The following is a Facebook posting from my twin sister’s beloved. I am posting here so I do not lose it as it is precious to me.
His words gave me the information I needed about Kishma’s last moments on this earth. Our feelings were/are still too raw to share them face to face. It makes it easier to be able to write. These words are painful yet comforting, sorrowful yet a treasure to my heart.
Thank you Tanamin.
This post is super-depressing. It’s long and rambling, and doesn’t make sense in places, and I recommend that you skip reading it. It’s about Kishma’s last day, and it’s really only for me, so I can get it down and hopefully start really dealing with it, and for Kyla, her twin sister, who wasn’t able to be here when her twin left this world. So seriously, don’t read it.
It’s been five weeks since Kishma died. I was amazed to realize that this morning. It certainly doesn’t feel like five weeks. It feels like five months. I keep having these terrible, soul-stabbing bouts of sheer, horrific grief, and I say to myself, “Come on, dude, pull it together. You can’t be like this forever.” But now I realize why I’m still getting these episodes: the wound is still very, very, very fresh.
It started, really, when Kishma was having chest pains from any little exertion. She would walk to the bathroom from her desk, only about thirty feet or so, and her heart would be pounding so hard she could hear it in her ears, what she described as a “kik-kik-kik” sound in her head. One day they started, and didn’t seem to stop, and when she realized that, she decided to call the paramedics and be taken to ER. Why not go to the doctor? Because her medical program was set up so that in order to see any kind of specialist, like a heart doctor, she would have to get a referral from her primary physician, (a doctor assigned to her who hardly knew anything about her) and then wait two months. You read that right. To see a cardiologist about her emergency chest pains would take two months. So we called the paramedics.
She was in the hospital for five days, during which her cardiologist, a heart surgeon whom she had been seeing for almost 30 years, decided to do an angiogram, which is an procedure in which they insert a long tube through an artery in your leg and push it up through the blood stream to check out the arteries of the heart from the inside. It’s seriously cool stuff, and we are only able to do this kind of thing because we live IN THE FUTURE!
While in there, the doctor discovered a pretty bad blockage, so he put in a stent, which is a tube that holds open the artery where it is blocked to keep it from blocking further, and also releases a tiny amount of medicine designed to reduce the blockage down the line. So far, so good.
Then, when he was going to check another area of her heart, he realized that Kishma’s arterial system wasn’t quite built the way most people’s hearts are built, and it took a bit of maneuvering to get around this one corner in the arteries around her heart.
Now everyone who knew Kishma knew that she had been taking Prednisone for a long time. And I mean a long time. Normally, Prednisone is prescribed for a matter of weeks because as well as it works as an anti-inflammatory, it has a lot of nasty side effects, both physical and mental. Using it for too long can lead to weakened bones, weight gain, and emotional problems akin to the “Roid Rage” that anabolic steroid users suffer. And that’s from weeks worth of use.
Kishma had been on high doses of Prednisone every day for more than three decades. One of the many, many side effects she suffered from this long-term use was that the tissues in her body were extremely delicate. She bruised easily, could break ribs just from coughing or even driving over a particularly bad bump, and was constantly suffering from broken blood vessels in her eyes. That kind of thing.
When the surgeon doing her angiogram maneuvered around that weird spot in her artery, the instrument brushed against the wall of her artery and caused a tiny tear in the interior wall. Blood began flowing into the tear, and separated the inner lining of her artery from the main arterial wall. The surgeon later described it to Kishma and I as “an ‘Oh shit’ moment“. It took seven more stents, but he was able to use the stent to force the blood back out of the tear and shore up the artery. A surgery that should have taken an hour ended up taking three and a half, but everything was looking good. No problems with the now bionic artery, and her chest pains were gone.
Over the course of three days of recovery, she was doing fine. Her blood pressure was a little low, but they adjusted her heart meds and said she was fine to come home on the sixth day.
We brought her home that afternoon, and she seemed to be doing really well. Happy to be home with her people and her puppies, she did what she normally did at home. She surfed the web, played World of Warcraft, answered some emails from her nieces and nephew, ate non-hospital food and played with the dogs. She was bright, chipper, and just every inch the Kishma we knew and loved, bouncing back from yet another health problem.
