Waiting 4

My mother passed away on July 4th, 2015 at the age of 88. I spent the last two and a half weeks of her life with her, much of it in hospice waiting for her to pass. It was the first time I had been that close to the dying process and I am grateful I had that time with her. It was a very strange experience, often fascinating, sometimes surreal. (4 of 5 posts)

Today was a peaceful day.  Mom's breathing is calmer, more steady.  She still can speak, sometimes garbled, sometimes quite clear.  Sometimes to us and sometimes to someone we can't see.  My sister and niece both thought it was my late father.  I asked why and they said it seemed as if she was answering requests.  Yep, that would be him.

Today is apparently not the day. Her breathing will get more ragged first, long pauses in between. Part of me wants this to end. We've said our goodbyes, it seems like time. The other part of me selfishly wants to be able to reach out and take her hand. She's not even the abridged version of her self, the Alzheimer's version, but there is comfort in physical presence and touch. Soon I won't have that. There is a lot of back and forth, ragged breathing suddenly calmed. It is not a steady deterioration. When she seems to improve I entertain a fantasy of running the film in reverse. All the events that led to her lying in this bed would suddenly run backwards. While I'm indulging in magical thinking I'll take her back to her pre-Alzheimer days, back to book discussions, travels and wise advice.

I take a break and go outside to absorb some sunshine, too many hours in a dark room and too much magical thinking. On the way out I pass the chapel. A half circle of people kneel on the ground. Hmm, Buddhists? Muslims? How ecumenical. We are Jewish in a Lutheran facility, so why not Buddhists or Muslims too? Then they partially rise and bow forward three times, hands pushing towards the ground below. It is only then that I notice the dummies below and realize it is a CPR class. 

I sit in the warm sun basking in the world of the living. I call my friend Dora who is in her 90s. We get together or talk every week and I've been away for a week beyond what I'd planned. Dora is a second mom to me and it is comforting to speak with her. When I didn't call, she worried that something had gone wrong. "You know I'll go eventually too," she says. "Yeah", I reply, "and I don't like that one bit."

Another day and my mother's breath still seems even. She doesn't eat. I can't remember when she last had anything but water. I am glad we didn't have to make a decision to pull a plug. Our choice was a relatively easy one. There was no viable choice given her age. It will be a peaceful death.   Just a limbo of waiting.

 

I have spent more time with family this past week than I have since we were children. We are different people. Sometimes the differences chaff. A spark flies and we quench it. Our relationship with each other will change without our mother at the core. I got to know my sister in a different way as we cared for my mother's needs. We shared a room as children, but I feel as if I only recently got to know her well. Will we drift back to our separate worlds once again? I watch my niece with her grandmother and am touched. She is so good with her, at ease in this strange situation. My other niece uses the opportunity to explain death to her four year old who had a loving relationship with his great-Gaya.

One of our favorite nurses just came in. She puts her arm around Mom, cradling her. She speaks softly into her ear. Then she turns to my sister and me. "Your mom is a fighter"she says. "She's still here because of you."

I take mom's hand and tell her I love her. I tell her we are OK, to do what she needs to do. We'll be all right. We've said that before. Does she hear the tears in our voice and think our heart isn't fully in it?

I tell my sister that if Mom is sticking around for anyone, it's her. My sister has been my mom's primary caregiver for several years and has built a strong emotional bond with her. 

She looks at me in surprise and says, "No, I think she's sticking around for you."

"Me, why?" I ask. She replies that my wiring and Mom's are very similar.  That is true. We have always understood each other viscerally. 

My sister read that people sometimes slip away when loved ones step out of the room, as if their presence ties the person to this world, the watched pot theory. We decide to vacate the premises for awhile. We ask the nurse to check in on her while we are out. After awhile I get a text from my sister-"It is OK to return now". What does that mean I wonder as I walk quickly down the hall. Did it work? Mom is still breathing quietly.

