Night and Day Forever: Reliving My Mom's Last Days
Tuesday, August 23
The hospital attendants have finished loading the gurney bearing my anxious mom aboard the ambulance. I've taken a seat by her side, along with her hand as she lays back, and an overdue breath. The attendants shut the back door and fasten their seat belts up front, closing their doors too loudly. Maybe it only seems loud compared to this compartment. So much silence in here.
"In ambulance terms, this is the first-class section." A little ice-breaking humor on my part. We both know this, and it's okay. Mom gives a slight smile, the kind that says not many of these left. Also: no need to entertain, but thanks. "I hope we're doing the right thing," she says. I nod. Partly letting her know I'm present and listening, also saying yes this is the right thing. I give mom's hand a pulse. She closes her eyes and settles a bit. Mom's name is Marmie.
I realize I've never been in an ambulance before, and she probably hasn't either, at least not as a patient. I can't remember the last time we've been in a vehicle together. This will be her last drive as a sentient being. We're setting out for hospice.
Doing the right thing has always been big for mom. Social norms, community expectations, caring about appearances. No suggestion of anything false or inauthentic in this. It's how she was wired as baby-daughter/sister-princess who reigned with quiet grace. Duty always trumped feelings. What's not clear is whether she's asking if it's right to go to hospice or should hospice care have been brought to her house across town. She wanted to be home but the doctor got her to reconsider. He knew there wouldn't be many more days. Even now I think she's asking if she rightly chose hospice before giving the hospital defeat-death paradigm one last try.
Earlier that day, The Conversation had taken place. First with doctor and the four sons who have gathered quickly in south Florida after learning that initial estimates of a few months to say goodbye have been greatly reduced. Mom's longtime slow-paced lung cancer has entered sprint mode; sons have gotten there just in time. She's been in hospital taking tests and treatments that go with the official mission of fending off death. With details of her prognosis made clear, the doctor ushers us down the hall to her room for part two.
Doctor: Good afternoon, Marmie.
Mom: Why, hello. How's my favorite boyfriend?
Doctor: Doing well [chuckling]. Let's all have a talk. Do you recall when we first discussed hospice?
Mom: I do.
Doctor: Remember we agreed on when it would be time for that?
Doctor: What's your recollection, Marmie?
Mom: Less than six months to live.
Doctor: Yes. And it's time. Today.
Mom: Oh. Okay.
A hospital exit plan kicks in. Is there anything you want? Mom asks for french-fried grouper (a popular fish akin to bass and halibut) from a favorite carry-out. Brothers Jeff, Tom, and George (I'm sibling three, between T and G) will run this errand. By unspoken consensus, I'm designated to ride with the guest of honor to the hospital. I count this a blessing. It could be my last solitary time with mom.
I'm alone with her when an orderly comes in to pack up her belongings. "Please hand me my purse, Sarah," Marmie says from her bed. She rummages a bit and seems satisfied she's not been robbed during her stay on the sixth floor of Naples Community Hospital. I step out to give her some privacy, and to grab some clarity for myself before we head out.
Rush hour. Slow traffic. Humid August air. Neighboring Louisiana bracing for a hurricane visitor named Katrina. Mom again saying she hopes "this" is the right decision. It has the makings of a mantra. I sit by her side feeling glad for a short reprieve from cross-currents of larger family dynamics. We've not all been together in one place since dad died nineteen years earlier. Regression to teenage emotions seems inevitable, how far it will slide is left to find out.
Mom and I have never discussed death. At times, she seemed intent on avoiding the subject, and on limiting her sons' exposure to its unavoidable realities. When her aunt Edna died and mom was heading off to the funeral chapel for visitation, I expected to come along but mom said, no, it would be better that I remember Edna as she was when living. (How wasn't this true for both of us?) When mom's second husband Richard passed away, I offered to come to Florida for the memorial, but mom assured me that "wouldn't be necessary" and I should carry on as normal. And, though I've got clear memories of my grandmother Helen—mom's mother, the family matriarch—dying when I was 16, I can't locate a single recollection related to her funeral.
Years later, I asked older cousins if a funeral had even taken place. Oh, yes. It was "quite something." Great, but what did that something look and feel like? I can't remember even one funeral we attended as a family, or even a death we collectively observed. (Sorry, JFK doesn't count.)
