Essays - Winter 2011

To Accept What Cannot Be Helped

At 80, a woman with a fatal disease knows she doesn't want to die in the hospital and discovers, with her family, what that really means

By Ann Hulbert | December 1, 2010

“Your hands are so wrinkly. Are you going to die?” my nephew asked my mother when he was about three. “Yes I am,” she answered, pausing to stick a knitting needle behind her ear and take his small, smooth hand in hers as they sat on the couch more than 15 years ago. “And you never know when it might happen.” Here she resumed work on the row of whatever it was she was knitting and added, “I’m an old toad, you know.” Daniel looked stricken. Telling this story, my sister rolls her eyes, knowing the rest of the family won’t be surprised by it. “Promise me you’ll pull the plug when my time comes” is a refrain we’d been hearing from my mother for ages.

Two years ago this coming June my mother—“an 80-year-old in a 60-year-old’s body,” the pulmonologist told her—was ambushed by a diagnosis of Stage IV adenocarcinoma of the lungs. It had already spread to her spine and left hip. Barely two weeks earlier, she’d gone out west for another grandchild’s college graduation and hiked along a cliff on the Oregon coast. Could she really have inoperable lung cancer? The pulmonologist, to whom she was referred by a GP alarmed at what he saw on her chest x-ray, needed a CT scan to be convinced. In the windowless examining room at the hospital in Brooklyn, my mother said sadly yet matter of factly, “Well, I guess that’s pretty much what I’ve been expecting to hear. We’ve all got to go somehow, don’t we?”

We all do, of course. But I don’t think there are many bustling, nonbelieving souls like my mother who are ready to face that fact when rudely confronted with it. In her case, facing it meant ruling out treatment—the chemotherapy and radiation that the pulmonologist urged to ease pain and eke out a few more months. “If geezers like me have lots of tests and treatments,” she told the doctor, “there isn’t going to be enough money to spend on the other end. This health-care mess isn’t going to be fixed if we aren’t ready to get out of the way.” Nonplussed on his little stool, he shook his head and raised an eyebrow. “Well, I’ve heard that view before, but never from someone in your situation. People generally change their tune when it suddenly applies to them.”

Actually, I think my mother delivered her pronouncement so she wouldn’t cry. As she sat there, suddenly told she would soon be gone, I imagine it helped a little to take aim at the Medicare cliché. With the nation’s health-care debate heating up in the summer of 2009, those words were at the ready: she could voice the non-interventionist, parsimonious, yet also generous sentiments long lodged in her now “moth-eaten” (the doctor’s words) bones. For she was a rarity—a grandmother in favor of having the plug pulled and ready to live, or rather die, by that all-but-taboo vision of the end of things. But right then, in that airless room, she needed most of all to rise above an abyss. Look at me, a very lucky old lady who has made it to 80; tell me it makes any sense to rack up huge bills trying to add on an extra couple of months (at best) to a life that isn’t likely to last out the year. It was her way of rallying, and relieving us of the awful weight of the moment. My father looked stricken.

Over a late dinner one evening three months after that day in the doctor’s office, I asked her if I might write something, sometime, about her end. An owl had just hooted as we sat at the table on the screened-in porch of my parents’ country place in a tiny Massachusetts town. She nodded, though almost imperceptibly in the candle-lit darkness, and waved away the notion that there was anything particularly notable in her approach to her last months (if only she knew how many). Yet as those numbered days passed at a curious pace, so slow and so swift, the experience of taking no extraordinary measures felt, well, extraordinary. The owls hooted, answering questions with questions. We listened and gazed at the coneflower in the bud vase, picked the first day my mother had arrived up there from New York, two months earlier. She’d had to trim its weakening stem, and the neck of the vase now offered crucial support, but the petals drooped only slightly and the yellow was still vibrant. (“O’Henry,” she had named it.) She savored the last bite of what little had been on her plate and looked at me: “Could I really be dying?”

