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My Mother’s Last Trip, III

Thursday, March 19th, 2009

Given how quickly she went, I will always regret that my mother didn’t start out right away in the soothing arms of hospice care–the coordinated, palliative ministrations aimed at making sure a terminal patient’s remaining days are as comfortable as possible. “Comfort care” was itself a comforting proposition. The more I learned about hospice, its philosophies and strategies–the more fervently I wanted it for my mother–the special nursing visits, the massages and music therapy, the extra baths, and the standing orders for ativan and morphine. All so that the end of my mother’s life might be a happy float downstream.

My mother, of course, was not going to achieve the hospice ideal, the gold ring of having a meaningful, self-directed “death with dignity.” Her cognitive faculties, and my father’s, had frayed too far for them even to board the hospice train in any active way. My mother had not lost all of her wits by any means. But she took in new information without absorbing any of it, quickly lost her way in conversation, and became befuddled when anything complex came up. She lived more or less affably in the moment, blissfully unaware that her short-term memory relooped every few minutes. She also could trot happily through reels of old memories that remained intact in what seemed to be a special archive in her mind; they were getting fuzzy, details dropping out–but of course they were already distorted from a lifetime of editing (and if the fact-challenged abridgments, which drove me crazy, had helped my mother endure her hard life, then it seemed only fitting that even less reliable variations should give her comfort as she lay dying).

Did my mother know she was dying? I do wonder about it. Was there a small firm patch of knowing somewhere amid the large sieves and small tangles, the consterning chutes and ladders, of her mind? Was there a knowing she felt, steadily or intermittently, a feeling in her vanishing bones, a whisper in her soul? At the very last, I sensed a shift in her, at once subtle and profound, and saw a new worry and preoccupation creep over her, and a little later a happy drifting. But it was like a curtain fluttering, or molecules rearranging themselves; if a clear notion about dying or death had ruffled her thoughts, she gave no clue that she had grasped it. But then thoughts flitted in her mind and then were gone; that’s how it was for her.

Denial, like selective memory, was a lifelong habit for my mother, and in the final weeks she repeatedly threw up roadblocks against bad news. At first it was just miserable for her, but when she weakly choked out the words “This is just gawdawful” into her breathing mask, there was resentment in it. She seemed to have given up, lost her will, the hospital social worker said–the closed eyes, the choked words, the untouched meal trays. I prayed that was true; the misery was real enough. But she came back, though barely; I think it was her habitual refusal to knuckle completely under.

She had little steam and seemed to accept her state of being bedbound and exhausted and feeble. She asked from time to time about what had brought her there, what had caused one of her nostrils to be stuffed rigid with gauze, how long she’d been there, and–most often of all, how long she was going to be there.

Her doctors realized quickly that she wasn’t able to follow, much less remember, their bedside chats about ailments and prognoses (and that my father was much the same). But even in her prime, she probably wouldn’t really have wanted to know. When a nurse let the word hospice dangle partway into a sentence before thinking better of it, I hoped my mother had missed it. But she went right to it, as though spotting a possibly invasive varmint at the gate: “Hospice?” she said, with a note of incredulity. Then, more anxiously: “Oh, Christ. That’s all I need.” I tried to talk her off the ledge: “She just meant making sure you’re comfortable, Mom.” She was lost within moments, but a residue of anxiety lingered even after she’d forgotten what had triggered it. “What is it we’re talking about?” she asked uncertainly, looking around the room. “Is there something I’m supposed to do now?” My father, who had been silent in his armchair, spoke up then, as though to clarify things: “Well, I don’t think we really know that,” he said, mustering an authoritative tone. “But when someone finds out, I’m sure they’ll tell us.”

And so the hospice plan went forward without them; A. and my sister and I met with the hospice team; I signed off on the plan.

