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Spring Without Her II

Friday, April 3rd, 2009

The room my mother died in seemed to be waiting for spring. It was a large, westerly-facing room with a windowed balcony onto a rolling wetland. We’d seen elegant Great Blue Herons wading in the pond during my mother’s previous care center visit, at summer’s peak. The pond was frozen now, drifted over with snow, ringed by skeletal maples and willows and the brown husks of dormant wildflowers.

From my mother’s bed, you could gaze directly out over the wetland. The vista had the spare, weary, beauty of winter; grey and white; architectural. Spring would be glorious. But even now, in winter’s diffused light, the room was still something to behold: spacious and sun-dappled, its freshly carpeted tidiness thrilling after the slovenliness of my mother’s first room. The large closet! The sparkling bathroom! The slender table holding a large vase of silken poppies I’d brought it, so real-looking their leaves were fraying from the inquisitive pinches of aides. A cd player on the nightstand, left by hospice’s music therapy team, cued to a new age piano cd called “Healing.” The pleasing hush of the choice end-of-hallway location; the soft whoosh of my mother’s oxygen concentrator, the gentle bubbling of the humidifier.

Procuring this serene and lovely room for my mother was a triumph. After hounding the staff for three weeks, it took a burst of full-throttle fury for me to at last spring her from the appalling shambles of a room on the ground floor. The snapping point had been that long Saturday evening when the world seemed to pitch sideways: That companionable and fervid night in the cramped room where clutter reigned and blankets were banked against the frost on the window; the night my mother grieved her vanishing vision and fretted about my 401K; the night I wept in a wing chair in a dimly lit lobby as the hospice nurse told me my mother was not going to take anywhere near 9 months to die.

By Monday—having used the word disgraceful, having emphasized tomorrow, having been ready to snap photos for a complaint to the state—I got confirmation from the social worker: “Your mother is being moved this afternoon.” A primo room, the care center’s jewel, I learned. Later, another social worker told me there’d been an internecine dispute about it from the moment the previous resident had died: “I’d promised the room to someone else, someone ahead of your mother on the waiting list,” she said. “Your mother’s needs were more urgent, but … Well, your mother had come off Medicare first, so that did give her an edge.” She paused. “And of course there were clearly some issues with your mother’s previous room.”

Blissfully unaware of these negotiations, or of how I had all but rioted on her behalf, on Monday evening my frail and bewildered mother was finally rolled to her new room in a wheelchair. She took the brief journey—a short hallway, an elevator, a long hallway—with her customary interest, smiling at aides, perking up at sight of the piano in the second-floor commons. The exertions of moving and resettling exhausted her, though, draining what minute dribs of stamina she had.

But there she was, at last, my mother, tucked like a pea-sized queen into fresh linens in a room so agreeable it bordered on the fabulous. She lay propped on her mountain of pillows just two feet from the large window with its wetland vista that all but promised a magnificent spring. How beautiful it will be! I began to say to my mother, but stopped; mentioning spring wasn’t smart; it would only have triggered one of my mother’s frequent bouts of anxiety about where she was, and why, and when she might go home.

And of course, I knew that my mother was not going to make it to spring. I also knew, as I looked at my tiny broken wren of a mother, her shoulders heaving, her breaths growing both more jagged and shallow, that I couldn’t possibly wish that for her, and didn’t.

She went faster than I had imagined or was ready for. She had just three days in that halcyon room, not even enough time to sample all the soothing hospice ministrations queued up to ease her dying: the massages, the music therapy, the pastoral visits, the little juice glasses of wine that would be catnip for her and might even, the doctors said, be good for her laboring lungs.

She didn’t see spring stir in the wetland, didn’t make it to February, didn’t even last a week. But I do know that she found in those serene surroundings whatever it was she needed for letting go, for the release of her spirit. Initially, she found the large, quiet room perplexing—not a hospital room, not an apartment; what then?

