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This is, in some sense, a sequel to another story by the name: The Beginning of the End. That story describes the steps that marked the beginning of when Marcia and I knew that her life was going to end in the near future, though we didn't know what "near future" meant at that point. This story deals with the end part of this window, or the shorter window in the near future, where the end really began.
For context, the prequel to this pointed to Mar. 3, 2019, as the day that the beginning of the end started. This was the day she last visited her oncologist as someone to help her extend her life. Marcia then died on Sunday, July 28, of the same year, almost 5 months later. In my mind, on Thursday, July 25, is when I marked what I saw as the final beginning of the end. However, to provide a little context, I am going to start two days before, on Tuesday, July 23. Since early May, I had started taking notes on her medications (since she was getting mixed up doing so), what she took, when, and what symptoms or issues were present. As time progressed, I started adding more notes and also began actually consistently entering journal entries for each day (for myself also) starting some time in May. What follows comes from my notes on her meds and my journal entries.
If you wonder why I am sharing something like this, and you don't want to wait until the end, you can jump there.
Tuesday, July 23
This day started early, at 12:30 a.m., when I gave Marcia an oral dose of fast-acting morphine. Marcia must have called to me for help. Since shortly after we arrived at the cabin, she had been on home hospice care in this county, and she slept in a hospital bed in the living room of the cabin, just 10 steps from my bedroom. Another dose was given to her at 4:00 a.m. Marcia woke up at 7:10 (with me earlier, but not recorded) and I gave her other meds: methadone (meth - for pain), dexamethasone (dex - purpose unclear now, though we both agreed to it), St. John's Wort (SJW - for anxiety and general), and lorazepam (loraz - for anxiety and vomiting issues) at 7:45. Her hospice nurse, whom I will simply call K, was scheduled to come that morning since it had been two weeks since her last visit (per Marcia's request to have that much spacing). K was also set to give Marcia's port a flushing (since it needs to be done every so often to keep it operating if meds need to be inserted there).
Marcia and I always talked about what issues to raise when K was coming. Today, we formulated the following questions to ask her: Q1. What help can be employed to help Marcia "swim" so that she can breathe better? Q2. Do you have all the details for the LifeQuest and Univ. of MN donation that you thought you wanted? Q3. Concern about the bump on the head; Q4. When should we change the O2 (i.e., oxygen) level?
K came about 11:30 or so, and at 1:15, we transitioned to the porch. Marcia's heart rate was 120 bpm, and her blood pressure was 130/98. K recommended using Senna (a stool softener) to get a BM started and to take it earlier in the day to help with water intake. She also said that Marcia can take another dose of morphine after an hour. For Q1, her initial response after hearing me describe how totally spent Marcia was after a swim she urged Marcia to not go swimming. After a moment's reflection, she recanted and urged Marcia to go ahead if she felt OK and that she was getting enough support. She said that she saw that it was meaningful for Marcia and thus worth it for that reason. I was pleased to see her initial reaction and then her final response. For Q2, I gave the information to K. For Q3, no real comments; we both felt it again and thought it was a little smaller. For Q4, just as needed.
K also responded to questions about using a mask vs the nose piece (for O2 intake), but she was neutral in her perspective. I walked out to the car with K to pick up some supplies. I asked her if she had any insight into how much longer Marcia had. She said that it could be just days, perhaps a week, even possibly months, and that she wouldn't be surprised by any of these three. That was the last time K saw Marcia. At 6:00 p.m.: meth*2; 7:30 loraz plus some anti-nausea at some point in the evening. It was a long day for both of us.
Wednesday, July 24
Marcia woke me up at 2:30 a.m. since she had lost her lip balm, and she needed me to find it. We both got back to sleep OK. She woke up at 5:30 and said that she had a hard night. Her pain level increased to 3 at 6:00 a.m. She said that she felt like throwing up, but she didn't. At 6:30, I gave her meth + dex; at 8:30, I gave her senna + dex + anti-nausea.
