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Thursday, May 17, 2012 my beautiful mom, Deborah Louise Appleby, met her Savior face to face around 8:00 in the evening.  She had battled cancer for two years.

Oh how she fought.  Initially, we were told she would only live a couple months.  She was so frail.  She could not walk or move without excruciating pain.  The reality of it hit me when I had to scoop her in my arms like a baby to help her move in bed.  She was 58 years old.  It really didn’t seem fair.

Mom liked to prove the doctors wrong.  She always outlived their predictions.  And she always responded better than expected to any treatment.

Mom’s last week was filled with tough decisions, pain, and then comfort and peace.  As noted in my last post, Brain Surgery, we had a tough choice on how to handle her pain.  We were told she would not leave the hospital.  Of course, we had heard that so many times.  We knew that, one day, they would be right.  I wondered if Mom passed away during or soon after surgery, would I have regrets?  I can honestly say that I don’t.  The relief of her pain was beyond evident after surgery.  She looked so much better.  She could move.  Her face looked so much more relaxed.  Her eyes were normal and clear.  Her blood pressure and heart rate were normal.  Lungs clear.  I stayed with her around the clock.  My husband gave me a few breaks, but I wanted to be with her.  She would nod her head or makes noises to communicate.  I didn’t want to miss anything.

Thursday started out bumpy.  Her breathing was slightly labored and she had mucus in her throat.  She wasn’t sleeping.  And her kidneys didn’t seem to be functioning.  All are signs of impending death.  As I was talking to Mom, I mentioned that we couldn’t get her to the bathroom because she had just had surgery, so it was okay to use her brief.  She always hated those things.  Within an hour, she had to be changed three times!  Her breathing improved.  I sang “Victory in Jesus” to her.  As I sang, she turned her face to me, smiled ever so slightly, and looked so content.  Peaceful.  She was doing well.  At 12:30, she was transferred back to the nursing home.  When we arrived, Mom looked around her room and seemed to relax.  This was home.  She dozed off a couple times.  Finally she could relax and rest.  I stayed for a couple hours.  Her lungs were still clear.  She was calm and had no pain (morphine is nice that way).  I decided to leave for a few hours.  I hadn’t seen my children most of the week.  As a family, we went to swim and gymnastics practices.  Afterwards, we headed back to the nursing home to check on Mom.

And that’s when we found out.  We were about 5 minutes from arriving, but she was already gone.

I wonder if she waited until I left.  She had worried so much about how my brother and I would handle her passing.  How would my children handle it?  And when I think about it, I really can’t imagine leaving my children or husband.  I’d want them to experience as little pain as possible (none at all, actually).  Would it be hard for them to watch me take my final breath?  Would they relive that moment forever?  She knew I had never been with someone as they passed away.   I think she was still being my mom, even in her last moments in life.  She wanted to protect me from the pain.  She was my shield, even on her last day.

Mom is healed.  Not the way I wanted it.  I want her here, sitting on my couch, telling me to get off the computer, wanting to know if I’ve planned dinner yet.  I want her reading to Joshua and sewing with Madelyn.  I want her to see them graduate and get married.  I want her to hold her great-grandbabies.  I want her to be here when we adopt again.  I want her fussing over how neglected our poor pets are.  But an earthly healing is never complete.  Our bodies are still flawed and still fail us.  And nothing can compare to the presence of the Father. Mom is completely healed now.  New body, worshipping at the feet of her Savior, praising God.  She is reunited with her sister, mother, and father.  No pain.  No disease.  She can talk and walk and leap for joy!  Her eyes can see clearly.  I couldn’t ask for anything better for her.  She can sing!

I can begin to understand the pain God feels when He is separated from us because of our sin, the pain Jesus felt on the cross when His Father looked away.  Separation is painful.  It aches.  It knocks you off your feet sometimes.  But praise, God, this separation is only temporary.