One of my mom's caregiver from the past few years stops by. They had a lovely bond and Sally talks with her about a recent trip to Niagara Falls. Mom went there on her honeymoon. Virtually every day, even in hospice, my mother has started the day by asking, "So what's the program today? An odd question from one's deathbed. We ask Sally if Mom said that to her as well and learn that was her daily greeting.

In the midst of this limbo, I continue to deal with practical matters, shutting down services for my mom that are no longer needed. If you ever need an outlet for all the emotion around the impending death of a parent, call their cable company. They will not disappoint in providing you with a cathartic experience. As my husband quipped, they have a reputation to uphold. 

I had cancelled her Direct TV service and was told we would receive a credit. I dutifully spelled out my address for them. We then received an email that they were sending out a debit card with the credit to an address which vaguely resembled mine, but was incorrect. I called to Citi, the administrator, to have them make a note of the correct address in case it came back in the mail.

Then the idiocy began. They wanted to speak with my mother, obviously not feasible as I explained to them. Then they advised me that they couldn't make that note without me faxing my POA to them and emails with scans were unacceptable. To correct an address that THEY recorded incorrectly. After working my way up a chain of idiocy, I must confess I was none too polite as I let loose from the middle of the parking lot, shaking with rage. This is not a time when one suffers fools well. Never was very good at that even on a good day.

We are obviously wearing thin. It has been nine days since that first phone call and seven days of hospice. And so we wait.

Waiting 3

objects in Mom's window

My mother passed away on July 4th, 2015 at the age of 88. I spent the last two and a half weeks of her life with her, much of it in hospice waiting for her to pass. It was the first time I had been that close to the dying process and I am grateful I had that time with her. It was a very strange experience, often fascinating,  sometimes surreal.  (3rd of 5 entries).

Today it is six days since that first phone call, four days since she entered hospice. They say this process takes a week on average. When they take mom's vitals, they always say she has a strong heart. All those hours on her exercise bike.

With the weekend over, our weekday crew of nurses and CNAs returns. Tamika pokes her head in to see if we want something to eat. "Hello my lovelies"she sings out. Her warm smile feels comforting. Our peeps are back. Nurse LaRosa comes in next, another one of the wonderful people who care for Mom. She has a special connection with her. She confides to us that she checked in over the weekend to see how Mom, her Rose, was doing. She jokes with Mom and gives her meds. We tell her about our conversations with Mom. She in turn shares her experience with her mother's death. Many of those who are most present and connected to Mom have gone through this themselves with a parent.

We are awed by the experience we have had here. The kindnesses shown our mother touch us deeply. I've learned a lot about medical conditions the past two weeks, but mostly I've learned how kind, caring people can make a huge difference in the experience of patients and family.

There are many types of care needs in this facility. Different worlds all co-existing. The first week when I was with my mom she was in rehab. I would take her to meals at the dining room, go to activities with her, and sit with her during physical therapy. Many people are here for rehab after a hospital stay. They will either go home afterwards or perhaps move to assisted living or memory care if they are in a transition stage. We had hoped to do that with my mom. I see that world when I walk down the hall and fervently wish my mother could join it.

Now we are in the limbo world abridging death, the waiting room. They check her progression and make her comfortable. We are afraid to leave lest we not be here when she needs us. The rest of the world is on hold unless we can reach it from the computer or it comes to us. The room is filled with our digital technology.

The doctor told us we had some time so I took a brief break. On the way out I saw that they had animals in the lobby, A small pony occupied the central area and a woman cradled a chinchilla. Another activity that mom would have enjoyed. 

When I returned I sat in the car to make a phone call. As I spoke a text from my sister scrolled across my phone "Mom's heart rate has slowed."I dash past a bingo game and rush to the room. Q36, the caller shouts as the bingo game fades into the world of the living and I return to the "waiting room".

We sit with her stroking her arm, holding her hand. She takes a breath. I wait for the next. I count slowly to eight before it comes. We tell her we love her and she tells us the same. "I have a very sweet family' she says. "That's because we have a very sweet mother" we reply. Then she says "I say goodby". We look at each other and whisper, "That sounds final." She squeezes in one more "I love you" and resumes her dozing.

