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Recent Musings

Swirling . . . swirling . . . down the drain     Posted on Communion Blog 20 May 2008

This is a story many of my friends know, and it’s bloody-well about time that I wrote it up.

So, about 25 years ago I was living in Montezuma, Iowa.  I’d moved there after college, wanting to spend a couple of years working while sorting out what to do with my life in terms of graduate school and so forth.  The old farmhouse I had bought at auction (a long story in its own right) had come with an established garden and many fruit-bearing trees.  Out of simple self defense, I had taken to doing a lot of vintning, and started to earn a reputation within the SCA for my various homemade wines.

One summer evening, late (about 10:30), after a long day of working around the house, I was racking off some rich, golden, crabapple wine for an upcoming SCA party.  It had been a very hot day (the house was without air conditioning), and all I was wearing was a pair of cut-off jeans.  Furthermore, at this point in my life my hair was long and my beard was full - I worked at a local radio station in a non-public role, and my employer didn’t care too much how I looked.

Anyway, I transferred over some of the wine into a gallon glass cider jug.  Since it was going to be drunk up in just a couple of days, I wasn’t too worried about properly corking the thing - the screw-top metal cap would be fine.  After finishing up, I took the bottle into the kitchen where I had a deep farmhouse-style sink, suitable for rinsing off the jug under hot water.

As I was standing there at the sink, letting the hot water pour over the jug, I looked out my window to the north, where on the horizon I could see the glow of the local fair grounds.  It was all lit up because the annual rodeo event was going on - this is the sort of thing that would have the entire town in attendance.  Not a lot happened in Montezuma, and people took advantage of what few opportunities came around for entertainment.

Looking out the window, thinking about this, my attention slipped from what I was doing for a moment.  And the jug slipped out of my hands.

I have very quick reflexes.  Always have.  One of the reasons why I was such a successful fighter in the SCA.  Unfortunately, my quick reflexes frequently get me into trouble.  Like this time.

I had instantly realized that the jug had slipped, and quickly moved to cradle the bottom of the thing to stop it from smashing in the deep sink.  My hands were directly under it when, unfortunately, the neck of the bottle clipped the edge of the sink.

In a flash I pulled both hands out of the way of the falling glass shards.  And I almost made it.  Except one fresh edge of broken glass managed to slice across my left wrist.  It wasn’t a particularly deep cut.  But if you hold your hands as though you were going to cradle something, wrists bent 90 degrees, you’ll note what happens to your inner wrist:  the tendons pull back from the surface of the skin.  And the vein and artery tend to push up against it.  That’s what happened to me.

As my hands flew away from the sink, a spray of brilliantly red blood streaked up the wall.  And onto the ceiling.

I have had a fair amount of first aid training.  Instinctively, I clamped my right hand across my left wrist, base of the palm up the arm to apply pressure to stop the bleeding.  “OK,” I thought to myself, “I’ll just roll my hand back, keeping pressure on the wrist with the base of the hand, and see just how bad the damage is.”

Blood spurted like some bad horror flick.  All over me, all over the window, and all over the sink and countertop.

“It’s bad.”

Now, what to do?  I couldn’t dial a phone - my left hand was numb and useless, my right hand needed to stop from bleeding to death.  Oh, yeah, the blood was still squirting with disturbing regularity between my fingers.

“Get help.  Go to a neighbor’s,” I thought.  I kicked open the door from the kitchen to the garage, and ran out into the street.  There in the street I looked up and down, trying to figure out which of the few houses in my part of town to go to.  Every one was dark - all the neighbors were at the damned rodeo.

I’m starting to worry a bit.

Then it hits me.  There was a nice octogenarian who lived at the end of the street, a bit more than a block away.  She wouldn’t be at the rodeo.  I ran.

Got to her door.  Could hear the TV blasting (she was a little deaf).  Frantically, I started kicking her front door, trying to get her attention over the sound of the TV.  “Lena!!”  I screamed at the top of my lungs as I kicked on her door “open up!  It’s Jim from down the street!”

A few long seconds later I hear her say “Coming!”.  Light on the small porch went on.  Door opened a crack.  She looked out at me, and her eyes grew wide.  The door slammed shut.

Of course.  Here was a long-haired loon, nearly naked, covered in blood and glass and wine, standing on her doorstep, raising hell.


I slumped down and sat on the edge of the porch.  The adrenaline burn was starting to give out.  I was getting cold.  I’d lost a fair amount of blood, and figured I was going into shock.  I needed to sit a moment and try to figure out what to do.