At about 3 or 3:30, we took a paddleboat ride over to Paul Minkler's dock and hooked up the boat there. We got some horse fly bites between our toes while I pedaled over. I disconnected the small O2 tank and the breathing line, brought them toward the shore, and placed them on the dock. Marcia was then able to go in and sit, wade, and exercise, but not submerge herself. I tried to swim and also watch her. After a shorter time than normal (last two weeks, she would spend up to 20 minutes there), she was ready to head back. We were more attentive to the horse and deer flies on the way back, and were OK. After getting to our dock, I unstrapped the oxygen tank and carried it while Marcia had her arms on my back as we slowly walked off the dock and then more slowly walked up the hill and then even more slowly climbed the stairs. The whole process was more than 5 minutes. She was thoroughly exhausted after getting into the cabin.
At 4:45 p.m., I gave her the anti-nausea; at 6:00, the fast-acting morphine; at 7:00, two meth halves; at 8:30, fast-acting morphine. This was noted as a hard day in many ways. In the next few days, I came to realize that this was her last boat trip to go swimming, and the whole ordeal was thoroughly enjoyed but completely exhausting for her. Also, she was doing something with a knife in the evening, and it fell and made a mess. There was also something about the microwave that happened, but I don't recall the details now. She had trouble during the night as well.
Thursday, July 25
At 2:00 a.m., Marcia had trouble breathing, so I gave her more O2. At 3:00, I gave her some fast-acting morphine. I couldn't get back to sleep until 5 or 6. At 7:20, I gave her meth + dex. Her breakfast for the day was a small amount of watermelon with bone broth, peanut butter, and prune juice - a common breakfast lately. At 8:05, I gave her some milk of magnesia. About 9 or 9:30, Lisa (maybe with Ed) came to visit, but I hadn't seen the text that she had sent indicating that she was coming. I think Marcia felt out of the loop, but she was not really feeling like any company. Lisa gathered that after a bit and left. Marcia was frustrated and worn out, and then asked for no more company. I reminded her that Nona was coming today or Friday, but she had no response.
At noon, I gave her senna and fast-acting morphine. Her lunch was one yogurt and a small amount of cookie crumbs (and she aimed for the small pieces). At 2:05 p.m. I gave her goat cheese and apple sauce, but only a small amount. Since Marcia had not had a bowel movement for some time, I called the hospice (per Marcia's request) about using the suppository, and they strongly recommended it in this context. I offered to help her, but Marcia made it clear in no uncertain terms that she didn't want any help. At 6:00 p.m. I gave her 2 halves of meth halves, and she went to bed with no supper at all. At 7:30, I gave her loraz.
After 7:30, since she was going to bed, either she encouraged me or I asked, and she heartily agreed that I should go out and kayak. (I hadn't kayaked by myself in some time, maybe not all since Christina's wedding.) I wasn't gone more than 35-40 minutes, but when I came back, she had recently (about 8:00) gotten up. Marcia thought she had to vomit, and then she lost her balance and fell, hitting her head and hip some on the way down. She was not hurt in any serious fashion, but it shook both of us up. I felt bad having left. Today was the first day that she didn't request going out on the lake on the paddleboat. Yesterday's outing was quite taxing, and she must not have had the strength to attempt it. She didn't raise the topic, nor did I. This lack of going out on at least a boat ride was my first indication that things were changing because she never passed up an opportunity to go out on this new paddleboat.
Friday, July 26
At 1:50 a.m., Marcia needed to go to the bathroom, but she was very confused. I am not sure why I didn't set up the commode right by her bed earlier since that would have been so much easier for both of us (and I did so later that day). At 2:05 a.m., I texted or emailed Nona, reminding her that she had said she was going to come Thursday or Friday, and I encouraged her to come tomorrow (which was already my today) because it may be her last chance. At 2:30 a.m., Marcia again needed to go to the bathroom, and again she was very confused and changed her mind on what she needed to do. At 6:30, I gave her loraz since she felt like vomiting. I used the rolling (old office) chair to help move Marcia out to the porch and then later back in. I did so because she found that easier than walking. To me, this was a strong signal of things changing.
