Mary Nell
Mary Nell was active. Three days a week she was in water aerobics or regular aerobics. On the days she didn’t do aerobics, she walked two miles. She was at church Sunday morning, Sunday night, and Wednesday night. She volunteered at church and at the local hospital. She was an amazing woman. She was the matriarch of a large family and widowed 15 years ago.


The Accident
On Friday, Mary Nell was at her home. Her granddaughter, Mary Anna, lived in a home at the back of Mary Nell’s 5 acre property, up by the main road. Mary Anna was getting ready to sell her home and was having a garage sale. Mary Nell heard a clap of thunder, thinking it was going to rain, she got in her golf cart and drove up to the main road to help Mary Anna bring in her garage sale items.

Mary Nell and Mary Anna started getting items picked up and put back into boxes. Mary Anna drove a load up to the house, and got off the golf cart. The golf cart had a broken key, so it was always on. Mary Anna left the golf cart in drive and did not set the parking brake. While Mary Nell was standing down the hill, a box wobbled and fell into the floor of the golf cart, pinning the golf cart accelerator to the floor. Mary Nell never heard or saw the golf cart speeding towards her. The golf cart flew silently down the hill in the rain and ran over Mary Nell at full speed. She ended on the ground with a broken right hip, a broken left hip, a shattered pelvis, a broken right femur, a broken right tibia/fibia. Mary Anna called 911.


The Surgery
The surgery, Saturday, was six hours, and they were only able to repair the hips and pelvis. Near the end of the first operation, Mary Nell’s vital signs began to drop and she required several post-surgery blood transfusions. Following surgery she was alert, however she wasn’t breathing on her own, so they took her to Surgical ICU and kept her on a ventilator over night. Mary Nell had a Do Not Resuscitate order, as in, if her heart stops, her advanced directive said do nothing.

Sunday morning Mary Nell had a lot of confusion- very common with elderly patients post- surgery. Her oxygen levels were good, so they removed the breathing tube and ventilator, and soon transferred her to a regular patient room.

Monday, Mary Nell returned to surgery to repair her broken femur, tibia-fibia and knee. More blood transfusions. Vital signs were not great following surgery, so she was back in ICU on a ventilator.

The Hopeful Recovery
Tuesday, Mary Nell was still in Surgical ICU on a ventilator and was very confused.

Wednesday, she got off the ventilator and out of ICU, back into a normal patient room, doing well.

Thursday and Friday she looked great and insisted she was going to be better.

Saturday, she began having some breathing problems, but they subsided.

Sunday, Mary Nell went back into ICU and was back on the ventilator.

Monday, still in ICU.

Tuesday and Wednesday, Mary Nell was back in a regular patient room and seemed just fine.

Thursday, Mary Nell was back in ICU on a ventilator with the diagnosis was Acute Respiratory Distress Syndrome. the treatment is to keep the patient on a ventilator. In the middle of the night she pulled out her breathing tube and feeding tube. The doctors re-intubated her immediately.

Friday, Mary Nell, in ICU, on a ventilator, nearly comatose.

Saturday, still barely responsive the family started to discuss Mary Nell’s wishes in the advanced directive. They were “If I am not awake and aware of my surroundings, and on a ventilator, then disconnect me from all life support.” In her confusion, Mary Nell removed her breathing tube again.

Sunday, trying to rouse her was difficult. There were conferences with the doctors and care team on what to do now.

Monday morning, more direct conversations with the doctors and care team about next steps.

Following the discussions Mary Nell was moved to a more private room. In the afternoon, she was still on a ventilator but woke up, and was completely alert. She wrote questions to the RN about what happens now and her prognosis. Later that night, unbeknown to her family, Mary Nell asked the nurse to explain everything to her about what happens if the breathing tube is removed and she is not on the ventilator. She was awake and alert.

Tuesday morning, everyone from the family was at the hospital saying prayers at Mary Nell’s bed side. There were multiple meetings with doctors. The decision was to not make the decision to stop advanced life support while Mary Nell was awake.

Her family went into her ICU room and had a wonderful lucid conversation with her. She told them she loves them. She told everyone going in and out of the room what she expects of them and how much she loves them. She was saying goodbye. She was reassuring people that she was OK.

Mary Nell’s amazing Pastor Alan arrived and was a huge comfort to everyone. He told us about having a long conversation with her about her recent renewal of extreme faith, faith like she had as a child.

Tuesday, Mary Nell told her family, “I am ready to go.” “Momma, what are you saying? We are not going to stop the ventilator while you are still awake” was the family response.
She said, “I am ready to go.” “Momma, when?” Mary Nell said, “Now.”
Mary Nell wrote “I am ready to go see Jesus and Poppy (her late husband). See you there.”

The Finale
The family had talked about stopping the ventilator, but really didn’t entertain stopping the ventilator as long as Mary Nell was awake and alert. Mary Nell was fully awake and alert and knew what was going to happen. She also knew where she was going to go and what her life held if she lived.
She was confident in her faith. She wasn’t afraid. Earlier in the week, during her “confusion” she had been talking to her deceased mother and husband.
She knew that physically the next step was for her was a tracheotomy, and that she would never get off the ventilator. She also knew she would never walk again.
She was confidant her final healing would be in heaven.
Mary Nell, like all good mothers, wanted to protect her children. She protected her children one more time by taking charge of the decision to stop her treatment.

There were fifteen family members in the ICU room, Paster Alan and a nurse. Pastor Alan said a beautiful prayer.
The RN told them what was going to happen, and was very reassuring.
Mary Nell looked each person in the eyes then pointed to heaven and mouthed, “See you there”. There was no question what she was saying.
The nurse removed the breathing tube and gave her some IV medication.
There was no gasping, just very shallow breathing.
The famiy sang her two favorite songs: Amazing Grace and In the Garden. The nurse sang the hymns along with them.
The room was quiet except for everyone telling Mary Nell they loved her, and that it was OK to go, and they would see her in heaven.
Mary Nell passed quickly and quietly, not a struggle, not a gasp, in less than 15 minutes.
Pastor Alan said another prayer, and the family stayed in the room for an hour or so.

The RN that removed the breathing tube said, “I have been an ICU nurse for many years, and I have never seen an act of faith and devotion like that. Did you notice that when we removed the breathing tube, your mother took a breath? She took a breath so you wouldn’t see her gasp for air. I communicated with your Mom last night and walked her through all the steps. She wanted to know exactly what would happen because she had pulled out her breathing tube twice before. She knew she needed to take a breath and hold it before the pain medicine kicked in. She did that so you wouldn’t see her gasp for air.”

Mary Nell saved her family from having to make a difficult decision.
Her last act was to save them from seeing any struggles.
She protected them all past her last breath.
The world is a smaller place without Mary Nell’s kindness, personality, generosity, wisdom, protection, bright smile and brilliant faith.

Something more about The Amazing Grace of Mary Nell...

The companion book to Gone From My Sight is The Eleventh Hour. I remind you all of this book because of how it especially helps the family in the hours to minutes before death occurs. It is also a guide for the moments after death, to the funeral, and beyond.