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My Mother’s Last Trip, II

Tuesday, March 17th, 2009

My mother arrived at the care center wearing a paper-thin hospital gown under the heap of warming blankets that had been tucked around her. She also had her oxygen tanks, a chapstick, and a bottle of lotion. She came with nothing at all of the life she had lived save for me, the black-parka-ed daughter leaping out of a car to meet her wheelchair, and A., my partner of two decades, parking the car. There was, for the record, also her husband–yes, there he was, my benighted father, standing in the entryway; somehow his failing mind had grabbed hold of the details of her coming here; somehow his erratic and increasingly alarming command of a car had brought him here. And here he was, a deceptively lean octogenarian moving stiffly to open the door; something grudging in his posture, the usual dark clouds on his brow and blankness in his eyes.

Wheeled from the van by Eve the paramedic, the bent-twig-in-a-blanket that was my mother was again surprisingly alert. I think she must have been frightened, although I could see little as I loped toward her except the too-big oxygen mask. From yards away, it looked as though a small plastic deli container had been plopped over her face. But by the time she spotted me, I could make out relief and gladness; she turned her head toward my voice and even before I reached her side I could see the weak smile. She had absolutely no idea where she was, or why, but–and here again the remarkable essence of her, her way of always turning toward the light–sick as she was, completely at sea after her medi-van ride, there was curiosity sparking in her, and a trustingness, and something of a feeble hopefulness.

With her mind no longer firing on all cylinders, though, the doctors had spared her the details. They’d only be a muddle for her, and give rise to anxiety–and then go right out of her head. The same, of course, was true of my father, although his muddle was also angry, landmines everywhere. The burden of the facts, of the hard truth of things, had thus fallen to me. My mother, the doctors had made clear, was in rough shape after her week’s hospital stay. The ruination of her lungs was nearly complete; now her wasted body was also under siege by a violent surging in her bloodstream.

A gaggle of doctors and social workers had kindly but clearly filled out the picture. With her COPD and now a rogue bleeding disorder, her weight 78 pounds and dropping, her appetite gone, her spirit weak, my mother was hanging on by half a thread. The scantest effort–I could see it for myself as she labored to lift a fork–left her gasping; her discomfort and distress was so awful when she shifted her weight for a sponge bath that she cried out. Her lungs were clearly failing. Now with the new bleeding problem she was also at dangerously high risk of clots and strokes. Her hemorrahging nostrils packed with gauze, a breathing mask now required over her mouth, she had lain with her eyes closed for much of her week in the hospital, all of her steadfast cheerfulness gone.

I had never seen her with her spirit so drained, her candles all but out; the grimness of her was unprecedented and shocking. In the hallway outside my mother’s room, tears poured out of me as I met with the hospital social worker. “She can’t live like this,” I choked out. “If ever anyone needed and deserved an angel of mercy to land on her shoulder, it’s this woman.” Angel. Mercy. Words not exactly right; words strange to my everyday lexicon, so often the stuff of Hallmark cards and churchyness and rainbow and unicorn art; but no other words swam into mind as I formed my fierce lamentations.

Mercy, I’d pleaded. How is it, then, that I was so unprepared for the stark prognosis. The leaden thud in my gut, the lurch of my heartbeat. “We’re there,” said the internist and the hematologist and the pulmonologist. It was time, they said, for my sister and me to think about hospice care. What we were looking at, they clarified carefully, when I asked, was no more than 9 to 12 months.

She lasted, as it happened, less than 30 days after leaving the hospital. Her medi-van deposited her at the care center on New Year’s Eve. By the end of January, she was gone.

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My Mother’s Last Trip

Thursday, March 12th, 2009

On New Year’s Eve, my mother took her last trip, bumping along a suburban freeway in a medi-van to a care center perched over snow-covered wetlands–the place she would, as it happened, spend the rest of her life. Descending on the van’s wheelchair lift at the center’s doorway, the scrawny white-haired thing swaddled in heated blankets–my mother–looked like nothing so much as a rescued wren. She looked disoriented, but also alert. Her face lit up when I bounded into view with my vase of wilting daisies.

