Gangrene and the Perfect Shell

The gangrene.

The leg.

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.

The leg.

  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.

He leaves.

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.

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: shells

  beach


About Sandra

Author;editor of The Woven Tale Press at thewoventalepress.net; mother; weaver
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14 Responses to Gangrene and the Perfect Shell

  1. Norma B says:

    My heart bleeds for you! I’ve been there…gangrene and all. It is gut wrenching! But those few seconds of “joy” are precious, so hang on to them. You’re doing a great job of being her daughter! and I bet she knows it!
    Hugs!

  2. Susan Kane says:

    Gulping down the tears is how I felt as my mom was in her final days, hours. It is so close, Sandra. Relief and release are much the same. At least it was for us. I don’t know what else to say.

    • Sandra says:

      Susan I have no idea how much time she has. Which makes it all harder somehow not that when she goes won’t be the hardest…but watching quality of life just slipping away…I do lose the words finally for it all.

  3. Hi Sandra,
    You amaze me – that you can find a way to express what you are experiencing. Please know that I pray for your mother and you, and I send you both love at times throughout every day.
    Your writings remind me of the care I took of my mother in 2011. It’s a life altering experience for us daughters, kind of as if it’s their final lesson to us about being fully human. Up close and personal they show us what dying is and they challenge us to stand up and face it – with love and compassion. Which we do.
    The lesson continues… Seeing them suffer causes us to question God’s love and benevolence. How could He allow such a beautiful person to suffer so?

    Sandra, you may find that she welcomes the morphine when you next try it. Maybe give the smallest dose you can to ease her pain. That’s what we did with my mother and it brought her great relief that she welcomed. Like your mother, she had not been keen on it at first. The best thing was that it eased her struggle to breathe. We used it “as needed” and I don’t think she ever had more than a fraction of the smallest dose and only a few times a day. Just my thoughts on that.
    <3

    • Sandra says:

      Thank you for that input on the morphine Mary; it’s a difficult choice because of the dementia; she really has no say in it. But when we had hospice in there they insisted on it and she was off the wall. This was particularly bad evidently because she was not treated correctly. So we will see next round. Though morphine no doubt is down the road. It’s the dementia that complicates so much with these meds.

      • You’re in such a difficult position.
        I found that the dose they wanted to use for my mother seemed too much so I insisted we try 1/4 of the minimal amount. That brought comfort to my mother w/o causing distress. But my mother didn’t have dementia so you are in a different situation.
        I’ll keep up my prayers for you both.

  4. I love the final picture, Sandra. How wonderful to remember your son and his grandmother, walking together on the beach, gathering shells, both with their walking sticks. Really poignant.
    I was just remembering how my grandmother (age 80, almost 81), back in 1957, developed heart problems and a blood clot in her thigh, and they did surgery to remove. I guess they didn’t have blood thinners in those days. Anyway, they said if they didn’t do surgery, she would have to have her leg cut off. After the surgery, one of the doctors said he didn’t think she had any sensation in her foot. My mother hired a private duty nurse to sit with my grandmother in the hospital, and while none of the family was there, the nurse slipped out for a break, and my grandmother’s surgical wound broke open and she bled to death. I’ve always been grateful that she didn’t linger or have to lose her foot. I still say things are best when they happen fast, no matter how bad it seems at the time.

    • Sandra says:

      Good god, Lorinda that’s rather a horrific story. Bleeding to death….no I guess it’s not lingering. sigh. And yes the blood thinners help to get whatever tiny flow there is to that leg but it’s the femoral artery that is completely blocked.

  5. The anguish of having to watch it. Why on EARTH did the nurse think you should be there? That’s the sort of thing they typically ask the family if they want to LEAVE for precisely so that they can be present for their ill loved one when they return. And so the nurse doesn’t accidentally wind up treating a fainted away family member!

  6. Good God, that is a lot to go through. I am so sorry. Will hold you all in the light.

  7. Hard to like this, but because of the content, not the writing—which is powerful. I read it in email (because I subscribe to your blog 🙂 ). Very moving, very difficult. I’d report the incompetent nurse who used gauze.

    Your motif of the shell reminded me somehow of Anne Morrow Lindbergh’s Gift of the Sea:

    “I do not believe that sheer suffering teaches. If suffering alone taught, all the world would be wise, since everyone suffers. To suffering must be added mourning, understanding, patience, love, openness, and the willingness to remain vulnerable.”
    ― Anne Morrow Lindbergh, Gift from the Sea

    When I read this I sense your mourning, your efforts to understand and find patience, your love, openness, and most of all your willingness to be vulnerable with all of us.

  8. Jane Ayres says:

    Reading your posts reminds me of the pain of watching my mother slip away, but the beauty of your writing reminds me that so many of us have been on this journey. Although the journey is unique for each of us, we still know what every one of us is going through.

    My mother did not have gangrene, but her skin would break at the slightest impact, and she always had one or more infected sores. I bandaged and re-bandaged between nurse visits. I learned the big difference between regular gauze and Telfa pads (it would never heal with regular gauze). I helped turn her in bed and pried her tight fingers off the rail so we could turn her to the other side (no matter how many times I reassured her she wasn’t going to fall and told her to let the rail go, she couldn’t bring herself to do it).

    The little tiny joys – having her say “I know you!” when my friend visited, even though she couldn’t remember anyone’s names – that’s what try to keep in my mind.

    • Sandra says:

      Oh my gosh, Jane that is such a literal echo of the experience with my mother; the having to roll her and pry her fingers off the rail. But once she is rolled to one side, she still clings. I find I spend a lot of time now watching her hands…it does help to know others have been there because I am indeed in this horror alone. Me and my mother.

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