March 8, 2011--Mothercare

Though my mother, now early 103, is not seriously ill, yesterday she called to say she wasn't feeling well and we raced over to be with her. She appears to be doing better, but it reminded me of something I wrote and posted here a couple of years ago; and since I missed my writing time yesterday, here it is again--

Though you hope that when your time comes you will be ready, there is in fact nothing that can prepare you for when your mother has a life-threatening condition. As mine did again three weeks ago.

A small stroke early in the winter had brought us to Florida in the first instance, and then there was that remarkable recovery and our promise to spend more time with her during her last days that contributed to transforming us from visitors into Snowbirds. Fortunately, up to now, those final days have stretched to weeks and months and years.

For most of us, our experience with our mothers and sickness is from when we were ill and she was selflessly there and, you thought, would be, eternally, to care for and protect you from threat and danger. So my first sight of her recently in the emergency room and then a day later in the Intensive Care Unit to which she had been transferred shook me at the core of my being.

There were four phone messages from my brother when we returned from breakfast at the Green Owl. This is never a good sign. We of course feared the worst. The last time there had been so many voicemails in such a short period of time was three years ago when my cousin Chuck died suddenly while exercising in the gym. We are not a family that does that much telephoning or leaves urgent messages unless . . .

In actuarial terms, my mother, just a few months short of 100, is the last survivor from her generation and is thus, by every expectation, euphemistically, next in line. Though Chuck’s premature passing disrupted that protective sense of security and unleashed shock waves of anxiety among all the grieving and surviving cousins.

It was thus with fear for some version of the worst that I returned my brother’s call.

He is a cardiologist in South Miami and, though he is used to medical crises, I could tell from his voice that he was calling as a brother and not a physician. “What is it?” I managed to ask. “Something bad I assume.”

“I just got a call from the paramedics. They have mom and are taking her to the Florida Medical Center.”

“Is she . . . ?”

“Yes.” He knew what I was asking. “But I don’t know her condition. From what they told me I think she had a heart attack or a stroke. But she’s conscious. Which is good, but at her age . . .”

I knew enough about medical emergencies for someone of her age not to need to have my brother complete the sentence.

“We’re on our way there right now. They’ll take her to the ER.”

“We’re on our way too,” I said, “We’ll see you in about half an hour.”

I didn’t need driving directions. I knew how to get there. My father had died in the same hospital more than ten years ago. And I thought, Isn’t it a good thing we’re here snowbirding in Florida. Next I thought, I hope I see her before . . . And, even more personally, What will I do now if . . . ? This latter thought was the first fearful inkling I allowed myself to feel of what ultimately, if after Chuck we returned to “proceeding” in order, what my life would be like if . . .

* * *

We arrived at the entrance to the ER just as the ambulance that had brought her to the hospital was about to pull away. I peered into the faces of the paramedics to search for any hints that would yield about the status of her condition. I was neither calmed nor made more anxious by their noncommittal look. They had obviously seen worse. And, I tremblingly imagined, better. They were busy changing the sheets on the gurney, readying themselves for the call that would summon them to their next run; and by professionally ignoring me they signaled that it was not their responsibility, or in my best interest, for them to share or for me to receive medical information from them. It was probably that bad.

They had completed their job—they delivered her there alive (how alive is what I was desperate to know) and in one piece. Still I leaned beseechingly in their direction. But before I could approach them, knowing they would have little to offer beyond what my brother had reported, still eager for any shred of news, their radio crackled and, as if liberated from me, they jumped into the front seats, pulled the doors shut, and raced off. For them it was another day at the office. For me . . .

And then the first of the waitings began. First for Rona and me to be admitted to the ER itself. They had a strict policy that only two family members at a time are allowed to visit with patients. Since we were told to take seats among the parents with small children, most of whom appeared to have the flu, we knew that my brother and sister-in-law had already arrived and were with my mother. And since he was the doctor in the family, this was good news. It would assure that my mother would be the beneficiary of whatever professional courtesy was offered in even a rough-and-tumble ER. And, truth be told, I still needed more time, after the wild drive down the Turnpike, to collect my thoughts and prepare a face to present to my mother that would communicate concern and love and strength she could depend upon while masking the anxiety and fear I was feeling.