But the day she died, as I knelt by her bedside massaging her forehead, one of the few sentences she uttered from her dozy drifting consciousness was about the pleasure of being in that room. “How do you like all this?” she said with a half wave of her hand. Her eyes were closed and there was a calm smile on her face. She nodded slightly. Then she patted my hand. “So quiet,” she murmured. “Peaceful.”

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My Mother’s Last Saturday Night

Saturday, March 21st, 2009

I rue that my mother spent most of the last month of her life in in a woefully small and dispiriting room, a room so drafty–could this truly be the room allotted to a patient with respiratory disease?–that pillows were banked against frost on the inside of the window.

The room was, in truth, a dump: chaotic, slovenly, every surface choked with clutter. There was barely space to pull up a chair up alongside her oxygen tanks and special bed. The television was nearly buried under tubes and and pads; the closet blocked by a nebulizer stand. With her nightstand jammed in a corner away from the bed—at least until I commandeered one of the aides to help me shoehorn it back next to the bed–, even my mother’s blanketed form became a repository for miscellany: Extra sheets and clothing were heaped on her legs, a brush and magazine on her belly, a heavy blue telephone wedged against her side. The vases of flowers I brought disappeared under a heap of towels. The photos I gave her vanished into a drawer, or under the bed, along with the cheerful cards I left out so that my memory-impaired mother would know I had been there and would return.

We would have 9-12 months, the doctors had told us. We knew it was not a promise. Still, they were off by a good mile. When I came to know this for certain was on a bitterly cold evening in late January five days before my mother died. On what turned out to be my mother’s last Saturday night in the world, I spent six poignant hours with my mother in her appallingly disheveled room, her bed in blue-tinged and weary-looking fluorescent brightness, my chair in shadows, blankets tacked over drafty windows, CNN on the television, our voices rising and falling softly in intermittent conversation, aides coming and going, frost gathering on the pane and dripping onto the floor.

When I arrived in her doorway at about 4:30, my mother was sitting up in her bed. Cradled in her left hand was the little stuffed bear I’d brought to her in the hospital. Her head was tilted down slightly to look at it, and she was stroking its contemplative brown face with the fingers of her right hand.

She’d been glad to see me. “Well, if it isn’t my darling daughter!” she said, beaming an expansive smile toward me. She was in her usual white hospital gown with the small blue flowers; a blue knit warmup jacket I’d brought her was crumpled around her thin shoulders. She looked clean, and –did I imagine it?–there was a hint of color in her cheeks. Her white hair, in its pert new bob, looked soft and fetching. The TV was on, loud–CNN’s anchors segueing from a suicide bombing in Somalia to the remarkable tale of the American Airlines jet that had recently landed, improbably, on New York City’s Hudson River, its passengers clambering to safety in the most literal way on a wing and a prayer.

The indelibility of that night. The desultory but companionable quality of it. The heartening perk and wit of my mother, no matter the usual repetition of her loop-de-looping memory. Her entertaining stories, though none of them new, of her happy childhood years. My efforts to improve her disastrous room, sweeping towels and tubes into drawers, unearthing cards and photos, cramming pillows against the frosty windows. Aides bringing in dinner, meds, rags to mop the puddles of melting frost near the window; eventually, taking note of my mother’s worsening cough (“It really is cold in here,” a handsome young aide named Lucas comments) they wheel in a space heater. My fury about the egregious unsuitability of the room, though I hide it from my mother.

My mother’s mildly monotonous chime of reiterated questions about what I’d been up to making a surprising turn: She wanted to talk about my work, did I still like being self-employed, what had I been working on lately, was I still making a go of it ten years in. She expressed pride that I had struck out on my own (“You’re your own boss … you’re self-sufficient; that’s wonderful,” she’d remarked, as I basked in her interest and the sudden clarity of her mind). Then, more remarkably, her trenchant interest in the nuts and bolts of self-employment: did I have a sufficiently sturdy retirement plan? “I worry about you,” she said.

“Don’t worry, Mom,” I replied.

“I worry about you,” she repeated. “I wish I could help you. I would if I could.”

