Siege

Monday 11 June afternoon

I can't believe I am writing all this down as if I were a spectator looking down from behind a window into an operating theater, making notes for my next clinical report. This must be denial kicking in. Whenever my presence is not contributing or even redundant, I phanatically read a new book I received yesterday as a present from a friend: "The Cellist of Sarajevo", by Steven Galloway. I go through it like a person possessed. Anything to help put a distance between my soul and reality. Telling about the Bosnian capital under siege, the story is easy to relate to for both Lara and myself. Lara was stationed in Bosnia in 1996 and the two of us drove down from Banja Luka to the city several times as it lay partly in ruins -  she on business, I as 'Mr. Gabriel' (oh, she liked that).

Lara woke up again to discuss with her doctor (over the phone) and careproviders (at her bedside) the best way forward. As from 4:30PM the levels of morphine and Tranxene are set at triple the dosage: 30 mg of morphine/day and 37.5 mg of Tranxene/day, both with possibility of hourly so-called 'bonus' doses of the same quantity. (These are still modest levels.) The sequel will be discussed with our GP as she visits this evening. In case Lara will no longer be wakeable (as is likely at that dosage), Isabelle and I will determine the rest of it.

Lara washed her teeth one last time with her own toothbrush and real toothpaste, rather than staining them with iso-betadine as she has been required to do since her hospitalisation in March. Using a regular adult brush carries the risk of bleeding gums (remember, no platelets) and even more so of bacterial infection. What a delight, she said.

As soon as the intravenous morphine pump is set in motion again, Lara solemnly takes off her wedding ring and hands it to me. We both agreed that, by doing so, she wasn't releasing me of my wedding vows before their time.

It takes quite a while before the effect of the morphine and tranquilizer has played out, even with the bonuses given to Lara right from the start. A coughing fit is in the way. I measure her saturation and her pulse: both stand at 96, quite reasonable. Pressure 9 over 5. Temperature normal. I stretch out alongside her and she rests her head against my shoulder, our arms intertwined. We exchange our last carinos.

A little after 5:15PM, Lara increasingly has trouble focussing. I tell her to just doze off. One careprovider asks if she is afraid. She nods. Of course, you are. That is why she clings to her presence in the here and now. Security. She takes time to put Caroline's balm on her chapped lips. At around 5:45PM she says: "I am slowly going away. In a good way." Half an hour later, the sedatives become stronger. "I am wandering but I am still here", she says. Her face and hands are cool on the touch. "Are you boarding yet?", I ask. Not even close, is the answer. Not even cueing? She shakes her head. What then? "Shobbing", she says. Leave it to Lara to secure a last minute bargain.

Monday evening

At 6:30PM she seems to have finally boarded. "You're making the people on the plane laugh", she tells me. I seem to have slipped aboard with her to make sure she's comfortable.

At 7:30PM she is soundly asleep, but still wakeable it seems to me. And indeed, as our doctor enters the living room, Lara opens her eyes and smiles at her. "Flap your wings carefully", I whisper in Lara's ear. She nods. It has been her longstanding adieu to anyone on an airplane who is about to take off.

At 8:15PM her pulse measures 8 over 5, her pulse standing at 126 beats/minute. Her saturation is still at 96%. At 8:40PM we enter final approach. Just before she goes under she turns to me and asks: "Can you fluff up my pillow?" "It will be my pleasure", I tell her. Everything is in place and I am given instructions. Two glass vials of Dormicum 5 mg are emptied through the central line. The doctor and the nurse take their leave. I am staying behind with Lara in the apartment, just the two of us. Alone at last. She breathes quietly. Pale is her face. Hard to say if she will pass quickly, or if she will take her time. A matter of hours at most, I'm told. My head is full of cotton.

Back to Sarajevo, a city besieged.

Then, in a spectacular development at around 11:00PM, I find myself moping about in the living room (where Lara's bed sits), when suddenly I hear: "Hey, Dingdong". I look over: Lara is sitting up and her eyes follow me around the room. In a flash it occurs to me that - praise the Lord - there is reprieve from death after all! Apparently one can come back out of it as if waking up from a nightmare. In an impulse I tell her she's not supposed to be awake and to please go back to sleep - admittedly an inane reaction on my part. "What's happening?", she wants to know. "I don't think this is supposed to happen, I said, I will call the doctor." Meanwhile I give her the water bottle which she empties in no-time, for her mouth is parched.

So our GP hops over in under ten minutes and is a tad taken aback at the turn of events, not knowing the answer to Lara's obviously pertinent question. The two of them discuss in French about what went wrong and how it can be made right. Lara makes the point that now she is really getting scared, for she no longer trusts the protocol chosen. Meanwhile a nurse is summoned and a different way of administering drugs is chosen. Pretty soon her eyes are swimming again and she has to lie back in order to absorb the extra morphine.

That's when Lara and I exchange what would be our last words, where I tell her - a bit counterintuitively - to relax and go to sleep and everything will be allright. Lara is not at all sure that it actually will be allright, since the point is she doesn't really want to wake up anymore and how can she believe she won't? Fact is from here onward we managed to keep her sedated until the end came, even though it took far longer than the doctor loosely predicted as 'a matter of hours'. I give her one last kiss and she kisses me back. (Oh, I liked that.)

Doctor Schroyens, our homeopathist, later tells me that these sudden surges of consciousness in a terminal patient occur exceptionally in response to homeopathic treatment. Astonishing the hospital staff, such episodes can be spectacular, elaborate but circumscribed, finite and always returning the patient to sleep or coma, with death not far behind. That is what happened to Lara here. Of course.