Operation apple juice

Today Kamalashila was taken to a hospice in Clapham. During the weekend it became clear he was living longer than expected initially. This was after his stay in the ICU and his kidneys no longer able to support his life. The ward at Guys is extremely busy. Everyone is doing their very best, but there is too much work needing to be done by a workforce that is too small. So yesterday I asked the palliative care team whether we could consider moving him to a hospice after all. They agreed it was feasible and an application was made. Last week it seemed we didn’t have time for the application to be granted and KS too frail to be transferred. Since then he ‘plateaued’ and it seemed very much worth it after all to find a more suitable place for his final days. We had a very difficult day yesterday with KS agitated and frequently in pain, and frankly, not in very good spirits. The news this morning that a place was found in a hospice was very welcome. His sister Zoë and I both travelled with him in the ambulance. The paramedics were very kind. The ambulance drove southwards and we closely passed our home near Oval. We arrived early afternoon.
At some point later in the afternoon I asked him whether he wanted to have some water. There was also some apple juice, so we tried that. He hasn’t been able to drink from a glass for quite a while. He didn’t have enough energy for sucking a straw. So I thought I would ask whether they had any of those sponges on sticks that are used in the hospital. I asked one person. Then met a nurse in the hallway and told her I asked for something to help KS drink. Operation apple juice started. There were three different kinds of syringes and three staff members involved. KS’s bed went up and it reminded me of a space ship. The bed was also adjusted to put KS in a more upward position. A pad was placed over his chest. Different syringes were used. It didn’t go that well. He said: I am exhausted. I smiled to myself thinking about this scene when I went home this evening. The people in this hospice are incredibly kind and so very eager to please and help. It is wonderful. I was also very grateful to have something to smile about after a weekend that I do not wish on anyone.

This is KS’s view from his bed in Clapham Common. He loves the colour of the flowers on the right.
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This is different

It is Saturday. Kamalashila is still alive. But I am not sure for how long. I am sitting on a chair next to his bed. And typing this text on my iPad. (I know he is happy with me doing that.) His eyes are closed. His breathing shallow. Just now the battery was running out on a device that is feeding a low dose of pain relief into his arm. I was meditating when the noise started. It didn’t wake KS up. I went to find the nurse who is looking after him this shift. She had to go to another ward to find batteries. I was anxious about the potential of the noise disturbing KS. It didn’t and hasn’t. 

When I was meditating before this brief incident, I encountered noises of a helicopter, airco, the pump for his mattress, clatter and voices from the ward, somebody groaning. And the wafts of lunch being served on the ward, reminiscent of mashed potato and gravy. When I wasn’t smelling odours or hearing noises, I was feeling into the heaviness of my heart, sensing edges of dark thoughts. Allowing those edges to smoothen. I was breathing in heaviness and breathing out lightness. For myself. For both of us. For all of us. 

One thing I am sure of. All of this, all of this experience is different from how I had imagined it. I am not even that aware of having imagined it. But however we had been envisaging KS’s dying process: this is different. 

Another thing happens. KS is in pain. All over his body, he says, and he also uses an expletive. It is the first string of words in many days. I try to find his nurse. We are waiting for some more pain relief. Luckily another nurse comes and responds, and now it takes twenty minutes for this to work.

After Kamalashila arrived on this ward from ICU it took a few days to establish ourselves here. I needed a bit of time to recharge, to a degree, from the very intense time since this last hospital admission started. But now we seem to be in another phase again. He needs more support. I feel far less at ease taking time away from him. Even if he loves his solitude. Right now that doesn’t seem as relevant.

I found this on KS’s desk this morning, ready for him to take the next day. Of course he never took them because we had to phone an ambulance in the middle of the night.
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Unplugged

On Tuesday during a big medical meeting, the decision was taken to not put Kamalashila through more new medical procedures. People came in twos: haematology, IC, palliative care, sisters. And there was myself and in the background KS: in the shape of the lasting power of attorney for health and welfare that he had arranged for me. It was difficult. It was strong. I cried and an unlucky someone offered me tissues. Over the course of that day and the next he was slowly freed from tubes and machines. He still has some, which are all about him being comfortable. He has not been able to take anything orally since last week. Perhaps the last thing he has eaten was a piece of mango. Last week he had a tube inserted through his nose leading into the stomach. This was to feed him and also to administer medication that needs to be taken orally but is not available in IV form. The food was originally also to help stabilise his bloods when the tumour lysis syndrome was playing out. The food has now stopped.
His kidneys are failing. His body is holding onto the water element. Unlike myself. Although I haven’t cried much these past two days. My role has shifted. I have became a protector of his space, alongside his sisters. People have asked me to pass on their wishes, but it looked as if it disturbed him when I did. It was taking him out of himself. He is concentrating on the dying process now. He was moved to a quiet room yesterday evening after a day of waiting for a single room in a hospital that was on ‘red’.