My mother, who died six months after she was diagnosed, was acutely grateful to be supported at almost every turn in her quest to end life on her own terms—which is not to say that “letting go” came at all naturally to her. Even for someone thoroughly out of step with our more-care-is-better medical ethos, it proved anything but easy to relinquish control. For her, resisting the doctors’ edicts was not so hard; that was her way of taking charge. Yet then what? To embrace ordinary, loving care, knowing the burden it put on others, was a struggle. But her odyssey—our odyssey—allowed us to feel our way toward those feats together, with few regrets and many rewards alongside the inevitable fear and pain. In a culture of Promethean aspirations, and in busy hospital corridors, it is rare to get that chance.

My mother was what I think of as “pre-choice”: saying no to doctors for her wasn’t the result of endless Googling and anxious deliberating with experts. It was a response to her past, reinforced by temperament. A child of the Depression and of Swiss immigrants, my mother never outgrew an almost un-American aversion to waste (of time, among other things) and an appreciation of the unintended consequences of so many of our fine-tuned, frenetic efforts at control. That did not keep her from more than her share of such efforts, as she was well aware—her sense of irony went deep. Throughout her life she fussed over others, briskly accomplished tasks large and small, and constantly planned far ahead. We joked about how obsessively she marked up her calendar with notes about who would be where when.

As for herself, she had a long record of reflexively resisting medical interventions of pretty much any sort. My mother made it to 80 without ever having a mammogram. A smoker since her teens, she was ready with her classic line whenever she was scolded: “Well, we’ve all got to go somehow.” Bad bouts of bronchitis after a harrowing hospitalization with pneumonia finally convinced her in the early 1990s to quit—with difficulty. As soon as she’d gotten the cancer verdict, she wanted to dispense with the probing, so expensive and so intrusive. She wanted to escape the dingy hospital corridors, the endless waits, the nurses who dragged their feet and addressed her and my father as though they were dim children, the doctors who urged procedures knowing she was a patient with top-notch health insurance. Under gentle pressure, she acquiesced to our desire for a basic round of screening, to confirm that the cancer had indeed started in her lungs and to check for imminent bone breakage. She couldn’t resist bridling even as she obeyed, noting that just about every procedure—whatever the result—was all but guaranteed to make yet another procedure seem advisable. How impossible it could be to escape! In two weeks she probably spent more time under medical scrutiny than she had in all her decades combined.

In June, my mother was looking at what was almost surely her last summer, and very aware of her enviable circumstances—a second house, a beloved husband, four attentive children with their own families. She wanted to get busy making the most of that good fortune, not to dawdle in a Brooklyn hospital submitting to radiation or chemo. She valued youthfulness, and it was true enough, as the pulmonologist reminded her, that she was still mobile. That was precisely why she was ready not to hang on. Prolonged shuffling was what she could not face—dallying and going through money and medical resources better spent, she often said, on the truly young.

In fact, she said almost immediately that she wanted to “be done” as quickly as possible. “I’m impatient to die. Oh, I’ve always been impatient,” my mother murmured one weekend soon after the diagnosis, before she and my father had yet left Brooklyn for Massachusetts. I had come upstairs to my parents’ bedroom to let her know the day’s plan. She was lying on their bed, alone and bleak. Downstairs my family, one of my sisters and her family, and my father were getting ready for a walk in the Brooklyn Botanic Garden. Outside the sky was 9/11 blue. Inside my mother’s body, all was murky to us and to her. Her color wasn’t good and her energy was much lower, but her hip hurt only sometimes. The coughing spasms came and went, but given her history of bronchitis, her hacking was in its way familiar. Stroking her back, I was alone and bleak, too. How could she be in such a hurry to leave us?

All of us wanted what she wanted. Or so we had been saying. We had mostly been believing it, too, and admiring her consistency in sticking to her pull-the-plug approach. How it cut through the confusion, the indecision about competing options, the intimidation in the presence of doctors who had plainly never paused to consider that a patient might simply opt out of their white-coated realm. How it pulled us together—that alone recommended her way, we had been saying, anxious to reassure ourselves that respecting her desires wasn’t just right, but wise. Her clarity didn’t come so clearly to us four. Reared on more than our mother’s staunch Swissness, we were baby boomers, accustomed to intervening and only distantly acquainted with death.

