Dwindle,  Hospice…… These are whisper words.  They have no hard notes.  There is no inclination to shout or spit them out.

Dwindle,  Hospice…… One word demands quiet attention, the other solemnity.

Just a little over a week ago, Uncle Bobby lifted me for a moment from my “Januarys”.  These last ten days he has found himself face to face with the ultimate “Januarys”.   His physical struggles are mounting, as his likely consuming lung disease is compounded by what appears to be a rapidly enlarging prostate. The two have joined forces to steal away his humor, patience, and energy.  This is how it is for the elderly at the end of a life well lived.   Their survival is tenuous.  Uncle Bobby has been a veritable house of cards for some time now. He is a fragile fellow.

My father died in this heinous month, seven “Januarys” ago.  In the late weeks of his final December, I recall a nurse selecting a charming word to describe his countenance,

“He’s got the dwindles”

The dwindles sound so benign, don’t they?  The word almost has a nursery rhyme lyricism to it:  Jack be nimble?  Jack has dwindles?  And if it is true that we revert to our child-like self’s as we come closer to our end,  then it is the perfect word.

Since an unexpected ambulance ride to the emergency room last Saturday,  Uncle Bobby has shown the tell-tale signs of “the dwindles”.  He is as moody, irritable and confused as a petulant three-year-old boy who can’t have what he wants, when wants it.  Despite his natural charms, he has always had room for complaint, but this past week they lack bite and fluidity.

The criticisms and concerns of this week are not spiked with entertaining self-righteousness.  His delivery is weak and his intellectual rants trail off prematurely.  There are no stories of yesteryear this final week of January, no perseveration about the Dow Jones, or sharp observations about the three-ring circus of presidential politics.  This week he is diminished; just a shadow of himself.  He will be 90 on April 7. He is deservedly exhausted. He has the “dwindles”.

The medical complication which landed him in the emergency room last weekend returned on Tuesday. It was suggested by the facility where he lives that a Hospice evaluation be done.  This exercise was done six months ago, and he was declined. There is a joke in here somewhere about a club into which you hope never to be accepted.  Suffice it to say, acceptance to Hospice care is almost akin to gaining admission to Harvard. If the standard at Harvard starts with perfect SAT’s, 4.0 GPA,  and a stacked resume, Hospice expects the same excellence in medical complication.  Remarkably, the “dwindles” qualify.

Hospice is a potent whisper of a word. It meant nothing to me at all until my mother entered its care in the last week of her life.  My father did the same three years later. From the cacophony of hospitals and nursing homes, Hospice nurses floated into our lives like gentle sprites, attending to my parent’s comfort and dignity with the kind of grace reserved for only the finest of angels.  Starting this week, Hospice will relieve Uncle Bobby’s underpaid, overworked and sometimes under trained CNA’s.  They will also help both of us prepare for the journey ahead.

When I listened to the voice message from Hospice while driving along a congested stretch of I-84, I was surprised by my own quiet tears.  For a year now I have been so focussed on the “tree’s” of Bobby’s care that somehow I lost the “forest”.  My heart aches to consider my own forest absent him.  He is the last of my Mohican’s.

Acceptance into Hospice care does not necessarily mean that death is imminent, though it suggests that 6 months is a fair barometer of time left. For my Mom and Dad, Hospice care meant days.  For Uncle Bobby, the prognosis remains unclear and there is always the chance that the gentility of Hospice attention will strengthen him somehow; that he will rise again to stave off the inevitable.

It is not lost on me that one year ago, when Uncle Bobby moved here from Providence, that I was experiencing my own emotional “dwindles” from which his presence demanded that I rise. He has been Hospice personified for my broken heart.

A dear friend gave me a poetic perspective today: Hospice suggests the “edge of the end”.   

She said it like a whisper.