Frontline

Non-fiction
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My mother didn’t die of COVID, but COVID killed her. The stroke killed her, too. World War II killed her. My dad’s dementia killed her. The dogs killed her. Technically, she killed herself. But that makes it sound so different than what it was. 

I was irritated when I arrived at work that Wednesday morning mid-August, 2020. I usually listen to books on my commute but my phone died and the only option in my twenty-year-old car was a crappy pop station crackling through the single speaker that partially works. 

The message light on my office phone glowed red but I didn’t check it. I’m not the nurse you call in an emergency, not if you’re smart. I’m the nurse you call when you can’t find a policy or want to talk after your patient dies or you’ve made a mistake and need someone to remind you you’re a human being and that human beings make mistakes. 

I run a nurse residency program, smoothing, as best I can, the transition between nursing school and the reality of the actual job. Our classes were supposed to be online except no one had planned for how bedside nurses with no offices, no computers, and no headphones would participate, so mostly the program was paused. It was the second peak of COVID deaths. We’d been in lockdown for months. 

I plugged in my cell and the screen populated with calls and messages, some from my husband, multiple from my sister-in-law—always a bad sign. I played her message first: “It sounds like your Mom is, maybe, having a stroke. Vince is on his way over there to meet the ambulance. I’ll call when I know more.”

I considered the situation. My mother would be in the hospital at least one night, maybe more. I live in Albuquerque. My mother and my brother Vince were in Los Angeles. With the pandemic, I wouldn’t even be able to visit her so why leave immediately? At least at work, I’d be distracted. At work, I could be useful. 

Pandemic-wise I was feeling guilty. Lucky, but definitely guilty. I could see the frontline from where I stood but I wasn’t there. Colleagues were getting pulled to staff the hospital. Friends volunteered at the Navajo Nation where the pandemic was raging. I was in my office tasked with administrative work to prepare our hospital for the worst. 

I’d developed a refresher training for nurses like me who’d been away from the bedside awhile and divided our RNs into groups by how many years it’d been since they touched an IV pump. I told a former resident, “When you see me working alongside you, that means all hell’s broken loose.” He thought I was joking.

I decided to stay at work and fly to California the next day. Vince called about thirty minutes later. Mom’s right arm and leg were slightly affected and her speech was slurred, but mentally she was totally herself. That sounded good; a minor stroke. She’d be discharged quickly. We’d do a couple of months of rehab, and all would be well. Or at least that’s what I thought. Two weeks later she was dead.

When I let myself into my mother’s house the next day, the first thing I noticed was the quiet, an intense and overwhelming absence. For fifteen years, entry into my mother’s home had been met by a flurry of yipping, yapping, and frenzied delight that put everyone in grave danger of tripping over her maniac Russel Terriers or at least getting plastered in dog hair. 

I knew the dogs were dead—one died in February, the other in July. But until that moment I didn’t understand the emptiness they’d left behind. For years, my mother’s life revolved around three things: my father, his dementia, and those dogs. Then, it was just the dogs. My brother and I had talked often about what would happen when they died. We knew she’d be sad, maybe even depressed. I never thought she’d die.

My mother had been telling us she was feeling poorly for about five days. Normally she’d go to an urgent care but she was terrified of COVID. Sanjay Gupta was on CNN showing people how to wipe down their groceries and make masks out of socks. Vince was worried. He wanted to visit her in person but I said, “What if you visit and she gets COVID and dies? How will you feel?” She was 83 and that was a real possibility. 

I didn’t think about the other side. What if no one visited and she died because of loneliness and depression? How would I feel when that happened?

Her medical complaints that week had been vague—the nerves in her legs were bothering her, she was tired. But San Fernando Valley temperatures were soaring into the 110s and she was texting us her daily step count. Without the dogs slowing her down—the chunky one could make a 20-minute walk take an hour—my brother and I worried she was exercising too much and eating too little. I ordered her protein shakes from Amazon. I had her check her temperature. On Sunday, I told her that if she wasn’t feeling better by Wednesday, she needed to go to urgent care. 

I was thinking it might be COVID or maybe hyponatremia (which she’d been hospitalized with before) or, the worst-case-scenario I’d been dreading for years, her chronic lymphocytic leukemia kicking into high gear. When she’d first been diagnosed eight years earlier, the oncologist told her, “Something else will kill you long before this does.” She loved that oncologist. 

What I didn’t think of was her severe paroxysmal hypertension. Every once in a while her otherwise well-controlled blood pressure would leap over 200. The last time it happened was more than a year earlier. She’d texted me from the doctor’s office, perturbed that they wouldn’t let her leave with a systolic of 220. She was sure it was just the doctor’s office making her anxious; they were sure she was at risk for a stroke. Commonly associated with childhood trauma, the condition is akin to the body having a panic attack without the conscious mind being privy to it. 