Sitting by my mother on the bed, not quite ready to give up coaxing her to join us on the walk, I suddenly didn’t want what she wanted. Our goal in the Botanic Garden wasn’t just to see the roses, which would be out in all their splendor, as my mother might say, the baptisia she loved, the Chinese dogwood, if it was still in bloom. It was to see her there, on the paths she’d walked for decades, bending over to admire a blossom and calling us over. “I need to start to retreat,” she said flatly, as though reading from a how-to book on dying. She didn’t raise her eyes to look at me, and I squeezed my own shut. My intrepid mother, who rarely sat still—and when she did, had her knitting needles clicking away like sleet on a roof—could not do this to us.

Which was precisely what she was thinking, it turned out: “I dread hanging around for the four of you and your father to deal with.” She curled more, almost recoiling at the prospect, and was appalled at the suggestion of a wheelchair to roll along the garden paths. “I can’t do that.” Her own parents had gotten sick when she was a college student and then a new graduate; she had felt stymied, inadequate, and never quite sure how guilty to feel about escaping as soon as she could. Still rubbing her back, gently—where, exactly, was the spine corroding?—I was no longer angry. My mother was terrified. She wasn’t going to measure out her days in waiting rooms and insurance bills, but she was desperate to have some role in death’s schedule. She was the woman who marked up that calendar of hers with our comings and goings. The indefiniteness of her own departure was too hard to bear—her hurry to be gone was really fear of letting go. Who wouldn’t panic at the prospect of living on, suddenly deprived of even the pretense of being in control?

I looked at my father’s pillow there beside hers and told her we weren’t ready. She took my hand and her eyes stayed on me. A little later, we heard her step on the stairs, coming down with unfamiliar caution. She had combed her hair, still far from totally gray, and she came with us. As we strolled, slowly, through the rose garden, she turned for the camera. She looks a little stunned. Her face is still so full.

Almost as soon as my mother and father arrived in Heath, Massachusetts, a month after her diagnosis, my mother announced a small quest: Where could she have stashed a couple of postcards of the village where our family has spent part of the summer for more than half a century? Her idea was to send them to the two doctors she wanted to thank for giving their blessing to her escape from the “bowels”—her word—of the Brooklyn hospital. One was an oncologist, a woman, who had listened rather than prescribed. The other was a radiologist who didn’t hedge, but said he’d put his bets on her hip and spine holding up. In both doctors, my mother had detected renegades of a sort, who unhesitatingly conveyed sympathy for her perspective.

We all remembered the postcard of the town center—an aerial shot, which must have once been for sale at the only big event that ever happens in Heath, the annual country fair in August. Taken in mud season, the photograph shows the church, old schoolhouse, grange, library/post office—white clapboard amid the brown—a few houses, and the flagpole on the small green where three roads converge, flanked by several fields. My mother thought these doctors would appreciate seeing the place where she was meant to be.

My mother had come to the birthplace of the Serenity Prayer to face, rather than fight, the inevitable. On our way to the post office with the one postcard my mother found, my father and I passed the church that is Heath’s minor (and somewhat disputed) claim to fame: behind these now not so freshly painted doors, there’s good evidence that in 1943, or perhaps earlier, Reinhold Niebuhr—a summer Heathen from the mid-1930s to the mid-1950s—delivered a rough draft of the famous lines long since appropriated as the Alcoholics Anonymous creed:

God grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.

There were only two problems. My mother was agnostic, and serenity wasn’t in her repertoire—or in ours. Walking on in the morning quiet, I wondered if the prayer perhaps had it the wrong way around. It takes courage—not serenity—to accept what can’t be changed when that is the imminence of death. That much was already clear. Battlers against cancer are always called brave, as though nonfighters aren’t. Yet to set aside hope and expert directives, trusting your body to endure the alien invasion unaided: surely that takes uncommon nerve—even more now than it once did, when there was no choice.

As for finding something vaguely resembling serenity, maybe that would come only in stumbling to learn what might still be changed, even as the end nears, and in understanding that no steady wisdom is likely to guide us. My mother’s enduring care for us was distilled in the nearly unbroken chain of summers here, imprinted on the height charts marked on a bedroom closet door and on the slope of the lawn outside the kitchen window. It was our turn now to learn to take care of her, if she could bring herself to let us. Summer smells—moldy old house inside, fresh-mown grass outside—and weeks without ends, no busy doctors or beeping machines, just us. “Think of all the people facing death who have no one.” She said that to each of us, more than once.

