Going Home

Janice Ruth (Williams) Nickles

September 22, 1930 – August 11, 2008

Mom’s last days on earth and first steps into Heaven

August 8 to 11, 2008

Off to the ER

Friday, August 8

Dad (Wally) called me at 9:12 pm on Friday to tell me Mom (Ruth) was not doing very well. She had been in bed all day aside from a one-hour spell at 2:00 pm to sit up and drink a bit of water. He had “threatened” to call an ambulance if she did not get up. She told him to be quiet. He said he didn’t know what to do asked me for advice. I suggested he get her to the hospital where they could examine her and get her the treatment she needed. He agreed and said he would try and get her up again.

At 9:30 pm I called back to check on their status. Dad answered, said the ambulance was there and “we’re going”. I told him to call me when there was a determination. I later learned that when Dad went back to see if he could get Mom out of bed, she told him to call 9-1-1.

I called my sister-in-law, Lynn, with the information, as my brother, Randy after visiting our folks, had left that afternoon to go hunting for the weekend in the mountains above San Jose. There would be no way to contact him by phone as there is no cell phone coverage in the area and the phone lines had been burned in a fire the previous year. Lynn said she would head over to the hospital and report back with her findings. Once at the hospital, we learned that Mom was scheduled for scans and testing that would take about 3 to 4 hours for all the results to be compiled.

Diagnosis, ICU and Calling to Jesus

Saturday, August 9

On Saturday morning Lynn called at 7:22 am with an update. Mom had been transferred from the ER to ICU. She was very dehydrated to they were giving her fluids via IV. The test results indicated an infection in her abdomen (septic poisoning), which appeared to be from an abscess following her surgery to remove twisted intestines the previous month (July 7). The staff had drained about 700 ml of fluid from Mom’s abdomen which would be tested for bacteria in order to prescribe a specific antibiotic; in the mean time a broad spectrum antibiotic would be used.

Lynn called at 1:24 pm with another update. She provided me with the ICU phone number, Mom’s room number and the medical records number.

At 2:46 pm Dad called, noticeably upset, saying the hospital had called, told him Mom was becoming less responsive, and he should call relatives to tell them to come now to see her. I told him to go to the hospital and I would be on my way up to San Jose. I called the ICU to get confirmation on what Dad had relayed to me. Dr. Erika Grimm confirmed Mom’s status, and restated what Lynn had relayed earlier. I asked if death was imminent, she was hesitant to say, but her choice of words and tone of voice seemed to indicate it was likely.

Before leaving, we briefed Rebekah and Jesse about the situation to see if they would like to join us; they agreed (in so doing Jesse would miss a wedding and Rebekah would miss leading the church junior high group). Emily was on a bus returning from serving on staff at the church high school summer camp at Lake Mead and would not be home until 6:00 pm. We called Emily, she confirmed her interest in joining us, so the kids planned to leave for San Jose together when Emily returned. After a quick shower and packing a few things, Leesi and I left at 3:45 pm for San Jose (a six hour drive).

Dad and Lynn each called us periodically while in route to check on our location and inform us of Mom’s condition. While not truly stabilized, her vitals were remaining consistent. The kids called at 8:00 pm when Emily finally returned back from camp. We agreed that considering the time, and Mom’s status, it would not be necessary or wise to drive up to San Jose that late – if at all.

We finally arrived at 9:45 pm driving directly to the Kaiser Permanente Hospital in Santa Clara. We made our way to the ICU (one of several) where we found Dad and Lynn in the room with Mom. We greeted everyone, including Mom, who was awake and cognizant of our presence. Mom seemed to be resting comfortably, as much as possible with all the difficulties she had recently endured. We quickly came up to speed with the situation at hand.

Dad and Lynn left for home about 11:00 pm while Leesi and I stayed with Mom. Earlier she had said she was hot and we removed the several blankets atop her and left only the sheet. The nurse said she was in the early stages of getting a bed sore on her bottom, so they were rotating her from side to side every two hours. Every time she was rotated, her blood pressure would drop, so they were careful to only move her as necessary.

About midnight Mom began to complain about some pain. We asked where she hurt and she said “all over”. I had thought she was on a morphine drip, but the nurse said she was not receiving any pain medication. We then requested some pain medication on her behalf and she was administered one mg of morphine. It was to take 15 to 30 minutes to take affect.