Now we wait. They have told us what to expect. We gather around her, all of her children and one granddaughter. Waiting. It will not be much longer.

Waiting 2

My mother passed away on July 4th, 2015 at the age of 88. I spent the last two and a half weeks of her life with her, much of it in hospice waiting for her to pass. It was the first time I had been that close to the dying process and I am grateful I had that time with her. It was a very strange experience, often fascinating, sometimes surreal. (2 of 5 posts)

Today Mom was chatty. It felt as if she was saying goodby. When she woke it was with the words, "it's lovely to wake to my two daughters together". She told us how much she loved us. Asked us to give her a kiss. We told her we loved her and were with her. She wasn't alone. We say those words over and over. She tells us she saw mama, her mother who has been gone for many years. Tears well up. I like to think of her going from our love to her mother's love. I say to her,"there is a special connection between mothers and daughters". "Yes, there is" she replies. We have a bit of a love fest, each pronouncing their love like a call and response. Then she says, "So to bed". Her sense of daytime versus night is a bit confused.

We are nearing the end. My brother came in Saturday night. He was the last of the immediate family to arrive.He came to the care center late at night and Mom knew he was there. They exchanged some words. I was unsure if she'd be able to talk much longer. Her voice was beginning to get garbled. She now has her family with her.

I awoke at 4:30 am to the nurses assisting my mom. My niece lay cocooned in a throw on the floor, my sister nearby on two chairs. We have been camping out in her room, afraid to leave for long. We want to be there with her to the end. The care center has been wonderful to her, but also to us. They bring us food and pillows. She had a roommate originally, but that was before her decline. It would be difficult for a roommate now.

We were never a family that was especially comfortable with touch. Now it's all I want to do. I hold her hand, I stroke her arms, her legs, her face. I want her to feel surrounded by love. I want my touch to communicate what my words cannot.

We met yesterday with the lay leader from the temple who will conduct her funeral. My sister and I both remembered that our mother always loved the Birkhat Kohanim, the benediction in the service. 

 "May the Lord bless you and keep you, may the Lord make His face shine upon you and be gracious unto you. May the Lord lift up his countenance upon you and grant you peace." 

When I hear it I always think of her. Strange how a whispered comment from her at a long ago service stays with us until this moment planning her funeral.

My brother has written a eulogy, as have I. My sister drafted an obit. My niece will also speak. I am not sure I can speak without tears, but they tell me that's permissible. We each know different sides of my mother. We plan her funeral as she lays nearby on a collision course with death, but still clinging to life. It is another surreal moment.

There are many details to dying. First the healthcare decisions, often closely intertwined with financial. Then funeral home, service, reception, cemetery. My territory is financial. Accounts and property to retitle, documents to file. I make a list of autopays to stop or continue, expenses to go away that require action on my part, number of death certificates needed. I wonder if other people think about such things. This is territory I know, something I can do in a situation over which I have little control. Oddly enough it calms me. Still, strange to deal with practicalities before death has arrived.

I wonder about my mother's experience. What does she feel physically? emotionally? Does she realize what is happening? I write down what she says. Precious words as we know they will soon end. Some are intriguing. She has talked of going on a trip, Asked how long it will take to go to her new płace. Why does she have to leave? Today she said "new body or old body". I discount nothing. There is much we don't know.

Some of her questions reflect the endless loop of Alzheimer's and we answer them over and over. Where am I? Why am I here? What can I do to get better? No purpose is served in telling her she is dying. She has told us in the past she is ready, happy with the life she lived. She told me early in the past week or two that she didn't think she would get better and maybe it would be better to go "bye-bye", her euphemism for death.

We think she is trying to resolve the loose ends in her life. The people she talks of are those who were close to her, but where there is something unfinished. She was with our father and her brother when they died and talks less of them because there was resolution.