At 8:00, I gave her senna + meth; at 8:30, dex + fast-acting morphine. At 9:30, Marcia said that she wanted to come in and go back to her bed. This was highly unusual since, generally, Marcia went out to the porch between 5:30 and 6:30 in the morning and largely stayed there all day until it was time to go to bed or eat (if I didn't bring it out to her), except when on the paddleboat or on a walk. She came in and rested, even falling asleep.
Nona did contact me about coming, and they came about 11:30. Marcia was still sleeping, so Nona said to let her rest. Nona, Paul, and I talked for a while on the porch. Nona then offered for me to go do something, if I wanted. I opted to go for a quick walk, and I brought my phone. After a few minutes, Nona called, saying Marcia was calling for me. I ran back and helped her to go to the bathroom, and told her that Nona was here. I helped her tidy up and brush her hair, and she got back in bed. Paul and Nona came in and talked with her for about 10-15 minutes. Nona read a note that she had brought and shared some experiences, and then prayed. It was an emotional time. Interestingly, Jo was here the prior Friday (one week earlier), and there was a night-and-day difference between the two visits (measuring Marcia's ability and interest in engaging). Marcia didn't engage too much, but she definitely was aware, listening, smiling and appreciating the visit. But then she said that she was tired, and they left at 1:00. Nona and Paul expressed that they were glad that they had come.
At about 1:15, Marcia asked to eat, but only wanted about 1/10 of a yogurt. At 1:20, I gave her some fast-acting morphine (P=3). At 2:15, she had more lunch consisting of some cold baked beans and goat cheese + V8. Earlier in the day, when trying to drink, she sometimes had trouble coordinating her movements to get the glass to her mouth correctly and sometimes spilled some. To help, I offered her a straw, but she didn't want it. At 2:30, when I gave her a drink, I just put a straw into her glass, but she threw it to the floor. At 2:30, I gave her more fast-acting morphine. At 2:45, I gave her a loraz and because it was quite hot earlier, she had completely undressed then. Realizing now that she was naked, she asked me to lock all the doors. She then fell asleep. For a long time.
I finally, and reluctantly, woke her up at 10 p.m. (about 7 hours later) because she hadn't had any pain medicine for some time. She then had a large BM. At 10:30, I gave her loraz and two doses of meth (2/2). By 11:00, she was asleep again. From 1:40 in the afternoon until dark, she was mostly asleep. During this window, a loon was hanging out close to our dock and in our bay. It was often within 20 yards of our dock. I have never seen a loon hang out so close, and for so long. I stayed inside all the time and was cleaning, praying, and preparing lists of things to do. I could see that she had clearly transitioned to the active stage of dying. I am not sure why the loon hanging around made me think of it, but I started thinking that she was going to die that night. So many things were pointing in that direction.
Saturday, July 27
I slept all of the night for the first time this week, and it felt good. (By all night, I mean I slept 9-10, 10:15-5, 5:30-6:30.) At 5:00 a.m., I covered Marcia up with a sheet partly because she was nude on the bottom half (it was quite hot), which would make her feel self-conscious, and also because the morning air was cooler and I thought she needed something.
On Friday, Marcia started using O2 constantly. I then became concerned about running out of tanks, even though we had quite a few that they brought on Wednesday or Thursday (but at that time, her rate of consumption was much lower). So I called Saturday morning, and they asked me how much we had. I figured I could make it work, barely, until Monday morning if I managed things well. The problem was that there were not a lot of larger tanks that she could use overnight without me needing to wake-up to change tanks.
Some time after getting up to go potty, she was dismayed to find that she only had a shirt on and no bottoms. I said that no one was coming, and that she had asked for that since it was hot. She went back to sleep. At 8:00 a.m., Marcia woke up and said, "Ready", as a statement, not a question. My notes did not show any further conversation about this comment, though other things pointed to her being ready for death. Then Marcia went potty, had meth + senna, and her pain was at 2. I played some Kari Jobe music quietly in the background (until she later asked for it to stop). I gave her some breakfast (not much since she wasn't very hungry) and some water (using a straw, but she expressed her displeasure, but also her acceptance).
