Hospice

Today after clinic in Carrefour, a dear friend asked me to visit her failing aunt in her home. She warned me that she was dying. Her aunt had been struggling with illness for a long while, and now was virtually bed-ridden. She has lost most of her cognition, slips in and out of alertness, is incontinent and can no longer move on her own thus requiring her family to take care of her around the clock.

I accompanied my friend into a very poor two-room cinder block house crammed with life. Two young women were sitting outside, starting to boil plantains. A couple of young men looked to be fixing a door jam to the kitchen with tools banging and grunts heaving. A baby lay in diapers on a blanket in a corner the of the main room, sweat beading on her forehead in the still heat of the breathless space. The smell of a charcoal fire filtered into the room, hinting of dinner to come.

We made our way behind a curtain into the bedroom with two large beds and a few wardrobes. As I squeezed between the beds in order to get closer to my patient, I marveled that the entirety of the family had to sleep together in this room at night. I found an elderly, frail, thin woman lying on a bed with her eyes closed. Her face wore the lines of a life long lived, her wrinkled, leathery hands spoke of hard work defining her days. Her clothes were neat, her hair was braided, she smelled like soap. An adult diaper was working to keep her and the bed dry. She lay quietly, appeared comfortable and didn't pay any attention to our entry. Two tired looking young woman sat on the bed next to her, her daughters I was told. They were in charge of her care. "She hurts all the time," they told me with eyes lowered to toward the floor. It is hard not to be able to take away pain, no matter how gentle you are or how much care you provide.

Although I introduced myself to the woman, she never opened her eyes. I started my exam to find the malnutrition common in the elderly and senile. Bed sores had started to form around her heels and tailbone. I discussed with the family who had been vigilant with her care about needs for turning to relieve pressure and pain. They nodded with understanding, seemingly glad for something simple to do.

As I discussed what could be done and what should be done, they listened stoically. We talked of signs of infection and whether or not they would want to use antibiotics that might prolong her life. They weren't upset by the proximity of her death, but by her suffering. I gave a little sigh of relief, glad for a perspective that didn't fight the inevitable, but only the unnecessary. Suffering.

We made a plan for every 2-hour turns while she slept in the bed, keeping weight off the pressure points that were starting to break down, for simple wound care treatments and medications to be given around the clock for pain.

My friend only admitted to me after we were leaving that she had brought me there not to recommend treatments (there weren't many to realistically recommend), but to give her an idea of how much longer her aunt had to live. There was family living overseas that needed to come and say goodbye. Funeral costs are hefty, so as a family they needed to be pooling money to pay for the funeral. She gave a strained laugh after admitting such as if to apologize for her bluntness. But after hearing her share many warm memories of her aunt in her golden years, I knew there was no question how much she loved her. She was only being practical. And merciful. "Its no way for her to live," she said.

I thought a lot about that family tonight driving home and what an invalid in the home means for them. End-of -life issues hit all families hard, those with resources and those with none. For this family it means two able-bodied women are pulled out of the markets where they might make a little money in order to respectfully care for their mother during her last days. Any extra money they have go to buying pain medication and adult diapers. An entire extended family must reach into their shallow pockets to scrape together money in preparation for an honorable funeral (that costs as much or more as one in the States, I've been told). Caring for someone bedridden is hard on the body, and watching your mother slip farther and farther away is even harder on the heart.

Yet I applaud this family who has pulled together and are ushering their elder through the final days of her life with care given by their loving hands. In that family a baby sleeps next to a dying woman. The activity of the tiny house and the family it can barely contain continues to cycle through lives, bringing them all together to work, live, love and care for each other as days go by. I felt honored and humbled to be a witness.