We deal with the mundane along with the spiritual, life and death coexisting side by side. We live in the surreal space between the two.

And so we wait.

Waiting 1

My mother passed away on July 4th, 2015 at the age of 88. I spent the last two and a half weeks of her life with her, much of it in hospice waiting for her to pass. It was the first time I had been that close to the dying process and I am grateful I had that time with her. During our vigil I recorded my observations which I will share in the next several posts. (1 of 5 posts)

It is 4 am and I am sitting next to my mother holding her hand as I type with one finger. She is in hospice. We don't know how much time we have, but we know the horizon is short.

Family is gathering. My sister and niece are spending this precious time with her as well and my brother is flying in. Yesterday my other niece joined us and brought her children, my mother's two great-grandsons. Mom loves children and lights up when they are around. We got her dressed and in the wheelchair and took her to the gardens outside. It was a good day.

It is not a bad conclusion to a life fully lived. We love her deeply and are grateful. We know we have been lucky. She has had a long life and we are here to ease her transition, to say goodby with all the love we hold for her.

There are moments when this feels very surreal. She is funny and we can see her personality come through. We laugh a lot which seems strange under the circumstances. We write eulogies even as she lies in bed breathing quietly. Life does not always take the form we expect. We are ready intellectually, but the emotions haven't fully caught up. We laugh and then we tear up mid-sentence.

I listen to the oxygen machine breath. I time my own breath to match its rhythm, a count of five. One thousand one, one thousand two... I listen for my mother's breath. She had just entered a care facility for rehab after a stroke. She was doing well. Then suddenly things changed. I came down to visit, to arrange the post-rehab plans. Fifteen minutes before I was to catch a cab and fly home, my phone rang. My first thought was the cabbie was early. "Don't get on the plane" my sister said. Mom's body was beginning to shut down.

We stayed by her side that night and many nights to come. I often can't remember what day it is. I sleep in snatches. One night we google the dying process, trying to learn what we should look for. Unless one is in a medical profession it is not a topic in which most of us are well versed. Friday is especially poignant. The nurses and aides who got to know her stop in during the day. They hug us with tears in their eyes. Many of them connected with her, saw the gentle person we love so deeply. They will not return until Monday. No one knows if she will still be there on their return.

I have never been so close to the dying process. When my dad passed I visited him at the care center and then returned to my home. Later when we got the call we drove through the night to get there in time to plan the funeral. My mother was there for him at the end. We are there for my mother. It is a different experience to sit through the night. To watch her sleep, to listen for her breath, to hold her hand and to answer her questions about long-gone family.

In between I deal with my life. All the practical matters that can intrude. Artwork to be delivered for a show. A pricy new hybrid battery for my Prius that died the day before I left. We need it fixed so my husband can drive down the minute he gets my call. We tell them why we need the car and a two day job is completed in an hour, the battery is comped. Everyone has a mother. I am grateful to my husband for dealing with these details in my absence. He understands too well this strange limbo world of letting go of one's mother.

And so we wait. 

Presence and Absence

I always come away with new information after Art a Whirl, our big open studio event. People frequently recommend books on topics related to art or on the topics I am exploring in my artwork. At our recent AAW I had a long conversation with some visitors about ambiguous loss, a term that was coined in the 1980s by author Pauline Boss. Ambiguous loss is exactly what it sounds like, a loss lacking clarity, hence a loss that doesn't conform to the structures we have to help support those experiencing loss. Responses don't fit the expected grieving pattern because the loss lacks clarity and finality.

The collapse of the World Trade Towers is a perfect example of ambiguous loss, We have had other recent examples with planes disappearing into the ocean. In these cases we have a physical loss, but without confirmation. Gone, but not gone.

I was interested in this concept because I often experience the reverse. Here, but not here. As my mother lives with Alzheimer's she is here physically, but not always fully here in other ways, at least not in the way to which I had grown accustom.