I heard a rattling of chain.  The door opened behind me.  Lena had had to close the door to remove the security chain.  She stood there, still wide-eyed and clearly started, but she stood there.  “Jim?”

“Lena, call an ambulance.  I need an ambulance.  Hurry!”  Montezuma is 20 miles from the nearest hospital, a little one in Grinnell which usually didn’t even have a doctor attending at night.  The amulance would have to leave there to come get me.

Door slammed shut again.  What seemed like an eternity later, she came back.

“Here, Jim, I brought you a towel so you can wipe yourself off a little.”

She was smiling.  I figured that I was dead.

“Lena, I don’t need a towel.  You have to call an ambulance.”

She looked confused.  “Here, I brought you a towel so you can wipe up.”

“Lena, I need an ambulance.  Hurry, please.” “Well, here, you’ll want this.”  She draped the towel across my shoulder.  “I did call the ambulance.  They’ll be right here, don’t you worry.”

I want to interject something here.  I have long known that I have the best bad luck in the world.  That is, I have bad luck - things happen that seem absurdly improbable - but then it’s like someone flips a switch and everything works out for the best.

I hear the sound of an ambulance siren.  From the fair grounds, not a mile away.

“See, here they come,” says Lena.

What should have been a 20 minute wait is less than three.  That’s a guess, of course, since by this point my sense of time was badly skewed.

The ambulance pulls up to the street.  I recognize the two responders who pop out of the back, because part of my job at the radio station was to get accident reports and so forth.  They recognize me, as well.

“Hey Jim, what happened?”

Briefly, I explain.  Said I figured I’d hit the artery.  They got me over to the back of the ambulance, sitting on a gurney.  One guy grabs a compression bandage, another holds onto me.  “OK, remove your hand, let’s see what we’ve got.  Just get a glimpse to see how bad it is, and then we’ll slap this compression bandage on and get you to Grinnell.”

I remove my hand.  Blood fountains.  Compression bandage gets slapped on.  I fall back onto the gurney.

“It’s bad,” says the driver, standing there watching.

Next moment, I’m strapped in, metal clip shutting off the artery on my upper arm, and we’re making about 90 mph to Grinnell.

Couple of minutes later, driver hollers back to me:  “Hey Jim, you’re in luck!”

“How’s that?”

“Oh, seems that there’s a doctor from the U of I who happens to be there at the hospital already.  Micro-surgeon of some sort.”


We get to the hospital.  Without further fanfare I’m wheeled into the OR adjacent to the emergency room.  By this point I already have IVs and whatnot.  They drape my arm, doctor comes in, freshly scrubbed.  Pokes around a couple of minutes.

“You are incredibly lucky.”

“People keep telling me that.”

“How did this happen?”

I explain.

“Huh.  Amazing.”

“How so?”

“Well, the position of your hand meant that the tendons receded.  All you did was slice the surface of the skin, and through both the artery and the vein.  And fresh-broken glass is sharper than a scalpel.  No rough ends, no damage to the tendons.  I’ll have everything neatly back together here in just a few minutes.”

He was true to his word.  About a half hour later, I was out of the OR.

“You can go home.  See your doctor in a few days for a follow-up.”  The surgeon nodded to a nurse.  “She’ll give you some information on caring for the wound.  And some pain-killers for when the stuff we gave you IV wears off.  Don’t drive tonight.”

“Well, my car is at home.”

“Can you get someone from here to take you home?”  asked the nurse.

“Yeah, just get me a phone.”

I called a kid who worked at the radio station with me.  He came and picked me up.  Pretty decent of him, since it was now about 2:00 AM.

We drove back to Montezuma, me mostly silent, somewhat in shock, somewhat dopey from the painkillers.  As we pulled into town, I told the kid to go around to the front of the house, and I’d let him in.

“Yeah, sure.”

We got to my driveway, got out of the car.  He went towards the front of the house. I went in through the garage, still fully lit from earlier.  It was like following a trail.  Of my blood.  Through the garage, up a slight couple of steps and turn into the kitchen.  Door still standing open from where I’d kicked it.  Sound of water running.

It looks like someone has slaughtered a pig in the kitchen.  Blood was everywhere.  I go over and turn off the faucet.  Look at the glass.  Look at the blood.  On the counter.  On the wall.  On the window.  On the ceiling.  I stood there, just taking it all in.

Until I heard the sound of someone walking into the kitchen from the front of the house.

I turned to see my buddy enter the room.  He took one look around, and vomited.