When my father and I returned from our walk, my mother had gone back upstairs to bed, a morning retreat that told us this was a bad day. The previous day she’d made oatmeal cookies, given grandchildren a knitting lesson on the screened porch, gone outside to hang up the wash and check her struggling hydrangea, done some reading, even felt a little hungry. Was she now sleeping? Or unable to sleep, and instead gazing at “my TV,” as she called it—a window high up in the rafters, offering a view of the sky, clouds, and a treetop as she lay in bed. “You’d be amazed at how much the scene changes,” she had remarked. Or was she behind the closed door trapped in misery she didn’t like to show us? “What could be going on inside there?” she had wondered aloud, with a shudder, on another afternoon as her hip and shoulder throbbed, her stomach swelled. The drugs had worn off and she was besieged by her body—“old paint” (as she sometimes called it, after a favorite Maxine Kumin poem)—transformed by pain. That was as close as she got to complaining. All was quiet, so I didn’t tap on the door.

“But if you’re dying, of course it hurts,” my mother said some time later. The Tylenol with codeine, now along with Oxycodone, had ceased to work very well, and increasing the dosage had its own painful side effect, constipation. But it doesn’t have to hurt, I told her, duly repeating what I’d read in the pain-management material. Her eyes looked trusting, as if she was eager to believe me and give up her Puritan logic, according to which letting the body weather pain would wear it out more quickly. “I am getting worse, aren’t I?” had become a wry refrain. Yet she also confessed that she came down every morning now hoping that O’Henry, the valiant coneflower, would still be hanging in there. Petals, I had noticed, were curling, but the color held. Some evenings my mother couldn’t possibly face food, or even sitting at the table. Other times, surprised by pleasure in tastes, she would pause and look at us: “And I’m supposed to be dying.”

The pain, by eluding all predictions, curiously eroded my mother’s sense of hurry. So did the steadiness of my father’s and our presence, one child or another coming or going, every grandchild visiting. She eased her hold on the expectation of some clearly defined downward course that she could somehow hasten. It didn’t happen abruptly. Nightly we rubbed shea butter on her feet—still incredibly soft after 80 years. (Was it because she’d staunchly refused ever to wear uncomfortable shoes?) We lay beside her as she recovered slowly from naps. “Oh, I’m indulging in a bout of self-pity,” she apologized on a day I found her weeping when she’d woken up; she didn’t want to see me succumb, too. When it began to hurt to raise her arms, my father, his big fingers clumsy but careful, learned to braid her hair—too loosely, but she was pleased. She asked me to bring from Brooklyn more balls of wool—scraps from her many afghans. In the sun, she sat knitting, and for the first time in my life I could sweep, wipe the table, make order in the refrigerator, fetch her pills, bring a drink knowing she wouldn’t jump up herself.

It seems strange to say of someone who shrank daily, but my mother also unfurled in a way. Every morning my father brought her mail from the post office: How had so many people heard the news? “It’s like being at my own funeral,” she said as he read aloud a letter from the daughter of a friend, who thanked my mother for several life precepts, among them to go ahead and eat the fresh bread before finishing the old. (Did she know that my mother wouldn’t dream of tossing the stale stuff? That was for toasting.) Several of us had gathered, like a 19th-century family eager to hear news from the larger world. My father finished his reading, and no one was in a hurry to get up. A granddaughter paused in her knitting, and held up her square for inspection. “Don’t you think this going out slow and easy is the way to go?” My mother actually said that.

Sitting one afternoon with her on the porch, getting ready to read aloud more of Lorrie Moore’s A Gate at the Stairs, I looked out through the screen, partly in the shade, partly in the sun. I had never noticed this before: I gazed through the darkened part, and the scene beyond was clear—the lawn, the stone wall, the small pond formed by the dammed-up stream, a bright pink floatie at the water’s edge. I turned to look through a sunny panel: now the scene blurred, and my eyes focused on the finely hatched barrier of the screen. Here was a metaphor I wasn’t going to try to parse. I looked back at my mother, who had paused in arranging her knitting to gaze at me with love and, a word I realized I almost never used, gratitude.

