Life in the 50s: Dear Doctor

During those last two extra years of her life, I got something from my mother that I'd needed my whole life.

Our mothers carry us in their wombs, feed us from their breasts. Our baby selves take comfort from their soft bodies; our heads rest against their shoulders, arms and chests. At first, they say, we don't even know we're separate. I am Mom and Mom is me. The relationship changes, but we carry our mothers, our shapers, within us throughout our lives. As we get older, we become more aware of this mother within, come to understand her (and ourselves) better, reject her (and ourselves) less. A mother's death may intensify this mother within. Formidable in life, my mother remains formidable in her death. Regular readers of this column may notice this is the third time my mother is playing a starring role. Some of us in our 50s are facing or will face the decision of whether or not to prolong the life of a failing parent. My siblings and I faced this during the last years of my mother's life. I wrote the first letter below two years before my mother died and the second just after her death, both to the capable health fund gerontologist who took care of her. I hope they may shed a little light for some facing this difficult dilemma. Dear Dr. B: I want to thank you for saving my mother's life. As you know, six months ago, at the age of 92, my mother broke her femur while standing in her kitchen. Surgery restored her bone, but not her independence. Before her accident, my mother made her own coffee and light meals, took her own pills, answered her own phone. Now, she is bedridden. She needs help doing everything, even turning over. "This is a life, this?" she asks. She pleads with us - as she used to even before the operation when she had become limited to her apartment and was losing her taste for food and for living - to help her end her life. But now her tone is more urgent. "Can't you children do something?" she asks. When I was growing up, my mother's food was a highlight of my life. Her cooking was her art, her pride, it was how she expressed her love. Born in Uzbekistan and having lived in Alexandria and Jerusalem before settling in Los Angeles, my mother's cuisine reflected her sojourns: lamb pilaf, Middle Eastern salad, baba ganoush, guacamole. Always the connoisseur of excellent, carefully prepared food, my mother now subsists on Ensure, a chalky, liquid dietary supplement that comes in vanilla, chocolate and coffee. My mother has had a long and if not always happy, at least an interesting and full life. She raised six children and was the beloved stepmother of five more. She lived on four continents and visited all the others. She spoke six languages. She's been a refugee, an immigrant and stateless. She lived in tiny apartments that housed more than one family and owned a home so large it took up half a city block. But she's never before been a prisoner. She's been saying for years now that it's time to go. "Why doesn't God take me?" she asks. "Enough," she says. Just after the surgery, my mother cut her already meager diet down to nothing. She just couldn't eat. And after a few days, she didn't want to drink either. You pushed for tube feeding through the stomach or nose. Not a big deal, you said. My mother didn't want it and we kids fought to guard her wishes. She had also made it clear, in writing, that she did not want her life prolonged in any way - including through the use of an IV. But you felt an IV of glucose water was necessary. When we told you about the document, you said, "That was then. This is now." You told my mother, "Everyone's been trying to push food and drink on you. This will give your mouth a rest." Sounded good to her. She okayed the IV. Without the IV, my mother would have become dehydrated and, after a few days, she would have died. It would have been extremely difficult for those of us who love her to watch her go. But I believe it is far more difficult for her to live her last years in an incapacitated state. Since the operation, my mom's memory has deteriorated. Most of the time she knows that she's forgetting the most basic things. She shakes her head in helpless dismay. "Sometimes I know everything," she tells me. "Sometimes I don't know anything. Not even who I am." There are still moments of enjoyment in my mom's life, moments when she smiles, like when she sees me or my sister walk through her door, or when she notices that my 13-year-old has grown taller than me, or when my children sing old songs and she joins in. But most of the time, she makes it clear that she's had it, that she'd like to move on. You saved her life, doctor, as your profession calls upon you to do - but you prolonged her suffering. Was it worth it? Two years later… Dear Dr. B: As you know, my mother died last month. If I wore a hat, I'd hold it in my hand, look down at the floor and say: You were right, I was wrong. Yes, my mother suffered during the last two years of her life. Yes, those last two years were the antithesis of the way she wanted her life to end. But I want to thank you for giving us two extra years with her. And this time I mean it. Two years ago, I disagreed with your decision to insert a life-saving IV into my mother's arm. She didn't want it and I wanted to respect her wishes. When I discussed your decision with the head social worker at her health fund, the woman smiled, leaned forward across her desk and gently said: "Sometimes there's a reason people have to live longer. We don't know what it is. Maybe there's something they need to say. Maybe there's something they need to hear." It turned out there was something I needed to hear, something that fundamentally changed the way I feel about myself. When I was growing up, my mother took care of business. She kept a clean house and cooked wonderful meals. She paid college tuition for those of us who wanted to go and later helped us buy our homes. But hugs and kisses and even loving looks were rare and we didn't get a lot of attention. Our feelings were of little concern and there wasn't much emotional nurturing. Some of us ended up wondering if we were really loved, if we were really lovable. I got some insight into how my mom parented her babies when I flew to visit her when my firstborn was four months old. One afternoon, she sat in a straight-backed chair across from where Ilana and I were on the couch. The baby was lying on her back next to me and I was playing with her, talking and cooing the way you do with a child her age. Ilana was smiling, cooing back with all her might and scrunching up her whole body in delight. My Mom watched us and said: "I never did that with the babies. I fed you and cleaned you but I never did that." During her last year and a half, however, my Mom seemed to be left with nothing to do but to open her heart. I would walk into her room and happiness would wash over her face. She would fix her gaze on me and say with wonder, as if she were seeing me for the first time: "Look at you. You're so beautiful." As I stood by her bed, she would reach up and gently caress my cheek. When she saw my children, her face would soften, overflow with love. I'd never seen anything like this in her before. One day, with my chair pulled up close to her bed, I took her hand and said: "I love you." She fixed me with a look that was both affectionate and disapproving. "I love you," she said, "but I don't tell you." I don't know if I'd ever heard my mother say those three little words before. Perhaps actions speak louder than words but to kids, those words matter. It took my mother 93 years to be able to say them to me and to have them show on her face. During those last two extra years of her life, I got something from my mother that I'd needed my whole life. I know now, without a doubt, that she loved me very much. The feeling strengthens me. It may be selfish on my part, but I'm glad, doctor, that you didn't let her die before she had a chance to let me know. For me, at least, it was worth it.