On Tuesday, I talked to my mom and she informed me that she had taken Nan Naw to the emergency room due to tachycardia and shortness of breath. Her being short of breath is really not a surprise to us, because she has been on oxygen for several years for her COPD and pretty much any activity made her short of breath. However, her shortness of breath had increased over the past several days and when she went to a routine doctor's appointment on Tuesday he instructed my mom to take her to the hospital and not let them send her home until they figured out what was wrong.
After hooking her up to the heart monitor at the hospital, they found her to be in atrial fibrillation with her heart rate being 150 - 160's bpm. That was new for her, and definitely explained why she was so short of breath. After finally starting an IV line on her, they started administering her blood thinners to prevent her from having a blood clot that would cause a stroke. They ended up doing a cardioversion on her heart to shock it back into rhythm on Thursday. One shock did the trick and that seemed to help improve her shortness of breath. On Friday, they ended up putting a central line in her after she already had a mid line put in the day prior. They were having a hard time obtaining her blood pressure and they were wanting to administer two units of blood to her. The reason for the blood loss was apparently due to a pulled muscle in her right groin which she sustained prior to her hospitalization. Even on admission, she had a slight bruise in that area that the nurse questioned her about, but she had no idea how it happened. After getting blood thinners for several days, it caused blood to leak out into her leg which caused her to have a very swollen and painful leg. They did multiple ultrasounds on the leg to check the leakage, and even talked about the possibility of taking her into surgery to drain the excess blood in her leg, however they doctor did not want to do that due to her condition. Of course, Nan Naw told mom she wished I was there, since I am the nurse of the family, but understood that we had company as well as my two little ones at home. Mom did ask the doctor that day about Nan Naw's prognosis and he told her he felt it was pretty good, however he knew she would have to go to a skilled nursing facility when she left there because she would not be able to take care of herself in the condition she was in.
On Saturday morning as I was making breakfast for everyone, I received a call from mom that was not good. She said we had some decisions to make in regards to Nan Naw. I braced myself as I waited for what our options were. She said that Nan Naw had a bad night and was now on bi-pap. Apparently her kidneys had pretty much shut down, which she really only had one good functioning one to begin with. The doctor told mom that they could intubate her and start dialysis on her and try to do what they could with her leg, however her chances were 25% and if she did make it, she probably would have no use of her leg. If they removed the bi-pap as well as the medication she was on to keep her blood pressure up and did not start dialysis, she would probably die within 24 hours however he was willing to admit her to Hospice and keep her on her bi-pap until we got there and they would remove it whenever we were ready. After weighing the pros and cons, mom and I knew that Nan Naw did not want any extra measures and the life she might have if she did make it would be a miserable life for her. After much thinking and contemplating, we decided we would let them remove her bi-pap after my sister and I arrived there and could visit with her and then when the good Lord decided to take her then so be it. Mom never discussed the final options with her because honestly, we think Nan Naw knew she was going to die the day she was admitted to the hospital. That day she started telling my mom who to call if she died and told mom where she had hid money in her house. She also reminded my mom that Paw Paw, her husband, had died on October 22nd eight years earlier - to which mom asked her if she was going to join him on that day and she never answered.
So Melissa and I got our families squared away, packed up our stuff and along with Casen headed to Kerrville. We arrived there at about 4:20 pm on Saturday evening and drove straight to the hospital. Melissa was a wreck - she didn't know if she was going to vomit, pass out, or poop her drawers (she does not do well with these kind of situations). She thought if anything, she could tend to Casen and that would help distract her. When we got in Nan Naw's room, she was resting with her bi-pap on. Mom said it was the first time she had rested all day, even though she was so wore out from the day prior. She finally woke up after we had been there for awhile and was so happy to see us. She was probably even more thrilled to see Casen than she was us, which is OK - she loved her grand kids and especially her great grand kids. She asked about Camden and Melissa's boys and after we talked with her a bit, we told her to rest some more, which she did. Since we were finally able to visit with her, we went ahead and told the nurse they could go ahead and remove her bi-pap, which she did, as well as decreased the medication that was keeping her blood pressure up. They removed her monitors as well as a lot of the different IV lines she had and just told her that she did not need them anymore. Nan Naw never asked why or questioned anything they were doing. They made her comfortable and had orders for Ativan and Morphine to give her if she became too uncomfortable.
Sometime after 8:00 pm we decided to head to my parents house. We honestly didn't know if one of us should stay or what we should do. As a nurse, it was so hard not having the monitors to see what her vital signs were doing. We talked to her night nurse and she told us to go home and get some rest and she would definitely call us if needed. The next morning around 7:30 am, Mom and I were just getting up to get ready to go to the hospital and Nan Naw's daytime nurse, who had been with her the day prior and was absolutely WONDERFUL, called mom and told her she didn't think it was going to be much longer. I had not even fed Casen, so I went in and asked Melissa if she wanted to stay or go and she decided she would stay and feed Casen and tend to him. Mom and I got ready and were heading to the hospital and before we even got there we received a call around 8:10 am from her wonderful nurse who was crying telling us she had passed. When we arrived to the hospital we were greeted at Nan Naw's door by her nurse who hugged us both and was just crying. She said she was with Nan Naw, caressing her head and holding her hand as she left this life behind. Can I tell you, I had not seen my Nan Naw look so peaceful. For so many years, she had been so short of breath and was always breathing hard. It was nice to see her at peace. The nurse and chaplain prayed with us and just talked with us for awhile and then let us have the time we needed with her. I couldn't really believe she was truly gone. It was like I told my sister, I knew some medical issue would take her life, but I honestly thought it would be cardiac related - I just didn't see it being like this. But honestly, what a blessing that it happened so quick. I still have a hard time knowing that it was our decision that allowed it to be that way - but I still think it was the best decision.
Nan Naw was cremated and her ashes will be taken and placed with the remainder of my Paw Paw's (half of his ashes are in Toledo Bend Lake) and buried in a plot they have in Rolla, Missouri. My mom is thinking sometime in the Spring we will do that - better when it is warm. Since the majority of her friends have passed and she has little family left, we opted against a memorial service, which still seems a bit odd to me, but we can still have something when we bury her ashes.
We went and visited Grandma Key and then spent the rest of Sunday as well as today until about 2:00 pm when we headed back home, going through Nan Naws belongings and packing her things in boxes and throwing away things that needed to be thrown away. After Melissa and I chose the items of hers we wanted, my mom asked the people that watched over Nan Naw at her apartment as well as the workers there if they wanted any of her furniture or other belongings. Nan Naw would have loved that mom gave her stuff to those people because she would have my mom pick up candy for the workers to give to the children knowing that they did not have much to begin with. The workers told my mom that Nan Naw was one of the nice residents there - that was good to hear. The items left were then donated to a local hospice group that came to her apartment and picked the items up. Aside from her antiques and other family heirlooms, mom pretty much donated it all.
Can I tell you, it was a whirl wind of a few days. It seems like forever since Ronald and Manya were at our house, even though it was just a few days ago. Everything happened so fast and I still can't believe that she is gone. I am going to miss her telling me stories of when I was a little girl and how ornery I was - no matter how many times she told those stories, she would just laugh and laugh when she told them. As stubborn as she was, she was still my Nan Naw and will be greatly missed. I pray she is with Paw Paw for she had missed him so much since he has been gone and looked forward to the day they would be reunited.
Unfortunately, I don't even know of the last picture I have with Nan Naw because I was always too concerned about getting pictures of my boys with her. These are the last pictures I have of them with her.