When we came upon a passage in Moore’s novel about listening to Glenn Gould play Bach’s first French Suite, my mother asked me to stop and read it again:

The piece was like an elegant interrogation made of tangled yarn, a query from a well-dressed man in a casket, not yet dead. It proceeded slowly, like a careful equation, and then not: if x = y, if major = minor, if death equals part of life and life part of death, then what is the sum of the infinite notes of this one phrase? It asked, answered, reasked, its moody asking a refinement of reluctance or dislike. I had never heard a melody quite
like it.

She had been feeling lousy, and I’d wondered if today she was indulging me when we’d sat down to read, but she was listening, hard. What is the sum? my mother repeated: Moore was definitely on to something. “The trouble is, how can I look back on this?” my mother said one night, after she’d urged my 18-year-old daughter to climb in beside her while I did the shea butter routine. At lunch not long after that, barely touching her dollhouse-sized portion, my mother addressed us all, her thinning face full of intensity, “What am I going to do with these memories?”

My father and I stood at the sink after dinner a couple of weeks later, finishing the clean-up. He was just back from a late summer weekend in Brooklyn, and I think I was about to fill the quiet with some comment or other on an article about Ted Kennedy’s death, headlined “After Diagnosis Determined to Make a Good Ending.” Dishtowel in hand, my father broke the silence. All he could think about as he drove, he said, was that he would never again make that trip with her. “It’s the last times that are so hard. There’s an ugly office building in Pittsfield, and for years there’s been a sign on it, SPACE STILL AVAILABLE. That’s always been a joke as we drive by.” His eyes had tears. “Of course, so many things that happen are for the last time. It’s just that we don’t know it’s the last time, we don’t have to think of that.” But imagine how hard it would be to be hit with someone’s end, all unprepared: as I tried to comfort, I couldn’t help hearing my mother’s blunt refrain over the years that death-by-a-falling-tree would suit her just fine. “Yes, I guess that might be worse. It’s just that one can’t be prepared,” my father said, putting his towel on the rack. “At least I can’t.”

The end of O’Henry in September marked the arrival of fall. My mother was also keeping her eye on the sorrel at the back of the house. When it turned crimson, she said, she would take it as a sign to return home to Brooklyn, where she had assumed she would go to die. The city was more accessible to more of us. There were no worries about icy roads; walks to grocery and drug stores were short. My father even toted up the number of stairs in the two houses, and kept reporting his results, like a mantra—not so many more in Brooklyn than there were up here. Yet he tended to leave out the front stoop, we murmured to each other: our mother would never again go outside. Which one of us could be where when? The calendars came out. We were back in time, counting days, assessing resources, hers and ours—and so was my mother, being my mother.

Earlier, in June, she had suggested hospice care, ignorant though we all were about just what it amounted to. I think my mother had a superstitious hope that signing up might somehow speed her demise. An introductory visit from the staff of a Brooklyn hospice had confirmed that very short stays on hospice are indeed par for the course in this country: a mere four days, on average, because hospice is so often a rushed last resort. So my mother was a thoroughly anomalous prospective client: in comparatively good health when she contacted hospice, and open-eyed about her impending death. But in June my mother herself had balked. She had resisted the idea of the requisite weekly nurse visitations. She absolutely wasn’t ready for interlopers into the family realm. She wasn’t ready to be a patient, either. My stoic mother, if you can believe it, would say almost to the end, and only half in jest, that she was “pretending to be an invalid” when she took to her bed at some odd hour, in pain.

Now as a mid-September chill came to Heath, she was ready because she could tell we were ready. Hospice emphasizes that its services are for the caretakers, not just the dying person, and my mother seized on that when the social worker came to sign her up and to brief us on what Medicare would now be paying for, from drugs to, if we chose, Buddhist-inflected spiritual counseling. (In the Berkshires, that had become a popular option.) It was true. We did need help, feeling helpless in the face of her rising pain. Or continuing roller coaster of pain. “I think I’m going to be one of those people who flunk hospice,” she pronounced on a good day, when the drugs—now morphine—soothed. On another morning, my ever frailer mother talked with the hospice nurse—quiet-voiced, with a long thick braid—about giving up food altogether to hasten the end. “You’ll be proud of me,” she told us, wry in her woe. “I cried with Dvora.”