After he was settled in the side room, with Manjushri by this side, I went home and slept well for the first time since he was taken to the hospital in an ambulance. I knew he was safe. But also he was alone. He has been craving solitude for such a long time. His month solitary in November could not go ahead as we were moving back to London. Then as he was preparing for a month’s solitary in April, in a field near Glastonbury, he fell ill and was diagnosed with terminal cancer. Since then it has been one medical thing after another. No opportunity to go off on his own. So now, as he is approaching death, we are riding the fine line between trying to grant him as much solitude as possible and protecting the space. I am trying to act on his behalf, in his spirit, with his character and wishes in mind. It is the least I can do. I am also trying to look after myself a little. These days are the most challenging of my life so far. And possibly the most rewarding too. I feel privileged in helping to support him to die in a way that honours his life, in these far from ideal circumstances. Though actually, strangely, they may be kind of perfect.

KS at Corton beach, Suffolk, two years ago.
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Tissues

It is Tuesday. I am in the kitchen of our flat with my laptop. The washing machine has a few minutes to go. Life goes on. A few miles down the road KS is plugged into a frame with pumps, tubes, monitors. This is exactly what he never wanted. But who does? When he was still in palliative care, he would not have been taken to the intensive care. But here he is. And he said last week he felt his body is done. It has reached its max. It cannot cope.
I had hoped that by now he would have come out of the hypo delirium he is in. It is probably down to the kidneys not working at full capacity. But the relationship between these markers and the delirium is by no means simple. When I arrived by his side yesterday, it was clear he was a bit less present than he had been the day before. I was upset. I had hoped for improvement. I cried. A nurse offered me tissues. I refused. She said I had to be strong. I said I was strong and that crying did not make me less strong. I even told her KS tells me it is beautiful when I cry. It shows what is in your heart, he said. The nurse laughed and said, oh, is that what it is. I had to calm down after all of that. Nobody can help it. In some way she is right of course. But this interaction was not what I needed right there and then. Of course I often get things I don’t need and don’t get another heap of things that I do need.
I am trying to be faithful to KS’s values and beliefs, as we negotiate the untrodden territory of him not being able to voice his wishes. I am attempting not to second-guess myself too much. I am touching in with my feet to ground me. I am calling on my strength to support me, to do what needs to get done. To still look after myself in the midst of it all. To do what is right. But I also cry. And why do people have to rush towards me with tissues? I have a serviceable sleeve. Sometimes you even have to stop crying so people can locate a tissue and then wait for them to deliver it. I tend to feel the tissue is to make me stop crying. Because it is difficult to be with grief, with sadness, with heartbreak. But when I cry, my body releases tension. What would be helpful is to just kindly let me be, witness it, bear it. There will be more tears. We can count on it. I might even get tissues.

KS, his sisters Zoë and Esther, and myself in February 2018. We went to see an opera.

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Afloat

I wrote this yesterday on my iPhone.


I am sitting next to KS in intensive care. He is asleep. He is less agitated today. There are a million impressions to digest. Impressions from the past week. But before me are the impressions of right now. Different shades of purple on KS’s right arm against light skin. This arm has two canulas, one wristband and large patches of dark and lighter purple and blue green. Also some brighter red. Matching the red in his wristband indicating he has an allergy. Every time he is admitted to hospital or getting any medical treatment, he needs to answer the question: are you allergic to anything. He has to answer penicillin. He is then asked how he responds to penicillin and then he says he doesn’t know as it was too long ago, when he was a child. If the question is asked by a doctor, they will then tell you that penicillin is still the best. Not sure where this story about penicillin is going. I am going back to his wristband. Noting all the tubes going into his body. And then back to myself.

I am not wearing a face mask today when I sit with him. I have had to keep myself afloat with paracetamol this week. My system feels awash with stress and adrenalin. I am hoping for a morning of rest tomorrow. But this is of course not guaranteed. On the table next to his bed, a Manjushri rupa, his glasses and his phone. He hasn’t used his phone for a few days now. This is another thing to get used to. He is normally so often glued to his phone. I rang him a few days ago about finding the rings. But then things went down and he hasn’t been very vocal. It was the last time he could pick up the phone.

