We had another care conference with the palliative care team and the ICU doctor to ask some questions about palliative care, comfort care, hospice care, and the current measures being taken. Between the options, we were deciding which one would be the best to help keep mom most comfortable.

We decided that mom was to remain as is until Natalie arrived the following day. She looked at flights and would be driving back to Colorado right after her exam that afternoon. Meanwhile if something were to happen with mom's heart, I signed off on her DNR approval. From this point on, only if her heart were to stop, no measures would be taken to revive her. She would stay on the breathing machine and medications would be used to maintain her stats until the following day where we would switch her to comfort measures only.

The conversation was emotional. Zack, Gayle and I were exhausted, but we stayed with mom until lunch time when we were hungry. We left the hospital for lunch and naps, and planned to return in the afternoon to spend the evening with mom. We hadn't discussed which two of us were coming back; we agreed to talk about it after naps.

At about 3:15 I got a call from the ICU doctor. Mom's stats were taking a sharp turn for the worst. They had her maxed out on norepinephrine to help keep her blood pressure up, however her blood pressure readings were in the range of 80/40. With the breathing tube on full pressure and 100% oxygen, her pulse ox level was only in the mid 80s. He was concerned that switching out her meds to others to bring these numbers back up that it would only make matters worse overall.

He said, "She is fighting all of our efforts to keep her here. She's ready to go."

I said OK, let me call my sister and my other siblings and I will be right over.

I called Natalie. She had already left and she was just outside of Dubuque, IA. I gave her the update and explained we were going back to the hospital to see how bad things were getting. While on the phone, I checked for any one-way flights from Dubuque, Des Moines, Cedar Rapids, Omaha and Lincoln going into Denver. The soonest one wasn't until Friday. With tears in my eyes, I asked Natalie what she wanted to do. She said she was going to pull off the highway and we were going to call her back once we were at the hospital.

We entered mom's room to the nurses repositioning her. Her stats had tanked, her norepinephrine IV was at max, and she looked exhausted. Her hands and feet were ice cold, but the arctic blanket was on full blast to keep her core temp below 100*F. 

We called Natalie from my phone first, then from Gayle's as my phone was almost dead. The doctor came into the room to explain the options, and as a group of four - with Natalie still 12 hours away - we agreed it was time to switch her to comfort measures immediately. Mom's body was fighting every effort we were making to keep her here until Natalie could say goodbye in person.

As soon as we made that call, the staff jumped into action. We were dressed into gowns with goggles and N95 masks so we could all to stay in the room . We were warned that this could take a while, or go very quickly. Whatever length of time it would take, we were allowed to be right there with her. One of the palliative care nurses held onto the phone by mom's head, facing mom so Natalie could say goodbye, while I called Matt and did the same so he too could say goodbye. 

I hung up with Matt as he was driving down to the hospital to be with us. Mom was quickly extubated, and machines were shut off. Natalie stayed parked in Dubuque and on Face Time with a nurse holding the phone so Natalie could face mom. Zack held onto mom's left hand, Gayle held onto her right hand, and I hugged her head and put my hand on her chest.

I felt the rise and fall of each breathe get more and more shallow. Tears were free flowing from everyone present. Mom's breaths quickly became further and further apart.

At 5:01 PM on Wednesday, May 12, 2021, my hand stopped moving. Mom took her last breath with all four of her children by her side.