The booklet tells us about sleeping and eating habits, blood pressure and congestion, breathing patterns and agitation.

What it doesn't tell us is how to handle the ups and downs over the last several months of being told this looks like the end, only to have her somehow pull out of the downward spiral.

It doesn't explain how to handle the rush of emotion, the sadness at knowing the loss is nearing or the relief when death doesn't happen. It doesn't help us deal with the guilt of sometimes wishing it would be over, not just for us but because it seems there is so little quality of life left for this beautiful, gentle woman.

My husband, an only child, has made numerous trips in the middle of the night or very early hours to the hospital or nursing home because of a crisis or change in his mother's condition.

A day or two later, she pulls out of the crisis to go back to a life where she spends most of her time in bed or in a wheelchair, unable or unwilling to eat, mostly sleeping and unaware of what day it is. Sometimes now, she isn't even sure who my husband is. She has introduced his as her father and her husband. In the delirium of a 104 degree temperature recently she even asked him if he was her mother.

Then there are the days when she is awake and aware. She knows him and holds tight to his hand telling him how much she loves him. These are now the good times. The memories he will hold onto after she is gone.

My stepson was here two weeks ago from Kansas City because we were once again expecting the worst. It had been several months since he was here to visit. I don't think I will ever forget his comment after visiting the nursing home.

"The people there kept telling me how giggly she was that day and what a good day she was having. That was not my grandmother. She never giggled. That is not the person my grandmother is," he told us.

He was right. I have only known her for ten years but the shell of person who has no real pleasures anymore, is not that person. Her sense of humor is gone as is the sparkle in her eyes.

I find this process so very hard. I can't image how difficult it is for my husband to cope with it. My parents both died very suddenly so while I had another set of emotions to deal with, I didn't watch this long, long "process" go on for what often seems an eternity.

I didn't have to make decisions about feeding tubes or comfort measures only. My husband has had to make those. And, he has had to do it without the help of siblings or other family members.

In the booklet they gave us there is a poem by Henry Van Dyke called "Gone from my sight." He talks about standing on a sea shore and watching a ship sail into the ocean. He watches it until it disappears from sight. Someone says she is gone and the person on the shore asks "gone where?"

The answer, of course, is "gone from my sight."

The truest part of the poem is the line, "her diminished size is in me, not in her." It's true my mother-in-law's death is diminishing my husband. That is something she would hate. She loves my husband unconditionally and fiercely. And, he loves her in return. She would not want him to suffer through this process.

Yet, he is. And, she is. And, that is the "process" of dying.

Note: Margaret Ruth Horstman died June 19, 2009.