Palliative Care: Planes, Trains & Automobiles

Sunset 15K Feet Up!

While the decline of someone in Palliative Care/Hospice can be identified by hibernation, as I wrote in my previous post. Some experience a phenomenon called Planes, Trains and Automobiles. Similar to the burst of energy they experience at the end, this one has the loved one making plans. From taking a trip, want to go see someone or something. It really can be anything. This also fits in with the moment of clarity most people experience towards the end of their care.

Moments like these are reminder of being present, listen and follow your loved ones lead. Sometimes, finals wishes can be interpreted in these moments. Sometimes it raises awareness of how care needs to be augmented to make them more comfortable. Nursing staff is trained to look for more telling signs in this moment of not only what more they can do for their patient, but also communicate with care givers of additional needs. Personally my mother was making plans with me about being present at her oldest granddaughter’s wedding the following year. In a way it was providing her hope to hold on longer, just to that one special moment.

I think most of the time, while we want to be brutally honest with our loved ones about future plans. Nodding your head “yes” and carrying on with an affirming conversation about their ideas, gives them hope but lets them rest easier. Trust me there were times I was banging my head on a wall with my mother and her plans. My mother used to share the same struggles she had with her mother as well at the end of her life.

I am also reminded of neighbor I had in SF at my apartment building. It was the late 90’s and I had a few neighbors in my building who lived through AIDS crisis and weathered the monstrous loss to their social circle during those years. One man who I met shortly after moving in, had been living with HIV since 1986, shortly after his partner had passed and her had learned of his status. I used to help him from time to time, bring in groceries from his taxi ride, or even grab a few items when I went to the store. Around 1999, myself and one other neighbor, who I loved to call THE COWBOY, noticed he wasn’t getting out much anymore. A couple evenings when I got home, I would catch him walking down the hallway of our floor to take a walk outside. A few times I even caught him outside while I was walking my chihuahua’s next door in the parking lot to do their business.

One of those nights as he walked slowly through the doorway to our building, I offered to walk with him. I dropped off my bike at my apartment and came down to hold his arm. I remember the conversation clearly that night. His plan was to have one of his friends drive to the Bolinas to go see his childhood home. I wanted to offer to drive him, but I was now without a car myself. a few evening later, I got home late from work and ran into the funeral home staff carrying the gurney off the elevator, as a I came up the stairs with my bike. The manager shared he’d passed at least one or two days earlier, and caregiver had just found him that evening.

No matter if it’s for a drive, or a walk, those moments of hope through planning is just a simple sign of the transition for your loved one. Keep it positive, don’t try to remind them of what is going on. Entertain the idea, build on the idea, give them some hope. When my mom talked about my nieces wedding she would like up like crazy. Those moments gave her something, I realize that now more than ever.