The Last Breath

a meditation on dying

What is it now? About three weeks. That’s when Jan’s mom signed the documents officially enrolling in Kaiser’s home hospice program.

In our marriage this is the third time we’ve lived with someone through the hospice process. Some twenty years ago my mother died while living with us. A bit more than a decade later my auntie died at home with us.

We’d retired a bit before Auntie died and had hoped to bring her home to California first. But it wasn’t in the cards.

Our intention at the time was to be near Jan’s mom, but not too near. So we could keep an eye out, but for neither her or us to feel crowded. Looking around the area, we purchased a condo in Long Beach right next to Los Angeles, which put us about an hour, a tad more, and even a lot more with traffic, from Jan’s mom. She lives in Tujunga on the north-eastern most part of LA tucked into the very furthest corner of the San Fernando Valley.

We were there about nine years before mom needed us on site. Then we sold our condo and moved in with her. We’ve now been here about two years.

While we’ve been in this rodeo three times, each is unique. The only fully mapped thing is someone died. My mother and auntie both died from reoccurring breast cancer.

Mom, Jan’s mom, is dying from extreme old age. She’s now 98. She will turn 99 right before we cross the six months prognoses. Of course that six months is a legal thing triggered by a doctor’s prognosis that unlocks medicare services. While many people die soon after entering hospice, it is not unheard of to live well past the six months. I personally knew someone who lived two years after the prognosis.

For mom the presenting issue is congestive heart failure. But she also suffers from COPD. (One of those ironies here is that she never smoked and never lived in a smoking environment. Unless, that is, you count the terrible smog years before the massive campaign to clean up the basin. I recall in 1991, when I graduated seminary and received the call to serve a church in the suburbs of Milwaukee, on our way there we drove south from Berkeley to visit mom and her husband in Tujunga. Driving down on the I-5 in our not quite falling apart VW bug. As we crested the grapevine into the LA basin we were met with tendrils of yellow brown green ick bubbling up. Like some science fiction monster. As we dropped into it our eyes and nostrils hurt, and continued so until we started east and were well into the desert.

Mom also has a host of lesser co-morbidities. All the fruit of living to be 98.

The worst of the many unpleasantnesses of this way to go is her struggling for breath. It was following the third visit to the ER and the second hospitalization in three months turning on difficulties breathing that led to the frank conversation with the doctor, and her entry into hospice.

Breath.

I’ve practiced with breath for many years as a part of my spiritual disciplines. I’ve given dharma talks on it, I’ve preached sermons on it.

Breath. Spiritus. Pneuma, Prana, Chi, Ki, to begin a list. Each being both the physical act of breathing and a spiritual assertion. Spiritual. Breath…

Diuretics have been her principal treatment for her congestive heart failure. And for a while now a boost of oxygen 24/7. She is tethered by a fifty-foot tube that allows movement throughout the house. Leaving the house is complex. What my auntie called a “muchness,” a lot of trouble.

And now about two weeks since that last hospitalization and treatment and entry into the hospice program she’s again having trouble breathing.

It’s not a big thing yet. And we may be able to handle it. But it scares her. I certainly understand that. Struggling to breathe is one of the worst things a human can experience.

Now she is ready to die. She has been ready to die for sometime. I can’t recall a week going by in the past six or more months without her saying she wished she could just lie down, go to sleep, and not wake up. Another favorite line for her is how she never planned on living this long.

She knows in her bones when she dies she’s going home to Jesus. So, she’s not worried about an afterlife or not, or even what it might look like should there be such a thing. There’s heavenk, and oh yes, hell. But she’s among the saved.

And there are differences between knowing this when breathing easily, and when gasping for air. Dead may be okay, dying not so much.

We have a few tricks up our sleeves in the next while. As I said, I feel kind of positive we’ll pass through this looming episode. She can get more oxygen. Possibly they can up the dose for her diuretic, although I have the sense that might not be in the plan. We also have a nebulizer, which we’ve not had to use yet.

And, should that not prove enough, sitting in bottles within reach there is morphine and an anti-anxiety drug to be taken in combination. Jan & I are familiar with those from my mom and auntie’s dying. But I think we’re a ways from that. And comforted its there if we need.

What I worry about for her, and to some degree for Jan and me, is when it gets bad, will she continue on this track, or choose to blow it off and return to the emergency room. A room we’ve all come to know rather well. That would end hospice, although we’ve also been assured she can always go back on.

Uncertainty comes with the territory.

And so lots of emotions. Lots of thoughts. Stories about how things will go. All meeting the moment. Changing and mutating and becoming new things.

True for me, for Jan, for mom. For those who know us and care for us.

Where I sit I hear the oxygen concentrator pumping away. In and out.

And I think of breath, of breathing. I think of my breathing.

I think of the last breath.

I think of how little control we have. I think of that control, as little as it is.

Inhale.

Exhale.

For a time to inhale again.

Breath. Spiritus. Pneuma, Prana, Chi, Ki, to begin a list. Each being both the physical act of breathing, and a spiritual assertion. Spiritual. Breath.

Our lives. Mom’s. mine. Jan’s. Yours…

The image of a Brahmin practicing Pranayama is from 1851.