So what have I learned on this journey?  Well, I’ve learned a lot about cancer and health.  But we’ll save that for another day.  The one thing that became more and more real throughout this journey is how it is so easy to get beaten down by the circumstances and not see the bigger picture.  I wish I could say that I cleaned vomit (and worse) with joy every time.  I wish I could say that I counted it a privilege to bath my mom each time she needed my help.  Or drive her to countless appointments.  Or hold her steady as she sat on the toilet.  Sometimes I grumbled.  I was angry that this interfered with my life.  I have children, you know.  But looking back, I realized that I was blessed to be able to do those things.  I’ll never get to feed her again or wash her hair or help her dress.  We humans are like that, aren’t we?  We don’t see the blessings until they’re gone.

Don’t miss out on life.  Even when it seems ugly and burdensome, find joy.  Know that one day the struggles will pass, but so will the good that came along with the burdens.  Sometimes they are a package deal.

Forgive.  No matter how much a person wrongs you or hurts you, we will all meet the same end.  Watching someone wither made me see how fragile we all really are.  I would not wish pain and suffering on anyone.  We will all experience it one day anyway.

I heard an old, 
old story
how a Savior came
 from glory
How he gave his life
on Calvary
 to save a wretch like me
I heard about 
His groaning, 
of his precious blood’s
 atoning
Then I repented 
of my sin
 and won the victory

Oh, victory in Jesus,
my Savior forever
He sought me 
and he bought me 
with his redeeming blood
He loved me 
e’re I knew him
 and all my love
 is due him
He plunged me to victory 
beneath the
 cleansing flood

I heard about his 
healing, 
of his cleansing pow’r
 revealing
How he made the lame 
to walk again 
and caused the
 blind to see
And then I cried
 “Dear Jesus,
come and heal
 my broken spirit”
And somehow Jesus
 came and brought 
to me the victory

Oh, victory in Jesus,
my Savior forever
He sought me
 and he bought me 
with his redeeming blood
He loved me 
e’re I knew him 
and all my love 
is due him
He plunged me to victory
 beneath the
 cleansing flood

I heard about a mansion 
He has built for me in glory.
And I heard about the streets of gold 
beyond the crystal sea;
About the angels singing, 
and the old redemption story,
And some sweet day I’ll sing up there 
the song of victory.

Memorial Celebrating Deborah Appleby
Tuesday, May 22, 2012
2:00 P.M.
Grace Bible Church Southwood
1901 Harvey Mitchell Pkwy S.
College Station, TX 77840

Visitation Noon-2:00 P.M.

Internment to follow at Memorial Cemetery
3800 Raymond Stotzer PKWY
College Station, TX

*Donations may be made in lieu of flowers to Grace Bible Church*

Brain Surgery


The first half of my Mother’s Day was spectacular!  Breakfast in bed with all my favorite breakfast foods.  Some awesome gifts from the kids.  John got me The Hunger Games and 4 hours of quiet time to read.  He cooked a fabulous lunch.  Everyone was in good spirits.  The kids were putting the final touches on a gift for Grandma, and I was getting out of my PJs.  We would head up to the nursing home and spend some time with my mom.

The phone rang.

It was the nursing home.  Mom’s blood pressure was high, and two extra doses of medicine hadn’t touched it.  She was in an ambulance on her way to the Emergency Room.


We get to the ER.  The doctor was already examining her.  I wonder if the kids will be doctors.  They’ve seen so much “medical” stuff at really young ages.  We have no family in town, so they tag along for most everything.  Thank goodness for Nintendo DSIs.  Where was I?  Oh yes, the doctor.  He suspected brain swelling.  He ordered labs and a scan of her brain.  He called a Neurosurgeon in to consult.  You have to understand something.  Mom’s cancer was Stage IV when she was diagnosed two years ago.  We have  never seen a surgeon.  There are some specialists I wish we would have pushed to see.  I can hypothesize all day long, but I’ll never know why Mom didn’t get the whole team-of-doctors approach to her treatment.  Nobody really thought she would live more than a couple months, and certainly not two years.

Wow, I am rambling.  Lack of sleep can do that.  So back to the ER.  Mom had too much fluid on her brain.  That fluid was pushing on her brain.  Her brain panics from the pressure and tells the heart to send more blood.  The blood pressure goes up.  The pressure on the brain increases.  The brain panics.  Ok, you see the vicious cycle.  This happened a year ago.  The pain was brutal.  Even narcotics didn’t touch the pain.  Thankfully, that time steroids worked.  This time, they probably wouldn’t.  Mom was admitted to the hospital.

