Holding the Net

by Melanie P. Merriman

  “Okay. I’ll bring you some dinner. What do you want?” Barbara got up to leave.

  “Just a sandwich, and maybe a cookie.”

  Around 9:00 p.m., Barbara dropped off a paper bag filled with goodies from her kitchen, along with a pillow and blanket. She blew a kiss to Mom so as not to disturb her, and hugged me.

  “I’m so glad you’re here,” she said.

  “Me, too.”

  I spread out my picnic on Mom’s small round coffee table—a ham sandwich with mayonnaise and lettuce on Pepperidge Farm white bread, potato chips, sliced apple, and several cookies. It was just like the lunches Mom had packed for us in elementary school—with one difference. Instead of a carton of milk, Barbara had included a Manhattan in a mason jar, with a separate baggie of ice. After an appetizer of tears and Kleenex in the bathroom, I sat down to supper.

  Mom slept quietly as I ate, read my book, and then turned out the light to doze a bit. At 11:00 p.m., an aide came in to check on her, and before I could intervene, she woke Mom to see if she needed a dry Pull-up. I couldn’t help being angry.

  “You have no idea what it took to get her to sleep,” I said, and then apologized. “It’s not your fault. You didn’t know. But she’s not doing very well.”

  “I’m so sorry,” she said. And, though we had never met, she hugged me.

  Mom was now awake, so I offered a wet sponge. She took only the tip into her mouth. As I used the sponge to moisten her lips and tongue, I noticed that half of the Ativan was still undissolved. I spread the now-mushy tablet along her tongue so it would be absorbed, then sat close to the bed, holding her hand and stroking her arm until she fell asleep again.

  I pulled Mom’s two armchairs close together with the seats facing, to make a very short bed. I got as comfortable as I could with the pillow and blanket, and after a while, I fell asleep.

  That was Thursday.

  I was already half out of my chair-bed at around 2:00 a.m. to check on her when I realized Mom was awake. I moistened her lips and mouth, but she didn’t suck on the pink sponge. Mom had stopped eating two days earlier. Now she was finished with drinking.

  I got the Seasons staff to give her a dose of morphine and she slept again, but fitfully. She’d half-wake—continuing, though less frequently, to moan or call for help, and draw up her knees. It seemed as if she was working hard at something. I could almost imagine her swimming across a river or crossing a burning desert, from life to death. I wanted to pick her up and carry her to safety. I told her I loved her. I rocked her, and said that Barbara and I would be all right without her.

  Mom had another dose of morphine at 4:00 a.m., but she never seemed to relax. Did she need more Ativan? At 5:30, I called the hospice and asked to speak with the on-call nurse. Leona called me back, and I took the phone into the bathroom so as not to disturb Mom.

  “Can you come?” I pleaded. “Her breathing seems louder and raspier. But even if she doesn’t need you, I think I do.” I was too exhausted to cry.

  “I just need to get dressed,” she said. “Give me thirty minutes,” Barbara arrived before 6:00 a.m. with coffee in hand. Leona came in a few minutes later.

  “She’s refusing even the mouth swabs,” I told them.

  Leona listened to Mom’s chest. She checked to make sure Mom was dry, and let us know that Mom probably would not make any more urine, especially as she had stopped drinking.

  “Her breathing is a little more liquid, but still sounds pretty good,” she said. “I’ll give her the next dose of morphine, and Tammy will come by later.”

  When Mom fell asleep, Barbara sent me home to get some rest.

  Back at the house, I fixed myself an egg and toast, and felt better after I ate. I tried to work on some email, but nothing made sense. I took a short nap and a long shower. Phil called from work to say he would bring home Chinese take-out for dinner. I named him “Number-One Assistant” to Saint Barbara.

  When I got back to Seasons, Mom was still sleeping. Barbara and I stayed with her throughout the morning, each of us slipping out now and then to take a break.

  Around noon, Dena arrived, and Barbara went out to get lunch for the three of us. We chatted quietly, nibbling at our bagel sandwiches until Mom woke up. She had slept more than six hours, which was good, but now she seemed to be in pain, which was bad. We should have awakened her to give her morphine, but as she had been sleeping so quietly, we assumed she was comfortable. Still, I knew better from my years in hospice work. Round-the-clock medicines must be taken as prescribed to keep the blood level up. Daughter Melanie needed to channel Dr. Melanie more often.

