On Sunday, November 29th, 2015 I understood and accepted that my daughter was dying. I lay in bed with her, cuddling her and talking to her. I stroked her face, touched her hair, held her hand. I kissed her – her cheeks, her lips her ears, her chest, her hands..her feet.  I looked over her body, just as I had when she was a newborn. Amazed at how big she had gotten, how her body had changed, how her hands still had the softness of a very young child. She was beautiful and she was leaving me. How could this be happening? I was not ready for this.

Part 5

Sunday night was a long night of resting between the alarms I had set on my phone to administer various medications to Kate. Dr.Splinter had increased her pain medication and we were now using her subQ port on her little arm more regularly. The morphine infusion also ran at a steady rate through her PICC line. We had increased it in order to ensure her comfort. The nurse who was supporting us had drawn up several syringes of pain medication and arranged them on a tray in Kate’s room. I pushed aside the cute pictures and stuffies on her dresser to make way for the tray of carefully labelled syringes so that I could reach for them easily. I thought briefly about my fatigue and worried about mixing them up and making a medication mistake.

Even if my nursing role had not been necessary, or I had allowed someone else to do it for me, I still would not have slept. I had entered that state of sleep deprivation where sleep would not come easily, and I was scared that something would happen to Kate if I closed my eyes. I did not want her to die without my witnessing it. I laid my head as close as I could to her, my face pressing up against hers, and I listened to her throughout that night.

Monday, November 30th was a much quieter day. So many people wanted to help in any way they could. We thanked them, but asked them to stay away. When I got up in the morning, the house was quiet. I came down the stairs from Kate’s bedroom and saw our Christmas tree fully decorated and lit. My mom had spent the previous day, fluffing out our beautiful (artificial) tree. Someone had dragged up the heavy boxes of decorations from the basement, and she had carefully arranged each one on the tree. It was her contribution. To help keep our home running, to keep our space organized, to do something special for me.

I loved Christmas. I loved the time with family and friends, watching my children on Christmas morning, the wonder of Santa (I still believed), Christmas dinner, the snow, the smells, the coziness of it all. I looked at that tree and I couldn’t decide if I was happy to see it up or not. Kate would not live to see Christmas.

Dr. Splinter arrived early to check on Kate. He would be there several times over the next 14 hours. There wasn’t much to say or do. He checked Kate. We chatted. I think there was a conversation with Brian about football (were the Ottawa RedBlacks playing in the Grey Cup?). He was so natural with us. Tending to our dying child, entering our personal private space at a time of intense emotion, and looking after us and her. I tried to place how I felt, whatever it was, it was familiar and comfortable. I thought that was very important. We talked about Kate and then we talked about football, or his adult children, or renovations, and then he’d leave and head home, or to Rogers House, or CHEO with a promise to be back “soon” and to “call him if there was anything”.

Brian’s sister Nancy, her husband Lloyd and daughter Megan spent a lot of time at our house that morning. Megan had held vigil with Kate much of Sunday. Megan (and Nancy) had been in Montreal to support us during Kate’s bone marrow transplant. She was an amazing grown up cousin, and she was beautiful with her little cousin. I love her so much for that.

My dad and my mom also spent time with their grand daughter. My parents have so much love for their family. They did everything in their power to support us and had moved to Ottawa to be with us during Kate’s bone marrow transplant. My dad, who NEVER wanted to see Kate in hospital and feared seeing her in pain, had stepped up to travel back and forth to Montreal to take shifts with Brian and I to stay with Kate. Kate loved her ‘Grandy’ as we all called him. He played with her, teased her, cuddled her, and sang ballads of ‘Soft Kitty’ to her (yes, Big Bang Theory Sheldon ‘Soft Kitty’). My mom found the stamina of hospital living tough, so she made sure our home in Ottawa was ready for our return – totally sanitized and ready for a child who required strict infection control. She shopped for Kate. Birthdays were a big deal for Kate, and she couldn’t see why Kate should not have a “Happy Day” a few times that fall. She and my dad would show up in Montreal with gift bags of toys, clothes, and crafts to cheer Kate’s day. My parents were incredible, but I found I had to shut down my emotions and avoid connecting with them about what was happening. It was too painful. I couldn’t handle their grief. Even to this day, as I write this, we haven’t been able to have that moment together.

