This will be brief, barely qualifying as a diary.  And as it does not pertain to either yesterday's election or today's news, I hope you will forgive the indulgence.

"What's wrong, Mother-In-Law?"

She'd been restless most of the afternoon, but each time she called or squirmed enough to prompt me to investigate, the most she had been able to tell me was that she was "uncomfortable."  I tried to tweak her meds a bit, but I suspected that the duragesic patches which are supposed to be good for 72 hours were running dry half a day early.

She took a sip of water from the straw I held to her lips.  She swallowed, then said: "I was just worried."

"Worried?  What are you worried about - maybe I can help?"

"Well, I think I need to go shopping."

"Shopping?"

"For clothes.  For when I take the train back to college this fall.  I won't have time to shop once I am there."

Lisa, our regular hospice nurse, arrived while we were getting my MIL dressed this morning.  She sat and watched, observing my MIL, seeing how she interacted with us, how she moved, how she looked.  Then she went through her usual examination, checking vital signs, listening to heart, lungs, intestines, asking the usual questions about sleep, and appetite, and signs of pain.  She sat back, looked at my MIL, and said pleasantly to her: "you always have such a beautiful smile."

Try to wrap your head around this:

NYPD Seeks an Air Monitor Crackdown for New Yorkers

Damn you, Osama bin Laden! Here's another rotten thing you've done to us: After 9/11, untold thousands of New Yorkers bought machines that detect traces of biological, chemical, and radiological weapons. But a lot of these machines didn't work right, and when they registered false alarms, the police had to spend millions of dollars chasing bad leads and throwing the public into a state of raw panic.

I sat, my back to the fireplace, feeling the heat from the fire, listening to the pop and crackle of the fresh log I had just placed there.  Across the room, the hospice nurse and my wife were sitting at my MIL's feet, the nurse doing her routine examination for the second time in a week.

This is new.  Previously, we'd only been on weekly visits.  But as it is clear that we're in the final days of my MIL's life, we decided to schedule an additional time.  And, thanks to how hospice works, we've the option of calling for additional visits as needed, or adding in more regular scheduled visits each week.  Just knowing this resource is available is comforting.

Lisa, our regular nurse,  listens, touches, looks.  I am struck by just how much good medicine is still based on these simple techniques, when it all comes down to it.

As it does when you are dying.

With all the dignity and presence of a southern lady, my MIL held her self erect, looked at me and said "I've had a very nice time this evening. And dinner was lovely. And your performance, though I'm a little ashamed to admit that I can't remember exactly what you did."

"Well, thank you!" I answered. Then I helped her finish up on the commode next to her bed, and carefully laid her down for a nap.

It was 12:45 in the afternoon. She had just finished lunch consisting of a peanut butter & jelly sandwich, Pringles, and some chopped pears. Needless to say, there had been no 'performance' by me or anyone else.

I commented via email to a close friend yesterday about the persistent fever my Mother-In-Law has been running, 2 to 2.5 degrees above her normal.  We'd seen fevers come and go for the last several months, but this one seems to have settled in for a while.   I got back this:

Any particular reason for it, or is she just being like a star that's going into its final flameout?

* * * * * * * * * * * * *

"She's a strong woman," said Lisa, our regular hospice nurse. We were standing out in front of the house, talking the way people do at such times, in spite of the 11 degree temperature and bit of cold wind. Neither my wife nor I had coats on. But it didn't matter at that moment.

I walked into the dark room, stepped up to the bed. My MIL looked up at me, and said "I don't like these rails and straps."

There are the standard 'hospital rails' on the side of her bed.  And since she's several times attempted to climb over them (and broken bones in the subsequent fall), we put some nylon straps across from one rail to the other in a sort-of cargo net arrangement.  It allows her to move freely in bed, but stops her from trying to climb out on her own.  "Well, I'm sorry, but they need to stay on."

She smiled.  "Doesn't matter - I've decided that I'm going to leave today, go back home to Missouri."

"Well, I've enjoyed my time here, but I really should go."

I sat on the couch next to her chair.  The slight hiss of the oxygen cannula under her nose could still be heard over the sound of the concentrator in the other room.  Her hands picked absently at the shawl we had over her lap and legs.  "Well, we'll be having supper in about an hour."

"We will?"

My wife entered the room, sat on the floor by her mother's feet.  "What's up, Mom?"

"Well, I was just saying that I thought I should be getting home, but he tells me that we're going to have dinner soon.  I don't have any money for dinner."

We're back to the train metaphor.  My MIL has either been traveling via train, or is waiting for someone to arrive on a train, or is going to catch a train, or just thinks that she is presently on a train (this last happens when she's in bed, with the bed safety rails up).  I cannot help but think that this is her subconscious' way of understanding that she is in transition from this life to whatever comes after.  Why a train?  Because when she was a  young woman, that's how she traveled, to St. Louis for shopping, back and forth to college.

* * * * * * * * * * * * *

It was the second time I'd been in this morning, checking to see what the sounds I'd heard coming over the monitor were all about. My MIL was over next to the side of the bed, almost up against the safety rail."Are you OK?"

"Yes. I was just trying to turn on the lamp."

The lamp is deliberately out of her reach, otherwise she'd turn it on in the middle of the night in her confusion. "Why did you want the lamp on?"

"So that they could find me."

"Who?"

Just in time for the holidays, comes this friendly bit of advice from your Big Brother:

As the busy holiday travel season approaches, TSA would like to help you get through the security checkpoint quickly and have a safe flight to your destination. Our Transportation Security Officers will be working around the clock to provide an efficient security process. We're asking you to become an active partner in your security experience by knowing the rules and carefully packing your carry-on bags.

Pack smart to get through faster. Keep luggage organized by layering items; this will increase visibility for the security officers. When approaching the checkpoint, be prepared.

Over the weekend, news came out of yet another "Trust us, we're the government" debacle, this time in the form of the principal deputy director of national intelligence saying that Americans have to give up on the idea that they have any expectation of privacy.  Rather, he said, we should simply trust the government to properly safeguard the communications and financial information that they gather about us.  No, I am not making this up.  From the NYT:

It has been a difficult week in caring for my MIL.  As noted previously, we went to a three-day trandsdermal patch to help with the pain associated with her aspiration and breathing difficulties.  And that has worked pretty well.  But as I suspected would happen, after her trial period with the oxygen she didn't want to use it any longer - even when she was laboring to breathe and I offered it to her, she declined.  Only once, when she was having a coughing spasm, did she consent to put up with it again.  This means that she has continued her slide, probably at a faster pace than were she using the oxygen.  It is a tough thing to watch.

Gah.  This is like something out of a comedy sketch:

When my MIL's hospice nurse was here the week before last, she clearly saw a decline in my MIL, as I noted here.  What I didn't mention in that post was that one of the things she suggested we consider was to move to a transdermal patch to help alleviate some of the pain associated with the breathing difficulty my MIL is starting to develop.  (When people start to develop pulmonary aspiration problems, the coughing and gagging can be quite painful and cause a great deal of distress for both the patient and care providers.)  Pain relief and comfort are our primary concerns with my MIL, but choosing to go to a derm patch of a powerful drug could well contribute to hastening her death - a common concern about all opioid-class drugs with the elderly.  My wife and I discussed the matter, agreed that it was an option we should consider if conditions worsened.

I just lost my temper.  I just had a full-fledged screaming fit, eyes bulging, veins throbbing, face beet red.  At a 90 year old woman who knows no better, who is confused by the world around her due to Alzheimer's, who is likely dying.

Why did I just do this reprehensible thing, and why on earth am I admitting to it in a public forum?