The Long Goodbye

Reflections on my mother's dying days

My mother is dying.

As I write this, she is resting in front of me on a hospital bed that was delivered to our house. She is beside the beloved fireplace that she has enjoyed warming herself in front of over the past 4 months during which she has been staying with us.

She is comfortable, and every 4 hours we administer a dose of Morphine and Versed to help keep her comfortable (we think), and also shift her periodically so she doesn’t get bed sores. We wet her lips and teeth to help keep them from getting too dry, and change her when necessary. Once a day a group of nurses comes in to clean her and move her, and once a day a Palliative Care Nurse comes in and checks on progress.

I am told that she has perhaps 1-2 days left. We will see. She has been an incredibly strong-willed woman, and her grip is still very strong.

It is hard to believe that the vibrant party girl, who celebrated her 100th birthday this December (as shown in the photo above just before she left for the birthday bash), and who only weeks ago was flirting with her doctor, has come to this.

But such is life…and death.

The support we are getting here is incredible, and everyone’s goal is the same: To make my mother as comfortable as possible in her last days, and to have her experience these in a warm and familiar environment surrounded by family and friends.

Yet there is something strange in all of this. I am given a handbook and a tutorial on what to expect as we reach the end. These include the need for more regular injections of Morphine and Versed to reduce anxious movements and relax her, the need to dab her lips with water to keep them from drying out, and the need to shift her position her regularly. Then, I am told, she is likely to begin to wheeze, as her dehydrated body begins to shut down and something called terminal congestion (aka death rattle) begins. Ending in several long slow breaths.

If you are uncomfortable reading this, I am equally uncomfortable writing it. Why do we feel so compelled to allow death by ‘natural causes’? Death is one more insult that nature throws at us. There is very little that is dignified about the whole thing, because nature doesn’t care if we are comfortable, happy, or in pain.

What is great about being human is that we can overcome what once might have seemed ‘natural’. We can defy nature by creating artificial environments, stare down death in the face by extending life well beyond what was ‘natural’ for early hominids, and strategize about how to avoid and/or defend against all the other ways nature may try to ruin our lives.

Some say that if god had intended us to fly he would have given us wings, but the rest of us get on airplanes. Some have said that the miracle of childbirth is a gift from god, but now formerly barren couples can conceive, not due to any divine act, but due to the skill and technological wizardry of modern medicine.

So why do I sit and watch my mother suffer the indignity of these last days? There is nothing about her existence right now that seems to me to be remotely describable as a favorable quality of life. The drugs she is taken are keeping her as comfortable as can be, I am told, but she has lost complete control of herself and her surrounding.

I walked with my brother as we spoke about these questions the other day. He is very religious. I am most certainly not. Yet I was struck how even with our almost orthogonal worldviews these moral dilemmas were shared.

I understand that there is nothing unique about my situation at the moment, and that everyone has who gone through this experience has had to confront similar questions. My wife has reminded me of this. She had offered several books for me to consult over the past months, as we faced this inevitable end period. But my predilection was, for better or worse, to confront these things as they occurred.

Are we making these decisions—to administer these drugs, for example—for my mother, or for ourselves? Are we making her more comfortable, or are we doing this to make ourselves more comfortable as we watch her body slowly give up its struggle to survive? I don’t know what she is feeling or thinking, even as I stroke her hair and gently caress her, or as I watch her reach out to seemingly try and stop us or balance herself when we shift her position periodically. It is heartbreaking, but the alternative to trying in this way to keep her comfortable and safe would, I think, feel more heartbreaking.

I ponder this as I look at the syringes of Morphine that we administer every 4 hours now, wondering why I haven’t seriously considered just injecting all of them at once. I know I won’t, of course. It is an example of that weird ethical dilemma psychologists have uncovered, often presented as The Trolly Problem. When faced with the option of directing a switch down toward a track on which one person might be standing in order to an oncoming Trolley careening down a track where 10 people are standing, most people say they would redirect the Trolley down the less populated track. Yet, when faced with the option of actively pushing someone off a trestle to somehow cause the Trolley to stop before it killed other people down the track, most people say they would not choose this option.

Action or inaction that might indirectly cause death does not seem to be innately taboo. Directly causing death is. So I will continue here as long as it takes, not actively trying to keep my mother alive, but not actively trying to end her life either. The drugs we are administering may or may not hasten her demise, I don’t know. But I am administering them under the hope that they will also make this period more comfortable, for her, and for those of us who are at her side.

I will have moments alone with her to kiss her forehead and tell her I love her, without having any idea of whether those words mean anything to her at this point. I hope I feel in the end that we will have done whatever we could to help her during these last days, but I suspect a part of me will always wonder if turning these last days into a last day would have been a greater gift to her.

I’ll never know, but I can live with that. Not knowing, after all, is what motivates us to keep exploring the mysteries of the universe, as well as mysteries closer to home. In the meantime, I will keep my mother company.