During the intervening 30 minutes, Leesi and I were sitting/standing next to Mom trying to comfort her and talking to her. She looked at us and called out, “I want to go home”. I responded, “I know mom. We’re trying to get you better to you can go back home”. She then said emphatically, “I want to go home to Jesus”. Leesi and I looked at each other to see both of us beginning to shed tears. Mom continued, “I want to go home. I want to go home to Jesus. Jesus, take me home! I love everybody.” She then looked at us and asked, speaking her last words, “Where’s Randy?” Choking back tears I told her Randy was off hunting for the weekend and would return tomorrow to see her. She continued to moan in pain, so we requested additional medication. She was given another two mg of morphine. By 1:30 am her eyes were closed and she was resting comfortably. We left and got to bed at 2:00 am.

Prognosis, Waiting for Family and Saying Goodbye

Sunday, August 10

The phone rang at 5:03 am. I answered – it was Dr. Yay in the ICU asking permission to give Mom a blood transfusion. Her blood was not absorbing enough oxygen and she felt the transfusion would help. I deferred to Dad, gave him the phone and he agreed.

The phone rang again at 6:05 am. I answered – it was the ICU nurse attending to Mom – she asked for “Mr. Wally”. I gave the phone to Dad. After a brief conversation, he hung up the phone. He was visibly upset – the nurse had told him Mom was not responding and he should come to the hospital. I called Lynn and Rebekah and relayed the information. Having not showered or eaten, the three of us quickly got dressed (same clothes as the day before) and headed off to the hospital and arrived about 6:30 am.

We entered Mom’s room to see her with eyes closed laboring to breath beneath an oxygen mask – they had her using a cannula the day before. Lynn joined us about 7:30 am. Shortly thereafter, Dr. Daly came in to brief us on Mom’s condition. While her vitals were not significantly changed, it was apparent they had diminished somewhat from the night before.

His prognosis was not encouraging. The fluids in her body were building up as her remaining kidney was no longer functioning and she was not producing urine (likely due to the septic poising). Of particular concern was the fluid that had infiltrated her lungs, thereby decreasing their capacity, and the fluid around her lungs, adding pressure and making it difficult for the lungs to expand. The usual treatments were not viable options considering her condition. Penetrating the chest cavity to withdraw fluid could puncture the lung – she would not survive if that happened. Intubation was not an option as Mom had elected not to have any “heroic efforts” or mechanical devices used to prolong her life. Even if successful, the fluid would continue to build up. Dialysis would result in a drop in her blood pressure that she also would not survive. Diuretics were also not an option.

After a brief discussion and having our questions answered, we concluded that the most appropriate treatment was to continue in the current maintenance mode, particularly the use of Levophed to maintain her blood pressure, hopefully long enough until Randy returned. Lynn had left several voice messages for him, but we knew he would not receive them until he was already heading back to town. The timing of his return was unknown. The Doctor concurred – the wait continued.

About 8:00 am Jesse called to say they were considering driving up to San Jose. I updated Jesse on the current situation and told him to discuss it with his sisters. Emily called at 9:15 am to say they had just left the house and were on their way. Upon returning to her room I told Mom the kids had called to send their love and to say they were on their way up to see her. I did not notice any visible response.

The morning through the mid-day was spent in Mom’s room with family as we observed her, the monitors and the clock, hoping Randy and the kids could make it in time before Mom was called to Jesus. We were busy making and receiving phone calls, sending and receiving emails and text messages, trying to keep family informed of the developing situation. As we waited in her room, we noticed her respirations continued to drop. However, if we were to caress her arm and speak to her, her respirations would pick up a bit. We took turns standing by her side touching her and speaking to her.

At about 2:00 pm Lynn received a call from Randy that he was on his way down the hill and was about 45 minutes away – we told him to come directly to the hospital. We told Mom that Randy was on his way and should arrive in about an hour.

Friends Terry (Culberson) and Larry stopped by for a visit. Mom and Dad’s neighbor Andrea also stopped by for a while. Lynn’s friend Judy was with us much of the weekend. My cousin Keith Olson and his wife Barbara were also able to stop by.

At about 3:00 pm Randy made his way into the room. With two days growth of beard and two days of dirt on his clothes, the tears in his eyes and quivering voice were in stark contrast. “Mom…Mom…I’m here” he said to Mom in his typical quiet voice. Knowing Mom had lost much of her hearing, Leesi went to her other side and in a loud voice proclaimed, “Mums…Randy’s here!” With that Mom opened her eyes as wide as saucers and looked straight into Randy’s eyes. Randy continued to talk with Mom while holding her hand – she looked at him the entire time.

About 3:25 pm Rebekah, Jesse and Emily walked into the room. After hugs with the family in the room, they took turns talking to their grandmother, expressing their love for her and caressing her arm. I was finally relieved that the whole family was able to visit with Mom before her departure.

