So we went to see Dr. Mahoney this afternoon. It is so nice to have a doctor who knows you and is part of your community. Both Shannon, her nurse and Susan, the doctor were sweet. When Oma asked Susan if she will cry when she goes Susan said; "Yes, I will cry when you go". and it came from the heart. Susan really loves mother.   

First it was Shannon's turn to inquire about the state of things and prepare mother from the visit with Susan. Shannon asked mother if she wanted to know anything about her vital signs and mother didn't so Shannon didn't bother taking them. Instead we engaged in wonderful loving conversation about helping to alleviate the cough.   

With Susan we addressed the issues more specifically:  
1. Pain and anxiety suppression starts with over the counter drugs like Tylenol, progresses to Tylenol with codeine and the drug that was prescribed for pain after the last surgery (of which we still have a prescription). Then if the need arises there are stronger meds including Adovan for anxiety and Morphine for pain and anxiety. We will have access to all as the need arises.  
2. The Physicians orders did not need to be updated but it would be good to post one at home to have it at the ready.  
3. The form for an "Expected Death at Home" was filled out and will be filed with the sheriff so that there is no need for a coroner and other investigation when the time comes that I find mother's body after she has departed.  
4. 2 liters of oxygen is the norm, much over 3 liters the body can't use anyway but if mother is really short of breath and it seems to help go for it. Over 3 liters tends to dry her out a lot though.  
5. Diet restrictions and other treatment for diabetes and cardiovascular issues are strictly at the discretion of mother now. They are off the radar screen and mother should just enjoy her time.  
6. And speaking of time there is no way of telling how long the road will be. It could be 3 weeks it could be 3 years. But Susan noted how remarkable it is that mother seems to have her life in order, has re-connected with her family in Germany and has had a chance to see everyone at her last birthday.   

There was a lot of discussion about the process of dying and how some people have a great deal of fear and anxiety. Susan expressed pleasure that mother had her life in order much more than most people do at this stage and that she does not radiate a sense of fear. Mother was clear that she did not fear death at all in fact was looking forward to it. What she feared was the pain and discomfort of getting there. Susan re-iterated that she would be there to prescribe all the tools necessary to make the path as pain free as possible by giving mother a new directive: "you can have any food you want now but you are not allowed to have pain".   

It was so nice that the whole conversation was personal, joyful and compassionate instead of clinical, sad or impersonal. After Susan departed, mother wanted to sit in the office for a few minutes to let things sink in. Then she asked again what we got accomplished with this visit. I explained that it was to have Susan confirm what Trish, the visiting nurse had said, that the pain along the way can be managed and there is no need for her to suffer. With that mother responded by saying: "Good, now I can ask Jesus to take me home again. I only changed my mind because I was afraid of the pain but if that can be managed I am ready to go!"   

So I think the stage is set. I just re-iterated with mother that she is now free to take whatever risk she wants, not only in terms of eating but also activity.  What does she have to loose? If she collapses and dies, Amen. As I sit downstairs and write this I hear the dishes clambering upstairs as she is loading the dishwasher and shuffling furniture around. So I think this was a turning point. I think we can now settle into this last chapter with gusto and joy for the time we have left.   

On a beam of light, guided by love
Thomas