* * * * * * *

Addendum. It was because of this experience that I choose my SCA Arms, designed the way they are.  You can see them here.  What it is supposed to represent is a whirlpool.  Which is what I saw for just a brief moment when the jug first burst.  A whirlpool of golden crabapple wine, and my blood, swirling . . . swirling . . . down the drain.

Transitions     Posted on Communion Blog 28 February 2008

Last night, my wife washed off the blackboard which hangs in the kitchen.

* * * * * * *

I just got back from a quick trip to KC to pick up the first large load of books from the seminary.  Simple.  Got up this morning, usual routine, jumped in the car and drove to KC.  Met with the client.  Selected about 60 volumes to start with, wrapped them in cling film, boxed ‘em up.  Put the boxes in the car, drove home, pausing to check out a new store just off the highway - and amazing myself that I didn’t have to call home to coordinate the slight delay.

* * * * * * *

I sent this note to a friend:

Mostly I’ve been getting work done, at least in the afternoons.  Feels good to be able to focus in and do it - a nice affirmation, and there is that joy that comes with doing something well which most people can’t do.  Still struggling to shake off the last effects of the flu, which is annoying, but there is clear progress.
And that has been the real change this week.  Each afternoon I’ve been able to just dive in and work.  For hours.  Very productively.  Such a change.

* * * * * * *

It’s the little things.  Yes, there are the larger changes:  more sleep, no need to go around always listening to a monitor, being able to come and go as I please.  Those I expected, even if they have taken some adjustment.  But it’s the little things that catch you unprepared.

Last night, my wife washed off the blackboard which hangs in the kitchen.

The blackboard which for years had our contact phone numbers on it.  Those were first put there by Martha Sr. years ago, when her memory was becoming undependable and she might need to call someone for help.  Then they remained even once we moved in here, since both my wife and I still had our jobs elsewhere during the day.  After I closed my gallery and moved home that was no longer the need, but by then they were an institution.  More recently, long after Martha Sr had stopped using the phone, the numbers were there as a quick resource for the various respite care workers and whatnot, in the event of an emergency.

Last night, my wife washed it clean.  It was time to move on.

A Very Nice Time     Posted on Communion Blog 17 January 2008

With all the dignity and presence of a southern lady, my mother-in-law (MIL) held her self erect, looked at me and said "I’ve had a very nice time this evening.  And dinner was lovely.  And your performance, too, though I’m a little ashamed to admit that I can’t remember exactly what you did."

"Well, thank you!" I answered.  Then I helped her finish up on the commode next to her bed, and carefully laid her down for a nap.

It was 12:45 in the afternoon.  She had just finished lunch consisting of a peanut butter & jelly sandwich, Pringles, and some chopped pears.  Needless to say, there had been no 'performance' by me or anyone else.

* * * * * * * * * * * * * *

“I don’t know how you guys manage it,” said Lisa, the hospice nurse.  She had just finished her examination of my MIL, and had been going over what she saw as we talked after.  She’d mentioned the option to have an aide come over to sit with my MIL while we got out for a bit.

After my wife and I exchanged glances, I (or maybe it was my wife - these details start to slip away) said that we preferred to not both be gone at the same time at this point.  Why? Well, because it feels like the end.  We want to make sure one of us at least is here with her.

And it’s not just us.  Lisa commented that my MIL had never before looked so ashen, so grey.  We agreed that she would come again on Monday, unless we called her sooner.

* * * * * * * * * * * * * *

Her fever spiked about 4 degrees higher than normal last night, just as my wife and the overnight aide we have in three nights a week were getting her to bed.  I was washing the dishes when my wife came into the kitchen and told me, on her way to getting a Tylenol tablet for my MIL.  I dried my hands and followed her back to the bedroom.  We got the extra pill into her, I checked her pulse and the color of her fingernails, had her look at me to see whether she could focus or not.

She couldn’t.

I wondered whether she’d make it through the night.

She could.

* * * * * * * * * * * * * *

“My mother has passed on, but Auntie has taken over for her.”

“Auntie?” asked my wife.

“Yes, Auntie.  She has taken over for my mom.  I was waiting for my mom to come for me, but she’s passed on, so Auntie has taken over . . .” a pause, uncertain look around the room. “. . . everything.”

“Well, OK.”  My wife looked at me.  We’d been waiting for this.  Together, almost simultaneously we said, “MIL, if she comes for you, you can go with her.  It’s OK.”

“It’s OK?”

“Yes, when Auntie, or your mom, or your dad - when they come for you, you can leave with them.”

“I can?”

“You can indeed.  Until then, we’re taking care of you here.”

“But if they come, I can go?”

“Yes, you can.”

