A Parent Death

I was in my early fifties when I started to wonder where I would be exactly when I learned that my mother was dying. Would I be in the midst of a routine errand, idling in traffic at the busy intersection of Greenbay and Deerpath? If it was winter, would I be skiing in Utah, or if summer, vacationing along the shores of Lake Superior in the Upper Peninsula of Michigan? Would I hear ambulance sirens in the distance and try to determine if they were heading to my parent’s house, just two miles away from my own? Should I stop assuming that the jolting early morning phone call was just another wrong number? 

It was not that my mother was in extremis, or even acutely ill. She had been sitting in her wheelchair, immobile and mute, for several years, her bright and lively mind silenced by the suffocating tendrils of Alzheimer’s disease. Her doctor had told our family that she was in the last stages of the disease, and we all agreed that now was time to let “nature take her course.” Dr. Osher gave us a Do Not Resuscitate Order to post in the house, just in case an emergency medical team arrived. He said, “It’s going to be hard, you know, to let your mother go, not to intervene. I’ve seen this a million times, families will panic in the middle of the night and call the EMTs. These guys are trained to be heroic, to stop nature dead in her tracks. Isn’t that what you are trying to avoid?”

The bright caution-orange DNR placard arrived the next day, and I pasted it on the cabinet door, announcing that in this household death was anticipated, planned for, expected and even welcomed. My family was now in a grim waiting game. There was no specific timetable or schedule of events, our only goal was to keep our mother as comfortable as possible in her own home.

Finally I got the phone call, the one that I had been waiting for, and the one that I felt sure my mother had been waiting for. A few days before she had developed a urinary tract infection, which left untreated would be a certain exit strategy. As a family we resisted the seductive and sure-fire fix of antibiotics and maintained our resolve to step aside. My husband and I were playing bridge at our kitchen table with our friends Jack and Pam, when Iga, my mother’s caretaker, called to say that she thought Mom had slipped into a coma. I knew that Iga would not wake up Dad, sleeping in the upstairs bedroom. His dementia was a few years behind Mom’s and he had not actively participated in her care. I was local and available and the only one that Iga called. I thanked her and hung up – and then did exactly nothing. I sat back down at the table and continued with our game of bridge then went to bed after Jack and Pam left. A routine evening. At 6 AM the next morning, Iga called and told me that Mom had died in the middle of the night. It was over.

That was seven years ago, and there still isn’t a week that I don’t wonder why I did not go over to sit with my mother while she died. I adored my mother; everyone did. Mom was the emotional center for her six children but also for a broader group of extended family and friends, entertaining all with her quick and irreverent humor. I have sat drumming my fingers on my desk, tapping my foot on the floor, or have taken long ruminating walks whose only agenda is to solve this riddle, but I am still puzzled. I’m not afraid of death. As a physician, I am well experienced with this rite of passage; I have sat at bedsides and ushered many over the threshold. I remember a women whose breast cancer had flooded her bloodstream with calcium from eroding bones. She was confused, her breathing shallow and rapid. I sat with her, the total stranger who held her hand as she took one final gasp and then slipped away. I have tried to rationalize that my mother’s coma could have lasted for several days, giving me some wiggle room to say my final good bye, but I knew that I was dissembling. A septic death is merciful and quick.

My alternative rationalization was that Mom had essentially died several years before, it was just that her mental and physical death were poorly coordinated. My grieving had started when she announced that she thought she had Alzheimer’s disease, which began a relentless seven year decline, a fraught period testing loyalty and love on a daily basis. When Mom was still socially active, I shadowed her to make sure that she did not suffer public humiliation. I would stand next to introduce her to all of her friends, “Mom, you remember Judy, she was a member of your singing group. Mom, look who’s here, it’s Kay, your favorite tennis partner, remember when you played in that senior tennis tournament?”

The situation got dicier as Alzheimer’s tendrils thickened, strangled and gummed up her formerly agile neurons. At her granddaughter’s outdoor wedding, I had to find a discrete place behind a tree to undress her and twirl her backwards dress around; every hour I would take her to the bathroom to make sure that she didn’t have an accident. At home, I would stop by my parents house with dinner, fearful that my mother would be serving Dad some sort of ancient fur-bearing leftovers with a side of frozen peas. These caretaking issues were well beyond anything my father could deal with in his state of decline. In their traditional marriage, Dad was the recipient of care, while my mother did all the cooking and arranged their entire social life. My father would never have noticed that Mom’s dress was on inside out or upside down, or if she was wearing a mismatching plaid shirt with madras pants, or wonder about the origin of that disturbing smell.