I can’t remember much about Brian over those days. We were two parents caring for our child. We did what we had to do, when we had to do it. It was a pattern we had fallen into over the past 8 years of our life with Kate. The pattern had turned into a deep groove over the years, and we intuitively knew when one of us needed a break and seamlessly took over. I was the point person, the care coordinator, the spokesperson, the organizer, and Brian supported us all. I carried the weight of Kate’s care in Montreal until I broke down from exhaustion in May 2015. Brian stepped in, and he was amazing. The role of hospital parent is not an easy one. He advocated for her, followed the strict regimen she required, and cared for Kate in that very difficult time. That routine and those roles followed us home, and over the last few days of Kate’s life, Brian and I just found a natural rhythm of caregiving and vigilance for our daughter, and our son. We kept our deep and painful grief separate. I don’t remember crying together or holding one another. I remember feeling like I might break. I watched the pain in his face and I almost felt numb. He loved Kate so much. He was an amazing dad. And she loved him so much, “Papa” she would say “Brian, come”. How could this happen to him? Would he survive it, I wondered. Would we survive it.

I try to remember now what we specifically said to Jack and how we might have tried to prepare him for what was happening. I don’t think we did.
He was always at the house, he may have left for a hockey practise. He wasn’t going to school, but we tried to keep to some sort of routine. I am sure Megan or my mom or dad took him somewhere for some errand during the day. It really is a blur.

I always relied on Jack to just adjust to every situation. He was my helper and he had grown up fast and with more responsibility than most children as he helped us support his sister. There was a constant unpredictability to our life because of Kate’s frequent illnesses, but her bone marrow transplant had taken that to a completely different level. We tried to bring him to Montreal as much as we could, and involve him always in what was happening, but his life was in Ottawa and he spent most of those months with my parents or friends. He had suffered during that time, but I am not sure even now how I could have done things any differently. He was very accustomed to our family being together and the separation was extremely difficult for him.
Jack kept up his nursing vigilance of Kate, checking her heart rate and oxygen saturation with her portable monitor. Sometimes he would check his own for comparison. I let him help me with her medications. He was not scared, and he was very serious. My heart hurt as I watched him create little rituals with his sister. He was in and out of her room constantly, holding her hand, talking to her, and sitting on her bed. I grieved the time they had been separated. I wondered how that could have been different.

As the day progressed, Dr. Splinter was clear with us that Kate was declining quickly. There was no coming back from this, and she would likely die that day.

Brian and I decided to arrange a few very intimate visits of people who had been close to Kate. Because of Kate’s isolation, she had not had many visits or time with friends in the past 9 months. For a child as social and loving as Kate to have that kind of separation had been very hard on the people who loved her and knew her so well.

I am so grateful that we asked these special friends to visit Kate and spend time with her. We greeted them, led them upstairs, helped ease them into the shock of Kate’s appearance, and then we left them to have their time with her – shutting the door quietly. I know Kate knew they were there. I know she carries their words and their love with her even now. How special those visits were.

In the evening of Monday, November 30th, 2015 the last of our invited guests arrived. Dr. Major and Dr. Chakraborty came to say goodbye. Dr. Splinter was there as well. They each held her hand, and spoke to her. There were so many of us gathered in her room, Sunita and Stephanie were also there. I talked to Kate, and to those present in the room at the same time. There was stream of thought running through my head and I just let the words come up. I’m not sure how much sense I made. Kate’s breathing changed. We made a decision to remove her oxygen. Her breathing changed again. Dr. Splinter leaned down close to my face and said, “She’s dying now”. I nodded and the tears spilled down my face. Brian groaned. I heard the sounds of others, maybe chocked back tears? I didn’t look away from Kate to find out.

And then her breathing settled. It was 9 p.m.

Dr. Splinter told us he would go and we should call him once she had passed. He had increased her morphine. I think she was maxed out.

Dr. Chakraborty also left. We hugged as friends. I’m not sure what we said to one another. There really wasn’t much to say.

Dr. Major sat in the living room with Sunita and Stephanie, but after some time she also left. She knew we were well supported and she also knew this was a most intimate time for us.

