MY MOTHER’S LAST GIFT
MY MOTHER’S LAST GIFT
My mother died on December 14,1991 after a yearlong struggle with cancer.
My parents were in their seventies when they moved into a small house they built on our farm so they could be close to Patience and me. I was an only child and we thought it would be good to have them nearby, not knowing at the time just how good that would prove to be.
My wife and I were both working part time, she was a recovery room nurse and I worked in a nearby urgent care center. So when my mother’s illness progressed to the point where she needed more attention we were there to provide it. In addition, my daughter Beth, a year out of college and unsure of her direction in life, was living with my parents and was also available to help.
I was a board certified Internist with over 20 years of combined experience in primary care and emergency medicine, and what I knew about death and dying came from reading Kubler-Ross’s book, Death and Dying, and from my own experiences in the practice of medicine. During my internship and residency death was a frequent, but rather detached experience. There was little personal attachment to patients who came in and out of our lives too quickly for that to happen. Later, in my own practice, death was more personal, but still remained within the boundaries of a professional experience, and during my years working in the Emergency Room, death was encountered with rapidity and total detachment, often completely unanticipated. My mother was about to change that.
In spite of several hospitalizations, my parents managed to maintain some semblance of normalcy in the early stages of the disease. But as the cancer progressed and her condition deteriorated, Patience, Beth, and I became more involved in her day to day care, even after hospice was called in. My mother never complained, even as her pain grew worse and she became increasingly dependent on others to manage the routines of daily living. In the weeks prior to her death we began taking turns sleeping in the bed next to her because of increasing mental confusion and unexpected needs. She began to withdraw from us, not speaking, and often calling out to her beloved Grace, a deceased older sister who was more like a mother to her during her childhood. When my mother died, my father, Patience, and I were at her bedside holding her hands.
The circumstances of her last few hours were truly remarkable. Patience was with her that morning, while I left to deliver some paintings to a gallery about 20 miles away. As soon as I arrived Patience called and said I should return home immediately. My mother was struggling and Patience recognized that she was agitated by my absence. She assured her I would be there shortly, and when I arrived her agitation disappeared and she “settled down” into her mute state with shallow labored respirations. Patience and my father were on one side of the bed holding her hand, and I was on the other side. We knew it was time, and apparently so did mom. After perhaps 30 minutes, this frail woman who had been soundless and immobile for days suddenly raised her upper body from the bed and squeezed our hands, and while she was bearing down she emitting a faint grunt, as if she were pushing herself, and then peacefully fell back onto the bed. She had waited for me to come home before she died. I will never forget the willfulness of her last act.
The relief we felt from her death was overshadowed by the sadness of our loss. We were all physically and emotionally exhausted, from the entire ordeal. But in the days that followed I realized how fortunate we were to be able to be by her side through all of the stages of her dying. She was not alone; we had the opportunity to tell her all of the things we wanted to say, especially how much we loved her. In her suffering, she gave us that gift, to be a part of her illness and her death. We were a family sharing an intimate and inevitable experience with someone we loved. I cherish every moment of those final months, weeks, and days, as well as the final moment itself.
My mother taught me everything I needed to know about death and dying, and how it affects both the patient and the family. That knowledge helped me serve my terminally ill patients when I decided to return to a full time medical practice one year later. (We opened an office in the front part of the old pig barn on our farm, but that is another story.) I learned how incredibly important it is for the patient to be at home, surrounded by family and friends when they die, and I learned that it is imperative that the physician caring for a terminally ill patient also consider the family within the scope of his or her care. The death of my mother, and others like her was not a tragedy to be avoided. It was sadness to be embraced.
There was one final gift that came several months after her death. Beth, who had been looking for her place in life since she completed college 2 years earlier, turned to Patience and me at the dinner table and said she knew what she wanted to do. We both looked at her in anticipation of this announcement, and when she said she wanted to go to medical school…I could not believe my ears. Even now, as I recall that moment, my eyes get moist. Beth is now practicing internal medicine in Middletown, Delaware and she is a wonderful, caring physician.