins. You've found my new website and blog. Welcome.

After the death of my friend Laurie last week, I've come to know the time to do my work in the world is now. That call has never been stronger. I'm paying attention.

I teach about dying. Specifically, I teach about the trajectory of dying and the Signposts; the changing sights, sounds, and behaviors many dying people experience as they are taking leave of this world.

I believe in my bones if you know what to watch and listen for, if you have context, the dying experience with someone you love can be meaningful in ways you didn't know it could be.

If you're the dying person? I'm told, for some, there is comfort and helpfulness in hearing what has happened for others who have gone before you.

I became interested in end-of-life experiences after I watched my mom in her dying process. Here's a 3 minute 36 second story about that:

Interest morphed to fascination when I saw the changing patterns of dying, something I hadn't recognized until I watched my father engage in many of the experiences I'd researched for a decade.

Language changes as people near their end. What they see and where they see it changes. What they hear changes. How they engage in the world changes. The energy of these changes can be tracked. I want to teach you how.

I love this work.

I love the mystery and the elegance of the dying process.

I love the patterns that emerge over and over with dying people across the world.

I love helping family members make sense of what they're seeing, hearing, and experiencing.

I believe If you have context about what's happening as your beloved is dying, you can make meaning in new ways.

If you can make meaning in new ways, the leave taking of your beloved and the resulting grief will both be richer.

We're all gonna die and we're all gonna experience the death of someone we love. This is part of the wholeness and fullness of life. Here, we will embrace dying and all that it is. We'll talk about the big questions and the mundane ones. We'll help each other along.

If you'd like a head start on the conversation, go pick up a copy of my new book, Signposts of Dying. It's available for Kindle and will be available in paperback the first of April.

Dying is inevitable. All the pain, fear, and madness that often surrounds dying doesn't need to be.

My goal for this work?

To teach a million people about the Signposts of Dying.

To move the energy of dying away from fear and towards love.

To help grieving daughters like the one I heard last night consider the possibility that the hallucination could be seen another way. Maybe, just maybe her mama and aunt were there to help her dad as he was leaving this world. I believe that. I believe there is more to the story.

I invite you to join me in this conversation. Let's see what we can discover together.

Welcome.

 

 

Martha Jo Atkins, Ph.D., LPC-S is the Executive Director of Abode Contemplative Care for the Dying in San Antonio, Texas. Dr. Atkins is a professional counselor, coach, and researches and teaches about the trajectory of dying. You can learn more about Abode Contemplative Care for the dying at www.abodehome.orgYou can learn more about Dr. Atkins at www.marthaatkins.com or find her on Facebook here or here.