Unspoken messages are often the loudest. The message I got growing up was that death is an unwelcome visitor, certainly not a topic to discuss, for adults only to deal with—hush-hush, say no more. Today, dying is heading up the front sidewalk. Ding-dong. Who will get the door this time? We will. The two of us in the back of this ambulance will answer just by being here, as we already are.
With no great effort, we're making an ad hoc death-and-dying vigil of our own; this short vehicular journey is the start. I like that. Suddenly, the absence of family rituals for cease-and-demise seems less like something's missing, and more like a chance to make a unique rite of passage into this inevitable terrain. Is it ever too late to start a tradition?
"I wonder when we'll be there," mom asks, looking at the slowing cars outside Naples Zoo. I tell her it can't be too far. "I hope so," she says.
Mom knows nothing about my near-drowning experience in Hawaii over two decades before. This puts her among the many I've not told. Experiments with sharing details of the experience—seeing my body from above the water, encountering deceased relatives, telepathic communication, and the decision to return—have tended not to go well. Belief systems get challenged, buttons pushed, arguments raised, time wasted, distance created.
In some virtual realm of possibility, I can imagine using this cross-town trip to tell mom about the experience and the changes that ensued, chiefly the complete disappearance of death fears. Under certain circumstances, I can even envision confiding that I was greeted by the spirits of her mom and dad, and guided by a celestial being in reviewing my entire life on earth. I could tell her I never felt such freedom and unconditional love. Hypothetically, all this could happen. And that information could conceivably comfort her, perhaps a great deal.
Yet every cell in my body says these revelations delivered out of the blue in the back of an ambulance would be an Olympian high jump over her boggle threshold. It would also have the effect of making this moment be about me, rather than letting the moment be hers. If my dying mother is secretly hoping to get this type of account from a son she has not spoken with, ever, about the meaning of life—she's managing to keep quite the stiff upper lip. I'm going to respect that.
Growing up, our family's religious life was intermittent and nominal. My older brothers and I were acolytes in the Episcopal church for a spell, yet I can't remember a single time our family had spoken of God, except to take the name in vain, a favorite of the tall guy called dad, always to mom's dismay. Today I know zero about my mom's thinking on faith or eternal life, though I'd wager she's scared.
Would I like her to know she has nothing to fear, that she's in good hands from here on out, and that in fact this has always been the case? You bet. Can I conceive of a scenario in which telling her would feel like the "right thing" she's maybe been hinting at? Double yes. But there would need to be a sign, some suggestive word or gesture, that such a conversation might be useful and welcome. Otherwise, this is her time, her place, her space. I'm a guest here.
As for coming days, who knows what they'll bring. Perhaps an opening between us for real talk. For now, mom and I engage this exquisite and profound moment together, largely in silence, and it feels holy. I've come to Florida to simply be with her in the Great Transition. I raise her hand and give it a kiss, which prompts another smile, a little wider than before. This just as the ambulance arrives at the hospice, where a fresh team of attendants stands by the driveway. No sign of the grouper runners. Good. I'm liking the company, and the quiet.
But the quiet isn't absolute. There's a red Mustang in the parking lot with top down, a woman's voice going on about working in New Orleans. Saying she never saw the good side of that city, 'til she hitched a ride on a riverboat. It's a familiar story. The volume is just right, lyrics perfect. "Recognize that voice?" I ask mom. She shakes her head yes but can't recall the name.
"That's Tina Turner," I say. "Oh, yes. She's something," mom says. As the attendants guide her gurney toward the building, Tina's picking up steam.
Big wheel keep on turning
Proud Mary keep on burning
And we're rolling, tell you rolling, we're rolling on the river
I tell you we're rolling, rolling, rolling on the river
Soon the brothers are back with the requested meal and other assorted foods. When they get to the room, mom's already reclining in bed. She is obviously thrilled to be together with the sons she still refers to as "you boys." The brothers are relieved to have made it in time.
Mom's brother George calls in to say he and his wife Betty will visit tomorrow afternoon from a neighboring town. Her eyes light up as she laughs at something he tells little sis. Those eyes soon grow heavy. It's been a long day of travel, mom from nine miles across town, her sons via airports across the country. Quite enough for day one.
