Seventeen years ago today, myself, my youngest sister, only brother, and our spouses buried my mother.  Two days ago, I revisited the moments of my mother’s death as my brother lay dying.  Seven years prior he had survived a cardiac arrest, now he was home from a week-long intensive care stay having survived sepsis.  Naturally, since he could “come back from the dead” once with such alacrity, we all suspected he could do it again.  And indeed, he surprised his intensive care team by recovering and was released from the hospital in a weakened state but ready to do his part to rehab.  

Then the second day home he began to bleed.  I believe his refusal to go into the hospital was a foreboding-if he went back, he might not ever come home.  

As I walked into his bedroom, the smell of blood thick in the air, he said to me, “This is where I belong.  This is where I need to be”, and I told him that we would make it so.  His home health nurse, who had advised going to the ER, was there.

Concerns about his blood pressure and more bleeding were less frightening to me than the coolness of his hands and feet, the edema in his legs, and the faint mottling beginning on the soles of his feet.  My fleeting thought, “I don’t know if you will pull another miracle off this time, brother”.

Not unlike the experience with my mom, when my directive became “get her home on hospice”, for my brother is was “keep him home and get hospice NOW”.  We struggled for the next several hours with a less than optimum response from his primary care doctor, while having the local hospice team on stand-by waiting to do an urgent admission when they received the order.  

The nurse and social worker arrived in mid afternoon, with gentle words of support and reminded me of all the times I had been in their shoes—recognizing the immediacy of getting meds and equipment into the home before it was too late.

The bed arrived in the evening, with 3 burley fireman carrying my brother in a blanket from his bedroom to the living room, where he could perch between two couches with wife and sister on either side.  The meds arrived later in the evening.  He had not complained of pain, but cramping and aching had been his companions for the past couple days.  After his first trial dose of pain medicine, “get me another hit of that, sis”, was a comic relief moment.

The care of his body was constant that night, he tolerated our ministrations without complaint.  The work of his mind was concerned with making sure we were safe, was the house locked, would you make sure to get extra garbage service?—as the piles of wipes and chuxs became mountains.  He needed his phone.  Where was the controller? All these were his roles, taking care of things for his wife while he lay dying.  I became lulled by his clear headedness, asking for bites of yogurt, knowing me and saying my name, that perhaps he would linger for days.  He was strong willed, and had been so able-bodied.  Now my worry would be terminal restlessness, and how would we manage that for days?  

As though he knew, as though he had prepared so well for the moment, he simply asked for a little more of that medicine to help him relax.  His breathing became rapid.  With wife and two sisters at the bedside, aware of the change, we called his son to come.  Little sister recited his favorite childhood poem, “Now I lay me down to sleep, I pray the Lord my soul to keep.  If I should die before I wake, I pray the Lord my soul to take”, and his wife spoke words of love to him.  Within minutes he was gone.

I felt the finality as we sisters washed and cared for the shell of our brother.  I felt the finality of the family members who chose not to be part of his life.  I felt the finality of an only brother, gone from my life.  I also knew the gift he gave, the gentle passing he shared with us, the concerns he had for us at the very end.  He was right,  he died where he belonged, with loving family at his side.

It’s a common hospice tale.  

Peace and love brother, I will meet you soon enough.

Thank you to Cascade Hospice for making these precious moments possible for us.