There is always a point in the homes of the dying when there is a paradigm shift, that is when the dynamic changes, and the caregivers need caregivers. It is sometimes subtle, sometimes dramatic.  The patient needs care and attention, but less, and the caregiver not worn down, needs more.

In hospice care, a paradigm is always signaled when the patients starts taking morphine. That is the boundary between one phase and another Morphine eases pain and anxiety and brings a deep sleep.

The morphine eases the pain Ed has been having and helps him rest. It makes him comfortable. If necessary, the doses will be increased to keep him comfortable and ease, there is no need for him to suffer now, and Carol recognizes now that there will be no more walks outside to visit the cows.

Morphine means the patient will be less alert, will sleep more, be less available, less needy.

It means caregivers like Carol, who sit up alongside their partners all night in case they need something, will most often need something to read.

In fact, yesterday, Carol asked me if I could bring a book of essays by Joan Didion that I assigned to me writing class, and late at night, she texted me a photo of her sitting up holding one of my short story books. Before this, Ed    was up and calling for help, and upset and restless and Carol had no time to sleep.

I sense Carol needs Maria and me now in a different way than before.

She needs to talk and wants to talk and speak out loud about the things on her mind. She knows we have no answers for her, and so do we, but we can listen, and that is a big deal. She appreciates that we are not her to offer  advice.

I am also surprised to see that the fresh vegetables and fruit we bring are valued and devoured by her and her family.  I forget that farmers are always too busy to have healthy and fresh food around, they eat stuff my cardiologist would not like.

But now, Carol – she is in her sixties and had open heart surgery the same time I did, is a wreck – she is tired and emotionally drained –  and sometimes overwhelmed.

She is in great pain from her torn ligaments and has yet to get to see a orthopedist or  even have one call her back.

Time to focus on her, there is nothing much to do for Ed that I can do. He asked me to keep an eye on Carol, and I  will. She is my friend also, Maria’s too.

In such situations friends, cousins, blog readers, neighbors, all kinds of  people will bombard her with advice and ideas and experiences they think might be helpful to her, but I have no desire to do that.

Anyone in this situation will be drained and worn out, there is no easy or peaceful way to do it, especially if you live in America and are not rich. There is never much of  net between you, not even during this brutally difficult time. Americans, especially those online, think there is a miracle cure for just about everything. There is no fix for this.

I let Carol have her suffering, she is entitled to it.

Disaster and sadness are  always peeking just around the corner.

And that is life, sometimes it simply will be hard. You can make death softer  sometimes, but never easy or easier for those who have to wait and watch. Death is what death is. Books can make it softer.

Carol is also nursing torn ligaments in her leg. I keep asking her if she  has a brace yet, and she keeps telling me that the orthopedist hasn’t called her yet – he’s three days late – so that’s my limit, we went out to the pharmacy and bought an Ace adjustable knee support brace, it was recommended by the pharmacist.

Maria and I also gathered some books we had, and went to Battenkill Books to get a  few more, Carol might have a lot of time to read in the coming days.

I chose four books:

A new novel, Clock Dance, by Anne Tyler, a lovely story about family and connection.

A book by Dr. Gustavo Ferrer called “Graceful Exit: how to advocate effectively, take care of yourself, and be present for the death of a loved one.” I’ve been reading the reviews, the book seems right for the vulnerable who need to be very strong.

And there is the classic story of a prairie farm wife, My Antonia, by Willa Cather.Carol, like Maria, could easily be a character in that book.

The Inner Voice Of Love, by Henri J.M.Nouwen, a favorite spiritual writer of mine.

This kind of support is so important i think.

Carol has an army of practical helpers around her, including her four children and grandchildren. They are all a part of this, but they don’t have much time to browse bookstores. Thanks to Battenkill Books for helping me make these choices.

I believe these books are things she will need to take her out of herself, pull her into something else. You can go mad if you live with suffering and death 24 hours a day, seven days a week, and Carol is not good at  taking care of herself. This could go on for  days, or  weeks, and the darkest pace is just coming.

A friend and reader sent me a long message urging me to talk to Carol about acupuncture, for her leg and her psyche. I told her I can’t do that, she wouldn’t want that now, and I don’t interfere with her medical care or choices. She trusts her doctor and listens to him, and he is available to her.

It is not appropriate for me to interfere with her health care decisions, not unless asked, which I have not been. Lots of people are telling her what to do. And farmers are wary of new things.

The Gustavo Ferrer book gave me pause. Carol cannot yet say “die”  or “death” when talking about Ed, she is just not there yet, even though she does acknowledge it  is coming. But when she is there – and she will be – it will be good to have a gentle book that will help her understand the process she is in, and give her ideas about taking care of herself.

I think each book offers a different thing for her –  two readable novels from wonderful women writers, a deeply spiritual book when one needs to go inward, and a book that will make her feel less alone.

These are books to mark the new paradigm shift, it is a process and Carol is in it.