At about 2:45 in the morning, she said she was ready for bed, and like every night, we took the dogs out, locked the front door, turned out all the lights and retired for the night. Kishma brushed her teeth and gave the dogs their bedtime treats as I went and brushed my teeth.
When I came out of the bathroom, Kishma was sitting in the middle of the bed, panting a little. I asked what happened, and she and Ed said simply that climbing up into the bed took a little more effort than usual, and that she was having chest pains again. Not very bad, but enough to be noticeable. We let her take a few minutes, and when she was feeling better, Ed and I climbed into bed on either side of her.
As I was about to turn out the light, Kishma suddenly said, “Noooooo!” and slumped. I touched her and said her name, but she didn’t respond. After a couple more tries, I said, “Sweety, you have to say something. You have to talk to us,okay?”
To which she replied, weakly, “I don’t know what to say.”
She was able to talk with difficulty, and the feeling she described was like the low blood pressure incidents she had had in the hospital, only worse this time, so we once again called the paramedics. Normally Kim goes with her to ER, but I was already getting dressed, and so I decided to go with her this time. The paramedics arrived and did their thing, and I followed her to the hospital.
It was about forty minutes before I was able to see her in the ER. She was in a big open bay where the surgeon on call was doing an ultrasound on her heart and nurses went busily in and out. They let me hold her hand and talk to her. She was conscious and able to talk with difficulty, because her heart rate was very high, but her pressure was low, and I soon heard why. The doctor said, “Looks like we have a pretty large pericardial effusion.” He probably didn’t think I knew what that meant, but I did: she had fluid accumulating in the sac that surrounded her heart. The doctor asked if the MRI team had hone home for the night, and the nurse replied that they had just left. He said “Call them back in”, and then I knew things were worse than we had thought.
They rolled her out to radiology to see what was going on, and I was left alone in the ER bay. I texted home, letting folks know what was going on, and I saw in one of the trash containers that they had cut off her pretty blue night shirt. She had just bought it. It had yellow and white flowers on the front and the first time she had ever worn it was when I had picked her up from the hospital- ten hours ago? I remember thinking that having to ruin it to get it off of her would have made her really sad, but that was alright, we would buy her another one.
After about a half an hour, a nurse came and led me to cardiac ICU where they had taken Kishma after her MRI. I came in, and they let me hold her hand. She had her eyes closed, and her breathing was fast and labored, but when she heard my voice she opened her eyes and squeezed my hand tightly. There was a bag of bright red blood sitting on her chest with a tube leading under her blankets. I asked her how she was doing, and she just said, “Cold.“ Her hands were like ice, and the nurses put another couple of blankets on her. I could only imagine the pain and stress she felt.
The doctor said they had inserted a shunt into her chest and had drained off a lot of blood from around her heart, about 450ml (about a quarter of a two-liter soda bottle) but her heart was still bleeding. He told me that the MRI showed that the artery that had been repaired with the stents had ruptured anyway, and the only thing they could do was, in the words of the surgeon, “open her up and try to repair the damage manually.”
The doctor was bright, alert, and very forthright when he talked to both of us. He said that the surgery they would be attempting would have about a fifty-fifty chance for someone who had a healthy heart, and that if Kishma made it through, she would have to stay in the hospital for weeks and would require skin grafts for the scarring and would be in a lot of pain. “Now if she doesn’t have the surgery,” he said, “she definitely won’t survive through the day.”
That was the moment it hit me. The possibility was always lurking at the back of my mind, but now here it was, staring me in the face. Kishma was not going to make it. She was going to die. I looked down at her as she looked up at us, gripping my hand in her tiny little fist, and I said, “Well, Lady, it’s up to you. What do you think?”
She took a hard, difficult breath and said, “Okay. Let’s do it.”
From that moment on, things were very busy in that tiny room. The nurses came and went, doing the million small but incredibly important things that nurses do. The anesthesiologist (who surprisingly couldn’t have been a day older than twenty-six or twenty-seven) came in and talked with us, and I could tell from his demeanor that he didn’t hold out much hope. He had the air of a man about to undertake a difficult task that he knew would probably end in failure, but he was determined to see it through.
