Not to seem morbid or hardhearted, we’d been waiting for our mother to die. Now in her 90s, she said she was ready to go.
Roller-coaster years of injuries and illnesses, aided and abetted by dementia, extended her demise, which started with a fall. Shoeless, she missed a tread on her steep stairs and broke her ankle. (Who can remember which one, left or right. There were so many more breaks to come.)
The ankle was fractured and surgery needed. Like a jigsaw puzzle, the broken bones were pieced back together in open reduction. And the bones held together in the correct position with metal plate and screws, in a procedure called internal fixation. If one was looking for an indicator, you’d find it in the medical terms alone. The event reduced my mother’s condition from healthy to unhealthy. And her inner fixation, hinting at loss of cogency, began.
She recovered, but not enough to go back to the same apartment. Still semi-sufficient, she found another apartment – one-story with a breezeway from the garage, guaranteeing safe passage to and from in rain, ice and snow. She was able to go back to her church ladies circle, take a potluck dish to the semi-monthly luncheons, and get up early for the garage sales on Friday mornings.
My sister, two brothers and I began visiting more. Driving in or flying in to check up on her, which made her feel cared for and happy. We were briefly relieved that she could still manage on her own. Then, without much forewarning, she contracted pneumococcal pneumonia. Weeks later, she still didn’t feel like herself. Our visits increased, our concerns intensified.
On one of my last visits, we went for a drive in the country to see the fall colors and the migrating birds. I missed the elusive Sandhill Cranes, but not my mother’s first TIA. I can still see the confusion in her eyes as she heard the gibberish, amplified by her hearing aids, coming out of her mouth.
Her doctor, who she adored and we despised, told her it was time to give up the car and move to senior care. And so, the slippery slope loomed ahead. Independent living where she went from upright walking to hunching over a walker to push and roll. Norovirus and lock down. Disorientation that made her path to the dining room a maze.
The next move was to assisted living to up the amount of care, limit her footprint, and reduce distractions. And, the last coup d’etat, a stroll in the dark that ended with a fall and broken femur. Another surgery, another hospitalization, more trauma. All the signs of Sundowners Syndrome: agitation, confusion, anxiety, disorientation, mood swings and sadness. Sadness being the hardest of all for us as she would say, “Something’s just not right with me.”
We followed the professional advice as closely as possible. We validated, reassured, distracted. We let her know that everything would be alright even when uncertainty was the only thing we knew. We validated her feelings when they didn’t make sense to us as she she expressed them urgently and repeatedly. We diverted her attention to something she enjoyed, like Bingo in the game room or a drive for ice cream that would make her cough and hack. We’d laugh at her poorly told jokes and smile at her attempts at humor. And, even though we weren’t a physically affectionate family, we’d kiss her hello and good-bye or upon request.
A year before she died, my sister and I went through a grueling interview process to admit our mother into hospice care. She needed but adamantly didn’t want the visiting nurses, the social worker, the spiritual care for end of life. So, despite the heightened swings of anxiety and depression, she rallied for another six months. She’d be so excited to see each one of us. “This is my daughter from Chicago,” she’d say when introducing me to nurses and aides, who recognized me from a distance as I walked down the hall to her room. She’d quiz me about my family, my work, my well-being, and then, reassured that all was well, her mind would wander off. But she never forgot my name – until the last visit. And, even then, she was sly enough to hide the slip up.
When it became obvious she was fading rapidly, hospice sounded the alert, “Come now! Without delay.” By strange circumstances, all four of us were able to be by her bedside for the last three days and two nights of her life. She knew subconsciously that we were present. Half-heartedly resisting death, she hung on longer than anyone expected. Calm for the first time in memory as we massaged her cold mottled limbs and whispered in her ear, “We’ll miss you, mom.”