  Fifteen minutes or so after a dose of morphine and an Ativan on her tongue, Mom calmed down and slept quietly off and on the rest of the day. Letty was on duty at Seasons, and managed to give Mom the morphine regularly without even waking her.

  Dena left at 3:30. I walked her to the car and gave her a big hug. The next day, Saturday, was her day off.

  “Be sure to call me if anything happens,” she said.

  “You know I will.”

  Barbara and I sat by Mom’s bed, reading or watching her sleep.

  “If you could just give her the pill, wouldn’t you do it?” Barbara asked me.

  I thought about it. Wasn’t that what I had meant when I’d said I wanted to carry Mom to safety? Hadn’t I wanted to end it for her, quickly and painlessly? I closed my eyes.

  No, I thought, I wouldn’t. Whatever was happening felt unexpectedly natural to me, even sacred—something to behold without judgment or interference.

  “I suppose so,” I lied.

  Barbara wasn’t wrong to want to spare Mom any further, pointless suffering. I’d always thought myself capable of “pulling the plug,” but at that moment, I was relieved that the decision was not in my hands.

  Tammy showed up at 5:30 p.m. She checked Mom’s blood pressure and pulse, straightened the sheets, and gently changed Mom’s position, but only slightly.

  “Make sure she gets the morphine every hour, even if she is sleeping. She will need it now. We don’t want her to suffer,” Tammy told us. “I’m on call tonight, so I’ll come back at 9:30 to see how she is doing.”

  Barbara and I took turns going to the house to have some dinner. Barbara changed into comfy clothes, and gathered up her toothbrush and pillow to spend the night.

  At 9:30, we reconvened with Tammy. Mom was sleeping. We were keeping her lips moist with the swabs and ChapStick. She had not spoken all day. Her breathing was shallow and raspy, but regular.

  “I think she could use a little more Ativan, but her prescription has run out, and I’m not sure how soon we can get some more,” Tammy told us.

  “Do you want an Ativan?” Barbara asked.

  “Do you have one?” Tammy asked.

  “I do,” said Barbara, pulling a pillbox out of her purse.

  “Are you okay with this?” I asked Tammy.

  “I am if you are,” she replied.

  “We are,” Barbara and I said, looking at each other.

  Tammy checked the dose and said it would be best to give it to Mom rectally, as she had so little saliva. Barbara and I stepped out to give Mom privacy. Then Tammy called us back into the room. We helped her settle Mom into a more comfortable position.

  “I don’t think she needs any more morphine. I think she will pass easily now, on her own,” Tammy said. “I think it will be sometime tonight, or tomorrow.”

  That was Friday.

  After Tammy left, Barbara and I talked quietly.

  “I don’t want to go to the house,” I said.

  “But you’re exhausted,” Barbara said.

  “I am, but I know I won’t sleep.”

  “At least go stretch out on the couch in the parlor,” Barbara said.

  I took the pillow Barbara had brought the night before, and Mom’s afghan. The parlor was at the front of the Homeplace building. The furniture was comfortable, and the room smelled disinfectant-clean. Light spilled in from the main co
rridor, but the couch was in a darkened corner. I closed my eyes, not expecting to sleep, then jerked awake as the door chime bonged, and bonged again. I watched the day shift leave, and the night shift arrive. One of them asked me if I was all right.

  Then I slept again, until I felt a hand on my shoulder, gently waking me. Barbara sat on the coffee table, looking at me.

  “It’s over,” she said. “It was quiet. She just stopped breathing.”

  Silent, I bundled up the afghan and pillow as we both stood and walked toward the hallway. I touched Barbara’s arm and pulled her into a hug.

  My watch said 1:45 A.M.

  It was Saturday, April 10, 2010.

  Chapter 25

  THE LOGISTICS WERE SIMPLE. Barbara called the hospice, and Tammy came over right away. The Seasons night nurse called the funeral home—the one Barbara had identified, the one that would honor Mom’s longstanding contract with the National Cremation Society.