With the room now full of family and friends, I felt an urging to share with everyone the final words Mom had spoken the night before and to offer a prayer for her. While standing at her side, I asked for everyone’s attention and began an impromptu expression of my love and admiration for her. I shared her words from the previous night and told Mom that if Jesus was calling her, although we knew not when, it was okay to go – we would remain to support each other. I then concluded with a prayer. All the while Mom’s eyes were open and looking at me. While not eloquent in any way, including the tears, broken voice and long pauses, I felt a tremendous relief and a sense of closure.

A few moments later, Jesse proceeded to Mom’s side and shared with her some fond memories and his appreciation for what she meant to him. Then Rebekah followed, Emily, Leesi, Randy, Lynn, Keith, Barbara all in kind – almost as if it had been prearranged! Mom continued to look at each family member as best she could, although sometimes it was obviously difficult. A few times what appeared to be tears fell from her eyes. What a blessing!

It was now about 4:30 pm. Friends had to leave so we said our goodbyes and expressed our appreciation for their support. The staff needed to “rotate” Mom again, so the family went down to the cafeteria for a light dinner. We returned to Mom’s room about 5:30 pm and stayed until 7:00 pm. Since 3:00 pm her vitals had remained stable. We decided to leave for the house to eat and return later just to check in.

After some rest and pizza, our family returned to the hospital at 9:00 pm. With only four hours of sleep the night before, and the emotions of the day, Dad decided to stay home and go to bed. Randy was in Mom’s room when we arrived. We stayed until 11:00 pm then went back to the house. Mom’s vitals continued to remain in a “stable” condition. We were unsure as to how long she would be with us – hours or days.

Going home

Monday, August 11

Rebekah and Emily left for Thousand Oaks at 6:00 am to return to work. Dad left about 8:00 am for the hospital. Randy had arrived about 6:30 am. Leesi, Jesse and I returned to the hospital at 8:30 am. In looking at the monitors we noticed that Mom’s vitals had slipped a bit, but not tremendously: heart rate was down (from 114 to 105); respirations were up (from 18 to 24); blood pressure was down (55 average down to 44 average). The downward spiral continued.

About 9:00 am Dr. Fiske came in to brief the family on Mom’s condition. He restated that the infection of the abdomen was the main culprit, not the cancer directly as Dad had regularly asked about. The infection had spread to the lungs and blood – the white blood cell count was very high. Retention of fluids continued to stress her breathing ability. He also stated, as did Dr. Daly, that Mom was in a downward spiral with a very small chance of survival. We already knew that even if survival were possible, the quality of life would be questionable.

Dr. Fiske also informed us that Mom could survive in her current state a few more days with the artificial support of medicine, but probably no longer. He offered as an alternative “comfort care,” which would mean discontinuing medical support, oxygen and the use of monitors, and letting her body respond accordingly. She would probably not survive more that a few hours under those conditions. They would provide morphine to ensure she was in no pain.

After a brief and tearful discussion amongst family, realizing the gravity of the situation and that the time for Mom’s departure had come, we determined that Mom would want the comfort care. The doctor acknowledged our decision and said he would place the order and initiate the process. That was about 9:00 am.

Moments after the doctor left the room, we all gathered around Mom’s bed: Dad, Randy, Leesi, Jesse and me (Lynn joined us about 9:40 am). As we did so, Mom’s vitals began to gradually drop, more rapidly over the next 45 minutes. (The doctor had yet to initiate the “comfort care.”) The monitor alarms began sounding one after another as the critical levels were breeched for heart rate, respirations and blood pressure. I removed the oxygen mask so we could better see Mom’s face. “Come on Babe!” Dad exclaimed as he caressed her arm while looking at the monitor. The nurse would come in to silent each of the alarms, and finally just turned the monitor off. Dad looked up and said “No numbers!” I responded, “Mom’s going to see Jesus, Dad”.

As she breathed her last breaths, we each continued to express our love to her, caressing her and kissing her forehead. After her last breath, she finally lay calm and at peace with her color quickly changing. We consoled each other and watched as the doctor verified her death after confirming the last sign of a pulse had ceased. It was 10:00 am.

We all sat down around the bed, knowing that Mom had just entered Heavens doors – yet we were still crying, wailing, and saddened. The social worker came in to share her condolences (as did much of the ICU staff) and then provide resources and offered her assistance.

After gathering our composure as best we could, we went back to Mom and Dad’s house to talk about the next steps. It was very difficult, but we managed to make a few essential decisions. Lynn and Randy left for home. Later that afternoon the three of us left for home. At the end of the day we were all at home, but only one of us was at peace.

