In the past five weeks I’ve helped assist five people in their conversion from one form of energy into another. All of them were dear to me, and each was unique and interesting. Because I did not meet them until they entered dementia care in the last chapter of their lives, I knew them in simplified form compared to their former selves. They were all old by any sort of reckoning. Their bodies were like cars you couldn’t get parts for any more. We knew their carburetors or fuel pumps or batteries would fail soon, and we could not prevent it. Our job was what is called palliative care, which is basically the alleviation or mitigation of suffering during the process of physical death.
Many people pretend that living is something different and separate from dying. To me living and dying walk hand in hand as best friends in permanent companionship. It’s just the process of using the machine. With each bath or shower, we cast off millions of dead cells. We take in fuel and pass exhaust. The mental and invisible process works that way too. We learn new things and old ideas and concepts get thrown away. We’re always recycling and working out new paths for the flow of sensations and understanding.
Before I became familiar with the specific process of dying I held a number of misconceptions. Perhaps you do too. When someone enters the active dying process, their various biological drives begin to ramp down. They do not hunger as much or as often. Their menu preferences might shrink to a few items like pudding, popsicles and applesauce for example. They do not thirst in the same way as before, though they may wish small amounts of water or juice just for the pleasure of tasting it. Their mouths get drier because they stop swallowing, so we use little sponges on sticks to moisten them. A variety of discomforts may occur. It may become difficult to breathe. Because the immune system begins shutting down, opportunistic infections sometimes take hold. We have to keep an eye on their temperatures and levels of congestion.
Dying people may experience comfortable and uncomfortable sorts of hallucinations. If a person begins holding pleasant conversations with their long-dead friends and relatives, we don’t consider it uncomfortable. On the other hand, we are not averse to administering anti-psychotic medications for people who imagine enemies and demons are entering the room to drag them to hell. As the brain begins shutting down, they become unable to speak and are bed-bound. We watch for non-verbal pain indicators like grimacing. We shift their positions in bed to prevent pressure sores from immobility. Our overall effort is to address obstacles as they occur, not to cure because it’s too late in the process for that, but to do what we can to make people comfortable. There’s quite a lot that can be done with medications to manage pain and make breathing easier. Our presence and loving company do much to alleviate the fear some dying people experience.
I got an unexpected day off in which to write this. A truck driving out the main road caught a low-hanging wire and pulled down a power pole and some transformers. No one was injured, but it knocked out power to the Urgent Care clinic (my other job) for a day. The crews didn’t replace the pole. They strung up new cables across a different path. The nearby café I frequent served breakfast by flashlight thanks to their propane-powered kitchen and backup generator.
I thought about how we are animated by the electricity of our consciousness. At some point we will experience power loss. Sometimes it will get interrupted in a trauma, like with the truck and the wire. Sometimes the equipment will just wear out and expire, like with the dementia care patients. The power still exists. The cables get strung up along a different path. I still feel the electricity of the relationship I had with those who died. Part of their voltage is humming through my grid now.