Unlike a loss with clarity, ambiguous losses may drag on for an extended period and lack a means to acknowledge grief. I recently picked up Boss's book Loving Someone Who Has Dementia and was intrigued by a quote she shared by F. Scott Fitzgerald.

The test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time and still retain the ability to function. The Crackup 1945 p69

It is the ability to deal with ambiguity. Those of us who are Js on the Myers Briggs probably don't fare too well in this department. We like our clarity, but fortunately this is an ability that seems to grow with age. Those of us who have difficulty with ambiguity often seek control of our surroundings, but if we live long enough we learn that any control is largely illusionary. The world is filled with grey and the absolutism of youth takes on tonalities.

The only certainty with Alzheimers is that it is a progressive disease. It will unfold as a series of gradual losses. Boss writes of how those who cannot deal with ambiguity either deny the illness or write the person off. The former may say,"oh it's just normal loss of memory from aging". The latter may say "it's not worth me visiting as she won't know the difference". In either case it is a forced clarity even if it is an incorrect one.

My sister and I talk about this a lot relative to our mom and I think we are reasonably grounded in our approach. We love our mother in whatever form we have her and are both reality based, "It is what it is"- our mantra. Between those two premises we find our path by supporting my mother as she goes through this process and supporting each other. I often think how much more difficult this would be if I wasn't sharing it with my sister. We have a sense of my mother's essence that we continue to appreciate. I try not to think of what is gone lest I fail to appreciate what is still in front of me.

Boss writes of an accountant who had a low tolerance for ambiguity and struggled with his father's Alzheimer's. What served him well professionally was very counter-productive in dealing with his father, no doubt true of me to some extent. A career with numbers often attracts those drawn to control. I have often struggled to let go of that side of myself in creating artwork. Creativity is born out of the unknown, it is about feeling our way, uncertainty, ambiguity and exploration. And perhaps my creative work has ultimately helped me deal with the duality of my mother's experience, this thing I have absolutely no control over. Here, but not here.

The brain doesn't like ambiguity. It works hard to resolve it. When frustrated by the duality of absence and presence it frantically seeks resolution. As a culture we value mastery and control. We seek closure. We are also a culture that denies death and that causes dementia to be frightening. There is much ambiguous loss in the roots of American culture. Boss proposes that as a nation we are founded on unresolved grief. Immigrants left their family behind, often to never see them again. Slavery was also an engine for ambiguous loss. It occurs to me that the Jewish community that I explore through family history research is seeped in unresolved grief, whole communities wiped off the map during the Holocaust.

So how do we move forward when caught within this duality, presence yet absence? Boss advocates curiosity and it occurs to me that painting this experience is my way to explore it, to bring my curiosity to bear. I hear my mother's words and emotions and consider what imagery they conjure. To paint someone's experience you have to imagine it, to ponder what it feels like. Sometimes that takes me too close to the flame. It can be a frightening place. In every parent's experience is the often unspoken fear within their child that we too will share it some day.

I often find reading about Alzheimer's challenging. It is too close to home as I participate in my mother's journey. But this approach to the subject is intriguing to me, considering the roots of ambiguous loss in our culture, our brain's resistance to ambiguity. And of course I find myself considering how I would paint ambiguous loss.

Sometimes Yes, Sometimes No

Just when I think I have this reinvention thing figured out, I discover I have to learn a new trick.

When I first left my job and decided to dramatically refocus my energies, I soon discovered that saying yes to things I might have previously avoided opened many new doors.

My first yes was to delivering a talk. I didn't like the idea of public speaking any more than most people. I'm a shy person although people often don't believe me now when I say that. Apparently I've learned how to masquerade as an extrovert. Put me in a room filled with people milling about and you will soon see my introvert assert herself, but give me a microphone and center stage and I step into my inner performer. I didn't know that about myself and it has been one of my delightful discoveries along the way.

That was eight years ago and half way through the year I'm on schedule to do ten talks so far. I've learned that once you step through that door you have to keep practicing that skill. That is especially true of public speaking so I keep myself out there and speak about a variety of topics.

