Best Laid Plans

This is the second installment in a series of posts I wrote while taking care of my late sister Mary Claire Luce when she was in hospice in March.

Monday, March 17, 2014 
Jane, Mary Claire, Julia and I were supposed to be in New Orleans today.

A couple of months ago my sister Jane had come up with the idea of all four sisters meeting in New Orleans. It was a good choice, as New Orleans would have something for our many different interests: shopping, museums, antiquing, great food, and gambling. It was also a convenient place to fly into for all of us. Mary Claire and I were on board from the start. Mary Claire called Julia and convinced her that she could come, despite the trips being scheduled during part of one of the busiest weeks of the year for Julia's store on the coast of Texas.  Once we had all committed to the plan, Jane had flown into action and made reservations at the Windsor Court Hotel near the French Quarter and figured out how we could arrive at more or less the same time at the airport from three different cities. Tonight we had reservations at R’evolution for dinner.

It is the trip that will never happen. We are on a different journey now. 

The truth is, we cancelled the New Orleans trip a few weeks ago, before we knew that Mary Claire would be going into hospice. The swelling in MC’s right leg had gotten worse in January, so we had requested a return to lymphedema therapy at MDA. During one of the sessions, MC mentioned the plans for our trip and was told by the physical therapist that a flight, even a short one from Houston to New Orleans, was a bad idea for someone with her type of lymphedema. We already had doubts about the trip with Mary Claire’s increasing limited mobility and our worries about what we would do if she had a crisis when we were there. The therapist’s pronouncement made it official. We scuttled the plan for NOLA and decided to go to Plan B. We would all hang out together in Rockport or in Port Aransas during those days. We had already blocked out the time, we just changed to location to one that didn't require MC get on a plane and would enable us to get her to M.D. Anderson easily if a problem arose.

So, Mary Claire, Julia and I are in Rockport now. But instead of sitting in Julia’s newly installed hot tub and pool relaxing together, we are dealing with the very new reality of providing hospice care to MC.

A few facts about in-home hospice care: There is no ‘round the clock’ nursing care provided by the hospice service. The patient’s family provides the actual round the clock care. Yes, the hospice service is available 24 hours a day, but that is via phone. You call the main number and the nurse assigned to your loved one calls you back to advise you. If the issue is one that requires them they will come out, but at this point in time, we are scheduled to see the hospice nurse every other day. We also have a nurse’s aide who is assigned to Mary Claire who will come in Monday, Wednesday and Friday to help bathe MC and do other tasks for us such as change the bed linens, etc.

I don’t know how a person who is the sole caretaker of a patient who is in home hospice care does it. It is truly a 24-hour a day job, which requires a variety of skills: Organization, communication, and basic nursing skills. As it turns out, Julia and I have divided the tasks automatically. She is a take charge organizational genius, keeping on top of what is needed and dealing decisively with any issues that come up. I do the physical nursing including keeping track of Mary Claire's medications. And it works. Beautifully.
 
We are fortunate in that Julia and Jane both have financial resources that have enabled them to hire a lovely woman, Connie, who is staying with us at night, allowing us to sleep and get some rest. Julia had originally interviewed Connie as a possible nighttime care person for our mom, who is on the verge of needing round the clock care/supervision. But then Mary Claire reached this crisis point. So Connie comes at night to allow us to sleep. Not that sleep necessarily comes easily. But I am not taking anything to help me sleep because I want/need to be available if an issue comes up.

In between taking care of Mary Claire today, I worked today on setting up a remote office. Since there was no wireless network here at the house, my niece Ashley called the local network tech guys who came over and set up a wireless network for me here at the house. And I contacted the tech department at the school where I work to overnight the backup drive I have the majority of the photos and graphics I will need to get work done from Julia’s kitchen table. I am fully aware of how lucky I am to be able to work remotely and be supported by my bosses in this situation. Because right now, leaving Mary Claire is not an option. She needs help with almost everything.

We are noticing subtle changes in Mary Claire today. Signs that she is weakening faster than we expected. It worries us and we are concerned about when Jane should get here.  Julia has called Clark again and asked him to take some time off this week so he can be here by Thursday. My children are also making plans to come see Mary Claire. They cannot bear to not see her again. It’s a bit of a logistical issue, figuring out who is coming when and where to put them, but I work it out with them. I know how very much they love her. But I fret internally about MC ‘realizing’ that everyone is coming to say goodbye to her, knowing all the while that deep down, she knows.

One reason I know that is that today, MC’s main doctor from MDA called her to see how she was doing. I filled him in on what was happening with her while the nurse’s aide finished dressing her after her bath. Then I turned the phone over to MC, who told Dr. Zinner about how beautiful and peaceful it is here. And how happy she is to be here with the water and the birds and the sky. MC tells Dr. Zinner he must come down to Rockport as she is sure he needs a break. She tells him he can drink wine and Julia and Steve will take him on a canal cruise on their boat. We laugh later telling Julia about how MC has invited Dr. Zinner to come for ‘dinner and a boat ride.’ But not once during that conversation did MC mention getting better and coming back to Zinner for treatment. Not once.