My brother came out through a side door and said that it would be all right for us to bypass the rules—things were quiet in the ER and we wouldn’t be in the way of the staff (the first of the small but welcome courtesies)—and could therefore come in to see Mom. Though they still hadn’t run all the tests that they would during the next endless-feeling hours, he reported, to our great relief, that she was indeed conscious and, by his assessment, because of the symptoms he had observed—a slight slurring of speech--had more than likely had a small stroke. Again saying, “But at her age, no stroke, if it turns out to be that, is ‘small.’” And added, “So don’t dawdle.” With his trained and experienced eye he had undoubtedly noticed I was lagging behind Alice. “She’ll be comforted to see you.”

I took that as my mantra during the next weeks. Lacking any medical expertise, I came to learn that what comfort I might be able to bring as she moved from ER to the ICU to a regular hospital room to rehab, as she worked her way up the chain of care and restoration, could also be restorative. And so I did my best to do so—to bring comfort. And came to feel, which she confirmed in many subtle and direct ways, that this kind of involvement is an essential complement to all the testing, medications, and other treatments others were well trained to administer.

But I’m getting ahead of myself, though I do so intentionally in order to remove any false drama from this account. I want you to know that my mother is well, back home, living independently, and has no lingering effects of what in fact turned out to be a “small” stroke. So much so that she is right now taking an active lead in planning the ways in which she wants, in late, June to celebrate her centenary.

Having said this, trying to offer comfort to a mother who for some weeks was dangerously ill was not as benign for me as I had imagined it would be when my brother in effect said—You will bring her comfort.

One of the frequent side effects of a stroke is depression. Not just for the obvious reason that one had just had a potentially life-threatening physiological event (doctors I learned called these things that—“events”), and who after that wouldn’t feel depressed; but there is clinical evidence that the post-stroke depression also can be just as physiological as the stroke itself.

Thus the first kind of comforting I was able to bring involved trying to help raise my mother from her depression while she was still in the ICU in the hope that she would agree to eat something. Anything. This was extremely important, I was told, since the IV feeding was insufficient to help maintain her weight, which would be subsequently important if, in the felicitous words of one of the nurses, “She makes it [i.e., lives long enough] to rehab.”

It is never easy to convince or cajole anyone that hospital food is anything but abysmal and even unhealthy, and that they must view it as essential to their recovery as their almost equally unpleasant medications. It is a wonder that even a happy and optimistic patient—one, for example, who has just had a rejuvenating facelift—could mobilize any interest in overcooked vegetables or pot roast that is indistinguishable from those limp greens. Thus, to get someone in the ICU who has just had a stroke to think about eating that tasteless mush, even a forkful or two of it, is a challenge. It’s doubly difficult to feel motivated about eating when the screen that endlessly displays vital signs is constantly and alarmingly flashing and beeping and buzzing. Especially when on occasion the power surges and they go terrifyingly flat line. And it is additionally difficult to think about eating if that stroke, as it did with my mother, results in even a small deficit in manual dexterity. Her continuously quivering right hand was clear evidence of that.

Thus, you have a picture of my mother two days after the onset of her stroke. The ICU nurses reported that she hadn’t eaten a thing. Not even the Ensure supplement, which was prescribed to make up for any nutritional gaps in her “intake”--another infelicitous piece of hospital jargon.

Wanting to avoid the Ensure I understood. During one of my own hospitalizations, where the food was even worse that what the Florida Medical Center served up, they had tried to get me to down some. I made a valiant effort, but choked on the chalky taste that managed to penetrate the chocolate flavor that was meant to mask it. So I didn’t even try to get my mother to drink any, I knew better than that, concentrating instead of what looked like it might have once been chicken that was lying, untouched, on her tray that second evening when we visited.