Brian, Jack and I surrounded Kate on her bed. Jack shut her door – he wanted our privacy. We talked to her, and sang to her. Jack found funny videos on his phone of Kate giggling and playing. We watched them together and said to her, “remember when Kate-O”. Her breathing changed to become less frequent, and more shallow. We played “Fight Song”.

I can’t share the last moments beyond this. They are intensely personal. They are full of intense love and pain. I watched my daughter die. I watched my son shatter and lose part of himself. I watched my husband cradle him in his arms. The shattered pieces of our lives floated around me in slow motion. The most beautiful child had left this world and it was not ok. The universe shook and something shifted inside me forever. It was 10 p.m. November 30th, 2015

We called Dr. Splinter. He came and saw Kate. I asked if I could stay with her until morning and he said yes. He hugged us and told us he was sorry, and then left.

Stephanie and Sunita came in. They had asked our nurse to leave. I wanted to change Kate and to get the goddamn PICC line and subQ access out of her arm. I wanted her free of all of that. I pulled away the tape holding things in place and took everything off of her and out of her. I wanted all of medicine away from her. I wanted her to be free of it all. I had not seen her body without tubes sticking out of it for months.

Stephanie and I cleaned her and changed her. I debated putting clean pyjamas on her as she was still naked. I thought it would bother her, so I didn’t. She hated being fussed with. She seemed fine in her diaper and socks.
Brian arranged Kate in my arms. I had not held her. I lay in her bed cradling her. She was so big. I could not let her go. I thought to myself what an incredible gift that Brian was letting me hold her, giving ME the time with her, this absolute precious time. I couldn’t say the words out loud, but I thanked him.

Jack came in. I was worried he’d be scared to see her. He sat with us and laid our hands in a perfect pyramid, one atop the other. “She’ll always be with us mom”, he said.

He asked if he could cut a lock of her hair. I hadn’t thought about that. Her new hair was so foreign to me. I told him yes. He also started gathering things from her room, something he would do over the next couple of days. Pictures, books, a bathing suit, her cochlear implants. It was if he needed pieces of her to be with him always.

Brian came back later to check on us. I told him I wanted to stay with her. He helped us get arranged in her bed. I took that time to talk to her, squeeze her, hug her, stroke her face, kiss her lips. I buried my head in her soft crease of her neck and I smelled her. Inhaling her scent deeply. I was scared I would forget what she felt like, and how she smelled.

I slept that night, face to face with Kate. In the morning there was the most incredible pink and purple sunrise.

On Saturday, November 28th, 2015 we arrived home from Ste.Justine hospital with Kate. Kate’s pain was no longer under control and we did not have a good plan to manage it. That day was overwhelming while people caught up with the situation, and we were finally set up to support Kate the way she needed to be. It was adrenaline and pure love that kept us going after days, weeks, months of little to no sleep. We were emotionally and physically fried, fueled by desperation and an underlying sense of panic as we navigated something no one could imagine in their worst nightmare. 

 

Part 4

Saturday night was not a restful sleep. Kate did not wake. She seemed comfortable. I went to my own bed, as did Jack. Brian slept on the floor beside Kate. At midnight he came and got me. “Kate is making a funny sound”, he said.

I got up and went to her, and indeed she was making a strange sound. A sort of chesty gurgling, like she needed a big wet cough. I checked her oxygen saturation and heart rate, and all was well. We now had an oxygen compressor in the house and did not have to rely on tanks. I also checked her IV fluids that were continuing to run. I had not paid much attention to the rate, and now saw that they were at 80ml/hr. That was an unusually high rate for Kate, who was typically on ‘maintenance fluids’ throughout her life. A range of 20-40ml/hr was what I had been accustomed to. I made a mental note to ask Dr. Splinter when he came in the morning. I remembered that Dr. Duval had emphasized that rest, pain management and hydration was the way to treat an acute pancreatitis. I thought of turning down the fluid rate myself, as I was very familiar with programming the pump, but I chose to wait.

I thought of sending Brian to our room, but I knew he wouldn’t go. He looked exhausted. He was exhausted. He had been sleeping on the floor in Kate’s room, with his arm reaching up to her bed so he could hold her hand to let her know he was there. At some point in the night, Jack had joined him on the mattress next to Kate’s bed. I can’t imagine how he slept like that. He probably didn’t.