She’d been released from hospital to care center after a rocky week. She’d seemed at death’s door–in truth, the crumbled wisp of her would fit in death’s mail slot. But then she had begun opening her eyes for longer stretches, had managed a few frail tendrils of conversation, had nibbled at a yam and taken a bite of tuna on toast; this was apparently enough to get her discharged. Her feebleness was alarming, but the suits at Medicare, her doctors had explained–not without sympathy–had their rules. I’d hovered over my mother as her shriveled body was lifted off the hospital bed and packed into a wheelchair for transport by a capable paramedic named Eve; I’d trod alongside, with welling eyes and a vase of wilting daisies, as she was propelled slowly down hallways, onto an elevator, into the frigid winter sun of the hospital driveway.

Steam rose above her heated blankets as she sat in her chair outside the van, waiting in the January chill for Eve to work the wheelchair lift. The poignant white-crested wren of her, with her crumpled spine and oxygen tubes, the vulnerability of her, waiting for this uniformed stranger to cart her off in a van. Bafflement and worry flickered on her face behind the clear plastic oxygen mask that was two or three sizes two big for her. She seemed, here in the driveway, to droop and sag, to wither in the cold. Her feet, in size 7 pink terry-cloth slippers with a silk bow, barely reached the toeholds. You could make out the jut of one of her shoulder bones, like a stick near her tangle of white hair.

Yet even then–even so feeble that she could barely keep her head up, what I noticed was that she was startlingly and heartbreakingly herself. The bright candle of her. Her avidity toward life; a wanting to see things, to miss nothing–even as she automatically edited out, by instinct or sheer will, every unsettling detail.

My mother. It was, in truth, the secret of her, the core: this gift, or need, for being curious and open to life while also discarding the bad bits like so much dirt and grit in a gold prospector’s pan. That, and her knack for spinning the rest–the tailings, the flecks of gold, the bits she liked–into anecdotes, by turns pastel or snappy, often with a self-dramatizing twist: mom as The Heroine in the Grocery Store. For years, I rolled my eyes, cringing at what I saw as my mother’s silliness, her irrelevance, her falsity and pretense; more profoundly, I have raged against–and struggled to maintain my bearings against–the air-brushed gloss she brought to every account, every recollection, of our family’s troubled and traumatizing history.

But this is who my mother was. Her vibrancy and her sunny-side-upness stood in contrast to–and not only as a defense against–the unendurability of her humdrum and unhappy circumstances. A selective memory and a nimble imagination were her saving graces; she could keep her eyes and mind and heart open to the world because she possessed a fearsome talent for masking and retouching and rewriting it. The sure, if limited, triumph of it. Her way –as the years passed grindingly on, as the bad marriage threatened to crush her–of managing to be resilient, and even hopeful. Her way of keeping supple and alive all the warmth and joy and music that were in her when she started out.

As she was wheeled from hospital bed to elevator, the lively light of her was wan, but there it was. I saw and felt it–her spark of interest in the adventure of it all, in the minor frisson of excitement that attended her slow sail down the the fourth-floor corridor with her entourage–the solicitous attendant in her black-and-white paramedic’s outfit, the blue-jeaned daughter with tears drifting down her cheeks. I saw her eyes brighten, this bent and blanket-swaddled wraith who was my mother; this tiny white-haired wren of a woman gliding along the hospital hallway, for a purpose and destination she’d already forgotten, the corridors clearing for her rolling chair with its trailing tubes, for her entourage, for her pair of oxygen tanks.

Inside the van, though, confusion and anxiety bloomed. Her quicksand memory up to its usual tricks, resetting every ten seconds. “Where on earth am I going?” And again: “Now, tell me: where am I going?”

I stood there in the driveway, my heart breaking for her. I would be following the van in a separate car; across the driveway, on the apron of a parking ramp, I could see A. in our black Accord, handing a parking ticket to the attendant. I remained shivering by the transport van–it resembled an airport van but without seats– waiting with my mother in her chair as Eve fussed with brakes and bolts. The wheelchair and its blanketed cargo looked forlorn and puny in the middle of the van’s interior, and as Eve pushed and pulled at the the chair’s wheels, I suddenly pictured my strapped-in mother careering crazily around the van as it zoomed at 60 miles an hour down the freeway, spinning haplessly in an ersatz tilt-a-whirl. I leaned into the van. My mother seemed to be growing smaller by the minute. “Just tell me,” her weak voice said to me, again, “Where is it that I’m going?”