Yes, I would like to think that her coma was merely the period at the end of a prolonged death sentence, that it was no more or less significant than any other events. But who am I kidding here? Sitting at the bedside of a loved one, stroking a hand, murmuring love and acceptance or wiping a fevered brow is a uniquely human experience, and one that is used as litmus test for filial devotion. How many obituaries have I read that announce “Jane Doe died peacefully with her family by her side?” If I am feeling particularly snarky, I think, “I bet that family just flew in at the last moment. Where were they two weeks ago, two months ago, two years ago?”

On one of my walks, I recalled the book The Stranger by Albert Camus, which tells the story of Meursault, a disaffected man who is called to the nursing home after the death of his mother. Sometime after this, he inadvertently kills a man and is brought to trial where the key issue is whether or not he should be merely imprisoned or executed. The prosecutor uses Meursault’s behavior after his mother’s death as evidence of his amorality and pitiless heart. He interviews the nursing home staff who report that Meursault didn’t want to see his mother’s body, that he casually smoked a cigarette and had a cup of coffee, and then most damningly he did not cry at his mother’s funeral. The jurors vote for execution.

Okay, I’m going to cut myself some slack here because I am not on trial for murder, and my tears were readily forthcoming. However, even though I am overstating the following imagined conversation between the prosecutor and my bridge partners, the similarities are unavoidable.

“Jack, did the accused say anything to you after she got the phone call on the night of July 6th? My records note that it was at 8:45 PM.”

“No, she did not. She just sat down and we kept playing bridge. I don’t think that she mentioned her mother.”

“Jack, would you have been willing to cut short your bridge game so that the accused could leave and attend her mother’s death?”

“Of course. I can’t believe that we kept on playing, but I didn’t know that her mother was about to die.”

“Pam, Can you describe the accused state of mind on that night? Was she upset? Was she crying?”

“Well the best I can remember is that we had been playing bridge for a while and she had been dealt really rotten, unbiddable hands – no face cards at all. Her luck had just begun to change when she got that phone call. She had gotten two fabulous over twenty-point hands in a row and was excited to bid slam. You’ve got to understand. Ask any bridge player. It’s hard to walk away from hands like that. But I don’t know – a mother’s death?”

The prosecuter would now look at the jury and smugly say, “I have no further questions. Case closed.”

As much as I might try to position the bedside vigil as a socially-imposed ritual, I realize that I am being completely selfish. The real issue is what my mother would have wanted. Even though she had been totally unresponsive for several years, I could not rule out the possibility that deep-seated neurons, trapped in the clutches of Alzheimer’s, were still flashing and screaming for recognition. And, really, regardless of the mental status, who wouldn’t want a loved one by their side as they died? I then sought absolution in recalling one of my mother’s favorite expressions. “MFO” was her acronym for a mandatory family obligation, typically referring a birthday or graduation celebration, but at the same time she would slyly point out that MFO could also stand for “mother-fucking ordeal.” In her life-view, MFOs described other families, but certainly not ours where joy, laughter and harmony were defining themes. My mother would be horrified to think that she had imposed an obligation, much less an ordeal. This absolution was fleeting, since it forced me to admit that I considered a bedside vigil, at best, a dreary chore, instead of a beautiful transportive moment.

I have been at this for seven years now, and I still vacillate between considering myself a shallow individual who didn’t have the emotional where-with-all to see my mother through to the end, or someone more akin to Camus’ anti-hero who considered death just another random moment in life. Neither is flattering. However, in the past month I have found some closure in William Carlos William’s famous poem about a barnyard scene.

so much depends
upon

a red wheel
barrow

glazed with rain
water

beside the white
chickens

The meaning of this poem puzzled me in high school; I really couldn’t grok the significance of a bunch of wet chickens. The scene seems so trivial, but – and here comes my revelation – now I think that the poet is really pointing out that it is the mosaic of all these little scenes that form the bulk of one’s life. All of them are equally important and I shouldn’t beat myself up for punting on the final bedside goodbye. I need to focus on all the other moments that I am still proud of – the meals, the social shadowing, the diaper changes, regular visits, the household management. I might have missed the most iconic, high profile moment, but I absolutely nailed all the others. Case closed.

Mom, I’m sorry that I wasn’t there, but thank you for forgiving me. I love you and I miss you.

The missing words in the following poem are anagrams (i.e. share the same letters like spot, post, stop) and the number of asterisks indicates the number of letters. Your job is to solve the missing words based on the above rules and the context of the poem. Scroll down for answers.

I’ve tried and tried, but I can’t explain why I wasn’t *****

It’s not like I didn’t love her or simply didn’t care.

And c’mon, even though ***** bridge players can’t play the game,

Breaking up a bridge evening is an excuse both pathetic and lame.

I failed my mother, there will always be guilt and what’s more for me,

I missed that moment, as from earth to *****  her spirit finally flew free.

 

 

 

 

 

 

 

Answer:  there, three, ether

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