I climbed into Kate’s single bed in the space between her and the wall. I didn’t want to disturb her, but tried to gently move her over to create some space. We did a lot of co-sleeping with Jack, but never with Kate. She always wanted her own space. I decided this is where I would stay. I slept, which really was just resting my eyes and dozing off. I mostly listened. The gurgling became more pronounced, and at 5 a.m. I decided I needed to call Dr. Splinter. I described what was happening and he asked me to hold the phone to Kate. He said he would be right over.

I wasn’t ready for the incredible intimacy of those moments between Dr.Splinter, Kate and I. There in my pyjamas, my glasses on (I wear contacts typically), no makeup, hair tousled, sleeping with my daughter in her bedroom in our home. You would think I would not give it a second thought considering all of the years I had been admitted into hospital with Kate. (Yes, when you admit the child, the parent is admitted to). I had walked in the halls in my pyjamas to go to the bathroom, or upstairs for a late night tea in the kitchen. I had a nurse walk in on me more than once while I tried to quickly get dressed in Kate’s room. I stumbled for my glasses and to gather myself from a sleep stupor as residents came in to our room in the  early morning. Dr. Splinter and I had known each other for years, but I still felt a little exposed as he stepped over my husband and son on the floor next to Kate. He thought nothing of it. His incredible years of experience, our long term relationship, and his astounding ability to do this part of his job so well and with so much directness put me at ease.

He listened to Kate’s chest and told me she had fluid overload. He turned off the IV fluids. “She doesn’t need this”, he said. Her body was not using the fluids we were giving her efficiently and the wet sound in her chest was the result. (I learned later that this was also a first sign of her body shutting down.). He introduced a medication to reduce her secretions. We came to use it a lot through her subQ site over the next 24 hours.

I told Dr.Splinter that Kate had not been getting her post bone marrow transplant medications, including her heart medications. I had been told to keep to our schedule as much as we could, but the night before Kate was not conscious enough to take them orally. Dr.Splinter reassured me that he was not concerned. I knew on some level that this was important, but I didn’t process this information. I filed it aside as something to worry about later, when Kate was feeling better and more alert and we could get back on track with her medications. Although we had brought Kate home because her team felt nothing further could be done, I wasn’t understanding yet that she would likely die and that she was declining quickly.

Dr.Splinter was back and forth a couple of times that day. It was a busy, confusing, overwhelming day. It was a day of enormous change.

We had let friends and family know what was happening, and that we were home. On Friday I had called my brother to let him know we were taking Kate home. He  said he could fly to Ottawa early next week. “I don’t think she’ll be here Michael”, I told him. We had also called Brian’s sister in Newfoundland, she was on her way to Ottawa with her husband and daughter. His other two sisters were making arrangements. My parents were here. They had moved to Ottawa temporarily to support us during the bone marrow transplant. They had stayed after all of the complications had occurred and we found ourselves back in Montreal. I did not speak to them much over those few days. I could not even look at them as I could not bring myself to see their grief on top of my own. It was all I could do to keep myself together. I feared the grief of others, especially my parents. It would be too much to bear, and I would fall apart.

My tribe of friends from Rogers House and CHEO were waiting to take action. A couple of them came over and offered advice and assistance about oxygen lines, positioning Kate so she would be more comfortable by propping up the head of her mattress, giving advice about pain management, fluid overload etc., and taking on the massive job of cleaning out my fridge which had been filled beyond max with food from concerned neighbours. Other close members of our tribe kept in touch by text, and shared advice, and words of support. I poured out my heart and deepest fears. They responded with compassion.

These were knowledgeable, smart moms who also had sick children, or who had lost their child after a medically complex life. I know how lucky I am to have met them through the CHEO Complex Care Program and Roger Neilson House, and to have had their support and love. Sadly, they were also attending to other friends of ours who had lost their son several days earlier. Not everyone has that sort of ‘tribe’ at such an incredibly difficult time.

Sunita and Stephanie continued to manage medications and tried to set up a schedule to keep track of what was being given, by whom, and when. I relied on them both heavily. I did not want to have nurses in our home. I felt an immense need to nurse Kate myself, and with the support of Sunita and Stephanie, I felt I could do that. Between the two of them, one of them was always at the house.