I leaned in; I tried to explain about the care center, just a short trip, a place for you to get better, don’t worry, the place you were last summer, you liked it, just a short trip, you’ll be fine, I’ll be there. I stayed there, leaning in, as Eve finished anchoring my mother’s chair and began to pull the van door dangerously close to my head. Even as she slid behind the wheel, started the engine, I was leaning, talking to Eve through the van’s window, offering up utterances the sturdy paramedic could use to reassure my mother on the journey: “Don’t worry,” she was to say. “We’ll be there soon. Your daughter will be waiting for you.”

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What She Was, II

Monday, March 9th, 2009

She died in a flimsy blue hospital gown, her shoulders bare, the gown’s laces having been left loose so as not to strangle her. She had no use for fashion in the end, was in fact entirely devoid of vanity. Not that she was ever a fashionista, she of the knit JCPenney pants and poly blouses and faded cardigans. She threw on any old thing around the house with a comic carelessness, mismatching red plaid slacks of a 1950s vintage with untucked Target blouses, fraying headscarves unfashionable since Grace Kelly decamped to Monaco in the late 1950s, ragamuffin vests her daughter had worn in the disco years. But out in the world, my mother had had definite outfits. There was in fact a certain kitschy nattiness to her; the pert slack-and-blazer ensembles topped off with a geometric Monet scarf or a string of large beads, with a windmill-shaped pin or a seasonally apt cornucopia or pine tree.

She started out stylish. You can see it in photos. The university coed and budding businesswoman in chic shirtwaists and heels, in flattering pedal-pushers and strappy sandals, in well-cut suits and lovely dinner dresses. All of the chicness dwindling out of her later; no need for stylishness in the bad marriage, in the suburban split level, in the numbing routines of stove and washing machine, in the strife and chaos of the husband’s tyrannical fathering and the seriously ill children and her own valiant attempts at coping with it all. Her fashion know-how atrophying along with so much else. In my early girlhood, before the rare evenings out vanished entirely, she could still summon the knack for dolling herself up. She hummed going about the elaborate rituals, the hairdos and girdles, stockings and makeup. She had new skirts sometimes, a new pair of heels. She could still be elegant in a picture, and sometimes was.

But in the bigger picture of her life there was the futility of troubling to be chic. It shriveled her sense of style. But it did not take her yen for it, or all vestiges of her vanity. I have said she was careless, but in truth she was not, or at least not always. For Leaving the House—for the movies or the mall, and for holidays at her daughter’s house or the welcome theater outings of the later years—she mixed and matched her pant ensembles with consideration. She had her hair done. All her life, in fact, she managed to have more or less regular perms and tasteful dye jobs and to pick up the occasional Dayton’s sale-rack blazer, using socked-away scraps of grocery money and later her pittances as a part-time teacher’s aide and insurance secretary–those desultory jobs that were such a comedown for a once trailblazing businesswoman. Even well into her seventies, she kept a surprising number of shoes lined up in her closet, a row of fetching size-7 heels lingering, long after they’d last foxtrotted, next to her sturdy everyday Rockports. She also kept a drawer stuffed with rouges and powders and the expensive creams she tried out—confessing it to her daughter, with uncharacteristic abashedness; the wistful hope and splurge of it—when the wrinkles came.

She dressed only to please herself, to be sure, having taken in few fashion cues, or clues, in several decades. Her ideas of style seemed to harken back to 1960, to a time when sleek plaid slacks were just the thing for getting together for bridge, mixing a cocktail, trying the twist. But you could see the effort she made, mixing and matching those slack-and-jacket ensembles into her eighties. The gulf between her and Naomi Campbell was clearly vast; she seemed from a different millenium and galaxy than the women of, say, Project Runway. But she was always tasteful and on her own terms, coordinated; black or navy slacks on the bottom, white blouse or turtleneck on top, rarely chancing a pattern bolder than a calico, sticking mostly to safe tweeds and burgundies (and the odd red, in which she looked radiant). She always took the trouble to accessorize. If the overall effect–especially on her tiny and increasingly stooped body–tended to kitsch, it was also true that she was occasionally darling.

