Page 16 of Last Wish Wedding

“Like… an elephant…” He gasped between words. “Sitting right… here.” His trembling hand pressed against his sternum.

“Ruth, has he had any morphine before?”

Ruth shook her head. “Just the nitro and his regular meds. We’ve never…”

“It’s okay.” Kelsey kept her voice calm, though her mind raced. Of course they hadn’t. End-of-life care on the island was still catching up mainland practice. On her agenda to change. “Mr. Costigan, I’m going to give you something under your tongue to help with the pain and breathing, alright?”

He managed a nod, his knuckles white where they gripped the chair’s arm.

Kelsey retrieved the comfort pack from the kitchen refrigerator. Although Mr. Costigan wasn’t yet enrolled in a hospice program, Kelsey’d had an inkling he might be headed in that direction, so she’d gone ahead and prescribed the pack a few weeks ago. It was a small cardboard box that contained small doses of prescription medications for pain, nausea, and anxiety for use in emergencies instead of rushing to the ER.

“Ruth, watch closely, these drops go under the tongue. Start with two.” She demonstrated the technique, then turned back to her patient. “This will help soon. Try to relax.”

A floorboard creaked, and she glanced up to see Mac standing in the doorway, Noah still asleep against his shoulder. Their eyes met briefly before she returned her attention to Mr. Costigan.

“Your legs are pretty swollen,” she noted, pressing gently against his ankle. The indent remained. “How’s your urine output been?”

“Not… much…” His breathing was already becoming less labored as the morphine took effect.

“Ruth, let’s add an extra dose of his diuretic. I have an injection I can give him now,” Kelsey continued her assessment, noting with relief as Mr. Costigan’s color gradually improved. “Better?”

He nodded, managing a weak smile. “Much. Knew… you’d know… what to do. I don’t want to go the hospital. I’d die there. This is where I want to be.”

“Your grandfather’s in good hands,” Ruth said softly to Mac, who hadn’t moved from his position by the door, watching everything with wide eyes.

“The best,” Mr. Costigan agreed with a stronger voice. “Though… surprised to see… my grandson… playing nursemaid.”

Mac shifted Noah’s weight carefully.

Mr. Costigan chuckled weakly, then sobered. “Sorry to… wake the boy.”

“He could sleep through a hurricane,” Kelsey assured him, checking his pulse again. The rhythm was steadier now. “How’s the pain?”

“Fading.” His eyes were heavy. “Thank you… for coming.”

“I’ll stay until you’re sleeping,” she promised, then adjusted his oxygen. She glanced at Ruth. “We should talk about updating the comfort protocols. There are other measures we can put in place. For now though, it’s time to figure out his care for tonight.”

Already Ruth’s cell phone buzzed at her waist. “Busy night for on call.”

Kelsey listened to the one-sided conversation as the triage service gave Ruth information on another patient. “I really need to head over to the other side of the island,” Ruth whispered to her. “I hate to leave, but it must be a full moon. Everyone has issues tonight that can’t wait until morning.”

“I can stay with Mr. Costigan and show Mac how to administer the morphine if he needs it again. But we need a better plan for him if he is going to stay home. Time to not be on his own,” Kelsey replied softly to Ruth.

The room fell quiet except for Mr. Costigan’s now-steady breathing and Noah’s soft snores. Mac stood sentinel-like, holding her sleeping son. The expression on his face was unreadable.

“Mac, why don’t you lay Noah on the sofa over there by the window?” Kelsey guided him. “And come over here where we can talk with your grandfather.”

He did as she instructed woodenly, eyes following Ruth as she excused herself and slipped out the front door. Kelsey sat on the love seat directly across from Mr. Costigan, who watched her with knowing eyes. “Sit down boy, she wants to be sure we both hear what she has to tell us.”

Mac sat with wide eyes.

“You see my boy, it’s true that I’m dying.” Mr. Costigan’s color was back, and there were tears in his eyes as he spoke to his grandson. “I know I’ve said it a thousand times, but this time Kelsey can back me up.” He smiled in jest.

Kelsey gently reached over to touch Mac’s knee and leaned forward in her seat toward Mr. Costigan. “Tonight is evidence that your condition is changing, and you’ll need to have more care.”

“No hospital. No nursing home. Here is where I want to be,” Mr. Costigan pronounced stubbornly.

“I’m in agreement with your choice, however we have to make sure you’re still well cared for. I don’t want you to staying alone any longer. So we need to talk about what that can look like for you. Hospice agencies do come to the island and work with us to provide the supportive care you need to stay home. The nurses can increase their visits and send in aides for personal care. But the constant presence of someone here is needed. We’ll train them in how to give you medication to make you comfortable, just as I did tonight, and a nurse can come to help relieve your symptoms with medications we’ll anticipate that you’ll need. But it’s going to be up to you and Mac to decide how you want to structure things so you’re not alone,” Kesley explained. She was at ease with what needed to be done for Mr. Costigan. But delivering the information to the patient and family had to be done clearly and kindly.