The surprise of that exchange … and then the heartrending crisis, the moment when she discovered she had no vision in her right eye—her one good eye! she said in a plantive and panic-edged voice. The summoning of aides, the late-night visit of a hospice nurse, the doses of ativan and dollop of morphine. The sitting by my mother’s bed as she grew drowsy, as I flipped channels, as she suggested maybe I could stay all night, as she told me in a playful but poignantly small voice that she didn’t want to leave.

And then the end of it: The sitting in the darkened lobby with Laura, the hospice nurse with the mien of someone who lived alone and cared too much, the empathic on-call angel who’d ventured out late on a bone-chilling January night to answer my tormented call about mother’s eye. Laura had waited for me in the lobby as I said goodnight to my mother. We sat in facing wingback chairs in murmured conversation before heading to our cars.

I was bone-tired and heart-heavy and deeply unsettled. My mother’s heartrending anxiety about the loss of her “one good eye” (which the hospice nurse ascertained had happened some time ago, probably a result of the bleeding disorder; it seemed my mother kept forgetting and rediscovering it). Her touching plaintiveness, tugging me to stay. And what of her unexpectedly lucid preoccupation with the state of my 401K? It seemed to have come out of nowhere.

“Well,” Laura answered in her hesitant, gentle way, “I think that maybe what your mother was really doing was expressing her need to know about whether you’ll be alright when she’s gone.”

I choked up, tears streaming, the truth of it unfurling within me. “It’s very common toward the very end in hospice patients,” Laura was adding. My heart lurched; everything in me went heavy and soft. Yet this was something I’d already known, I realized. “We’re not talking about 6-9 months, are we?” I finally croaked out.

“Oh, heavens no,” Laura said, her voice soft. She saw that I was shivering, and covered my cold hand with her warm one. My mother was profoundly, even impossibly frail, she said; frightfully tiny, almost nothing left of her, breaths so hard and wispy, so little fuel for a famished heart. “I was shocked by the feebleness of the woman I saw when I walked into your mother’s room.” Six to nine months–“I’m so sorry, Mia, but no.”

The truth of it. But … “But she was so cheerful,” I said to Laura. “She was so amazingly lucid.” Not just that. ” She was so upset about losing her eye–her one good eye, she kept saying: ‘What am I going to do without my eye?’ That’s what she said.” Her anxious, woeful laments about her eye had cut me to the quick; the loss of her vision, and her rue about it, somehow seemed the cruelest of all the hard, sad things that had unfolded in the past few years.

Her strangled breaths, her shredded lungs, her vanishing bones, the oxygen tether, the wayward shamblings of her bladder and bowels, the shrinking of her life to a circumference barely bigger than her bed–none of the trials and indignities that had befallen my mother seemed as painful, as cruel, as significant, as the failing of my mother’s vision.

My mother the voracious reader, the inveterate camera-clicker, the eager observer of the world beyond her door; my mother the lover of extravagant blooms and vivid hues and the endless variety of the human face—“no two alike!” she would marvel. My mother with her treasured morning newspaper, her CNN, her calming bedtime tea of Everybody Loves Raymond or reruns of Frasier; her heaps of photo albums and scrapbooks: the lovely silver-toned pictures from her vibrant early years, the fuzzy Kodacolor snaps that she culled into a bright and glossy record of all that came later.

“She still wants to see things,” I said again to Laura. “She wanted me to leave the door open. She’s so much better than she was in the hospital.”

Laura was quiet, her gaze level and kind and, I noticed, glistening in the corners.

“”She was so wistful and hopeful about her eye,” I reiterated. “She kept asking if it could be fixed.” Even as I rattled on, though, I knew. And it came to me then that some part of my mother, witting or not, quite possibly also knew. “What am I going to do without my good eye?” she had asked with such plaintiveness. “Will I get it back?” “We don’t know,” Laura had answered simply, with touching tenderness. “I hope so.”