Wednesday, Aug. 24
I wake early and go for a run along a fairway before the golfers come. Mists of humidity already rising from ponds with swans floating on the surface and alligators cruising below. I return to mom's townhouse for breakfast that she'd be whipping up if she were here, like that Christmas in the 1980s when we all gathered for a historic cold snap that kept us all indoors and on each other's nerves. TV news in the living room tells the tale of Katrina becoming a tropical storm as it moves toward the Bahamas.
Everyone's treading lightly in that familiar way of houseguests who don't know where things are, or what's quite expected of them, like should we have our shoes on or not, which furniture is for show and which for sitting. That the host is dying in a nearby location adds to the ambience of oddness. Courtesy levels are up. All to the good.
Thoughts of my dad Reed while on the golf course; a sense of his presence. Not surprised. Traditions speak of an impending death as a time and space in which the membrane between worlds grows thin, with much traffic back and forth. My parents split up a long time ago, but that didn't end their bond, their marriage of essence. Both are remarried when my dad dies. On the day of his funeral, mom had taken me aside, put her hands on my shoulders, looked me in the eye in a way that had not happened before. "Your dad will always be my first love," she said, tears in her eyes, mine as well.
It makes me smile to think of him today. He was a pilot who picked up the best bad jokes in circulation from hanging around in private-aviation airports around the country. For years, he flew a twin-engine airplane called the Aero Commander, hence his nickname.
Hey, dad. Of course, you're here. Same crazy bunch, we're all just older. But you know that. Welcome, Commander.
I call hospice for an update. "Your mother is awake and resting. I'm sure she'd be delighted to see y'all." Florida's not technically the South, but Naples is about south as the USA gets. There's comfort in how she says y'all. The way itconveys, Howdy, make yourself right at home, biscuits coming up. Brother George is reading a book by the Dalai Lama, called Advice on Dying and Living a Better Life. We decide to go see mom. The others say they'll be over soon.
When we get there mom is resting with eyes closed. We ask how she's feeling. "They're treating me well." Did you have breakfast? "Couple of poached eggs but wasn't really hungry. Coffee with cream." On the way in, the attending nurse say the doctor has put her on a light morphine drip to reduce discomfort. This will cause some sedation initially. Her team will be on the lookout for side effects like agitation, confusion, and nausea.
We talk. About the grandchildren back home. The approaching tropical storm. Our flights from California. Politics. She likes Florida's governor, the Bush named Jeb. What have I been writing lately? Am I still running? George, have you been playing your banjo?
She likes her room. "They're very nice here." (Maybe "doing the right thing" was off the table for now.)
Mom says a minister dropped by to chat before we arrived. How had that gone? "Quite pleasant. He read from the Bible." Which passage? "The Lord is my shepherd," she responds.
I said, "I shall not want."
Mom nods. "Green pastures…"
"And still waters…and poached eggs and four sons come to visit," I say.
Mom smiles. The gamut is officially covered.
Soon brothers Jeff and Tom and wives show up. The talking continues, more animated, more one-liners, plenty of laughter. Mom says again, "I'm so happy you all are here."
Jeff says, "Even George?" Mom says, "Oh, especially George." George says, "Jeff, you're welcome to stay for now. That shirt, did you think this was a polka festival?" Good natured ribbing, provocative within limits, nobody too far out of line.
With the whole cast assembled, smaller conversations take place in groups with mom and each other. As the morning goes on, her energy starts to wane, or perhaps she's becoming more inward and settling into herself. When a medic stops by to check her vital signs, the room clears to give them privacy. Word comes that mom's older brother George and wife will be here within the hour. Mom gets soup for lunch. One of my stepsisters bring her a hair brush to get ready.
Warm greetings when the relatives arrive, and everybody disperses to give them private time. Ninety minutes later they're still together. Eventually George and Betty emerge quiet yet radiant, goodbyes get said and mom goes down for a nap. Various plans get made. Somebody talks about making a trip to the mall. I head back to mom's room and massage her chilly feet as she sleeps. After some unknown amount of time, Jeff and Tom return to the room, and I go for sunshine. These are rhythms of our living wake.
A while later, Jeff comes up to me outside the chapel. "Let's walk," he says. We head outside and stand in a cool patch of shade. "The doctor said mom's getting weaker. We want you to know we really appreciate everything you're doing." I didn't know for sure what I was doing, but in our family compliments are rare enough not to urge second thoughts. "I just took some alone time with mom, and now Tom's with her," Jeff continues. "We're going to head back to the house, okay?"
"For sure," I say. "I'm going to stay around."