Reinvention is a mix of creating opportunities by actively seeking them out as well as responding to those that knock on your door. And some of those that knock don't always present themselves as the major door opener that they prove to be. For a long time I said yes to those knocks on the door just to see where they might take me. It all seemed like a grand adventure. 

Lately though I've been noticing a change. I've started to say no. I've begun to create CRITERIA! If you say yes often enough you create a lot of activity. Some of it is meaningful, some of it less so. I have a better sense of those things that can be time drains and I have personal goals on which I want to focus. Sometimes I feel like that proverbial crow drawn to a shiny object that can distract me far too easily and yet...I've learned that sometimes that distraction is important and opens a new door. How do I discern a distraction from a door? I'm not sure and the fact is a distraction can be a door also. It may well be an opportunity that I'm saying no to and I hesitate each time that I do that, but I need to preserve room for the opportunities on my plate.

So what about these criteria? I've realized that public speaking takes time, even on familiar subjects, but especially when developing new material. Like many shy people who present publicly, I prepare. Actually I over prepare. I rehearse until I can speak spontaneously. I design my visuals and handouts. I work hard at my talks and that takes time. In addition to actual time, public speaking takes psychic time and energy. It will never be an effortless expenditure of energy for me so I need to be careful about my mix of activities and realize that time takes many forms. There is time to prepare, time to present and time to embrace your public persona. I suspect extroverts need less of the latter, introverts need a lot.

Recently I've turned down some speaking engagements, some that were at times when I needed to leave time for creative energy for artwork or writing and others which weren't in my sweet spot. I mention creative time because I've learned that it isn't the same as calendar time. It starts with calendar time being available, but it doesn't work on anyone's schedule, including mine. If I have a creative project I need to leave time for things to bubble up when they're ready. So I need a buffer of psychic time for speaking and bubble-up time for creative work. Then there are all of those things that just take good old fashioned time, often more than we anticipate.

One of my projects involved doing 17 oral histories out of which I developed artwork. Now "doing" means creating questions, drawing out my subjects in an interview, video recording, transcribing, editing the video and creating documentation. While I had grants to do them, I put in many additional hours and it proved to be a much bigger project than I had imagined, albeit very meaningful. Now I often have people tell me they have someone interesting for me to interview and I have no doubt that they are, but I'm done with that. It is a huge commitment of time and not inexpensive if I were to get paid for that time. And then I remind myself that even if they paid for my time, I'm not in search of money making projects. I am in search of projects that take me in certain directions related to my artwork and writing and there is a choice about how I spend my time. So one of my criteria is purpose. Not just is it worthwhile or meaningful, but does it advance my purpose. And so I've turned down interview projects with some regret. I always hate to walk away from a good story.

And about those money making projects...even while working on my many creative projects, I've often done consulting projects in my old field of finance. Each time I do one, it takes awhile to get myself back into that space. I still enjoy the problem solving aspects of the work, but it is not where I find my larger meaning in life. When you are immersed in that world you don't spend much time thinking about larger meaning. Your focus is on making a living and you are absorbed in that world. It took me some time to unhook from that and it has become harder to re-enter that space. Part of the difficulty is in giving up control of my time. Time and flexibility have become more important to me because I have other things I want to do and money is no longer the yardstick.

When I got a call on a job the other day, I had a different reason for saying no; the often stated "I want to spend more time with my family". In this case family meant my mother who is in her late 80s, 500 miles away and experiencing changes in living arrangements and health. I am well aware that this is time for which I don't get a do-over so want to be there for her. She needs me more now and I am fortunate to have control over my time to make myself available.

So I've become more discriminating in what I say yes to, weighing time, priority and purpose. And yes, I realize it is a luxury to even be able to think about purpose and I am very grateful to have those choices.