  It turns out that funeral homes have a man available in the middle of the night to carry away your loved one. He will arrive as if he has just stepped from behind a desk, dressed in a suit and tie, shoes shined. He will not look tired. He will not say much, but his few words will reach you on palpable waves of compassion. Perhaps, like me, you will wonder how he can seem to care so much about one more person, one more body, at 2:30 in the morning. Maybe he is simply adept at reflecting grief.

  We were home by 3:00 a.m. Barbara poured herself a shot of Maker’s Mark, and I sipped some red wine. We collapsed on the sofa in the family room.

  “It’s so weird,” I said.

  “I know,” Barbara replied.

  “I mean, she’s gone, but where did she go?”

  “It makes me wish I believed in the kind of heaven where she could be reunited with Daddy, and with her mother. It makes me wish she believed in it.”

  “I guess I don’t think she’s anywhere, but maybe everywhere—like a little bit in you, and in me, and in everyone she’s known and touched in some way.”

  We sipped our drinks. I leaned my head against the back of the couch and closed my eyes.

  “I don’t know if I’ll sleep, but I need to lie down,” I said.

  Barbara slid over and hugged me.

  “Sleep as long as you can. We’ll figure everything out tomorrow,” she said.

  We took the rest of Saturday off. We slept late. After I called Klein, Phil drove us to Beaufort just to get away from New Bern. We had lunch by the harbor, then wandered the docks. Barbara called Dena. I called mom’s best friend Lenore, who agreed to let Ginny know, and Susan, the manager of Gulf Harbors in New Port Richey. I remember bright, hot sunshine, and feeling dull and gray by comparison. My eyes hurt.

  It took only a day and a half to clean out Mom’s room. Some of her clothes went into bags for Goodwill, some we threw away, and some we left for the Seasons staff. I packed up all the family heir-looms from the étagère for transport to Barbara’s house, where we would divide them up. After clearing it with Letty, we decided to leave most of the furniture, which she would offer to the staff.

  Dena joined us on Monday morning. We gave her Mom’s garnet ring and matching earrings, and one of the bird figurines from the étagère. We told her she was welcome to take any of the furniture she wanted. We let her give us one dollar, so if anyone asked, we could say she had paid for the items.

  “What are you doing with that?” Dena pointed to the portrait of Barbara and me as children in our poufy dresses.

  “Well, neither of us wants it,” I said, “so I guess we’ll just get rid of it.”

  “Could I take it?” Dena asked.

  Barbara and I looked at each other. “Uh, sure,” Barbara stammered.

  “I think it’s pretty, and it will remind me of you two every time I see it,” Dena said.

  We helped her load the two-foot-square picture and a small table into her car, then hugged her and said our goodbyes.

  “I’m gonna write you,” Dena called.

  “I’ll write back,” I said.

  “What in the world are her friends going to think when they see that portrait hanging in Dena’s house?” Barbara chuckled as we walked in from the parking lot.

  “Gotta love her!” I said.

  On Monday afternoon, Barbara and I met with the funeral director. We declined to have Mom’s cremains made into pendants or dolphin statues. Mom had not left instructions about where to scatter her ashes, but she had scattered Daddy around their New Port Richey condo. I thought she might like to join him there. Barbara and I agreed to have Mom’s cremains shipped to me so I could take her “home.”

  Mom’s estate had been in the best possible shape when she died. All of her assets were in either the joint bank account she had shared with Barbara, or the revocable trust that named Barbara and me as successor trustees. That meant we could cover all her bills by writing checks, and then distribute the remaining funds when we were ready. Even so, it would be several months before we worked out all the details of how to close the trust and file taxes for 2010.

  Mom’s will contained instructions for certain bequests to friends—Lenore, Ginny, and Susan—and she had left handwritten notecards for each of them. Though there was no obligation to make these bequests (the trust took precedence over the will), Barbara and I knew why Mom had named these people in her will. She wanted them to celebrate their treasured friendships with her. Before I left New Bern, we wrote the checks and sent the cards with our cover note.

