This Friday I watched my grandmother die.
While out to dinner Thursday night, I received a call from my cousin in California, "Grandma's neighbor found her unresponsive, she's on the way to the hospital in an ambulance. I booked the first flight I could, but it doesn't get in until tomorrow morning. You have to get there now!"
My Grandmother lived alone. Her incredibly kind neighbors would check on her every day. Thursday afternoon, they noticed she was laying on the bathroom floor. When they asked if she was ok, she told them she was cleaning the bathroom.
They came back a little later and she was still on the floor, nearly pulseless. At this point they called 911, and tried to assure her that help was on the way. She thanked them for always being there for her, then became unresponsive.
I drove 5 hours through an ice storm that night to get to the hospital, where Grandma lay in the critical care unit on a ventilator with a poor outlook.
While I knew one some level what to expect from my experiences in tissue recovery and pathology, nothing quite prepared me to see the other side of death. I walked straight onto the unit(rural hospital security protocols are slightly more relaxed than what I am accustomed to), expecting the worst, but no one prepared me for what I was going to see.
When someone is in this condition, they have a breathing tube down their throat that looks terribly uncomfortable. Their tongue is pushed back and their mouth is wide open. They try to breathe over the tube, and occasionally gag. Their eyes open, close, and dart around. They wince. Their hands and feet move and occasionally jerk violently. But they don't respond to commands, their eyes can't follow you, and their pupils don't dilate. The lights are on, but there's no one home. These responses are caused by random synapses firing in the brain due to the action of a temporary pacemaker. Multiple monitors in the room beep, alerting unconcerned staff to wildly irregular heartbeats and dramatically fluctuating blood pressures. Witnessing this for the first time is confusing and unsettling...and it's totally normal to everyone in the unit but you.
I tried to hold back the tears. Grandma wouldn't have wanted me to cry or be upset. She was always so stoic and acted as though everything was fine until the very end. On the phone a few days prior, she sounded completely fine, and asked about things I was doing in her usual strong voice. Recall that she told her neighbors she was cleaning the bathroom. She didn't clean the bathroom. Ever. I found no evidence that she was cleaning either. She wanted to go.
I held Grandma's convulsing hand and told her how much I loved and appreciated her, recounted memories of us, and shared what was going on in my life. Somehow I kept apologizing for the fact that she was here like this. She didn't want this. We knew she had a living will with DNR/DNI orders, but I didn't possess it. Her daughter had to be there to make medical decisions, and there was nothing I could do until she arrived. Unable to sleep, I just sat next to the bed and held her hand all night long.
By Friday morning, the convulsing and eye movements had slowed. After the nurse performed her exam, Grandma's only movement was an occasional, slight flickering of the eyelids. At this point I called my mother and sister, who were both unable to travel, and explained that sometimes people in a coma can hear what is said to them. I put the phone on speaker and held it up to Grandma's ear so they could talk to her. Whether or not she could hear them is unknown, but I think it helped them to be able to say goodbye.
Shortly after this, Grandma's eyelids stopped flickering and remained frozen in an half-open state. Her hands stilled and and stiffened. I'll never know for sure, but I think she was brain dead at this point. I had been requesting eyedrops from the nurses throughout the night and morning so her eyes wouldn't dry out. This enabled me to close her eyelids so she looked more peaceful once the rest of the family got there. That's the funeral director in me. I am glad they did not have to witness the contorted expressions on her face from the night before.
My aunt and cousin arrived from California with the living will expressing her wishes. They talked to grandma for about an hour, telling her positive and encouraging things. My aunt cried a little, while my cousin remained strong. I had no more tears left. I knew I needed to be strong for this part.
I watched as grandma's blood pressure dropped lower and lower on the monitor. When her heart went into a prolonged abnormal rhythm, the staff advised us that if we wanted them to take her off the ventilator, we should do it soon, as she was very close to death. We gave them the go ahead. The nurse informed us that she was going to turn off the monitors, disconnect the temporary pacemaker, and remove the breathing tube. She followed this sequence, then left the room as we said our goodbyes. Grandma died seconds later. One of the monitors played a four note beeping lamentation. We sat there in anticlimactic silence for a few seconds, in anticipation of something-I don't know what. When nothing happened, we started discussing funeral arrangements and I stepped out to talk to the nurse about disposition forms and funeral homes, returned and explained that the funeral home would come to pick her up after we left.
My aunt and cousin stopped to pick up pizza at my grandmother's favorite pizza place on the way to her house. Dairy-free me ate some of the crust in her memory.
The doctors and nurses didn't know much beyond the fact that my grandmother's heart stopped(complete heart block). Scans showed that her coronary arteries were clean. For her age, she was incredibly healthy, which is why this was such a shock. She went for walks almost every day in the warmer months. She was active and spent much of her time volunteering for Meals on Wheels and multiple church ministries. Eight months ago she helped my mom for a few weeks when she was hospitalized.
Her primary care doctor talked to me earlier in the morning, stating she seemed healthy, and that a recent physical showed nothing aside from low vitamin B12 levels. He didn't suspect cancer. I told him I knew what had happened. She had stopped eating and drinking. Her heart stopped due to dehydration/malnutrition. Her emaciated appearance, low potassium, and low calcium levels reflected my suspicions.
No one knew why, but we think she was depressed and didn't want to be here anymore. She was so stubborn, there was nothing anyone could do to change her mind. Neighbors brought her food, my cousin and I took turns travelling to her house to cook months worth of freezer meals for her. She barely touched any of it. When we spoke to her on the phone, she sounded normal and acted as though everything was fine. We suggested getting her a caregiver or having her move in with me or my cousin, but she wasn't in favor of any of it. Assisted living was definitely not an option. "Over my dead body" was what she said about letting a caregiver into her home, and she was serious.
My husband and I helped my aunt make funeral arrangements the next day. That was the easy part. We knew what she wanted.
Watching someone you love die is awful. Nothing can prepare you for it, not even 13 years working with dead bodies. What made this a little easier was knowing exactly what my grandmother's wishes were. I encourage every one reading this to make your plans known. Write your living will, tell your family and/or close friends, make your funeral arrangements, or at least tell people what you want. Do your Swedish Death Cleaning. I know it's uncomfortable, but it's such a gift to your loved ones. I am grateful my grandmother gave this to us(sans cleaning, but that's ok).