The physical markers of his body are stable at the moment. The tumour lysis syndrome seems to be under control. The severe constipation has cleared. But there is still infection and a body trying and working so hard to find balance and health with the awe-inspiring help of IC wizardry and skill. After I came back from an hour break with a friend, he seemed to be more responsive. There were a few minutes of presence and lucidity. During this brief time we had an absolutely amazing conversation in which he told me, loud enough for some of the nurses to hear: I am not going to die. It was much more magical than that. But I will not commit this to words here. It may or it may not be. We don’t know yet.

Some religious objects are allowed in critical care. Here is Manjushri by KS’s bedside encouraging clarity and wisdom. Never more needed.

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Rings

It is hard to imagine the joy I felt last week when Kamalashila was spending time on the Southbank with a good friend. Just the fact he could go out on his own, walk around and come back hours later. It made me so happy. He had, however, he was so sorry to tell me, lost his wedding ring. This is one of the rings that we ordered a few months ago. They had arrived and had turned out to be too big. Through no other fault than me having a narrowed awareness when it came to sizing. And KS’s fingers were thick with oedema at the time. So I was wearing my ring on my middle finger and his was on his index finger. Weeks later it occurred to me we could try my ring on his hand and have mine resized. It was a perfect fit on his hand. So I arranged to have the bigger one resized. I arranged it during one of these times he was either in or out of hospital: I have totally lost track. Then this morning as I was rooting around for a longer charging lead, because the sockets in his critical care unit are quite high up, I found the lost ring under his desk. I phoned him. I was so glad he picked up the phone, as texting is impossible at the moment. He was happy to hear it and called it auspicious. I very much hope that it is.

KS’s ring that was first on my middle finger and that I found under the desk this morning. I made this photo to send to a friend at the time.
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Just an update

I do not feel like writing a post, but wanted to give an update. I am pasting below what I sent to the WhatsApp support group yesterday evening:

“Esther [Kamalashila’s sister, YB] and I were in Guys this afternoon. Unfortunately KS has been transferred to the Critical Care Unit. The next few days are going to be crucial. He has far too many toxins in his blood after the chemo therapy and his heart and kidneys find it very hard to keep up. He will receive special treatment for the overflow of toxins, basically cancer cells breaking down too rapidly. He also has a strong infection and the constipation is still not solved. He was more lucid today, but had had a difficult night. the confusion is probably caused by the infection and the kidneys not working well. Esther and I are going back tomorrow.”

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Beans

I have located myself on the ground floor of the Guy’s Cancer Centre, next to the main hospital. There is a café. People are sitting around waiting for appointments, accompanying family members, staff members are having lunch, or perhaps people are just dotted around biding their time, like I am. But I guess not a lot of people may do that. I hope not. Kamalashila’s bowels are not showing any movement, in spite of attempts. It is complicated, with a big tumour there responding to the chemo, fluids, and masses of digested food.

This morning after feeling frustrated with breakfast offerings that do not contain fibre, he was adamant he needed beans. He asked for beans. Demanded beans. But of course he didn’t get anywhere. All food is standardised at the hospital. I saw somebody posting a pic of being in a German hospital and I saw fresh vegetables, salad, a healthy slice of bread. That is not how it is here. Food has been a big problem ever since KS became ill, and it is at its worst when he is in hospital. Though he had a week or so in the Summer when all seems to be going well on the food front. But this morning he was ravenous and he knew he needed to help his body with fibre. So after the failed attempt in-house, his next attempt was me. ‘Why a whole hour?’, he texts me. This is one of the texts that have come across clearly. The opioid pain killers are making it hard for him to be present and coherent at times. He has asked for them to be reduced. He has less pain this morning. I was so glad to hear it. Pain is a weird thing. And medicines build up. It is hard to get it right.

Anyway, back to the beans. Why did I need an hour to get there? It was mid morning, but I needed to have breakfast, hang up the washing, put some clothes on, and then heat up the beans, put them in a thermos, pack my bag and get on the bus. This all happened. Having delivered the beans, and watching him forcing himself to eat them, I could only stay for 10 minutes, as it was outside of visiting hours. So now I am here. Waiting for the visiting hours to commence.

Apart from a wobbly table, all is very well here, with me. With KS not so much. There seems to be another infection brewing and fluids are not going to the places they are supposed to go to. Luckily it is Monday. The PIIC line is being cleaned, or doctored, or repaired. This will make it easier to get bloods. The doctor has had to take some from his knuckle, which is not a great place. As I am sitting here with my elbows leaning on the wobbly table, my chin leaning on the palms of my hands, I just know this is life happening. It is no use not wanting it. It will come. It is here. It is moving. My prayer is now for the bowel to do the same. To give in and let go.