* * * * * * * * * * * * * *

We met with the social worker for an hour or so yesterday afternoon.  She is kind, intelligent, insightful.  She offered a lot of suggestions for us to consider, from a respite break (which would take my MIL to a skilled nursing floor at the local hospital for five days), to advice on how to better manage the stresses we’re under.

None of it was useful.

Oh, it was, in the sense that had we not yet considered those things, it would have been very beneficial to bring it up.  And neither my wife nor I were aware of the option for the five-day respite break.

But we’ve managed through these things long enough that I think, honestly, we’re doing about all that can reasonably be done to handle the stresses, to give ourselves (and one another) what breaks we can.

And right now we’re not willing to see my MIL off to the five-day break. Not right now.  If she rallies again, and seems stable, then we’ll consider it.  But not when things are so shaky with her health.  After all we have been through, after all we have done, to let her slip away now in the care of someone else in a strange environment would be just too painful, would feel very much like we had failed to see the thing through to the end.

Neither of us wants that.

* * * * * * * * * * * * * *

As I got the safety rails and straps on the bed in place, my MIL looked up at me, concerned.

“Something wrong?  Something bothering you?”

“Well, like I said, I have had a very nice time tonight.”

“Yes, thank you.  It is kind of you to say so.”

“But I think I should be going soon.  My mother and father have been on a trip, and they are looking for me.”

“And when they come, you can go with them.”

“But if I am sleeping,” she said, that worried look on her face again, “how will I know?”

“If they come looking for you, I will be sure to tell them where you are.  I promise.”

And I keep my promises.

"Thank you, son"     Posted on Communion Blog 9 November 2007

It has been a difficult week in caring for my mother-in-law (MIL).  As noted previously, we went to a three-day trandsdermal patch to help with the pain associated with her aspiration and breathing difficulties.  And that has worked pretty well.  But as I suspected would happen, after her trial period with the oxygen she didn’t want to use it any longer - even when she was laboring to breathe and I offered it to her, she declined.  Only once, when she was having a coughing spasm, did she consent to put up with it again.  This means that she has continued her slide, probably at a faster pace than were she using the oxygen.  It is a tough thing to watch.

* * * * * * * * * * * * *

After a particularly rough patch of it yesterday morning, I was helping her from the toilet to her usual seat in the front room, where she likes to sit and look at magazines.  As we transitioned from the wheelchair to her comfy chair, and I got her settled safely there, she looked up at me, her frail thin arms still around my neck, her light brown eyes clear for a moment, and said "thank you, son."

In the over twenty years I’ve known her, in the twenty years I have been married to her daughter, she has never once before called me "son."  In fact, since my own parents died almost 40 years ago, no one has called me that for a very long time.  It was a strange word to hear directed my way.  And it touched me like no other thanks she has ever offered.

* * * * * * * * * * * * *

She had a restless night last night.  I was 'on call,' and consequently didn’t get a lot of solid sleep.  After I had been downstairs early this morning, trying to get her to settle down through one of her (fairly rare) combative fits, it hit me:  we’d screwed up and not replaced her duragesic patch late afternoon, like we should have.  Meaning that the opioid in her system had been tapering off for about 12 hours, with nothing else to mitigate the effects of pain.  And with all the other difficulties her brain faces, that extra pain causes unpredictable effects.

I mentioned this to my wife, who woke somewhat as I came back to bed.  Shortly thereafter, we were back downstairs, getting a new patch on my MIL, and getting her something else to relieve her pain more quickly than the patch would kick in.  As we were getting her tucked back in, she whispered to my wife, asking:  "who is that strange man?"

* * * * * * * * * * * * *

Lisa, our hospice nurse, did her routine check of vitals, asked the usual questions about changes we’d noticed.  After spending an extra long time with the stethoscope, she looked over to me and my wife, an honest but pained look in her eyes.

Later, after all the rest was done, she chatted with us on the front porch, my MIL again sitting in her comfy chair in the living room.  "Yeah, there’s a lot more crackling all over her lungs."

This came as no surprise.  I’d been able to hear it myself, just in my MIL’s routine breathing.  But it was a substantial change from the aspiration congestion being confined to just one part of one or another lung.

Then she added:  "And her heartbeat is much more irregular."

Ah.  I asked, already knowing the answer:  "Is that . . . significant?"


* * * * * * * * * * * * *

My wife’s older sister is coming to visit from California beginning Thanksgiving weekend.  Last week I was worried that my MIL might not last that long, given how things had been going.  The beginning of this week I had changed my mind, since the duragesic patch seemed to help so much.