When I first learned about it, I stupidly said, “But my mother didn’t have any childhood trauma.” I was thinking abuse. My husband looked at me, dumbfounded. “The war?” he said. 

My mother grew up during WWII in Kent, one of the most heavily bombed areas of London. She came home one day, after hours in an air raid shelter with strangers, to a bombed-out house. She had no idea if her family had survived and wasn’t reunited with her mother and brother—injured but alive at a local hospital—until the next day.

I picked my mother up from the hospital late Thursday afternoon. I was too scared to hug her. I’d just flown on an airplane; I worried that I was exhaling invisible assassins out the sides of my mask. 

A few weeks earlier my mother had called me in the middle of the day on FaceTime. I thought it was a mistake because she never liked to bother me at work. But after feeling the emptiness she was living in, I realized that it probably hadn’t been a mistake. As we drove, I thought of her alone in the house. No one to talk to. No dogs to walk. No friends to bowl with. She’d been trying to keep the silence at bay. 

I looked over at her and said, “When I said you needed to go to the doctor’s on Wednesday, this isn’t what I meant.” She laughed. 

My mother first talked about killing herself that night after dinner. Even the minor deficits from the stroke were going to necessitate life adjustments she didn’t want: help with meals, laundry, walks. She sent me to check her medicine cabinets for options. I went, despite being relatively certain I wouldn’t find a handy stash of opioids. There was only Tylenol, a few blood pressure meds and her levothyroxine. No peaceful pill tucked behind the Q-tips. My mother had a penchant for tossing things. She’d thrown out her EpiPens a few days after they expired, even though she was deadly allergic to the bees that hovered around the feeders of her beloved hummingbirds.

“You got nuthin’” I said as I sat down next to her, trying to shift the mood. “Maybe you could try to get stung?” My brother and I both inherited our mother’s distinctly British sense of humor. Sarcastic banter was a cornerstone of our relationship.

But she didn’t laugh. “I never should have let it get this far,” she said, making it sound like we were at the end of a long struggle not the beginning.

This topic of suicide wasn’t unfamiliar territory—we talked all the time about how my father would’ve killed himself if he’d known he’d face dementia for ten years. My mother even had a role model; her friend Ann killed herself after getting sick with cancer. My mother was the one who found her, a bag over her head. 

There was a line I wasn’t going to be willing to cross but I didn’t know where it was. Could I hand my mother a bag? Help her get a prescription? Stay with her? “I’m pretty sure if you put a bag over your head, instinct will make you pull it off.” I hesitated, on the verge of tears. “I won’t hold your hands down.”

We sat quietly for a moment. My mother had always been a fairly classic British stiff-upper-lip perpetual optimist: You’ve still got four perfectly good fingers. Why are you moaning about that little one that got chopped off? I wasn’t used to this mother who wasn’t looking on the bright side of death like my brother’s beloved Monty Python.

“We aren’t there yet,” I said, confident any life modifications would be temporary. “Let’s do rehab for a couple of months and see where you are in December. You can talk to me about killing yourself at Christmas.” That got a smile. 

December was four months away, enough time for research and a plan if we needed one, but I didn’t think she was actually going to kill herself. She was bummed because she’d had a stroke. Who wouldn’t be? Once she saw things were going to be okay, she’d perk up. Her stroke was minor. “You got off lucky,” I told her. I said those exact words. 

I was sitting across from my mother at the dinner table the following evening, when I noticed the left side of her face drooping. We’d just had a great day of home-made rehab—she’d hardly needed the walker—plus a beautiful drive up the Pacific Coast Highway. I felt sick to my stomach. New side. New stroke. 

I had her hold out her arms. The left one hung significantly below the right. In my best calm nurse voice I said, “I think you’re having another stroke.” I got her into the car. She was not happy. 

“Everything’s going to be fine,” I told her. I believed it. “They can give you medicine because we’re catching this stroke early. Not like the last one.” As they rolled her away to the CT scanner for the second time in three days, I reassured myself. They’ll give her thrombolytics, dissolve the clot. We’ll only have those minor right-sided deficits to deal with. It will still be okay. 

When they brought my mother back, the nurse pulled out a tele-stroke iPad. Like an idiot I thought cool. Tele-stroke allows a hospital with no onsite neurologist to manage strokes and we’d just got it at our hospital. I was going to get the patient-side experience. Then, they turned the face-in-a-box neurologist toward my mother and me and he said, “I don’t think this is a new stroke. I think it’s the same stroke crossing the midline.” 

I didn’t even know what he meant. Strokes kill and run, right? They destroy chunks of tissue in one cataclysmic event then they’re done. How did I not know what he was talking about? 

“If you aren’t going to give her thrombolytics, can I take her home?” I asked. 