When at last they disconnected all the machines and rolled her to the operating room, I said to her, “Okay, sweety, just relax and let them do their thing. They’re going to take care of you.”
She closed her eyes, squeezed my hand, and said, “Let’s go. Let’s get it done.”
As they wheeled her away, I said, “I love you, sweety. I’ll see you in a while.” And then she was gone, and a nurse led me to an empty waiting room. It was still dark outside.
Alone among all the chairs, I just… waited. I texted home again, and then texted her twin sister, Kyla, letting them all know what the doctor had said. I didn’t say that she wasn’t expected to survive, because I couldn’t. In the face of overwhelming evidence to the contrary, I was still convinced that she would be fine, just like she was always fine. No matter what happened, broken feet, broken legs and arms, stroke, diabetes, all of it, she always bounced back, ready to take on the world again. This was just another of those times. It had to be.
An hour stretched into two. I pulled out a sleeve of pop-tarts that I had grabbed on the way out of the house and ate them slowly, not tasting them. The sun was finally coming up outside, and it was fully light when the surgeon came out to see me.
He said that they had opened her up and he had tried to repair the artery, but the sutures simply wouldn’t hold. Her tissues, weakened by the prolonged Prednisone use, were pulling free of the stitches. There was nothing he could do, he said, but close her up and wait for her heart to finally fail. He said that at this point, with the opening they had made during the procedure, if she regained consciousness she would be in extreme pain, so he said they wouldn’t be waking her up.
There is a vast difference between knowing something is coming, and being prepared for it when it does. We all knew that Kishma would not live much longer. Her endochrinologist flatly told her that with the Prednisone use and all of her other issues, she wouldn’t be getting any healthier. But still, shock doesn’t adequately describe what I felt. There was no denial, no anger, nothing like that. Just a finality. “So that’s it, then,” I thought. “She’s gone.”
I shook the doctors hand and told him I was certain that he and his team had performed brilliantly. He went back in to finish his work, to put the pieces of my Kishma back together for as long as they would continue to work.
I called home and told them what was happening. I talked to Kim, who cried, of course, and I wish that I could have been there for everyone, but my task was here. Then I called Kyla, and she said that she and Jim were already on the road and would be there in the afternoon. I don’t think Kyla cried while she was on the phone with me. She was just as strong as Kishma, that one, cut from the same cloth since before they were born.
I had been texting Lore, but she had not answered. This wasn’t surprising, considering the early hour. So I called her. I was glad that she picked up, though I was not looking forward to telling her the news. I explained what led up to that moment, and told her that Kishma wouldn’t be surviving the day, and wouldn’t be waking up. All I can remember when I told her all this was her saying, “Tanamin!” in disbelief, as though some part of her was expecting this to be some cruel joke. I couldn’t blame her. I could hear her tears, and mine wouldn’t wait any longer. She asked if it was alright for her to come and see her, and it took me a moment to realize why she would even ask permission. As far as we were concerned, Lore was one of our family. She said she would be there soon, and hung up.
I still had one call to make. I called Kishma’s dear friend, Denise. I think I had texted her as well, so when I told her about where things stood, her first question was a trembling, “Did she pass?” I told her no, not yet, but it would be soon. Again I heard a dear friend, who loved and was loved unreservedly by Kishma, ask permission to come to the hospital. I of course told her yes, she could, and she too said she would be there immediately.
It was a while later, what felt like hours, but was more like forty minutes, that a nurse came out to take me to see my Kishma one last time. The doctor was there to meet me again, explaining that she was still unconscious and would stay that way. He told me that her heart was still beating, but would probably not last for long, and he asked if, when it did start to give out, she would want to be resuscitated. I thought for only a second before realizing that no: scrapper that she was, even Kishma wouldn’t want them to keep her heart beating any longer than it wanted to beat. For what? A few more minutes of unconsciousness before it quit on her again?
I told the doctor no, not to resuscitate her, to just let her go. He gave the order to the nurse, and said to me, “That’s the way I would want it if it were me.“ And I had to admit, I shared that sentiment.