Untethered

I've had a routine with my mother for a number of years. I call her in the morning to check in. Gradually our calls have devolved into a few minutes in which I tell her which aide is coming when. Actually I call to make sure she answers. Sometimes she doesn’t. Usually that means she doesn’t hear it over the TV which is turned up because her hearing is poor. I always panic when that happens, fearing she has fallen or worse.

Part of me is always awaiting the "worse". That phone call from my sister, the nearest and hence the early responder.
"Come now. Something is wrong." 

We got that call for my father a few years ago. Jumped into our car and drove through the night. Even though I knew his kidneys were failing on my last visit, knew death was imminent, I still responded, "Oh my God, oh my God!" It's never real until it's real.

A few days ago it became real once again. My sister called and said,"I think Mom is having a stroke". She described the symptoms, but I heard nothing after "stroke". Fortunately she was with my mom and knew to respond. I spent the day making flight arrangements and feeling like I was moving through molasses. I didn't know what to do with myself, unable to calibrate my response to this potentially serious yet still unknown situation.

I thought back to my recent calls with my mom. There had been a change as of late and my sister and I had begun to talk of how we could better support her. My mom had startled me recently when she said. "I'm confused, something isn't right".

"What isn't right?" I asked.

"I was napping" she said. "I'm in my own home," she noted, like a person who has fallen and is taking inventory. No broken bones. All intact. But she adds, "It doesn't feel like I belong here."

Then I got evening call duty, filling in for my sister who calls her in the evening. Evenings with Alzheimer's are worse as the brain gets more muddled. My mother was having a hard time remembering relationships or even when she last saw my sister (the prior day). She knows she's confused which I think is the most difficult stage of this disease. She still remembers that this is not the norm. 

"Hold on to me" she said. My heart aches for her. We talked about how things have gotten harder for her. Just acknowledging that seemed to calm her. "I'll always hold on to you," I said.

I mulled over our conversation. Her home of almost sixty years had a feeling of unfamiliarity. No longer anchoring her by its pull of memories. She's come untethered. And then I thought, "What would that look like?" I pictured her floating above her armchair. The ties that anchored her tightly releasing her like a flower blooming or a hand opening up to release her. She is looking down, her mouth an o of surprise, her limbs floating out around her. Her cat looks up at her wondering what is going on.

I have a sketch program on my iPad and I do a quick sketch of this image with my finger on the screen. A few quick lines on a black background to hold that thought. It is a dark void that she is floating in. Then I set it aside, the idea captured until I can consider next steps. So much easier to consider next steps for a painting than for my mother. "Hold on to me" echoes in my mind.

Next steps are often forced by events out of our control. My sister and I have spent the last few days in a hospital room with my mom. She did in fact have several small strokes, but recovered quickly due in part to my sister's fast thinking. And I do mean FAST. My sister recalled an acronym that is used to identify a stroke. Well she kind of remembered it. She remembered F and A and then debated if the acronym was FACE or FAST. So this is my public service announcement. It is FAST which stands for Face-look for an uneven smile, Arm- check if one arm is weak. Speech-listen for slurred speech and Time-call 911 right away. My sister got as far as A and noticed my mom's arm wouldn't move and jumped directly to T and called 911. 

We've spoken with many health care professionals in the last few days. We especially appreciate those who are good communicators and find the nurses often excel at this. We also appreciate those who can use humor and warmth to engage my mother. We will have more decisions to make in the coming weeks, but are relieved that my mom now seems to be OK, but tired, hit by a truck tired. We joke that it was only a car in this case as she withstood it fairly well. We want to prevent a more serious stroke so my sister and I are working as a team in sifting through medical information. We are both information junkies so after we speak with a doctor we go to our respective computers and read up on treatments and medications, then convene a decision making session. It is good to have a team.

My mother feels more untethered than ever, confirming periodically where she is and what happened to her. Forgetting and then confirming it once again. Medical situations are challenging even when your memory is intact. Having to gain that understanding over and over is especially taxing. The coming weeks will be full of changes for her. We will be there for her with our love and our presence.