Now I’m not sure again, even though we are a week closer to Thanksgiving.

That may be the toughest thing about this, the not knowing.  I mean, there are few of us who know in advance the how and when of our deaths - I’ve long accepted that, having lost both parents suddenly (and separately) just as I was on the verge of adolescence.  But when you are dealing with a terminal illness, such as hospice usually aids with, you usually have some kind of time-frame that everyone understands.  This is different - this isn’t cancer, or a fever, or some other relatively simple cause & effect.  This is a general debility, prolonged by our caring and care giving in a way that both breaks your heart and makes you proud.

Dying at Home     Posted on Communion Blog 14 August 2007

About 15 months ago, I wrote the following:

I sit, listening to the labored breathing coming from the next room.  The end will come probably sometime this next week, likely as the result of a fever and while she is asleep.  As deaths go, it'll be one of the best possible, with minimal pain, discomfort, and fear.


. . . because some short time ago, when it became clear that my mother-in-law was not going to recover from her latest medical problems, my wife and I decided to enter her into Hospice.

I knew of Hospice as an medical movement designed to make the last weeks or months of life as comfortable as possible, with a primary emphasis on palliative care.  And this it is.  But I've discovered that it is so much more.

Our "hospice team" includes a nurse who comes by as often as we need her.  If that's once a week, or twice a day, it doesn't matter.  We have on call personal care aides, a chaplain, a social worker (to help me and my wife with any of the issues surrounding the imminent death of a loved one), as often as we need them.  If we need any medical equipment, from a hospital bed to oxygen, it's arranged for.  All prescribed meds for her condition are delivered to our door.  Basically, anything we need or want which pertains to my mother-in-law's health is provided.  And it is all 100% covered by Medicare.

And it is a shame that you have to die to get this kind of medical care.

As is clear from my other posts, my MIL actually didn't die.  Yeah, she's one of those rare people who "graduated" from Hospice care.  Basically, we were too good at providing care for her, and she just wasn't ready to go yet.  So, after the initial 90 days of being enrolled, she was dropped from the Hospice program administered by one of the local hospitals.  I'm actually still a bit upset with the way that transition was handled - my wife and I very much felt like we were abandoned.  The extensive network of support we'd had just disappeared, leaving us unsure how to proceed (because while my MIL wasn't ready to die, neither was she going to 'get well', and her care needs had increased significantly.)

Anyway, now we've noticed another downturn in her condition, and one of the significant markers of end-of-life has shown up:  my MIL has dramatically increased how much time she spends sleeping, with no indication that she is suffering from any secondary illness or infection which would explain it.  Her afternoon nap has gone from 90 minutes to typically three hours (or longer).  And she now wants to nap after breakfast most mornings, for an hour and a half to two hours and a half.  Noting this, my wife sent me this:  Eldercare at Home:  Chapter 28 - Dying at Home which contains the following:

The end of life cannot be predicted for any of us.  We do not know when it will happen, who will be with us, how it will occur, or what we will feel.  However, we do know some useful things about how many people die and this can help put your situation in perspective.,p. Many misconceptions exist about what can happen during the final days and weeks of a person's life.  One stubborn myth about dying is that the person will die from only one cause.  In some cases this is true, but many older people do not die from one major event or for only one reason.  Instead, they die because of many different factors that combine to slow down the body's important systems, such as the heart and lungs.  In a sense, the physical body slowly "gives up."


Certain physical signs warn us that the end of life is growing close.  Most people with an advanced, chronic illness spend more time in bed or on a couch or chair.  People with any type of advanced disease eat less food, and drink fewer liquids.  They also sleep more, lose weight, and become much weaker.

Not every warning sign is physical, however.  People may talk about "leaving" or "having to go."  Their dreams make them feel as if they want to "get going" or "go home."  Although this does not occur in every situation, this language and the emotion behind it are ways of talking about dying.  The person also may ask to see special friends or relatives, and some haziness or confusion can occur as each day blends into another.  Keeping track of the day of the week becomes less important, as do other daily living details.

My MIL has been doing more of this, though it is difficult to really say whether it is pertinent, since she suffers from dementia.  Still, it is good to see it described, to be able to point to this document to help friends and family understand a bit better where we are (the excerpts I cite are just one small bit of that chapter - and the whole thing is worth looking at).

And it helps some with my ambivalent feelings towards Hospice, which, in spite of what happened to us, I know is a good program.  I just wish I knew when to turn to them again - having the full support followed by being dropped like a hot potato isn't something I think I can take emotionally again.  Not at this point, anyway.

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