Trying to be upbeat and chipper in spite of her unaccustomed immobility and the look on her face that could not hide the fact that she realized the trouble she was still very much in—it is difficult in an ICU to distract yourself from feeling dangerously—in the face of how I found my mother, and not being very good myself at pretending that all was well when I knew it wasn’t, still I tried, in the spirit of knowing that my assignment in this was to bring comfort, I said, “You’re looking better than you did this morning.”

Nothing came back to me from my mother so I chirped on, “But I see that you didn’t touch any of your food.” To this she grunted and, with eyes closed as if to put the tepid food out of sight, she agitatedly shook her head from side to side. I was glad to see she had the feisty capacity to do that. I took it as a sign that she was in fact doing better than during our morning visit when moving her head or just smiling seemed beyond her abilities.

“Did you try any? The nurse told me it’s very important to eat. I know the food’s not good, but . . .”

“Salty,” my mother grumbled and resumed shaking her head from side to side. I knew she hated salty food.

I looked over at the tray and saw that the chicken, as it cooled, appeared to be growing a crust. But still I said, “I know it’s salty,” almost adding and drying out, “but you need to try to eat. You won’t get better if you don’t.” To this, with great effort, she raised her left hand and, letting it tremble, drew attention to the fact that an IV line was inserted in the crook of that arm; and, by looking up at the plastic bag that was connected to the line, showed me in that way that she was getting nutrition.

“Yes,” I said, “you do get some benefit from that but not enough. You still need to eat. Food.” She continued rolling her head back and forth. I was beginning to worry that by doing this she might bring about another stroke. This couldn’t be good for the blood flow to the back of her brain where the clot had formed. So, to try to stop her and to get some real food into her, I said, “How about if I help you.” Immediately she lay still.

“What if I cut the food into little pieces and feed you?” She made a humming sound which I took to be assent.

Taking advantage of that, before she could change her mind and resume her head shaking, I rolled closer to her bed the adjustable table on which the tray had been placed and cranked it up so it would fit comfortably over her. I then raised the top of the bed so that she was more or less in a sitting position. Rona adjusted her pillows to make her more comfortable. And while she was doing that, I cut the now room-temperature chicken into tiny pieces. Below the plastic line that brought oxygen to her nostrils, my mother appeared to be smiling.

“Here are some mashed potatoes. I know you like them.” (But you won’t like these, I thought.) “Now open wide.” I brought the fork with a small amount of the potatoes to her mouth while cupping my other hand under her chin to catch whatever might drop off.

“That’s good,” I said encouragingly as she strained to lift her head from the pillow and, as I had instructed, opened her mouth.

“That’s good,” I said as she sucked in some of the potatoes while the rest fell into my waiting hand. “That’s a good girl.”

A good what? Had I said girl? To my mother? I called her a girl?

Indeed I had. And, I realized, I had been talking to her as if she were not only a girl but a little one.

As I heard myself—especially my deliberate cadence and tone—from some deep almost prehensile part of myself--I recognized the echo of these words and this intonation as the very ones my mother had employed with me many decades ago when I was her little boy, sick at home with the chicken pox or measles, as she, in the ICU, had become my little girl.

* * *

But even with my mother there, connected to a forest of life-sustaining IV tubes and monitor lines, with the diagnosis still uncertain, with her not as yet out of danger, and with her rapidly approaching 100th birthday, still, in spite of all these signs of frailty and the evidence of her impending mortality, I continued to need to believe that she was capable of rising from that bed and unhooking herself so she could be available to take care of me if I needed her. As she had been through the decades when I had the croup or my tonsils needed to be removed or when I came home bloodied from the schoolyard or, much later, when I faced intestinal surgery. Because, though our roles have to some extent been reversed as a consequence of aging and illness, I still need my mother to be my mommy.