I gently knocked on the door and then poked my head around the corner. I paused briefly before walking in and saw him sitting there holding his wife’s hand. He bent down and talked gently into her ear. They had only been married for 62 years, and had been together as a couple much longer. She had looked after him well according to his daughter, he had always been treated like a king. In recent years Dementia had meant that he had needed more care than ever. His queen kept him in line but as her health deteriorated she could not keep up with him.

She had lived with her daughter, son-in-law and had practically raised their children. The grandchildren were emotionally close to her and had spent six to eight weeks with her over the Christmas break before heading back to their overseas-based lives. Since her cancer diagnosis seven months ago, she had been cared for by her youngest daughter. She had to keep a close eye on her husband, as he was a flight risk. At times he didn’t even recognise her as she had recently lost a lot of weight. He would ask, “Who is the nice old lady?” With a few prompts he could be reorientated to the love of his life.

The queen had to be admitted to hospice as she had persistent vomiting, uncontrolled pain, and was acutely confused. Lying in bed she was mumbling unclearly, and could not find a comfortable position. None of the medications helped any of her symptoms. When she first arrived the hospice team shared their concerns that she might not live for much longer, and prepared the family for her imminent death, possibly within hours to days. The next day she had improved, was sitting up, talking in a lucid fashion, a smile decorated her face and she was hungry.

He may have become cognitively impaired but he was still physically strong and fit. The other day when his daughter and other family were not looking, he spotted an opening and made a run for it. He scarpered over the fence and he raced off as if someone had fired a starter pistol. The family searched for him around the neighbourhood but he could not be found. The police had to be called to find the runaway. Maybe he had gone out looking for his misplaced queen? Is she at the park waiting for me?

The queen’s improvement was sustained much to the delight of her family and her king. Discharge plans were made as she had stabilised. The family decided that they could not provide the level of care needed by both of their elders, and arranged for a residential care facility placement for the queen. They had found a hospital level care facility with staff who spoke their native language, they booked a room for after the weekend.

During the weekend the queen’s condition changed for the worse, her pain worsened, she became much more fatigued. It looked like time had become short for her again. The family were told that the queen might only have days left to live. They understood this in their heads, but in their hearts it was much different. They wanted her to hold on for longer, she had always been so strong throughout her life. She had a successful career in a field that woman of her era never went into, she had always been determined, and worked hard for the important things in her life. Family was always at the forefront of her mind, and she had instilled this concept into the next generations.

The doctors thought that the queen could die at any time, and were surprised each of the next four days when she continued to carry on. Any other patient in a similar situation would likely have died days ago, but the queen was stronger than most humans. She hadn’t taken anything significant by mouth for four days, they could not figure out what was keeping her going, what was she holding on for?

The grandchildren had been kept up to date and were video-calling the queen everyday, the time differences were marked, but did not affect the quality of the love that was transmitted over the internet between the generations. They heard that grandmother was dying and wanted to be there to see her and to support their mother. She said not to hurry back as with COVID restrictions it was still difficult, and that she felt well-supported by the hospice staff. They purchased the tickets anyway and started to make their way back from their far-flung overseas lives.

This afternoon the expected changes in her breathing pattern were observed. Apnoeas started to occur regularly, pauses when her breathing would fully stop, before starting again. Laboured breathing, two second gaps to start with. Five seconds, then ten seconds. One hour later and the gaps were now 15 seconds. It was explained that this is what happens at the end of life, all of the bodily functions stop working. The gaps in the breathing become longer and longer, until the breathing finally stops.

Two more hours before her grandchild arrives in the country, 18 second apnoeas, will she still be alive when they come to see her?

19 seconds…
20 seconds…