The next morning, after 3 hours of sleep, I met with the Neurosurgeon.  I was given two options.  1. Send her back to the nursing home on high doses of narcotics to keep her comfortable until she passes away.  2. Place a shunt in her brain to drain the excess cerebrospinal fluid (CFS).  So I talked to family.  I actually consulted more family than usual.  I have Power of Attorney and the final say, but good grief, who wants that burden to oneself?  I even talked to a friend who is a Hospice Nurse PRactitioner (I probably butchered her title).

Option 1 Narcotics:  I would like to go this route.  I want Mom comfortable.  Peaceful.  Pain Free.  Not poked and cut.  This is the norm for end of life.  And I recognize we’re getting there.  And I would be fine with that if I KNEW it would work.  The big problem is narcotics didn’t work last time.  Her mental state was such that she wasn’t showing pain when painful things were done to her.  Was she experiencing pain but her body couldn’t communicate it?  I really don’t know.  And it made me VERY uncomfortable to think she would be in pain and we wouldn’t know or we couldn’t alleviate it.  As I told a friend, I felt like there would be a special room in hell for me if I knowingly let her suffer excruciating pain.  The doctors thought she would pass away in a few days.  Since they have been dead wrong on predicting her death for two years, I couldn’t really count on the idea of her suffering for a few days and then it would be over.  What if she was still here in two weeks?  Two months?  Two years?

Option 2 VP Shunt:  A shunt would relieve the pressure in her brain, thus the pain. It would lower her blood pressure.  All measures that would make her comfortable.  In a normal situation in which the swelling was new, a shunt might offer improvement in body control, speech, continence.  The chance of that in our situation was around zero.  A shunt would likely extend her life.  It would mean more tough choices like this down the line.  Pneumonia.  Problems with shunt.  Feeding Tube blockages.  How far do you go to treat things?  What is comfortable, moral, or just plain cruel?

We decided to go forward with the shunt.  Trust me, I didn’t take this lightly.  I wrestled with this.  I cried more than I care to remember.  There are no good choices here.  In the end, I made a choice that I felt I could live with.  We’ll never know what the other road would’ve looked like.  We can’t go back.  I know I did my best to make sure Mom suffers the least as she completes her journey on this earth.  Some disagree with me.  That’s ok.  I completely understand.  I hope you won’t judge me.  I certainly won’t judge you when you’re making these choices for someone you love.

Oh, and to clarify, I strongly considered what Mom’s wishes were for treatments and end of life stuff.  She never was the end-it-all-fast-no-life-support type.  In fact, I’m probably less aggressive than she wanted.  But she didn’t get to see what this looks like when we talked about this…back when she still talked and drove her car.

So what happened, you ask.  The surgery was last night.  Anesthesia took about an hour to set her up.  Brain surgery requires more stuff than say, ear tubes.  The surgery itself was about an hour, and recovery was a little over two hours.  The surgery went well.  Mom came off the ventilator immediately.  There was a 20% chance she never would, very high for a surgery.  The nurses were very surprised and pleased that Mom was more alert and responsive than prior to surgery.  Remember, we expected pain relief, nothing more.  She was moved to the surgery floor instead of the Intensive Care Unit (ICU) as planned.  When she arrived in the room, I asked her how she was feeling.  She opened her mouth and let out a series of growls and groans, the first sounds I’ve heard in a while.  Later I asked if she was okay, and she whispered, “I don’t know.”  Speech!  Words!  A Phrase!  She moved a leg a little, winced and grimaced.  She swallowed her spit.  All very good signs.  And her blood pressure was normal.  Normal, I say!

2:00 A.M.  Blood.Everywhere.  Her head incision was bleeding like crazy.  I’m not good with this.  Never was.  Three nurses wrap her head and give her morphine.  Her blood pressure has been elevated since then, but nowhere near where it was before the surgery.

10:00 A.M.  She’s still bleeding.  I finally remember that she’s a bleeder.  Her Central Line once required three days of sandbags.  Why did I forget this?  The doctor is on his way to put in more staples at lunch.  I think we’ll be here another day.  Please let us be here another day.