At one point there were a few nurses downstairs, all sent from various agencies via CCAC. There was much discussion about who should be there, what their roles were, and who was best suited to support our family and care for Kate. A nurse we had worked with all fall, finally put her foot down, insisting she knew our family best (she did) and that she would look after us. The other nurses left. I was grateful I didn’t have to intercede and grateful for the quiet presence of this nurse who knew us, and played an important background role of organizing medications and drawing up syringes, and monitoring Kate.

What I remember most from that Sunday was confusion. I had convinced myself that this possibly wasn’t the end. No one had said it was. Maybe it wasn’t. I asked about bloodwork, maybe we need to adjust her fluids? When Kate opened her eyes, unfocussed and rolling, I thought it was a sign of her regaining consciousness. She was squeezing the hands of people who were sitting with her, I thought in response or recognition that they were there. I reminded myself that we were managing her pain, she was well hydrated and she was resting, all the things we were supposed to do to manage the pancreatitis crisis. We just had to wait and see and give her time. We could have weeks, maybe months if we got her stable. Isn’t that what we had talked about less than 48 hours before?

I blame panic and and inability to process what was happening, for my confusion about what was happening to Kate. It was the denial of grief, and I was exhausted. Beyond exhausted. I had not slept in 48hours. I had had little sleep in the past 9 months, while living in 24/7 isolation with Kate. Compounded by 8 years of caregiving that never involved a full night sleep.

I asked my questions and made my case to Dr. Splinter when he arrived in the afternoon to check on Kate. And he reacted exactly in the way I needed him to. Firmly and directly. Kate did not need bloodwork. We are managing her exactly as she needs. She is declining faster that he had anticipated. We are doing all the right things for her. “You are doing a good job”, he said to me.

We set up a chair next to Kate’s bed. If I was not laying in bed with her, someone was always with her to hold her hand. Touch was important. We respected Kate’s space and did not put her cochlear implants back on. We also tried not to move her or pick her up. As much as I wanted to hold her, I did not want her to have any pain.

Jack took charge of monitoring her vitals. He wanted to know exactly her heart rate and oxygen saturation. If they changed or were elevated, he would let us know. It was a good indication if we need to increase Kate’s oxygen or morphine. When she developed a fever, Jack got cold face cloths to cool her off. I let him help me manage her PICC. He was better than most at ensuring infection control was respected and knew what materials to hand to me and when. As much as anyone, Jack was involved in nursing her. He was her brother. He had always been there for her, and that wasn’t going to change now. It was also very natural for him to be involved and helping me. He always had. I am so proud of him.

I was scared to sleep that night, Sunday, November 29th. I was grateful the day was over. I was grateful for the stillness and the quiet of just us in the house. Brian and Jack slept on the mattress on the floor again, and I climbed in with Kate. She was naked, having soaked through her pyjamas and her body heating up. We thought it would keep her more comfortable not to fuss with putting another set on pyjamas on. I stroked her chest, her arms, her face. She had changed so much physically. Her face was distorted from steroids, her hair was growing back a light brown, her body was puffy, and her hands were exceptionally warm.

I talked to her that night. I told her it was ok, that I understood what was happening now. I told her how amazing she was. How brave, and beautiful, and smart. I thanked her for being my daughter and for all she had taught me. I told her I was sorry. I was so so sorry for all of it, all of this, everything she had had to endure. I told her that I would always be with her, that I would NEVER leave her. I would find a way. And no sooner had those words left my thoughts that I felt an incredible intense pain in my chest. A ripping sensation, a tearing, a shredding. I couldn’t breathe. I didn’t understand. And then Kate showed me, it was her. She had heard my words, she was taking a piece of my heart for herself. So that I would always be with her. I smiled at her and I cried. “Oh smart girl Kate-O”, I said. “You figured out how to keep us together”. “I don’t want you to go Kate, but you don’t need to stay for me. I’ll go with you.”

This is what I can remember. The raw truth and love and honesty that spilled in whispers from my lips to her ear. She couldn’t hear me, but I held her hand to my mouth so she could feel my words. I whispered to her so we wouldn’t wake the boys. Mother and daughter secrets. Kate-O and mama. I felt calmer after. A strange aura of calm and understanding between she and I. I also felt gratitude. Grateful we were all together and at home. Grateful she would not suffer with strangers at her side. I didn’t want her to die, but if she had to, this is the death I wanted for her.