This day has been coming for a long time.  The closer it got, the less aware that mom seemed about it's arrival.  Mom has suffered with vascular dementia for about two years.  This type of dementia has it's challenges, but appears to be less damaging than Alzheimer's.  There are no "good dementias", but clearly some types are more difficult to live with than others.  I'm grateful that mom's dementia was manageable, for the most part.  The medications took a while to dial in, but mom's Psychiatric Mental Health Nurse Practioner was truly a professional who had good instincts and a lot of experience to guide her.  It made a big difference in mom's mental health.

Mom was able to stay in an assisted living community because her medications were adequate to control serious behavioral issues.  At one point, it seemed that mom might have to move into a dementia unit.  Fortunately, she was spared that locked down level of care.  Her life was far from normal, but she was calm enough to live among the other residents.  She was largely ignored, but found a few kind elders who accepted her obvious mental shortcomings.  God bless those few people who are willing to befirend someone who is a bit imperfect.

August 31st began at 5:55 AM for me, when the phone rang and a Hospice nurse advised me that mom was starting the dying process.  She said that mom might only live about four more hours, but that such predictions were hard to make with any certainty.  She apologized for calling so early, but said that she wanted me to have an opportunity to spend time with my mom if that's what I wanted, too.  I got dressed, grabbed something to eat and hurried over to the assisted living facility.  Mom was asleep and under the influence of morphine.  She had several pressure sores that were all less than a week old, except for one on her foot.  Her life was ending and her body was giving in.  Her eyes were partially open, as was her mouth and her breathing seemed labored.  She wasn't awake in a way that anyone would recognize.

I contacted my wife at work and my two daughters, asking them to come and join me.  I agreed that mom was actively dying and that her condition could change very suddenly.  Oddly, it didn't seem to change much in over six hours.  It seemend that mom might even survive the night, so I suggested that I might go home and get a few hours sleep while my wife and daughters kept mom company.  I ate a hamburger that my wife had brought to me and made plans to leave for a while.  I decided to closely check out mom before leaving and turned off the television.  Over the drone of the oxygen machine, I detected some irregular breathing patterns that I had been warned about by a nurse earlier in the day.  I decided not to leave and to spend the evening with mom and my family.

I moved my chair in closer to mom's bed and reached for mom's right hand.  I gently squeezed it and softly stroked her wrist.  I quietly told her that it was me.  Her eyes had a fixed gaze with no particular focal point.  In less than three minutes, mom took a few gulps of air, completely closing her mouth twice and her breathing ended with a slow exhale.  It was over just that quickly.  I rose to my feet, kissed her forehead and switched off the oxygen machine.  The room filled with silence and I glanced up at the digital clock atop the chest of drawers.  It was 4:40 PM.  I sat back down and we reflected quietly on the preceeding few minutes.  Mom was lying motionless, but looked very peaceful.  I removed the oxygen tubing from her nose and checked for a pulse.  There was none that I could detect and there was no evidence of shallow breathing.  I pressed her call button and closed the chapter on this part of my life.  At age 89, mom was gone and my parents were both now a part of my past.