How’s the cognitive progress?  Well, she regressed.  She’s more alert.  She tracks you with her eyes.  But that’s all.  The Speech Therapist said this was normal for brain surgery.  Right after surgery, you see big progress.  Then the swelling sets in, and you regress.  Hopefully in several days, she’ll start making steps forward.  But because we saw things like speech, movement, swallowing….there is a sliver of hope.

And this is my mom.  Oh how she loves to prove doctors wrong!  But if she doesn’t, I’ll certainly understand.  She has fought this fight with valor.  We’ve all had our weak days, but on the whole, she’s been strong.

Thank you for all your prayers.  Thank you to the friends who’ve taken our kids.  Thank you for the visits and texts.  Thank you to my hubby who brought me clean underwear and deodorant.  Thank you to God for giving me sanity through all this and hearing my literal cries of frustration and confusion.

Mother’s Day





I’m probably breaking some blogger rule by posting an unrelated article during a series.  Fire me.


Tomorrow is Mother’s Day.  Actually, by the time I post this, it may already be Mother’s Day.  This will be the second Mother’s Day that has been, well, different.  A few days after Mother’s Day 2010, my mom was diagnosed with Stage 4 Breast Cancer.  A very aggressive type of breast cancer.  It was in her breasts, spine, liver, lungs, lymph, bones, and brain.  That first year was rough, but I guess I had in mind that the treatments would fix her quickly.  Last year around Mother’s Day, we found out her brain cancer was active and the doctor gave her a maximum of 4-6 months to live.  In August, she had a heart attack and moved back in with us.  In October, she moved to a nursing home.  A year later, she’s still alive, but different.  You see, the brain cancer isn’t growing as much as they thought, but the brain radiation did a lot of damage.  At her worst, she could not move her arms or legs or talk.  With therapy, she’s started moving her legs around in bed.  Sometimes she’ll move her arms, usually if she’s in pain.

She’s not a vegetable, though.  I told her about my hubby’s mom’s trouble with cancer, and she cried.  While the nurse was changing her brief (grown-up diaper), I asked her if that was the worst part of her day, and she nodded.  She reacts with facial expressions or movements.  I guess she’s kind of trapped in her body.

I miss my mom.  I miss talking to her.  I miss texting her.  The kids miss the insane amounts of candy she gave them.  I don’t miss that.

Don’t get me wrong.  My mom wasn’t a saint in her healthy life.  She made plenty of mistakes.  We all do.  But no matter how bad it can get, we all need our moms.  I wish she could still hug me or talk to me.  I wish she could have gone to the kids’ gymnastics meets.

Some days she squeezes my hand and won’t let go.  I think she misses these things too.

Semantics, Connotation, Denotation, and Hospice

Last summer, we were faced with the decision regarding Hospice services for my mother.  Going in, I had little knowledge or experience with Hospice.  Two of my grandparents were on Hospice at the end of their lives, and there was some family turmoil regarding it.  But I was young, living in another city, and either pregnant or had a new baby (they were on Hospice at different times).  The nitty gritty of it all was far removed from my world, though I loved them dearly and tried to be there near the end.  My mom, however, feared Hospice.  She felt they speeded death.  Or allowed family members to speed death.

As the decision approached, an Oncology Nurse at the hospital met with me to explain the differences and see what our goals were.  What I found was that Hospice means different things to different people.  As a doctor told me a few weeks ago, his impression was that Hospice speeds death in a comfortable manner.  He was the first professional to ever say that to me.  In some cases, I believe he is correct.  But back to my discussion with the Oncology Nurse.  Basically, there are two camps of Hospice.  On one side, all medicines are discontinued expect those for pain and nausea regardless of the patient’s terminal condition.  The other camp believes that, while a patient is terminal, life should be as full and as  long as reasonably possible.  In other words, you may have terminal cancer that will take your life 6 months from now, but you shouldn’t die 4 months earlier from a Urinary Tract Infection or have a stroke because you no longer take medicine for your high blood pressure.  To us, one side’s goal was to approach the end quickly and peacefully.  The other’s was to enjoy it to the fullest until the patient was truly at the end.