Jeff nods. "That's great, thanks again."
That's when I get it. They've just had their final time with mom. They weren't telling her goodbye in words, Jeff says, just being loving and grateful, being together while she's still conscious.
"It's hard, seeing her like this," Jeff says. "It's all I can take. I wish…"
I tell Jeff it's totally okay, we've all come to say goodbye, you can be with her from the house, she'll appreciate you keeping watch there. Jeff and I get back to the room as Tom is walking out. "I just spoke with mom," he says. "She just now nodded off."
I tell them to call when they want updates. Quick hugs and they head out, looking back at the end of the hallway to wave. I give thumbs up and stand alone for a few moments. Well, isn't this it. If I didn't say that aloud, it's what I felt. The sense of just this moment, timeless, whole, complete.
I walk back in the room to be with mom as she sleeps. I don't think it's just the two of us. There's presence all around. The invisibles have come. I go to my laptop and open up the music section, then create a playlist. I name it "Marmie" and start moving songs that seem appropriate into the folder.
I got my appreciation of Cole Porter from Marmie. Long ago and far away, she'd told me about being at a movie theater on a winter night in a very pregnant way, when her water started to break and her sister took her straight to the hospital to deliver a child already named Keith, if a boy. The movie, "Night and Day," was a fictionalized account of the great songwriter's life. She played its theme song often on the piano, haltingly. Mom was earnest with the ivory.
There's a way I've always thought of that song as kind of a theme for my personal creation myth, in a family tribe I joined by being born. If a myth's not personal, it's just words.
I take mom's hand as she slumbers. "This one's for you and me, kiddo." As Ella Fitzgerald's voice meets the silence of our sanctuary, no words come close to describing her tone and phrasing:
Night and day, you are the one
Only you beneath the moon, under the sun
Whether near to me or far
It's no matter darling, where you are
I think of you night and day
The ancestors are here. Swaying to Miss Ella, yes they are.
When the nurse Miriam stops by, mom's temperature has dropped a little. Miriam fetches a light blanket from the closet and together we cover the top layer of mom's bedding. When I ask for instructions in basic care, Miriam shows me how to gently wash face, arms, hands, and feet with a cloth, and how to apply moisturizer to her dry mouth and lips.
Realizing at that moment I might not be here now if I hadn't been tended and nurtured as a newborn to get a foothold in this world. The care I got bolstered my chances to stay, just as the care mom is getting now enhances her passage out. Then I was the dependent one; roles are now reversed. The circle is unbroken. Big wheel keeps on turning.
Standing by the door, Miriam invites me to talk to mom if there's anything I want her to know. "Her hearing will remain acute. She's present in many respects." This lady called nurse is a messenger of light. When Miriam leaves, I walk over to recliner chair I've had my eye on across the room, and pull it over next to mom's bed. There's an extra blanket and pillow, and I settle in.
"Mom, it's Keith. Couple of things I'd like you to know. First, Jeff and George and I are all doing well in this life. Hard to imagine, but there you are. We're able to take care of ourselves quite well, and now it's your turn to get what you need. You need it, you'll get it. There are probably a lot of others here I don't see, family members I don't recognize and they're probably all around us, I can feel their presence. You're in good hands, mom. I once had a close call, and it gave me a look out there, beyond here. It's beautiful and spacious and open and free. A place of unbounded love. Mom, just trust this moment, take a breath, and follow the light that's welcoming you. The light is who you are, who I am, who we all are."
I stay with mom the whole night, waking whenever the nurse stops in. Periodically I wake to check mom's pulse and breathing on my own, and to quietly remind her, really,the boys are fine and the weather's great for traveling if you've got any ideas.Otherwise, sleep is restful. If there be ghosts here, they're not of the haunting kind.
Thursday, August 26
A nurse named Lisa stops by early to check mom's vitals. In the hallway, she lets me know mom won't likely return to conversation ("not impossible but really not to be expected") and her dying is accelerating. I thank her for everything she's doing to make her dying part of mom's life and ours.
"That's what we're about at hospice," she says with a smile. "Take care of yourself," she says. I'm doing that.