Later, she asked for her purse, but I don't recall the purpose or what came of it. She expressed that she wanted the Lord to take her. I rubbed her legs some, perhaps for neuropathy and/or early mottling. She looked at me and sincerely asked, "How do I do it?" Since I was quite sure that she meant "How do I die?", I just generally encouraged her to just let go and be at peace. She said, "Come, angels." She then asked for a hug and kissed my forehead.
At 8:30, she went back to sleep; at 10:00, she wanted some water and then back to sleep; at 10:25, Marcia looked at me and said, "Al, are we dying?" I responded affirmatively that she was in the process of dying (and I think I foolishly corrected her first-person plural to first-person singular). A bit later, several times, she said, "Where am I?" in a confused fashion. I read Nona's letter to her again, and then I read her the book of Philippians, which I had been reading to her a lot in the last two weeks. I gave her three spoons of yogurt (per her request. She was then in and out of a wakeful state until 1:10 p.m. She then asked for some water, went potty, and I helped her back in bed with some readjustments of the bed angles and height. After a bit, she asked, "Is Marty here?" I asked, "Marty, who?" She answered "Marty Schmidt", who was a former youth pastor at Third and is now pastor of a satellite church (The Bridge) 50 miles from Pella. She gave no response to further questioning about this. I had told her several times that day that I loved her and said it again at this point. She said, "Stop saying that!" But because she was not totally coherent, I said that I couldn't understand what she said (but as I finished that statement, my brain put together what she had said), to which she responded: "Be Quiet!" She drifted in and out of rest. At one point, she said, "What's Emma Jean's name?" I asked her follow-up questions since I knew no one with this name (and also checked my genealogy database), but she gave no response. After this, she said, "Mallory," and again no response when I asked for clarification. During this time (and actually during the last 3 days), she frequently belched or burped. At one point I apologized for something I said or did, to which she responded, "No more apologies". I wrote a Last Update on Marcia to the kids, Nona, and Jo at 4:45. At 5:00 p.m., she looked at me and ordered me to "Go swim". I didn't want to leave her, and so I didn't. I recalled that two days before, I had left for a kayak ride, and she had fallen. (Some context for this swim issue is given in the update link.)
At 6:00 p.m., I gave her meth doubled (2/2) + loraz + fast-acting morphine (with pain at 5 - out of 10). This was highest level she ever gave in the last 3 years, but there was no evidence of her in that level of pain. Now, as I write up these notes, in hindsight, I am surprised that she gave a response to my query about her pain level, since for most questions she had no response. But she had moments of lucidity and other moments of drifting in and out, though I was not always sure which state she was in. She now wanted to eat, and I offered some ice cream that she had special-ordered on Monday. One bite was sufficient. This was her only food since breakfast.
At 6:15, Marcia asked for her phone (but didn't tell me why). She really struggled to type something for which she did not have the fine motor control to execute. She either typed the wrong letter and tried to backspace, and then sometimes did too many, or she typed the letter she wanted but got several copies of it. I made an offer to help, but she persisted. After struggling for more than 5 minutes, she asked me to help her. She wanted to call the hospice (though she was in the Photos app). When I asked her what she wanted me to ask, she said that she wanted to ask them what to do since she was dying. I asked her to trust me since I had talked with them about what to do, and I could help her. She seemed satisfied. She then went to sleep. I didn't record the time, but I think it was before 7. For the rest of the night, while she was sleeping, there were some moaning sounds with each breath, not in pain but perhaps what is sometimes called the "death rattle". The hospice actually gave us some meds to combat this "death rattle" sound, but I saw no reason to suppress it - that just happens. In contrast, the night before and this morning's sleeping, she was completely quiet.
Sunday, July 28
At 12:30 a.m., Marcia called for me because she wanted to go potty. She tried to throw herself toward the edge of the bed, and between her efforts and mine, we got her close to the edge. The good news was that the commode was within inches of her bed (for several days). The bad news is that she couldn't stand on her own strength, so I tried to help her stand and turn her so that she was oriented correctly for the commode. However, in my efforts to support her and trying to turn her, I found that I had hurt my back and I didn't think I could turn her, help lower her to the commode, help raise her off it, turn her again, and then get her back into bed in my current state. I decided to put her back into bed, which was also a challenge. I then did what I could do to put a diaper on her and reposition her. That was the first time using a diaper, but that is why we had them, but it was still hard to do (emotionally) for me to do to her. She was not aware, or at least didn't communicate anything; she said nothing. She fell back to sleep and slept the rest of the night peacefully. The diaper never did get wet or soiled.