By mid-October, the sorrel was crimson. On the gray day I drove with my parents down the hill toward the highways, we didn’t do our usual farewell to house and garden, field and lawn. It was a quiet ride. We were greeted at home by papers to sign, transferring my mother’s care to the Brooklyn hospice—a formality that could have waited, I thought, eager as I was to settle my mother into a warm bed in a cold house. My father and I soon joined her, “the Bucket family,” she joked as we lay there, three of us in a row under the covers. Who, she asked, had the golden ticket? And then, as though the enormity of the journey could only now register, my mother suddenly began to have trouble breathing.

Within mere hours, how the scene had changed. Hospice (what foresight it now seemed to have gotten those signatures) promptly dispatched an oxygen machine, which exhaled noisily in the corner while my mother inhaled until she could once again hold her own. By the next day, with the delivery of a hospital bed, placed by the windows not far from my parents’ bed, we had left our rural retreat far in the past. Our new nurse, Paula, took to lingering when she came for her twice-weekly visits, plainly happy to spend time with someone so open to talking about what her patients rarely wanted to discuss—death.

Not that she could do much more than, at my mother’s bidding, describe a physical process that evidently varied up until the very end, when the bleak basics of a body shutting down converge for everyone. If turning inward was a telltale spiritual marker—as the hospice pamphlet said—my mother didn’t seem to be close. “I was somewhat, I don’t know, nonchalant about death when I began this job,” Paula confessed one day as we sat downstairs after my mother had again asked about self-starvation as the way out, and Paula had noted it wasn’t pleasant. “I’m much less so now. Death is the great un­known.” From the hospice social worker, we got this nostrum: “People tend to die the way they’ve lived.” For my mother—hanging on so fiercely, while wondering daily how much longer this would take—that certainly seemed right. The rule, it struck me, probably applied to cultures too. In Tibetan “sky burials,” vultures swoop down to carry off remains set out for them on hilltops. Here death is mediated by machines.

My mother slept in the hospital bed rather than beside my father, but her perpetual tinkering with the controls to find a comfortable position—and her clenched hand on the bed rail when she finally did lie still—said it all. “I am getting a lot worse, aren’t I?” She posed her question eagerly at the start of the day, before forcing down her pills; swallowing was hard. My yes didn’t relax her. The arrival of the home health aide, the kindest of women, stirred anxiety. Preparing for a shower, my mother would fuss about water temperature and about just how they would maneuver without hurting Joanne’s back. Finally, she would relinquish herself to Joanne’s capable arms, and then make a joke about “baby’s first bath,” mocking her own dependency. Dried off and dressed, she would muse that we truly do circle back to our beginnings, don’t we? On a good morning, my mother might then make her way up to the third floor, a step at a time, to sit in the best light and work on embroidering several dragonflies on a hat she had knitted. But afternoons, like new parents, we kept an ear out for her waking after naps. “Oh, stay with me, don’t go”: each of us—my sisters, my brother, my father, and I—had been heartbroken by that plea, as though we could help fend off an assault by a body that barely let her breathe, that she right then didn’t dare inhabit all alone.

In bed with my husband, when I was back home in Washington briefly or he had come to Brooklyn, I would wake up and think his back was hers, whose bony geography I knew so well now. And one night I awoke barely able to breathe, the familiar room I’d shared with my sister decades ago suddenly a dark and terrifying well. This is how my mother feels, I thought, as the panic squeezed my lungs even tighter. In the sunlight of the next November morning, I told her about it. She pulled me to her, her eyes tearing. “I do think you actually feel what I’m feeling, that you have trouble breathing at night when I’m having trouble. It’s so . . . umbilical. It feels sort of like pregnancy again. How did I not know until now that it could be like this, that it could come around like this, and there could be this shared feeling? It’s not sad, it’s happy, so know that when I cry, it’s not that I’m sad. It’s that I’m feeling that about you.” She plucked some Kleenex from the box. “There, I’ve gotten that off my chest. I wanted to try to explain that.”