The outfits were just part of it. She never left the house without color on her lips and a splash of perfume. She’d pluck one of a bevy of bottles from her dresser, spritzing her neck and wrists what she cheerfully called “a good stink,” no matter that it was from the drugstore or bore the name of a passe celebrity or had been faithfully dusted for far too long. Surprisingly, she always smelled good. The perfumes always light and vaguely garden-y, mingling pleasantly with the faint scents of lipstick and Prell shampoo. You did catch the whiff of cigarettes; there was no disguising it. But on the whole it seemed a minor distraction, just part of the aroma of her, a lingering of the lacy smoke–swirls that were as much a part of her as the glasses she wore and her sensible shoes. The toxicity of those swirls was of course odorless, or the odiousness hidden. It was inside, of course, inside her–blackening the pink of her lungs, hollowing out the tendriled air sacs, shredding the delicate tissues, slowly taking away my mother’s every last breath.

Mom in her flimsy blue gown, the whoosh of her oxygen tanks now silent. Her head has lolled to one side. Her eyes closed. Her glasses left on the nightstand. Her mouth is open, the O of her last ravenous inhalation. Pink fuzzy socks on her feet. The whiteness of her hair. Where the gown has slipped off her bony shoulders, a glimpse of the small pale rise of her right breast, plain and weary looking. Her bureau drawers here all but empty. A few socks, a comb, some denture cream, a chapstick. Her closet here just a sea of empty hangers. A handful of cardigans and hoodies; a single pair of grey sweatpants, provenance unknown, with a “Minnesota Wild” logo on the waist. A pair of never-worn pink terrycloth slippers.

No natty outfits here these past few weeks, no lipstick, no eau de anything. Just the scent of the fading bouquet next to the TV and of her body soldiering weakly on. Even so, even with all ornament stripped away, even in the flimsy gown, there was the remarkable mom-ness of her, so clear and definite and striking. Who and what she was, needed no plaid pants and cardigans for, and is no more.

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What She Was

Thursday, March 5th, 2009

She was much more, of course, than the weakly wasting she-gnome in a nursing home bed, her hair gone white, her back stooped, her wrists like twigs and her nostrils flaring oxygen tubing. The woman in that bed herself offered a few clues, stirring from sleep with a radiant smile, wanting CNN on the TV, making endearing and funny chat with the young male aide bringing her meals, the nurse bending to check her bedsore, the daughter who arrives with sweaters and a fake peony from Target.

A bony slip of a thing with her lungs failing and her mind going fickle, yet still the smart and funny remarks, the unerring sense of comic timing, the wanting to know about the daughter’s life (and reasking the questions, when the answers quickly vanish in her head, with the same generous attentiveness), and the spirited, if much-repeated, anecdotes, disproportionately drawn from the earliest, happiest decades of her life—the charmed childhood years in a lake-dotted city neighborhood with her musician parents and her swell big brother, the adventurous young adult years of a business career she relished and—in marriage to a deceitful and selfish man—lost.

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Grief in the Grocery Store

Wednesday, March 4th, 2009

In the checkout line at the food co-op this evening, after a trip to the movies, starting to bag my yogurt and pommellos, spinach and pasta, I suddenly found it difficult to breathe. The thought, as I battled dizziness and panic, veering ever closer to full-fledged hyperventilation as the unwitting checker scanned items and asked me for my member ID, that maybe I was channeling my emphysemic mother, taking into myself her laborious and heartwrenching doggedness to draw even slender wisps of oxygen into her damaged lungs and to dispel the carbon dioxide always wanting stubbornly to lodge there.

Another odd experience earlier, both in the bread aisle and near the vitamins: Staff members troubling to ask me if I needed help with anything, an uncommon solicitude at my bustling food co-op.

Do I exude brokenness? Is my grief that open and tangible?