At 6:00 a.m., I woke up. I called Itasca hospice at 7:00 with questions about positioning her, dealing with a diaper vs commode, and more. The hospice nurse on call, B (what I will call her), asked if I wanted her to come, and I thought I would appreciate some extra support right then.
At 7:05, I crushed into water a full dosage of methadone and 2 fast-acting morphine (which Marcia never did since she could swallow pills fine) in the morning. Since I didn't know how to get her to swallow the pills, I then took the liquid and used an injector to squirt it into her mouth. I didn't want her in pain, and I wasn't confident she could communicate effectively if she was. At 7:45, hospice nurse B arrived. She helped rearrange her, teaching me how to do so, and also showed me how to move her to put a diaper on. She also brought me more supplies. Marcia continued to rest peacefully in this better position. At 8:00, B then wanted to take Marcia's vitals. She loudly announced to Marcia that she was going to do so (and used her name), and Marcia's eyes opened in surprise and looked around a second, but no response to anything or any questions, and then went back to resting with her eyes closed. B could not find any blood pressure after several attempts. Her pulse was 120. Her respiration was 9 breaths/minute. B asked if I wanted her to stay with us. I indicated that she had helped enough and that I thought I could manage going forward. She then left about 8:15, offering to come back if needed or to answer questions by phone, if I had any.
At 10:30, Marcia's respiration was 7 breaths/minute. At 12:00, I brought in from the porch a new small tank since I didn't have any larger ones. The smaller ones can go 4 to 4.5 hours, but I mentally noted (and on paper) to check things at 3:30 (to be on the safe side). During the morning, I was organizing things and making space on the porch for all the equipment. I was quite confident that she was in the final stretch, but I wasn't sure if she would die before the night or wait until Monday. I prayed over her and read her the Bible from numerous places, particularly Philippians. I played some Christian music quietly and tried to be quiet myself, trying to create an environment of peace. I also started processing some of her things on the porch, her food caches, her supplies by her bed, and so on.
Since 8:15, when B left, she had remained silent and in the same position with her arms crossed on her tummy with no effort to communicate or respond to me. At 10:30, I called the LifeQuest (BioGift) organization to clarify what steps needed to be taken in case Marcia did die today. I had called them earlier in early May while we expected to stay in Pella. Then, I got some general guidance, but now I thought I needed more specific guidance. After checking and asking about the location, she told me that MN was one of the states where they don't operate their services, and so she couldn't help. In times like this, one is glad that a plan B was already inplace, which I had done back in Pella when we were considering going to the cabin. I had made arrangements with the University of MN at their medical school and had received a confirmation of acceptance while up here. I called them and found out that someone would come from the Shakopee area (when death had occurred), and it would take about 4 hours, and I just needed to call back when things were finalized.
At 12:30 p.m., I gave Marcia 2 dissolved fast-acting morphine by using the injector, giving her most of it. At 1:00, she was restless for a minute and moved a little bit. At 1:45, she was at 5.5 breaths/minute. At 2:15, since it had been a hard week for me, and I was tired, I decided to take a little nap. At 3:15, I woke up, and I checked her breathing, which had decreased. I checked the oxygen tank, and it was fine. I kept checking the oxygen tank since I wanted to maximize the consumption in case I had to go through the night, since there was not a lot left. About 4:10, though the tank was still giving OK, the meter said almost empty, and I set up to switch tanks. I quickly made the transition to the new tank (taking at most 5 seconds) and then checked her breathing. It was hard to tell if she was breathing, though moments before I had heard her. I couldn't detect any breathing, so I checked for a pulse, and I couldn't find that either. I had already noticed that in the last few hours her legs were getting mottled and cooler, and now I could not find any sign of life. I cried, praised God, and committed her to Him.
