By Laurie Floyd
The thrump of my mother’s heartbeat was likely the first thing I heard when my embryonic ears began functioning. I’m of an age now when I begin to worriedly monitor the internal sounds of my own heart but if I am at all like my mother who lived to age 88, my heart will continue its essential pumping for at least another quarter century.
At spring’s end in 2012, I moved into my mother’s hospice room and stayed for the final twelve days of her life. It was a pleasant room with a view of a huge old tree we watched leaf out over the three months she was there, finally getting the more complex care she needed in the final stage of lung cancer. One thing that eased this last move was that my five siblings and I were not wrenching her from a long-lived family home. Luckily, a Depression-era child, she was never tied to things, never wanting us to spend our money on extras she did not need, casting off excess as she moved from the Midwest, down to Florida, then after losing my dad, back up north. Her late life involved five moves; none were forced and each lightened her load.
Now all her things were down to a bare minimum in this spare private room, but we made sure her radio was among them, and the classical station provided the same soundtrack she’d listened to for years. We set a bottle of white wine in view on the counter opposite her bed, and just seeing it there satisfied her enough, an evening quaff now just a familiar icon. When I arrived mid-June and told her I was staying, she asked how long, and I said as long as it takes. She just nodded. I had to keep the door mostly closed as neighboring rooms were blasting the most awful primetime TV shows at full volume. I turned up the radio to comfort her instead. I was so glad I was with her then – to control that cacophony as she must have had some perceptual challenges then.
Between the supersonic flush of the toilet reverberating off the tile in her bathroom to the screeching of the reclining vinyl chair I dubbed my ‘lazy bed,’ I was regularly trying to muffle sounds so as not to startle her out of much needed relief when the meds finally did kick in.
Beside her bed at night, I lay monitoring, listening as her breathing lapsed, then resumed, dozing and awakening as the caregivers came for the turnings and checks, thanking them each time, ever-present interloper that I was.
Sometimes she got confused and would ask us, “Who are all those young girls, coming and going?” of the caregivers who came to check on her, but other times she’d joke, “Do I have any choice?” about the vitals checks, and eventually I could tell she was even accepting her impending death more easily, now that her symptoms were under control. She seemed to relax, and though she’d always say “I’m fine,” before this, it simply hadn’t been true for months. Her whole demeanor improved as she found relief, and so we, too, were relieved.
Then as the days progressed, my mother’s pain relief needs progressively would not fit the dosage schedule, especially in those dark nights. She was no longer communicative, and there had been regular incidents where it appeared she was close to death, but her heart would then rally. We were on a slow roller coaster that struggled through the lowering valleys. At this point, I was referring constantly to a booklet on the signs of imminent death, and more symptoms seemed to be matching up. I was hoping for the end to it all as the rallies were tough going, and although I felt reconciled with this, it did concern me that I not seem calloused to others, as I asked the nurses about symptoms I was noticing. No, not wanting to hasten my mother’s leaving, but yes, wanting her to be free of the late-night turnings which caused deep semi-conscious groans, the grimaces of the half-hour before the next drug dose took effect, from other unexpressed discomforts I had to imagine were underlying everything in this end-stage. When the case manager told me the drug used to facilitate her breathing was also possibly prodding her heart beyond its natural strengths and artificially pushing her back from the brink, we discussed it not being necessary any longer, as she was no longer in a fully conscious state. That evening I asked that it not be administered and the nurse, after my insistence, did comply. My mother began to visibly fade from then on.
This is what it looked like: generally, she became more drawn through the face, her hands remained elegant— even more so in their weakness as I held them—cool as they were. They darkened with a bluish cast that grew up her arms, the same with her feet and ankles, which the hospice nurses dutifully monitored. Her breathing became increasingly irregular, and although she appeared to be sound asleep, there was a more profound stillness about her. For the whole twelve days of my stay I watched her like a tense mom with a first-born, unfamiliar and trying to learn what each wince, sigh, or startle could mean.
The last day, six to eight of us were gathered at any given time in her small room and she was so still that no one felt comfortable leaving, as we all sensed her death was close. In the habit of our large clan, my siblings were joking and their spouses were laughing along, just carrying on as usual, in that unusual realm, buoying each other up. It was too much, too noisy for me after a while, so I just sat by my mom and watched her. My hospice stay had made me overwrought, I knew, so I just disengaged rather than rudely shush everyone. Finally, by ten that evening, they all headed home, and the quiet was palpable and a balm. I made sure my mother was comfortable and read my book – what was I reading? I don’t remember any longer – I was skimming and re-skimming the whole stay anyway. Then her breathing caught, and I leaned over her to watch it catch twice more, followed by a long full sigh when her last breath left her body. I waited a few moments and saw she was completely still. I kissed her cheek and said I loved her. I think I said goodbye even though she didn’t like that word. Years of raising adventurous children, she didn’t want to say that final word as we flew off to parts unknown, but now it was time. With no more urgency, I rang for the nurse.
The beat of my mother’s heart was the last thing the nurse monitored, as it faded slowly into its final stillness that last day of June. I watched her listen and then nod. I imagined the waning pulse of that strong heart I knew first and longest, and then my vigil was over, having attained its purpose. My mother was not alone in the end and no matter how hard, there was nowhere else I’d rather have been.