This is a continuation from the previous column about the final days of my mother.
Caretakers and family members kept a 24-hour watch in the hospital. Mom was given antibiotics for the infections. The first cardiologist ordered steadily increasing doses of a heart medication, and her blood pressure became very low, but the heart rate still spiked at 150.
On the Labor Day Weekend, a different cardiologist was on call. He told me that HE could make her heart rate come down and he immediately added two different medications. He was right. Her heart rate returned to normal, but whereas she had previously been able to tell hospital personnel her name and birth date and answer some questions, she was now in an almost coma-like state, unable to open her eyes, speak, or even swallow except for brief periods once or twice a day when she would resurface.
After almost two weeks in the hospital, doctors and discharge planners declared her ready to go home. At the advice of her long-time physician, we signed up for a hospice group he recommended. In spite of reassurances from the hospice director that the necessary medicines, hospital bed, and oxygen equipment would be in place on time, the transition home was rocky. Some medications didn’t arrive for 24 hours. The bed and oxygen were delivered just 15 minutes before Mom’s medical transport pulled in the driveway. In spite of great care on the part of the medical transport team, the ride home was traumatic and Mom had to be put immediately on an assisted breathing machine. We were not sure she would make it through the night.
However, Mom again showed her resilience. The next morning I could replace the breathing machine with regular oxygen delivered through nasal cannulae. She continued to retreat into a profound sleep. We changed her diaper and her position every three hours to prevent bedsores and infections, and sometimes she would rouse just enough to swallow water thickened with yogurt.
We kept her mouth moistened with sponges. Once or twice a day she would be able to eat food blended to a puree and I fixed her an array of nutritious food that I thought might tempt her. She would usually eat with her eyes closed but would respond to the pressure of a spoon on her lip and the taste of food and would continue to eat just enough to sustain her for another day.
To our amazement, she made it to her 97th birthday. Family members dropped by to have individual time with her, ostensibly to wish her happy birthday, but really to say good-bye. For some she was able to smile and even reach out a hand for a hug or a kiss. Every once in awhile, she would surprise us with a meaningful phrase. One morning, she told me, “Hi, there, Shiny Eyes.” I played her some of her favorite song s on my guitar and sang to her and she smiled.
But every day she woke fewer times, ate a little less, drank a little less, spoke a little less. On several occasions, we were sure that she was near death, but she would surprise us the next day by rousing to eat.
Five weeks after she had returned home from the hospital, I had taken a short break to check on my house and pets in Chico, to visit a friend in Santa Rosa for a birthday celebration, and to meet three college friends for a mini-50th reunion. On Tuesday, October 10th Mom was reported to have roused from an especially long period of inertia to be eating again, but by the evening my sister reported a big change. I told my friends that I felt I needed to return to Mom immediately. When I got there, I knew that my instincts had been right. Her skin was taut and dry. Her breathing was shallow. Beneath not fully closed lids I could see sightless eyes.
The next morning she began to show signs of agitation, restlessly plucking at her night gown and turning her head from side to side. Her breathing rate rose to 45 breaths a minute. By phone I confirmed with the hospice nurse that it was time to begin the “comfort care” morphine that would ease Mom’s anxiety, slow her breathing, and eventually lead to her death.
Every two hours I gave her a small dose of the liquid morphine under her tongue. Her breathing slowed to 30 times a minute, then 20. By early evening her feet started to get cold. Her skin became mottled, her fingertips turned blue. The oximeter and blood pressure cuff would only read “Error.” Suddenly I realized that she had only breathed 9 times in a minute. My sister held one of Mom’s hands. I held the other. My niece caressed her head. The caregiver, who had become like family, wept silently nearby.
Those last breaths were so slow, so quiet, we were not sure she had actually died. We held our breaths and listened. I put my ear to her chest. I checked for a pulse. We waited for another breath. Nothing.
As instructed, I noted the time of death to report to the hospice nurse for the death certificate. I closed Mom’s eyes and tried to close her slackened jaw. Each of us stepped forward for a last hug.
Eventually my sister and niece went home. The caregiver packed up her things and left. My brother had not been with Mom for two days because he had a flu that had turned to pneumonia, but when I told him of Mom’s passing, he made the trip home to say a final good-bye and then returned home.
The hospice nurse told me that no doctor needed to pronounce Mom’s death and there was no rush to call the mortuary to pick up her body for cremation. Mom and I spent one last night together. I slept fitfully and would wake and wander into her room to find her a little stiffer, a little colder. We had some final one-sided conversations. I held her hand and kissed her until I could acknowledge in my very deepest core that she was irretrievably gone.
Now I am sitting at the kitchen table, writing this, thinking of what comes next. The house, the family home, will be sold as soon as possible. Mom’s neighborhood is going through a phase of gentrification in which the older modest homes on large lots are bulldozed to be replaced with beautifully designed 5000 square foot mansions. Mom’s round the clock care for four years cost $12,000 a month and the only way we could pay for it was to take out loans with her house as equity. Now the loans must be repaid so the house will be sold and bulldozed.
Houses hold memories. They cling to the corners. Footsteps and laughter echo down the halls. This is a final good-bye not only to my mother and my 71 year old relationship to her, but also to our family home.
Earlier losses of my father and then my husband have taught me two comforting things. Death breaks the bonds to Time and releases the loved one from age and suffering. In my memory my mother now is free to be the Mommy of my early years making cookies for the Girl Scout meeting or the mom of my middle years talking with enthusiasm about her projects at work or Mom as a grandma cradling a new grandchild with looks of mutual adoration.
A second truth learned from earlier losses is that the sense of her absence will gradually be replaced by a sense of her presence. Certain daily occurrences will summon her and she will pay me unexpected visits in memory. We have said a long good-bye, but it is not final.
Leslie Howard is a retired English teacher and certificated gerontologist. She welcomes comments and suggestions at leslie.t.howard@gmail.com.
