Last Moments with My Best Friend

Belle and Maria

By Maria Williams

I lost my best friend a short time ago. As I sit here re-reading through the e-mail she sent me regarding her final wishes I find something I had either forgotten or suppressed. She asked, with great clarity, that I write about her final experience, her death. This is something Belle and I often spoke of in her final weeks. We discussed how there are detailed accounts, opinions and specifics about all other aspects of life: birth, marriage, divorce, illness, treatments, etc. Death, is the one aspect of life no one can really share.
I will attempt to convey Belle’s specific experience. Many of the signs death is approaching can be found described in the books hospice provides. These books were extremely helpful in the days and hours prior to her passing. However, she wanted to convey her experience in the hopes of helping to dispel some of the fear and mystery that surround death.
Let me back up to the past four weeks. Pain and nausea growing out of control leaving her dehydrated and needing IV fluids. This resulted in a three day stay at our local hospice house. It was here she was presented with options to manage both her pain and nausea more effectively. A pain pump was provided and the suggested use of applesauce to assist in swallowing her anti-nausea meds and other larger pills. These changes gave her better control over these two areas.
Over the next couple of weeks her pain pump had to be adjusted to manage her increasing pain. Along, with these increases came a decrease in appetite and greater confusion and difficulty completing routine tasks. Organization was one of the first skills to disintegrate. Each day brought dramatic changes in her health, always declining. Due to the nature of her tumor breathing became quite labored to the point of needing oxygen. With the physical changes came mental and emotional changes. Belle was trying to make sure “all of her bases” were covered. Recording messages to her children, purchasing gifts to thank those who had been helping her and ensuring she told those closest to her how much they meant to her. The latter was often given … by “you will never know how much you mean to me!” There were so many individuals heard these words, her only concern was if they were truly listening.
Next came her internal emotional conflict. This conflict was deep and between her duties as a mother and her need to care for herself. She wanted desperately to care for her children, check on her daughter when she had the flu, but her body was too weak and the danger of complications from contracting the flu too great to do what came naturally. Then coming to understand her capabilities were extremely diminished brought about tears and grief. She felt she was being selfish because she needed to withdraw from her motherly duties and focus solely on her own health.
Another example of her coming to grips with reality came during the last time we went shopping together. She wanted to purchase dahlia bulbs and asked if I would plant them for her. Then changing her mind and putting them back because she knew she wouldn’t be here to see them bloom. The realization her death was impending was more than she could handle. Often, breaking into tears and then coming to quiet uncomfortable resolve. It was at these times I would ask if she was still at peace with her decision to end treatment. She would firmly reply, “yes”, she just didn’t expect things to progress so quickly.” None of us had expected it to go this rapidly. Her health and ability were truly changing exponentially with each passing day.
The day before she slipped into unresponsiveness, she was having trouble with her vision, extreme disorientation, difficulty with thinking and speaking coherently. It was heart wrenching to see her in this state. She desperately wanted to make cookies and a cake for Valentine’s Day for her children. She wasn’t able to stand or read the recipe for longer than a moment. Her vision was causing her grief. It was at this point she found some construction paper and created a makeshift eyepatch on her glasses. After trying desperately to read and follow a recipe, she had made hundreds of times before, it was clear this just wasn’t going to happen. She finally and reluctantly conceded to allow Carol to finish making the cookie dough for her. She left the kitchen, went to her recliner put on her oxygen and fell asleep.
The next morning she was unresponsive. Stephen called to say he couldn’t wake her, the fear in his voice was overwhelming. He told me he’d called Hospice and asked if I could come as soon as possible. It wasn’t long after I arrived when she finally awoke utterly disoriented and needing to use the toilet. She was unable to reach the bathroom. Her body was quickly becoming deadweight. Once Stephen and I were able to get her back to bed we decided that she needed to be catheterized. This decision was not made because it would be easier, but for her sheer safety. From this time on she remained bedridden with limited lucidity. At first it was just Stephen, my husband and me to monitor her. Soon we were joined by other friends and her brother, Henry.
Pain management was a very real issue and was one of her biggest concerns. It was highly important to her to not experience any pain in the end. She was most fearful of being in excruciating pain as she lay dying. Once we realized her pain indicators, it made pushing her bolus button to manage her pain easier. What we had thought was her tumor pushing on her nerves and spine was actually a manifestation of her pain. Her pain sign was her leg or toes twitching. Her toes would start in the most subtle of ways and then ramp up until her leg was jerking most vigorously. Since she had no other way of indicating she was in pain we needed to watch her constantly. Sitting and holding her hand while monitoring her pain became a 24-hour-a-day labor of love.
Her last four days were spent in rotation sitting vigil and hoping for some glimmer of lucidity while monitoring her pain level. We were blessed with a few occasions when she could communicate fairly clearly. However, most of her time was spent sleeping. We would talk to her and offer her our love and words of how much she means to us. We could tell she was hearing what we were saying because she would squeeze our hands, smile, flutter her eyes and even make grunting sounds of acknowledgement. These gestures no matter how small brought us great comfort. It was during one of these times I witnessed an endearing moment shared with her husband. Belle was able to wrap her arms around Stephen’s neck and without saying a word she communicated volumes. He told her that he understood and could hear what she was saying, even though she didn’t utter a word.
As her breathing became more labored and her limbs started to her turn the palest shades of blue we knew the end was near. Her last day was different from the others, signs of pain were diminished and the need for constant boluses from her pain pump decreased. She was completely unconscious and unresponsive. Any glimpse of acknowledgement she was able to convey in previous days was gone. This day was spent watching for her last sign of life. This day was not only about spending as much time with her as possible but about giving those who needed a chance to say good-bye just that. Even though her passing was imminent there was a sense of serenity in the air. It was mere moments after her children had said their final good-byes and told her that they were going to be alright that she took her final breath.
We sat in her room, on her bed crying and saying what we felt needed to be said. In turn we each said, “She was the best wife, sister, mother and friend!” The final squeeze she gave my hand is something I will always remember. She passed peacefully with grace and dignity surrounded by those who loved her immensely. As she always said, “Cancer is not a Sprint, it’s a Marathon!” She reached her finish line on February 18, 2015 at 5:20pm.
Thank you to Belle for the honor of allowing her family and friends to be with her as she passed from this world onto the next. Thank you to her family for allowing her friends to be a part of her final days.