Shortly brother George arrives with his Dalai Lama reader. He talked to Lisa on his way in. I tell mom, "Hey George is here, see you in a bit." I step outside to use my phone to reach her last sibling, older brother Jack in neighboring Georgia. I woke today with a plan to give them a chance to talk by phone. The revised scenario is to let Jack know his little sister will have the phone next to her ear so he can say what's in his heart. I reach his granddaughter and bring her in on the project. She loves it and says she'll talk to granddad and get back to me. Ten minutes later she calls to say it's a go, and gives me the number to dial in half an hour. I go back in the room.
"Guess what, mom? Somebody special wants to talk with you today by phone. Your brother Jack. Hold on a sec." I bring the room phone close to the bed and call the number. Sarah answers.
"Hello, uncle Jack, this is your nephew Keith. I'm here with mom, your sister Marmie. We're at hospice. What I'm going to do is put the receiver right up to Marmie so she'll be able to hear your voice. You'll be able to talk to Marmie while she rests. And she'll be listening. Do you understand?"
"Oh, my." Pause. "Yes. I understand." Jack sounds very old.
Me to mom: "Mom, your brother Jack is on the phone. Listen." I place the phone next to her ear.
Me to Jack from a distance: "You can start talking…right…now."
At a distance, I hear his voice croaking. Pretty sure he's weeping. Fragments, sections of silence, more words. Is he recalling old times, or recent days, some of both? I'll never know. It's privileged, classified. The conversation lasts between five minutes and eternity. When the sound stops, I lift the receiver.
Long silence. "Yes," he says. "Thank you so much." Pause.
The next voice is Sarah's. We wish each other well and the call ends. George and I look at each other with amazement. If another word is never spoken by anyone anywhere at any time, that'll be fine.
* * *
This is the longest day, and the shortest. Everything's on time, nothing early or late. Really the only hint of time passing is the play of shadows and light throughout the room.
Next to the last song on the playlist: "My Way." A favorite of mom's, Sinatra recorded his first version the year she and dad split up. I like thinking the song's celebration of resilience steeled her nerves and steadied her for her next phase of life. "I planned each charted course, each careful step along the highway…And more, much more than this, I did it my way."
Beautiful, yet it doesn't hit quite the right note. Mom had heroic moments for sure, especially getting on with life after the divorce. But this is really to say she lived. Today is neither triumph nor defeat. If her life on this earth is passing before her eyes, how many scenes will echo this: "To think I did all that—and may I say, not in a shy way—oh no, oh no, not me—I did it my way."
Being of an earlier generation, mom might never have heard the last piece, Joni Mitchell's aching, orchestral return to "Both Sides Now." Softly with layers of violin, cello and alto sax, the singer recounts revisiting old viewpoints ("I looked at life that way") and realizes how differently she sees things now. As for the clouds that once blocked the sun and seemed to keep her from "so many things I would have done," it turns out to have been nothing personal. Those clouds actually "rain and snow on everyone." The storyteller slow-walks her way to recognition, inevitable once she's there, that "something's lost, but something's gainedin living every day."
* * *
Long shadows of late afternoon. Lying by mom's side, watching her chest scarcely move. Wiping around her mouth with a warm cloth, observing the slightest tremble of closed eyelids. Feeling for a pulse at her neck. Barely there. Her chest quite still. Waiting for that sudden intake of air after longer pauses, as has been happening. This time it doesn't. Feel for her pulse, neck and wrist. Nothing. Eyelids still. Mom's gone.
George walks in from the outdoor porch. He knows. We sit silently together. A clock says six-fifteen. It's seven when I next check. Then comes the notion. I step over to mom's purse. There's lipstick and face powder, and a hair brush. George smiles. I powder her forehead, cheeks, and chin. I paint her lips with rose colored gloss, and dab with tissue as she always did. I brush her short brown hair, once long and blond streaked. She's always been a lady of impeccable taste and style. Honoring her presence this way just seems right.
A new nurse stops in. Her badge says Marie. How are things going? Unspoken answer: things are going. Spoken version: mom has passed. How long ago? Marie seems surprised when she hears, as if when death comes the help usually gets summoned first thing. Maybe that's how it normally goes. Perchance family members usually don't sit in silence, and then break out the lipstick. Hospice make-overs might be rare. We don't know what's normal here. And nobody says.
Marie invites us to go get some air while she attends to duties. Outside, there's word Katrina has briefly touched down in Miami, before heading further west. In a while Marie calls us back and steps out the door to give us final moments. Dusk has come.
It's not a long drive back to mom's house. It's quiet though. Just like now.