We opted for a company that was extremely life affirming.  My mother had cancer and heart failure from chemotherapy.  Therefore, we did not treat those conditions.  However, everything that she wanted treatment for, she received treatment.  Pneumonia, Urinary Tract Infections, Dehydration from Infections, High Blood Pressure.  The staff provided us great support and encouragement.  They contracted a physical therapist to train us in how to care for Mom as her abilities changed.  Unfortunately, a time came that my mom became too much for us to handle.  I was failing at the balancing act.  I couldn’t devote enough attention to my husband and children, nor could I devote enough time to her.  She recognized this as well and decided to go into a nursing home.

This is where my title comes in.  While I understood the differences in Hospice philosophies, I did not realize that the bulk of our local medical community had one view of Hospice.  The view contrary to the one we held.

Mom and I had many discussions before she became very ill.  We discussed feeding tubes and ventilators.  Cremation versus burial.  We discussed money and costs.  We discussed dividing her belongings after her death.  We discussed the impact of her end of life and death on her grandchildren.  Should she die in their home?  What if they were to find her?  Should they be present?  The conversations no one wants to have.  She decided not to put these into writing for the simple reason that there are too many contingencies.  Her idea was that she made her wishes clear to me and gave me the legal power to carry them out.

The funny thing is (not really funny), I always envisioned battles between doctors and patients regarding the removal of life support.  In reality, most doctors did not want to provide any care because she was a “Hospice Patient.”  It started with the need for antibiotics for a Urinary Tract Infection.  UTIs in the elderly can be brutal.  It’s not uncommon for a simple infection to cause changes in mental status along with a general shut down of the body.  Then it was the need for a food and hydration source.  The opinion was that since she couldn’t feed herself, she was ready to die.  We were told things like “you’re delaying the inevitable,” an argument that could be used for any life sustaining action.  Eat lunch today?  Well, you’ve just delayed the inevitable.  One doctor said she shouldn’t have any treatment because she hadn’t talked to him in three days.  He went so far as to refer us to a Medical Ethics Committee for the horrendous act of treating her UTI and Sepsis.  And having a feeding tube placed, as it was one of those wishes she had made clear to me.  And for clarification, feeding tubes will not grant you immortality.  If it was truly Mom’s time, she would have died regardless.  Her tube has been in for about a month now.

To admit Mom to the hospital, we had to sever our relationship with Hospice.  We decided not to go back solely because of the predominant view in the local medical community that Hospice patients should have high doses of morphine and anti-nausea medicine to ensure tolerance of the morphine.  I truly miss our Hospice team.  They were loving and compassionate, but we had to do what is best for Mom.

So what have I learned from all this?  In regards to Hospice, it’s important to understand the predominate view even if it conflicts with my own views or even the views of the Hospice provider.  On a larger scale, understanding the cultural connotative meaning of a word or idea outweighs my own understanding of the denotative meaning.  Example: I may know what a Classical Liberal is, but modern culture has a connotative definition of Liberal that is contrary to what I know about Classical Liberalism.  Telling someone that I am a classical liberal does not make me sound conservative, but liberal, regardless of definition.  I wore myself out trying to explain our view of Hospice to every nurse, doctor, therapist, and aid.  In the end, it was a battle that was killing my mom, and I could not accept the collateral damage.  Sometimes it’s best to use language everyone understands.

On a happy note, Mom has made improvements that we were told she would never make.  This is an answer to prayer.  Getting simple treatments proved monumental and impossible at times.  It was miraculous indeed that she was able to be treated at the level she needed.  Also, she is now opening her mouth for food, chewing, and swallowing.  She is moving both arms, one leg, and one foot reflexively (responding to tickling and uncomfortable stretches).  She is answering yes/no questions, though not all the time.  She also mouths things like “I love you” and “Goodbye” when we leave.  The blood clot in her arm seems to have passed with no medications or treatment whatsoever.  She makes facial expressions appropriate to the conversation.  All miracles in my book.  She’s not giving up, and God doesn’t seem ready for her.

If you are ever in need of Hospice Services, I would highly recommend Compassionate Care Hospice.