“Oh, the question is, How is this all going to go?” my mother said as we lay side by side under an afghan. I half believed she would be granted her wish not to make it to Thanksgiving, but on the day of cooking and crowds, my sister went over to spend the day just with her—no turkey smells, no commotion downstairs; my father went to feast with my sister’s family. Back in Washington with my children, home from college for the week, I walked down to the Starbucks at the corner early on a clear, cold Saturday morning to buy another pound of coffee. My mother would be waking up, too, and wishing that she wasn’t, wishing that death had crept up on her and seized her during the night. I looked at the bare ruined choirs, where late the sweet birds sang—we had recited that Shakespeare sonnet, one of my mother’s favorites, the weekend before. I will hear them sing again and she won’t: that thought made my love for my mother more strong, as the closing couplet promises. I will also love that well which she must leave ere long: the birds, this world, and all that will still be in it when she no longer is. I can let her leave. The ground coffee was warm in the bag in my hands.

The Serenity Prayer surfaced in The New York Times that weekend, in an article reporting new evidence that Niebuhr had indeed written it. A Duke librarian had tracked down an early version that put to rest lingering debates about his authorship. As I read the less-polished supplication, it was some comfort to think maybe Niebuhr had felt as buffeted as we did:

Father, give us courage to change what must be altered,
serenity to accept what cannot be helped,
and the insight to know the one from the other.

So he had originally relegated serenity to second place and a much more precarious status. I wasn’t just reading in, was I? The lines themselves had lost their serene tone. “To change what must be altered” sounds less like a choice and more like a challenge. “To accept what cannot be helped” evokes stark limits you don’t hear in the near complacence of “to accept the things I cannot change.” And wisdom has disappeared. There is “insight,” which usually arrives unbidden—and is fleeting.

To someone hallucinating on morphine, or to anyone tending to that person, courage, serenity, insight—they’re all elusive. My sisters and brother had prepared me to be shocked after two weeks away. Rising drug dosages had left my mother succumbing to long pauses, and seeing horns on cheese, contortions on beloved faces, as her body’s pain receptors adjusted to new opioid levels. But on the Sunday I returned, my sister told me she had woken up from her nap, a smile on her face and her hands unclenched, fingertips loose—no longer holding tightly to the ship rail, perhaps ready to float away.

I went upstairs to find my mother sitting on the edge of the hospital bed, her legs now mottled and, I felt them, cold. Eyes closed, color ashen, her face looked like Blake’s death mask (do we all look something alike in death, if we’ve wasted away?), but she greeted me. She wanted us near her. My sister and I sat with her, and my father crawled into their bed and was soon snoring quietly. I was beside her, rubbing her back. My sister was at her feet, swaddling them under fleece against her stomach, as she does for her daughter after skiing. “I feel like a bird,” my mother said after silence. “This is my nest.”

My sister and I talked late into the night, wondering if this was the end. My mother and father slept in, so long that I thought perhaps it had come. But I heard them stirring, went in, and my mother sat up, ready for the regimen of pill swallowing, eased down by applesauce and yogurt, that she hadn’t been able to face all weekend. And we had thought her retreat, long desired and long resisted, had at last arrived. So, it seemed, had she. “I had a night like no other,” she said. “I thought I was cashing it in. I had a lovely farewell time with Richie.” And then . . . here was one of her long pauses. “I realized I wasn’t cashing it in after all. But I really thought this was the end.” My father said they had spent a very peaceful 45 minutes or so, just sitting together in the semi-darkness.

It was the beginning of the end, which arrived four days later, mid-morning on December 4, 2009. None of us was granted serenity, but I don’t think it’s wishful thinking to say we were united in a sense that it was turmoil preceding release. “I’m trying to die, I’m trying to die,” she told me in the middle of the second night as I sat holding her hand. By the morning she had slipped into a coma. The five of us gathered around her for her final 24 hours, sometimes taking turns and sometimes all together, talking, stroking, moistening her lips, quietly singing, every so often taking her clenched hand off the bed rail so she could relax, only to watch her grasp it again. My brother was there when our mother called out for her own mother.

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