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My Mother

Tuesday, March 3rd, 2009

My mother. She was not part of the daily weave of my life. She was in many ways deeply significant to me. Yet she was also both real and unreal to me, in some respects a sort of phantom presence in my life. Everything about my relationship with my mother is complicated—a vast unsettled sea of emotions and memories inseparable from the wreckage and ruin of my colossally troubled family. And so the grief is also unfathomably complicated. And vast. Sometimes in roiling waves that find me sobbing in the middle of an art show, as I did last weekend … one minute turning in an ordinary interested way, wine glass in hand, toward a bird print in a crowded gallery, and the next moment overcome with grief for my mother …

My father. He is confused and irrational. He is surely lost and hurting. The lightness and warmth in my mother’s marrow made her late-life confusion of the cheerfully addled variety. But my father, his childhood abuse and abandonment early gone to gangrene, has become in dementia only a more distorted version of the self-pitying intellectual bully boy has always been. Most of him these days is delusional, spiteful, and even mean. His head is filled with bizarre imaginings about plots I am cooking up against him. The truth is that notwithstanding all that was admirable and interesting about his philosophy-reading, foreign-film loving, war-protesting self, he’s always been fundamentally a jerk. The most important truths are that he visited massive damage on his children, and that he all but ruined my mother’s life. I may as well toss in the postscript that he has spent much of the last year laying plans for a shirttail cousin, crazy and recently living in a car in Texas, to come and cook for him as soon as my mother died.

Most of all, my father and all of the problems he brings–the calls from alarmed doctors and social workers and, on the very morning of my mother’s funeral, the crazy shirttail cousin; this man’s ongoing attempts to pull me into the swirl of nastiness he feeds on; all the ways in which his needs are deposited, unwanted on my doorstep–this tragically wrecked and destructive man who happens to be my father continues to intrude far too much into my grieving for my mother. Which has made things infinitely messier this past month, and more difficult. The fact of of having so much anger tangled up in so much grief. The fact of losing the parent who loved me, and whom I loved, and being stuck with the one who got, and still gets, in the way.

My mother. She was, I think, not amazing, although she could have been, especially had she not been taken hostage by my father. But I do think she was remarkable. She was smart and had the best heart of anyone I’ve known. She was resilient and, despite every reason not to be, hopeful. She devoured good books, gladdened at red zinnias and pink cosmos, deplored injustice of every kind, and sighed and ached for the world’s sad and unlucky people, its hungry children, the shivering souls in ragged coats sleeping under bridges. She played the piano with spirit and would break into a lively foxtrot or rhumba when snappy music came on the radio. She unfailingly turned toward life and people with interest and warmth. Even in the worst throes of family shipwreck, her impulses were generous ones. She lit up a room. That’s a lot for a life. It’s also what she had to give me, and did. Her legacy. I was able to tell her that, for which I’m grateful.

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Loss of the Ground Note

Tuesday, March 3rd, 2009

My mother died January 30. Can it have been a month ago already? Her death was not unexpected, but was unexpectedly expeditious. She succumbed to emphysema, finally out of breath for good after a journey of surpassing hardness. Her death in hospice, relatively peaceful and fast, was in no way beautiful, but in almost every way a grace granted. It took just a single dose of morphine, just a week into hospice care; she no longer labored quite so assiduously to draw breath into her remaining shred of lungs, and that was it.

But in truth, nothing about my mother’s dying was easy. It took three years, and mostly was a big mess of almost unendurable struggle. In the picture with my cheerfully addled but seriously ill mother was my unpleasantly impaired father, whose confusion tipped into meanness. He coped poorly, irrationally, and often belligerently with the crumbling of life as he had known it, requiring me to call in the Marines (or at least County Adult Protective Services). All of it was endlessly painful on so many levels, but particularly wrenching because my mother was a woman of such intelligence and heart and vitality, a bright and warm center that held, at least a little, in what can only be called a truly and remarkably dysfunctional family.

What there is now … what there is now is just tremendous loss, grief, and all that goes with it; there is just so much, and I feel so often just undone by it. “The loss of the ground note”–the title of a book I have seen about women losing their mothers.

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