Final Words

Seeing God’s hand at work

In a matter of hours, we witnessed Gods intervention in many ways. Here are just a few:

• Lynn being available to help Dad at a crucial time
• Leesi and I arriving in time to converse with Mom Saturday night
• Us staying just a bit later to hear Mom’s final words calling out to Jesus and asking for Randy
• Mom staying with us until Randy returned and the kids arrived and continuing through the night until we all returned the following morning
• The friends and family that joined us Sunday afternoon
• The impromptu bedside “celebration of life” for Mom
• Mom opening her eyes and “connecting” with us
• Not needing the “comfort care” option (answer to Leesi’s prayer)

Biography for

Janice Ruth (Williams) Nickles

Born: September 22, 1930, San Francisco, CA

Died: August 11, 2008, Santa Clara, CA

Parents

• Father: Floyd Sheldon Williams; born July 11, 1905 in Benton County, Arkansas; worked as a General Contractor for Fisher Industries in Fresno, CA; died September 29, 1983 in Fresno, CA
• Mother: Eleanor Florence (Welch) Williams; born November 23, 1904 in San Francisco, CA; homemaker; died March 30, 1970 in Fresno, CA
• Married August 27, 1927 in San Francisco (at her parents home)

Siblings

• Lucille Elvira (Williams) Olson born May 19, 1932 in San Francisco, CA; married Gerald Daron Olson on August 19, 1950 in Fresno, CA (double wedding ceremony with Ruth and Wally); currently living in Reedley, CA
• Elizabeth Ann (Williams) Sturdivant born October 4, 1942 in San Francisco, CA; married Bill Sturdivant on December 5, 1964 currently living in Lynden, WA

Schools

• Roosevelt High School, Fresno, CA; graduated June 1948
• Fresno Junior College, Fresno, CA; 1948-1950

Marriage

• Married Verne Wallace (Wally) Nickles on August 19, 1950 in Fresno, CA
• Honeymooned at Curry Village in the Yosemite Valley
• They first met at Mt. Herman Bible Camp the summer of 1947

Children

• Douglas (Doug) Verne Nickles born November 19, 1954 in Redwood City, CA; married Melissa (Leesi) Dianne Ballard on March 17, 1979 in Thousand Oaks, CA; currently living in Thousand Oaks, CA
• Randall (Randy) Dean Nickles born September 27, 1956; married Lynn Wagner on April 8, 1989 in Santa Clara, CA; currently living in San Jose, CA

Family Activities

Camping and waterskiing at lakes throughout California; Little League Baseball with the boys; holiday visits to family in Fresno and Reedley; weekend getaways to the various family cabin(s) in the Sierras

Grandchildren (Doug and Leesi)

• Rebekah Ruth Nickles born March 17, 1983 in Redding, CA; graduated Cal Poly San Luis Obispo, December 2007, BS Psychology
• Jesse Jacob Nickles born August 3, 1985 in Thousand Oaks, CA; graduated UC Irvine, June 2008, BS International Studies
• Emily Elizabeth Nickles born February 23, 1988 in Thousand Oaks, CA; attending San Diego State University with majors in Nursing and Spanish

Places lived

• San Francisco, CA; 1930-1940
• San Carlos, CA; 1940-1942
• Redwood City, CA: 1942-1945
• Fresno, CA; 1945-1950
• Seattle, CA; 1950-1954
• Menlo Park, CA; 1954-1955
• Sunnyvale, CA; 1955-1978
• Redding, CA; 1978-1979
• Sunnyvale, CA; 1979-1984
• Santa Clara, CA; 1985-1989
• Coarsegold, CA (Yosemite Lakes Park) 1989-2008
• San Jose, CA; 2008

Employment

• Homemaker
• Paul’s Fabrics in Sunnyvale, CA as Office Manager/Bookkeeper
• Interlink Electronics in Sunnyvale, CA as Office Manager

Churches

• Trinity Baptist Church, Sunnyvale, CA (founding family)
• Emmanuel Baptist Church, Santa Clara, CA
• Redding Area Baptist Fellowship, Redding, CA
• Yosemite Lakes Community Church, Coarsegold, CA

Hobbies

• Helping others
• Sewing, knitting, crocheting, handcrafts
• Playing board games with grandchildren

Passions

• Women’s Ministry at Emmanuel Baptist Church
• Women’s Ministry, annual retreat and crafters at YLCC
• Grandchildren

Noteworthy

• Exceptional daughter, sister, aunt, mother, mother-in-law and grandmother.
• Have never known another woman who balanced work and home so well.
• Always was a homemaker.
• Would give you her right arm if needed, could always be counted on.
• She loved unconditionally.
• Never spoke an unkind word about anyone.
• Gave the best inheritance in the world, raised her children in a Christian home and told us about Jesus, AND lived her life according to Him.

And now she is perfected!!!!!!!!!! PTL!