When I finished the long, long journey down the short hallway, I found her in the same bed, the same room, but she wasn’t the same Kishma any more. She still had the ventilator in her mouth, and blood still stained her lips, probably from the insertion of the tube. Blankets seemed to be piled onto her, and I wondered at that until I realized it was probably to protect the eyes of her family and friends from seeing what must have been horrific damage from the surgery. The nurse said I was welcome to come and talk to her, even though she was still under the anesthetic and was not awake. I reached under the edge of the blanket and took her cold, tiny, arthritic hand. There was no reassuring squeeze this time.
I talked to her then, while there was no one in the room but us. I told her that I loved her so much and that I was so proud of her, and that she had done such a good job. I’m not sure what I meant by that at the time. Maybe I was referring to the way she faced her ordeal, or maybe her entire difficult life. Maybe it was referring to her loving and taking care of us all. I still don’t quite know. Maybe it was all of those things.
I reassured her that we would all be fine, and that she could go and do whatever it was that she was meant to do now. I promised to look after Ed and Kim and Ben and the puppies, and that things here would be okay. I didn’t know how I was going to do any of that, but it felt like something I needed to say.
After a while the machine to which she was hooked began beeping softly, almost unobtrusively. The nurse came in and switched it off. She quietly said, “Her heart is beginning to stop now, so the machine is going to be making some noise.” I smiled at her and said thank you, and I held that little hand like my world was ending. Which of course, it was. I held her hand as she died, and I like to think that even though her body was not aware of my presence or my touch, that her spirit knew and could see, and was grateful for my presence.
The first ones to arrive were Denise and Mark. I was so grateful to see them. They gave me hugs and Mark asked how I was doing, and then immediately regretted it. I told him I understood, and that I was doing as well as I could. Denise went to Kishma’s side, overwhelmed with her own grief, and started talking to Kishma with so much love and warmth. I won’t repeat here what she said in that utterly private moment, but my heart broke all over again to hear it.
After a moment, Denise looked at me and asked if I had been drinking water. It seemed like an odd question, but I see now that even in the midst of her grief, she was reaching out to take care of me in true Denise fashion. It was one of the things about her that made Kishma love her so much. Denise handed me her purple plastic water bottle, the one I had seen her carrying around for months, the one with its own filter. It’s sitting on my desk beside me even as I write this.
Then the nurse came in and shut off the respirator. Denise was alarmed, asking almost frantically if they were shutting off her life support. But I just shook my head with that sad smile again, and said, “Oh, no, she’s just turning off the respirator, Denise. Her heart stopped about fifteen minutes ago. She’s gone.”
After a few more minutes, Denise and Mark hugged me and left, Mark comforting his crying wife.
The next to arrive were Lore and Noe, Chris,and Jonathon. They hugged me, and I smiled through the tears again. I think at the time I was trying to put on a good face for them, so as to not make things any harder on my friends and family than they already were. Now that I look back on it, it was probably just shock. I didn’t know what to feel, so I defaulted to being friendly and sociable Tanamin, even through the devastating emotional pain.
I watched as one by one they said goodbye to Kishma, holding her hand, kissing her mussed-up hair. Although we were all trying to put up a strong front for one another, I could still feel the pain and loss coming from each of them, and I remember feeling so helpless. What could I say to them to offer comfort when I myself was slowly cracking apart inside?
We stood around her bed and talked about Kishma, and how she was so full of life right up to the very end, and how things would be so different without her now. I don’t think any of us had any idea what that really meant yet. Lore, like me, was smiling through the tears. Jonathon was supportive as ever, a steady hand on my shoulder. Chris kissed her forehead, which I didn’t expect, but then she had always been encouraging to him, even through his troubles. I think the one I felt the worst for, out of all of us, was Noe. He was the youngest of us, for one, and even though the rest of us were smiling, he was not. Maybe he was the one being most honest with himself about his feelings, but he just looked so terribly, utterly lost and sad.
As we were standing and talking and looking down at Kishma’s poor little used-up body, Mark and Denise came in again with Stephanie and Jacob, along with Stephanie’s mother. Kishma and I had just seen Stephanie and her mom the week before at Les Miserables at the Saroyan theater. That had been the day before Kishma went into the hospital with what we now know was a heart attack. The last time she had seen them Kishma had been smiling and laughing and snarking about the show. And now, a week later, here they were, saying their final goodbyes.