  Several days after my return to Miami, I stopped at my neighborhood Starbucks and ordered a cappuccino to go. While I waited for the barista to make the drink, my friend Kim called to see how I was doing.

  “I’m at Starbucks, 95th Street,” I said.

  “I’ll walk the dog over and meet you.” Kim lived just six blocks away.

  I found a comfortable chair in the corner, and sat down to wait. I never go to the coffee shop without something to do. Usually, I have my computer and a work project. I like to get out of the house, and I find it easier to concentrate when surrounded by quiet conversations that don’t concern me. Sometimes, I bring a book. That day, I had nothing to occupy my mind while Kim gathered up the dog and walked those six blocks.

  I rummaged in my purse for something to read. I found a grocery list, a bunch of receipts from the Harris Teeter in New Bern, and a copy of Mom’s living will. More than a year earlier, I had reviewed the legal document, then put it in my purse. I’d carried it with me all that time without ever looking at it—two pages bearing the letterhead for the Law Offices of H. Curtis Skipper, P.A., New Port Richey, Florida. The memo was addressed in all capital letters:

  TO MY FAMILY, MY PHYSICIAN, MY ATTORNEY, MY CLERGYMAN:

  TO ANY MEDICAL FACILITY IN WHOSE CARE I HAPPEN TO BE:

  TO ANY INDIVIDUAL WHO MAY BECOME RESPONSIBE

  FOR MY HEALTH, WELFARE, OR FINANICAL AFFAIRS.

  The first page included a declaration—Death is as much a reality as birth, growth, maturity, and old age—and her wishes for the end of her life: her desire to avoid the indignities of deterioration, dependence, and hopeless pain; her desire that her death not be artificially prolonged, and that she be permitted to die naturally, with medications to provide comfort; her wish not to have artificial nutrition or hydration; her acceptance of the consequences of refusing medical treatment when it was determined she was terminally ill; her hope that those who cared for her would feel legally and morally bound to fulfill her stated wishes; and her intention, through the living will, to relieve us from making these difficult decisions, and to place that responsibility on herself.

  “I just don’t want to be a burden.” She had said it so many times, in so many ways. This document laid out the strength of her convictions.

  Reading that living will, I was flooded with relief. We had honored her wishes. We had found compassionate caregivers who had spared Mom from being completely dependent on us—perhaps her biggest fear. We had let her go naturally, without tubes or
machines. I wondered, is this why I came to hospice work? To prepare me for this death?

  Still, as sure as I was that Mom had died on her own terms, there were aspects of the final years of her life that I’ll never be sure about. Did we wait too long to move her to North Carolina? If we had forced her into assisted living, or to have a caregiver at night, could we have prevented the big fall that precipitated her decline—or would those changes have dampened her spirit, which could have been as devastating as the fall? Did the pacemaker surgery, meant to improve her quality of life, actually diminish it by landing her in rehab?

  I had been haunted by these decisions at the time they were made. I thought writing about it all would dispel the ghosts. Instead, I have come to think that doubt is the nature of this beast. We can never be certain what constitutes the “best” option when caring for aging parents. We can only try to discern what seems right at the moment. Barbara and I always erred on the side of preserving Mom’s independence, knowing how fiercely she claimed it. Had that been best for her? It was never easy for us.

  What puzzles me most is why, over and over again, Mom chose Barbara. She chose to move to New Bern, not Miami. She chose to die when she was alone with Barbara. And, on the second page of her advance directive, she designated Barbara as her primary healthcare surrogate, with me as back-up if Barbara was “unwilling or unable.”

  The language was legalese—boilerplate. Mom never doubted whether she could count on Barbara. And Barbara, who perhaps never thought she would be chosen, who never expected to be “the one,” who was perhaps more able than willing, had stepped up in every way. When I overreacted out of emotion, Barbara could be more dispassionate, and therefore more effective.

  I’ll never know whether Mom thought it through, whether she had a plan. I do know, however, how it turned out. She spared me the enormous burden of her day-to-day care—a job I would have taken on without question, and with such fervor that I would have risked my job, my health, and my marriage. Mom and I had been close for years; we were sympatico. She did what she thought was best for me. She protected me.