“No,” the neurologist said. “We want to observe her.” 

If I’d been this patient’s nurse, I would’ve advocated for her. Or at least I like to think I would’ve. I would’ve found out why she wanted to go home, learned that she’d lived in the same house for sixty years. It was the only home she’d ever owned. It was where she wanted to die. But I was at a loss for how to advocate for us. I didn’t know what I was talking about. I didn’t seem to know anything. 

I left my mother at the hospital and returned to the quiet, empty house, taking refuge in my parents’ upstairs bedroom where the ancient air conditioner valiantly fought the raging heat. I called a friend, a thirty-year critical care nurse, who said that my mother’s stroke was evolving, which made me see slithery creatures dragging themselves from the muck, wrestling each other for dominance. I no longer thought it would be okay. I called my husband and told him we’d have to buy a bigger house. My mother would be coming to live with us.

When I brought my mother home two days later, her left-sided deficits dwarfed the right. She could walk but was so unsteady I was afraid she’d fall and crack her skull. She was aspirating badly, coughing after every sip even though she dutifully tucked her chin like the speech therapist taught her. 

Surprisingly, however, her mood was upbeat. A nurse in the hospital—a practitioner of tough love—had pointed to another patient and said, “That woman over there can’t move at all. You should count yourself lucky.” My mother complied. For a whole day, I had back the mother who was certain that every dark cloud had a silver lining, even one pounded so thin it was microscopic.  

We did more DIY rehab. My mother sat in her armchair using her left hand to move spoons from one paper plate to another. She laughed when she dropped them saying, “This is harder than it looks.” Our masks were gone; the battleground had shifted. The pandemic was outside. We were inside, alone.

That night we were watching some terrible doctors-doing-everything-they-don’t-actually-do-in-a-real-hospital show, when she tried to fling her left arm up from the shoulder. It hardly rose off the seat. The remnants of motor coordination she’d had a few hours ago were gone. Innocently, she said, “Look at this,” like it was a parlor trick, like it wasn’t the moment that would change everything. 

 “You’re just tired,” I said, but I could feel primordial mire swelling around our feet.

My mother decided to kill herself on Monday morning, five days after her original stroke. She couldn’t get up the stairs to her bedroom so she was sleeping in my childhood room, the second coolest place in the house. The afternoon heat was reaching the 120s. 

Together we struggled to get her to the bedside commode, then out to the living room using the walker that her hand couldn’t hold anymore, the left side of her body only minimally responsive to the mental orders she was sending. 

When she was in her armchair, I brought her breakfast. She took a single bite then put down her spoon. “This is stupid,” she said. “This is only going to make it last longer.” 

I knew she meant to starve herself to death. We’d talked about it. When I’d told her I could get in trouble for helping her end her life, she’d said, “We can’t have that.” This path wouldn’t leave me culpable. This wouldn’t require more than I had to give. 

I lifted her into a kitchen chair with wheels and rolled her back to the bed. There was no more reason to cajole her body to comply. 

Once she was settled, I asked, “Are you sure?”

She said, “Yes,”

I said, “Do you want to come live with us?” 

In a flicker, I saw her consider and dismiss the possibility of coming to live with me, my husband and her only grandchild. “No,” she said. “Not like this.” 

“I love you,” I said.

“I know,” she said.  

My mother was awake when I came down stairs on Wednesday morning, a week after that original call. Hospice was coming to enroll her. We’d get medicine to make her comfortable. 

“Good morning,” I said.

“I’m still here,” she said, thoroughly annoyed. She’d decided it was time to go and expected the universe to get on with it. 

Mostly she’d been sleeping, the oppressive heat an uncomfortable blessing. Every few hours she woke to remind me to review financial paperwork, check the safe, unlock the padlock on the side gate. I was taking care of her while she was taking care of me. We didn’t talk much. I laid with her patting her hair, rubbing her arm, holding her hand. 

I don’t think I’d do the same thing if I were in her position. But I’m not 83. I didn’t survive a war. I didn’t spend years caring for someone as they forgot our life together. I haven’t just lost my beloved companions. I’m not looking at a future of dependency in an uncertain world. 

A few weeks into the pandemic, when there was a run on toilet paper, my mother had texted me and my brother after a trip to the grocery store. “The shelves are bare,” she wrote. “It’s like the war.” I don’t know for sure but I suspect that Ralphs in Woodland Hills, California in 2020—no matter how empty the shelves were—was nothing like 1944 London. But how hard are you willing to fight when you don’t know what world will be there at the end of your battle?

It took a week for my mother to die. She and I were mostly alone. My brother Vince came a few hours each afternoon. He and his wife were juggling work and caring for her frail mother who lived with them and also had dementia. My husband offered to fly out but I didn’t want him to travel and I didn’t want him to leave or bring our daughter, who was already suffering enough with the school closures. 

