My mother’s leg.
The dying left one.
Most visits to her house, I am alone there with her aide, and I have helped to change the dressings on bedsores. To roll my mother toward me, reassure her that she is not falling while she clings to the railing of her hospital bed.
But rarely do my visits coincide with her nurse who comes in 3-4 times a week to change her leg dressings–until yesterday.
When I visit it has always been neatly bandaged–concealed. The last time I actually witnessed this merciless progression of decay, was before the nurses began bandaging her toes–the flesh of her big toe had been hanging off in a strip.
At the beginning of this new odyssey of a dying limb due to no blood flow to extremities, it was just an open sore on top of her foot. Though one deeply infected, and she was hospitalized for five days on IV antibiotics.
Amputation involving a 96-year-old was certainly not an option. The only option was to slow the progression by sending her home for life with powerful oral antibiotics.
And her doctor had been frank with me. “It will progress.”
Prognosis: eventually the gangrene will take her. She will succumb out of pure weakness.
Except for having noticed that the bandaging has been extended farther up her leg as well as now binding her toes, I have been blessed with not having to actually see the progression.
Until this coincidental visit: “Well it’s good you’re here,” her nurse says as he snaps on vinyl gloves.
“So you can see exactly what is going on.”
Exactly what is going on.
I’d planned on leaving the room, and now realize that was not only cowardly but neglectful; I am her daughter.
He began to cut open the bandages with small metal scissors. Cut up the length of the bandage.
He began to gently pull it open. Unwrap the packaged leg.
And there it was: the toes. Now completely blackened. The toenails–at odd angles as if glued on. Stark white contrast against the charcoal-dead skin. The opaque white of dried sand crabs she and I used to find on our beach combing expeditions. When we were always searching out the imperfect shells, of far more interest in their surprises of sharp angles, odd shapes.
No perfection here. And now I am longing for perfect shells.
The black of her toes extends up her foot. Up her leg. Almost to knee. Speckled, tar-like now….
The nurse takes out a disposable paper ruler. To measure the blackness. The blackened.
He seems pleased. “It’s progressed a bit, but not too bad.”
Not too bad.
My mother’ s aide has snapped on those vinyl gloves as well; she is used to helping. There is a method and a rhythm to this wound redressing; she holds up the leg so the nurse can cleanse her blackened heel.
I sit stone still in a wooden chair.
The light is bright coming in the windows. Icy-white reflecting off the frozen snow from my mother’s deck. Where summers, she used to have breakfast every morning in her lounge chair to read the paper. To look up at the trees. A deck she no longer recognizes.
Icy-white light now too garish. Brazen. On the blackened heel.
And my mother began to wail.
“This is new,” the nurse says. She does not evidently usually wail with the wound changes, the nurse said.
And he is the most careful of nurses.
But with these wound re-dressings, my mother is not aways blessed with the same careful nurse. The previous nurse had not followed directives in chart, to not use gauze; gauze becomes embedded in the sores and then must be carefully peeled away without peeling away the skin as well. The pain of even dead skin being peeled away…
I want to look away. Out at the bare crooked cherry trees in her yard. But in their own crookedness, contortion, I only see reflected back at me my own agony.
I make myself stay in this moment. With my mother. I rub her shoulder. I tell her it’s almost over.
“Don’t,” she said. “Don’t touch me. I’m done, done, done!”
Truth is, this process is a long one: saline cleansing of sores. Then application of the anti-fungal meds that effectively dry up the sores if not heal. No hope of healing. He applies the preferred nonstick plastic-coated Tefla pads; he arranges them carefully, a well-orchestrated patchwork, around her foot, toes and lower her leg, then wraps it all securely with the gauze.
And my mother. Exhausted, falls into a deep sleep. Mouth open. Breathing hard.
He peels off gloves. “We may be getting there.”
Meaning needing to administer morphine before dressing changes.
The morphine. The emergency box. Kept in fridge. The little bottle with the tiny syringe. Until needed. Morphine which does not give her rest. But rockets her off into a mental state of true wailing, not from pain but from complete and utter disorientation.
Her aide peels off her own gloves. She leaves the room. I know how she feels about the morphine. She’s been down this road before. And she knows best my mother now. Her good and bad moments, her capacity for joy. Not joy exactly…maybe there is not a word for these end-of-life moments. Maybe more a metaphor; the finding of an interesting shell along the beach.
“Let’s see how it goes next time,” the nurse says to me. “Then you can let me know what you want to do.”
What I want to do.
They had rolled my mother onto her side to relieve pressure from her tail bone.
She lays with her hands folded up near her chin. She actually looks comfortable which most of the time she isn’t.
I don’t wake her to say goodbye. I dare not even kiss her on her forehead. Because this appears to be real sleep; often she may lay there, even snoring a bit, but she is not sleeping. Behind her closed eyes she is stressing whether she is up for the “trip,” or what to do with “all her houses,” and she is so tired from moving from place to place to place…
Now she sleeps. I am relieved.
And in my heart I now seek out the perfect shells. The ones her grandchildren liked to find when she would go beach combing with them, and they’d fill plastic bags with shells to string into necklaces: