My mom spent her last days in pain morphine and fentanyl never conquered, flat on her back in a rented hospital bed.
Until her mind failed her a couple of years back Patricia Ann Harvey Koenen went to church every day, organized prayer chains and funeral lunches, ran Camp Grandma for all the family’s dogs and stayed in close touch with a score of relatives.
Slowly parts of her melted away and though she didn’t see an issue with the meatloaf left cooking (on low) for three days or the donations she made to pseudo-charities (“they sound so nice”), when she missed church by nine miles one morning she finally agreed to look at an assisted living facility.
That made my brother and me happy, which probably had more to do with her decision than her wants.
She began in an independent two-room apartment, though she somehow managed to lose both phones on the system, her purse and even a pair of glasses. At meal time she always graciously accepted the day’s special.
Yet, the building became too large for her and she transitioned to Memory Care. (Though she believed – at first – the reason for the move was to fix a leak in her apartment’s ceiling…which really was a problem.)
Throughout the building the staff loved her. She was always happy and polite. Her physical health slipped and she needed a couple of trips to the hospital (along with a replacement pacemaker), still, her attitude never wavered.
Despite frequent therapy, walking became harder but a walker helped with that. She went all about the Memory Care floor, often spending the early hours of the morning talking to the staff.
The combination of issues with her memory and her heart kept further limiting her world. In recent months even getting up from the dining room table became a challenge. Still, once up so motivated about the floor.
Very early on the morning of Sunday, August 3rd she got up from her bed – and fell hard and flat to the hardwood floor. She managed to drag herself about a dozen feet and climb up on the love seat near the other end of the room. She bled from a wound on her head and multiple skin tears on her arms. She was badly bruised too. The staff called me a bit after 5:00 a.m. She had begun receiving hospice care several weeks back and the on-call hospice nurse determined that she had probably broken her left hip.
X-rays at the first hospital confirmed that. Alas, that facility no longer has orthopedic or gerontology services. (They don’t deliver babies either.) That meant another painful ambulance ride to a hospital 28 miles west.
There the bad luck continued. That facility’s staff explained that mom wasn’t a candidate for surgery due to her age and overall condition. In effect, she would get the same lack of care as at the first hospital.
Monday the chaplain suggested it was time for family to all come and visit.
She rallied and, less than 48 hours later – still in incredible pain – the hospital wanted her gone. A pointed discussion with an attending physician (who seemed to think he outranked God) took a good bit of effort but got mom one more day in the hospital. Still, Thursday afternoon she returned to her room and her bed.
Now here’s a flaw in the way Medicare works: while in the hospital virtually all of mom’s care cost her next to nothing. Even with an approved hospice diagnosis, to get mom the close care she needed at the assisted living cost us $1,080 a day above the $10,600 a month Memory Care charge. My brother and I spent great portions of each day with mom. While we love her dearly we weren’t trained to handle liquid morphine and fentanyl patches, nor did we know how to change a Depends without putting any pressure on her damaged left hip. The extra cost was steep – and unavoidable.
Fortunately, that extra cost would not be an issue for a good while. Yet, it hurts to know that others who need similar care don’t get it because their pockets don’t reach as deep. No one last days of care ought to be determined by their bank account.
Even while thrashing about my mom always said thank you when she got her medicine, a spoonful of oatmeal or a bit of ice cream. Numerous staff who knew her came by to visit. She tried to smile for them. Yet the pain prevented her from sleep or rest. From Thursday till Tuesday afternoon we guessed she had earned less than two hours sleep, total, and ingested just a couple of hundred calories of food and less than a half glass of water.
Despite a tremendous love of life, late Tuesday my mom rested. Wednesday evening, August 13th, at a quarter after 6:00 p.m., she left us.
The good she accomplished in her 90 years, six months and six days will not be forgotten. Nor will be the agony, despite her kind words, of those last 10 days.
Glenn Koenen