My mother had been quiet for a moment. When she spoke, she sounded small and possibly scared. But what she uttered next was not another distressed lament about her eye. “Will you pray for me?” she’d asked.

A short time later, as I kissed her goodbye, as we exchanged “I love yous,” she’d asked again if I might stay. “I’ll be back tomorrow,” I reassured her. “Will you?” she’d asked, the question–edged with urgency, the hint of a plea—startling me. “I’m counting on you,” she said. The unfamiliar and disconcerting unease in her, something small, woebegone, little-girlish newly floating in this wrenlike white-haired wraith who was so heartbreakingly my mother. As I turned toward the door she called to me once more. “Can you leave the light on?” she had asked.

I knew. The heaviness of it. The deep ocean of it. The dead certainty of it. “I’m so very sorry, Mia,” Laura was saying again as we sat in a shadowed lobby on what proved to be the coldest night of the year. In the window over her shoulder I saw the glow of a large winter moon, nearly full, on the snowy parking lot. “I know this is very hard to hear,” Laura continued gently. “But I can’t imagine your mother lasting more than a month. Probably less.”

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My Mother’s Last Trip, IV

Friday, March 20th, 2009

We didn’t, of course, know how short her remaining time was to be. But it is hard to make peace with the fact that she was able to experience hospice’s happy float for a mere week before she died. Instead, she spent the first 21 of her last 29 and 1/3 days enrolled in a mildly taxing regimen of post-hospital rehab.

The very idea of rehab for my mother was preposterous. But she’d had the right sort and length of hospital stay to garner a primo Medicare bennie: If she went on to a rehab round, Medicare would cover every aspect of her care for 21 days, including the $250/night room charge she would otherwise pay out of pocket. We may as well use the all-expense-paid days, everyone counseled; such a deal! We’d also gain time to plan mom’s hospice care–the months of hospice we thought she’d have–along with a strategy for dealing with our impaired and obstructionist father.

As a result, my mother, who entered the care center on death’s door, spent the first three of her last four weeks exerting herself each day with Janet, a plus-sized physical therapist of kindly disposition whose daughter and my sister’s daughter had once appeared together in a community theatre production of The Wizard of Oz. With kindly Janet’s coaxing, my mother weakly flexed her emaciated legs each morning; she fluttered her arms up and down; she gamely buttoned up a sweater. By the end of the second week, she pulled herself–her grip tightening on Janet’s doughy arm, her legs buckling–to a standing position next to her bed.

Her wheezy exertions proved of no real therapeutic value. But in those weeks in the care center, my mother did rally to an extent that seemed startling. The improvement was not so much physical, although she did manage to pull off the ambulatory triumph her therapists needed to satisfy the suits at Medicare; my mother had walked five feet, Janet exultantly reported at the 21-day care conference. No matter that it was at a painfully shaky and shuffling gait, and was accomplished with the aid of a walker; no matter that it required her oxygen tank to be pushed to the highest possible liter flow, or necessitated several rest periods to quell her panting enough that she could continue.

What really changed, for a time, was her spirit. She perked up so much that the hospice team was called upon to reassure me that, yes, she was as gravely ill as before, the prognosis was the same, a late-inning rally wasn’t uncommon, the game plan and the dismal life expectancy had not changed. The perking up was almost jarring. She had a bit of appetite again. She took an interest in surveying her dinner tray; her interest in its contents was fleeting—“I know, ish kibbibble!” the young aides would tease her—but she could be persuaded to eat a few bites of sweet potato and yogurt, and she tucked into each evening’s ice cream treat with genuine glee.

Her customary “hello, lovey!” greetings were back, along with her gift for gab; no matter that she repeatedly uttered the same sentences and posed the same questions; an endless loop. She again took an interest in things, even if she remembered nothing. The inauguration of Obama was interesting, and always news to her constantly rebooting mind; ditto the stories her daughter shared, or the small dramas she observed in the care center hallway. “Leave the door open,” she insisted to aides with a coquettish air, “so I can see what’s going on.”

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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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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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