I came across this fence yesterday when I walked to the hospital (Bath Terrace, Southwark) and recognised it as recycled WW2 stretchers.

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A real alarm

After celebrating a false alarm on Friday, KS wakes up in the night with terrible pains in his abdomen. I phone 999 and an ambulance is sent. It arrives after about 20 minutes, which is fantastic. It is now becoming more difficult to get anything in or out of KS’s veins, so the morphine cannot be administered via the vein. It has to be orally, which takes more time to kick in. By then we are in the ambulance and shortly after that we are on our way. The two excellent paramedics look weary coming to the end of their shift. After we have arrived at the hospital and before we go in, KS gets another dose of morphine. We are now in a cubicle in the Majors ward and it is nearly 6am. KS gets a scan. After quite some time and a shift of staff, we hear that the problem doesn’t seem to be as serious as was feared. KS is still in a lot of pain. A nurse walks in after the takeover and says that KS is free to go home as the potassium is not dangerously high. Here I start crying. I am more upset than I remember being since this whole journey started. KS is still in a lot of pain and I feel desperate. I explain this is wrong, and this info is about yesterday evening. It is all understandable, but yet it is hard. It is also very cold and KS has lots of blankets piled on top of him. The nurse tells me later the heating has stopped working a few days ago. I am getting a cup of tea to warm me up. For KS it is nil by mouth, as they say. By midday things seem to clear up. It was said it was not serious. KS is able to walk around a bit to stretch his legs and he has less pain.

We will now be waiting for the haematologist to decide what needs to happen next. And the hospital is on weekend time, so seeing a specialist is much slower. I take the opportunity to go home for a few hours to receive the broadband engineer. KS is adamant I should go as it is important for us to have a working internet connection, he says. After I go, things go down again. His blood pressure drops and it is hard to get a working drip for him. I reenter the cubicle a few hours later when everyone is working to make this happen. By this time (5pm) he hasn’t had some important meds for quite a while. I have brought them along from home, and we access a list of medications on his phone, and soon he is getting the most important ones. He is also transferred to the medical ward. A haematologist comes and because of the blood pressure dipping, he still wants to make sure nothing is damaged in that bowel, which could happen as a result of the chemo. Now we are waiting for the surgeons, who have been operating the whole day. KS is sleeping through most of it now, finding it difficult to be present with so much pain medication in his body. But occasionally he comes out with a joke, an apology, a grunt or a tired smile. I leave, which is difficult to do but which makes sense. He texts me late in the evening he will be transferred to Guys hospital. Which is where he is now. It means the bowel was considered to be undamaged and other treatment can start to help the bowel and the pain. I have spoken to the nurse who is looking after him this morning. I will go to see him this afternoon when the visiting hours start, but I am taking the morning to decompress, text and write.

KS during his second round of treatment last Thursday.
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Hyperkalemia

I was very much enjoying a week without medical emergencies and some new and exciting offers of work flowing in. All was going well, apart from the broadband packing up and a family crisis. KS had his second round of treatment yesterday and all the various fluids went in one after another without any problems. The doctor had wanted another blood test, so this was attempted. Not much blood came out so the nurse ended up sending three vials with a small amount of blood to the lab, hoping it would all add up to be enough. After all was done, we had a bite to eat in the cafe of the cancer centre village, collected more drugs from the pharmacy, and then took a taxi home .

Today I went out shopping in an attempt to spend a voucher somebody very kindly sent to cheer me up. Next time more lucky. When I came home and walked into the flat, KS told me the doctor had just phoned. His potassium was too high and he had to go to A&E. Ok, I said, let me make a sandwich. I did and we took a taxi to A&E. We waited, an ECG was done, and a blood test, and then we waited some more. KS was feeling fine. We were hoping it was a false alarm. After a while the nurse helpfully told us the potassium was not high enough to be treated. It had either come down since yesterday or it was a false reading. We then waited for a doctor to arrive to confirm all of this. And this is what I am still hoping the story will be as I am typing on my phone sitting in a cubicle with KS. I am hoping we will just be going home together a bit later this evening. I am hoping we will celebrate a false alarm. And it was and we did. Home, and we encountered two foxes on the way.

Our auspicious number in the A&E waiting room, with KS’s liquids intake chart in the background.
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