I then called Nurse B and told her about the last moments and how there was no more breathing or pulse and her coolness. I was trying to convince her to call the U of MN person to start the trip up here. At first, she agreed, and then she said that, formally, she really needed to pronounce her dead before she could call. She came as soon as she could, confirmed the death, and then called them. They would try to leave as soon as they could. We talked for a bit, and she asked how I was doing. I convinced her that I was OK, both very sad and relieved that she was with God (though I am not sure if I expressed these thoughts exactly to her). I then talked to her about the unused supplies and the process for picking up the equipment. She said that she couldn't take back anything that had entered the house, but that she would take care of the arrangements for the equipment being picked up. She then left.
The man who was coming for the body called me and asked me some questions about Marcia's size and other things, trying to discreetly determine if he needed to bring another person to help him or not. I finally figured out his goal, and I assured him that I was fit and that I could help with the lifting and moving of Marcia so that he didn't need to bother asking another person. I gave him general directions and asked him to call when he got to the turnoff.
I got supper, though I was not really hungry. It was also a little unnerving to have Marcia lying there, though I knew that she was gone and this was just her shell. It still had a minor effect. Nonetheless, I continued to organize things and make room for the person coming. While I was glad that I had the nap, I was starting to get tired, especially after 9:30, when it started getting a little darker. However, I continued to find things to do, though I had to keep walking past the corpse of my beloved. It was a bit surreal to see her body, but to know that she was not there. Finally, at about 11, he called and was a bit confused. Our road is hard to navigate in the light, but in the dark, especially the first time, it can be confusing. At the public access, he went around the circle and started going back out, and I needed to redirect him back. I told him that he should wait at the top of the road, and I would be out there with some lights and help him back down the hill with his van.
After arriving, he set up his gurney in the living room, and we worked on putting a plastic wrapping around Marcia, sealed at both ends, and onto the gurney. He then had some paperwork for me to complete, and we talked. Timothy was a funeral director who did this for the Univ. of MN and enjoyed the process. He was a kind man and quite considerate. He understood death and its impact and was gentle. When done, we rolled the gurney through the dark porch (with one light on in the closet) and then out to the van, where we lifted her in. I bid farewell as Timothy left at 11:45, and I retreated to bed. As I lay there trying to get to sleep, I kept thinking of more things that I needed to add to my to-do list, but I eventually fell asleep some time after 12:30. It was another long day.
By Friday, when I was fairly confident that Marcia's death was in the very near future, I contacted Bruce and Jo. I sent them the following email:
Marcia appears to be getting close to graduation time. When the time comes, if you are free then, and I inform you, could you call our/your siblings? I have all the numbers, if you need any. If you don’t feel comfortable, that is fine.
I knew that this would be easier for me, and it would take something off my plate. They both responded affirmatively. So, after Marcia died, I called both Bruce and Jo and gave them the simple information of her death, time, and the peace that accompanied it.
As I indicated at the beginning, the original reason was just to help with Marcia's meds and symptoms. But as time progressed, and my inclination to history in general and family history in particular, I added more details. About a year after Marcia's death, I added detailed expansions of my notes into my daily journal. I did this partly for a sense of completeness of a project, but I also found it cathartic.
After Marcia's death, I prepared materials, found a useful book, found people willing to share, and designed a class to be taught at my church called Preparing for Death that incorporated these three ingredients. This was done twice there. My goal was to help others learn how to prepare themselves for either their own death or someone else's death (or both).
In the last several years, I have been working on writing up stories of my life and of others in my life. Remembering the goals that I had in this Preparing for Death class, I thought it might be helpful for some readers to follow along the steps of someone who was in her final days of death. To read some specific things that happened and didn't happen, in contrast to the silly death scenes in many movies and on TV. To that end, I hope you found this informative and perhaps helpful for your own walk in confronting death.
Published 2026-07-19.
If you find any errors in the text, please let me know. Thanks. Contact me with errors or comments using hibbardac@gmail.com. [Back to the top] [About the author, Al]