Stephanie’s mother, the gentle old soul of experience, just hugged me and everyone, smiling with sympathy, knowing there was nothing she could do to help, but offering all the same. She had been in this position before, I could tell. Quite the opposite, were Stephanie and Jacob. All poor Jacob could do was hug himself and weep, looking down at poor Kishma, and I don’t know that Stephanie was even able to make eye contact with anyone in the room. I doubt either of them had ever had to deal with anything like this before, and they both looked stricken to their core. Once again, my heart broke for them.
It was at this point that the utter, palpable weight of the morning began to crash in on me. Kishma’s death, lack of sleep, pain and stress, stress and pain, all felt like they were going to crush me if I stayed there in that room. I know now that it was naive to think that leaving the room would somehow leave behind the ragged hole that had been torn in our lives, but I still had to get home to the rest of my family. I said my goodbyes, thanking everyone for their care and support, and I walked the long walk to the car and drove home.
The dogs greeted me excitedly when I got home, and the first of many, many sharp pangs went through my heart as I realized that they would never see their Mama again, never greet her with kisses and excited wiggles. And I couldn’t explain to them why.
In the weeks that have passed, I find myself constantly reminded of things or seeing something that makes me say to myself, “I’ll never get to do that with her again.” Or, “I can never show her this.” Or, “We can never share this with one another again.” I will never again shoot the paper off of my straw at her when we buy some crappy fast food meal on our way to the Opera House, or go see a movie with her, or have her show me some cool critter or pretty piece of armor she found while wandering around World of Warcraft. I will never wake up next to her and put my arm over her. I will never put the laundry in separate piles with her, hear her delightedly say, “Ooh! It’s *raining*!“ or get a text message from the bedroom in the back of the house saying “Come help me with my bra.” A thousand thousand things that make up a life shared, gone forever.
I sat with Ed and Ben and Kim in the living room and told them everything that I could remember up to the drive home, and they were in as much shock as I was. Except for Ed. He was not crying and breaking down. He was strong and resolute and resigned to this new state of living. At least, for now.
You see I know Ed, like no one else. Now that Kishma is gone, I am the world’s foremost authority on Ed, and knew that it would take a while. The emotions and grief would take their time, like water soaking into dry, cracked earth, but they would eventually, inevitably find their way to his center, and he would feel Kishma’s loss as sharply, and overwhelmingly as I did. If not more. And now, without Kishma, I would have to be there for him. And continue to be there for him for a long, long time to come.
Once, after getting up from watching television, Ed walked into the office just as he had a thousand times before. He saw Kishma’s empty chair in the corner and asked me, again, just as he had done a thousand times before, “Did Kishma go lay down?”
All I could do was stare at him and say, “Ed… Kishma’s gone.” Then I saw on his face the same emotions that I feel. For a brief second, I saw the grief and the hurt as Kishma’s death struck home again. It’s an expression, a feeling that I imagine we will all see on each other’s faces many more times in the days to come.
Eventually, sitting with the family in the living room, I said all that I knew to say, and I told everyone that I needed to get some rest. I went into the bedroom that still looked for all the world like Kishma would be home any minute. I lay down on the bed that we had bought only six or seven months earlier so that Kishma could maybe be comfortable enough to sleep more than a couple of hours at a time. I covered myself in a blanket that still held her smell, and I cried, unsleeping, for two hours straight.
The days get better. There are ups and there are downs, and I can tell people that there are more ups than downs now. Friends ask how I’m doing, and I know that they are really asking how I am holding up. I always say that I am doing as well as can be expected. I never say that I am fine, because I am not fine in any way, shape, form, fashion, or degree. But I know that eventually I will be. I’ve found that the loss of someone this close after so many years of being so tightly intertwined will never go away. The waves of pain are always there, but over time, they decrease in frequency and intensity. Right now I feel her absence every minute. Some day, I will feel it every hour, then every day. Though truthfully, I doubt I will ever go an entire day without feeling the keen stab of her loss.
Sweet dreams, my Kishma. I will love you forever, and miss you until the day I die.