The hospice nurse came a few times. They’d offered an aide but my mother dismissed the possibility. She pointed at me and said, “She’ll take care of everything.” 

And I did. I turned her every two hours. I swabbed her mouth. I diligently doled out the Ativan and morphine so she was comfortable and asleep like she’d asked. I was both her daughter and her nurse, saying things I’d never say to patients. “You’ll be with Pa soon.”

 I thought the pandemic would test me a different way, take me to a different frontline, back to the ICU where too many times I questioned how far we were willing to go in our battle against inevitable death. I want people to know it’s okay for them not to go to the hospital, to fight to die at home, to decide when they want to go. But this was different. This was my mother. 

Several times I thought the end was close but I was wrong. On what turned out to be the last night, I woke in the darkness and went to her. As I had each night, I laid with her, my hand on her back or side where I could feel her ribcage rise and fall. When my daughter was a baby, I sometimes put a hand on her the same way as she slept, to make sure she was alive. I know my mother did the same, terrified of losing me. 

I stayed about an hour waiting for the stillness to come but the long pauses always ended with the rattle of one more breath. Finally, I had to leave. I was exhausted. I couldn’t sleep there. I couldn’t wake up next to her dead.

When I got up the next morning, I could tell from the doorway that she was gone. I felt guilty that I hadn’t been there at the exact moment, like somehow I’d failed her. I called my brother, then went into the room. I washed her face and closed her mouth, posing her to make her look at peace. 

Then, I called the hospice. They asked, “Do you feel comfortable pronouncing her?” With the pandemic, they didn’t want to send the nurse back if they didn’t have to. They were asking if I was certain she was dead. I was, but I wasn’t comfortable pronouncing my mother. How could I be?

Vince had found a no-fuss cremation company—our parents never wanted fussing—and they arrived a few hours later. When we were little my mother made us go outside every morning to wave good-bye to our father as he left for work. It was a family rule. As they took my mother out of the house for the last time, my brother and I stood at the threshold. The wheeled stretcher wouldn’t fit up the steep old stairs so they carried her in a sling. We watched as they put her in their van and drove away. We didn’t wave but we waited a long time, held at the invisible line between home and not home. The line that had become my own frontline. 

Originally published in Bellevue Literary Review 2023 – Issue 44

2 Comments. Leave new

  • Susan Roemer-Schmitt
    February 10, 2024 11:10 pm

    Dear D.
    I just finished reading your essay on your mother’s death. What a lot to go through after having already lost your father. My father died of a stroke and dementia also but he was nowhere near to the degree that your father was. However, it was bad enough as I have no siblings but luckily have a wonderful husband who got me through that time.

    In regards to your wonderful book, I told two more friends about it yesterday. The person I could not stand in the book was the self righteous sister. I also didn’t care too much for the partner of the main character. I can’t imagine being with someone who is so irresponsible and still living in a hippie environment as a grown man.

    As I mentioned previously in my FB comment, I love nurses and in my next life I’m going to be a hospice nurse. I found out way too late in this life what I really wanted to do and that’s it. Not sure if you’ve heard of comfort care homes. They are mainly on the East Coast of the U.S. They consist of a two person house that’s run by volunteers and a couple of nurses. Volunteers do all the work of a certified aid. I volunteered at one of these places for five years. It was the best thing I’ve ever done. Now I’m living in the southwest, and of course they have not heard of these.

    You mentioned that you felt guilty because you weren’t with your mother when she died. I previously felt the same way about my mother‘s death until I started volunteering at hospice and realized that people pick the time of their death. Case in point – one night as I arrived at hospice, I walked into this room of the woman who was the patient and she asked me if her sons had left. I told her they had both just left. I passed them on the way in – she died within the next 5 minutes, she was waiting for them to leave. That helped me a lot with my guilt of not being there for my mother.

    Again, congratulations on writing such a heartfelt page turner.

    Susan Schmitt

    Reply
    • Hi Susan,
      Thanks so much for your comment. It sounds like you went through a lot with your parents’ passing. Dementia is a such a terrible thing for people to go through. I love the idea of comfort care homes. With the large, aging population of baby-boomers, our society is going to have to come up with better ways for caring for people both at end of life and for those with dementia. Otherwise we’ll break our already challenged healthcare system.

      I appreciate your comment about my mom’s passing. I said virtually the exact same thing to my mom when my dad died. We were with him everyday for most of the day and he choose to die about 30 minutes after we left one evening to get my mom something to eat. She was devastated but I told her, “He waited until you were gone.” It did really help. With my mother, I had been there 24/7 for two weeks taking care of her and still I felt like I’d failed her somehow. I know that’s not true but I still felt it. Our brains put such burdens on us.

      Thank you for telling people about my book. That’s the best support an author can get.

      Reply

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