My mother had planned carefully for this trip to the hospital for a total knee arthroplasty. These are rare and precious moments, being allowed to leave her station as Dad's caregiver. Till death do us part. For better or worse. At this time, my parents were navigating the "worse" times as his body became frailer by the day, fueling anger in his heart and mind.

Figure. No caption available.

They have lived in an assisted living community over the past 3 years, on the independent side. Help is only a touch away from a button on the necklace, but she is responsible-a heavy burden to bear. My father has always been difficult to live with, given a lifetime of untreated obsessive-compulsive disorder and a myriad of other mental health conditions. But with his physical decline over the recent years, it was no longer safe for him to live independently.

My mother's hospital trip will not be short-unlike the glorious night she spent in a sleep lab 4 years ago when she was diagnosed with sleep apnea. Now that was a night. At that time, she hadn't left my dad's side for 10 years. "Sing to me," she said while I helped her unpack before I went back to care for my dad and assume her night shift duties. "Here is Miriam dancing with her timbrels," she sang, approximately recalling a Biblical melody of a woman with power and a mission.1,2 She danced and twirled with some electrodes she found on the back of the door.

For her upcoming hospital trip, her surgeon had promised weeks in a lovely rehabilitation center. Three nights in this newly designated center for excellence in orthopedic procedures, then glorious rehabilitation. She thought that she would be waited on hand and foot and have an endless number of new people to talk to and good food from a menu, almost like eating out. Dad could not say no because the doctor ordered it.

She dove into her physical therapy immediately post-op, to the delight of her therapists. On postoperative day 1, a volunteer from the chaplaincy department offered his services, which she gladly accepted. She wanted me to stay while he visited, and I listened as she explained her situation at home, the stress of caregiving, and the relief she received from her spirituality and meditation. He offered to meditate with her through guided imagery and she gleefully accepted.

After that meeting, the case manager checked in and explained that Mom had met all of her therapy goals and would be discharged later in the day to return home. Mom looked at me in terror. Our eyes locked. She started to wail. "Noooooooooooo. I am not going home. I am going to REEEEEHAAAAAAB!"

The case manager could have investigated further by speaking to her primary physician or contacting the assisted living administration, or possibly negotiating on her behalf with the insurance company. Instead, as Mom continued the spiral into despair, the case manager said in a stony voice, "You live in assisted living. I don't see what the problem is. They will care for you there."

Figure. DeLeeuw, SD. Miriam's Song. Mixed media and acrylic paint. 2022. Miriam's Song is a reminder of hope and redemption. In times of struggle or adversity, people often lean on support systems that have served them in the past, such as family members, trusted friends, faith or spiritual traditions, care providers, and so on. In this painting, the figure draws strength from memories and shared experiences to move toward hope and deliverance from restrictive ties, breaking free to rejoice and find new meaning. The color purple signifies the theme of deliverance-as the arm reaches through. Purple symbolizes peace, wisdom, and redemption, with the thin silver line serving as an acknowledgment of something markedly different on the other side. The blue over the paper mache represents the shared life we are all part of-separate pieces but one within the blue of humanity. The brown lines crossing over the arm represent things that bind, such as oppressive and restrictive thoughts, emotions, or experiences. The Hebrew writing on the forearm serves as a constant spiritual reminder that anchors one's hope in tumultuous times. The gold-colored hand holding the timbrel rejoices in the realization of release or freedom. The pink and orange ribbons are playful elements that add to the concept of celebration.

Before Mom could come to grips with the fact that she was going home, she developed respiratory distress. Her color changed from ashen white to dusky blue then to purple. A rapid response was called.

What seemed like the entire hospital's staff flooded into the room. I glued myself to her nurse. "Daughter" left me and "nurse" clicked in. I whispered report firmly to this orthopedic nurse who I suspected was witnessing her first rapid response. "Mom is having a panic attack. She has a history of COPD and asthma, both were completely controlled at home on meds. All of these people will make it worse." Then a request. "Can you clear the room except for the respiratory therapist, and call the chaplain?" She looked at me and hesitated. "She DOES need a breathing treatment, she WILL respond to meditation," I continued with external confidence, though inside I was wondering if I was making a terrible mistake. Mom had made a connection with the chaplain. I was sure it would work. On the contrary, if this chaos continued, my mother would be intubated. To my surprise, Mom's nurse agreed.

The respiratory therapist gave Mom a nebulizer treatment and the bewildered chaplain was at her side, helping her to meditate. Mom's breathing slowly returned to normal.

An hour later the case manager returned. Mom looked at me with fright, but the woman said with resignation, "Don't worry. You have bought yourself another night in the hospital." The creases at the corners of Mom's eyes twinkled, and I wondered for just a moment if it had been a ploy. But, something deep inside me said, "You can't fake purple."

REFERENCES