This is Getting Old (5 page)

Sitting in a chair, I feel gratitude for the practice. I enjoy sitting upright. I enjoy my breathing. I am not guarding against the onset of pain and I am not fighting with myself for being a sissy. I am not making bargains with myself the whole time, such as:
ten more breaths and then I will allow myself to move
. I check my posture: I feel my feet firmly planted on the floor, I feel the uprightness of my spine, I feel my sitting bones on the seat of the chair. I am close to the others in the room; whether they are on the floor or in chairs, we are practicing together, held by the same silence.

What's next? Perhaps I'll go on to hammock practice, or sitting zazen in a chaise longue, poolside. I'll let you know how that goes when I get there.

The Breathing Tube

On a Sunday afternoon in late September, my eighty-four-year-old mother, Alice, went out for a drive with an elderly man she jokingly called her “boyfriend,” who took her places after she gave up driving. Going north on Chicago's Outer Drive, they came over a rise and crashed into a stalled car in the middle of the road
.

THE FIRST WEEK

M
Y MOTHER
'
S SWOLLEN HANDS
stayed where they lay by her sides when I leaned down to kiss her at the hospital. Her breath smelled rotten. Worst of all was the breathing tube they had plunged down her throat, a thing I knew she never wanted. It looked huge, this blue plastic pipe that snaked out of a machine and into her perpetually forced-open mouth. She couldn't speak because of it, but she looked at me with her open eye and blinked in greeting. The other eye, the droopy-lidded one, was now, inexplicably, all the way shut. Her blue-and-white hospital nightgown had slipped off one shoulder, exposing part of her breast, as if she had been running away and her pursuer had been pulling at her clothes. I pulled it up and tucked it back around her shoulder.

Dr. M. talked with me and my three siblings—all of us having flown in from far away—in the corridor of the ICU. Red-haired, forty-something, he spoke in an uninflected voice as if to bring calm to a situation that wasn't calm at all. It was he who had taken out our mother's ruptured spleen when she arrived in the ambulance. He said that when she came into the emergency room, she had been not only conscious but irritable, and we took this to be a good sign. He explained that she had broken some ribs, fractured her collarbone and a bone in her neck, and badly bruised one lung. He said that if she were young and healthy she'd be able to recover from everything easily, but because of her age and the fact that her lungs were already compromised by emphysema, she had a struggle ahead.

Her friend, the driver, had been shaken but not seriously injured, and was released from the hospital wearing a neck brace.

“We're aiming to wean her off the ventilator as soon as we can,” said Dr. M., “but her bruised lung will have to do some healing first.”

It was clear to us she wanted to be unhooked. Her wrists were tethered to the bed rails to keep her from pulling out the breathing tube, but she kept raising an agitated hand in the direction of her mouth. A plastic clamp was wrapped around her face to hold the tube in place; it was tight across her upper lip, below her nose, and the pink flesh of her lip swelled out beneath it like a bubble. Whether she was awake or asleep, she always had one eye open and one eye closed, as if in simultaneous commitment to the dream world and the world of the ICU. She was heavily sedated, but when the nurse told her to wiggle her toes, she wiggled her toes.

We stood around the bed and sang, afraid to stop. We didn't know what to do if we weren't singing. We sang the songs our father used to sing, when we were children. All the songs seemed to be about death, but my mother wasn't paying attention to the
words. Her heart rate slowed as we sang: “You are lost and gone forever, dreadful sorry, Clementine.”

“Would you like me to rub your feet?” I asked when the song was over.

She nodded and I took one foot in both hands and stroked the smooth skin on the top, feeling my way along the bones to her toes. I could tell by the way she gave me the weight of her foot that it she liked it. I knew the look of her feet, of course, with their perfectly graduated toes, but I had never formed the thought:
My mother has beautiful feet
. Nor had I ever rubbed her feet before. My mother had had to put herself in the ICU to get me to come as close to her as she had always wanted.

My mother had written a living will, stating that she didn't wish life support to be continued if she was stuck in a comatose state, and she had sent us copies years before. A few days after the accident, we found another paper in her apartment—an undated note in our mother's handwriting saying, “Do NOT put a tube down my throat to keep me alive.” The pressure of the pen had a commanding tone; I could hear my mother's voice. Upset, we showed the note to Dr. M.

“This is different,” he said. “She was in a car accident—it's not as if we're keeping her alive in a vegetative state. I understand your concern, but she's getting better!”

“How long can a person be on a ventilator?” we asked.

“You don't want to go much more than two weeks,” he said. “At that point we would recommend a tracheotomy if the patient still needs breathing support. But I don't foresee that happening in your mother's case. I hope to wean her off the ventilator in a few days.”

OK, we could wait “a few days.”

We slept, or tried to sleep, in our mother's apartment at the other end of the city, and we spent long days at the hospital. We took turns staying with her, watching the monitors, calling the nurses to raise or lower the bed, or to brush her mouth with a wet swab,
surrendering ourselves to her care with an unfamiliar abandon. This room that was cluttered with medical equipment was miraculously swept clean of all our habitual impediments to love; I wasn't worried, for example, about what she thought of my hair.

“That clamp looks so tight on her upper lip,” I said to the nurse.

“It has to be tight,” the nurse said, “to keep her from pulling it out.”

My mother was trying to communicate something: she was waving her arms, she leaned forward and shook her head in frustration, then fell back on the pillow, exhausted. A nurse brought a felt-tipped pen and a whiteboard, and we wrapped her fingers around the pen, but the marks she made were too wobbly to read, and the pen soon fell from her hand. Next we gave her a board with the alphabet on it, and her hand moved across the smooth surface like the pointer on a Ouija board, but it was hard to tell when she was stopping over a letter and when she was just on her way to another letter. We kept guessing the wrong letters, until she pushed away the letter board with a frustrated shrug.

We supposed she was trying to say something about the breathing tube. “We know you hate this tube, Mom, but we promise it's going to come out, and then you'll be able to say whatever you want!”

A few more days went by—it had been a week now—and we were told she had pneumonia, probably because of the breathing tube, and she was put on massive doses of antibiotics. This was a big bump in the road. They wouldn't be able to take the tube out until she got better from the pneumonia.

THE SECOND WEEK

A respiratory therapist came a couple of times a day to suction her out—a dreaded procedure. He pushed a tube the width of a straw down inside the wider ventilator tube, working it down,
inch by inch, into my mother's lungs, as her left eye opened wider and wider in alarm, and even the heavy right lid lifted enough to show a slit of eyeball. I gave her my hand, and she squeezed it. Then came the bad part, when the RT pulled the little tube back out, creating suction. There was a rasping noise for a few seconds, like the sound a straw makes at the bottom of a milkshake, and my mother shuddered, and we watched the yellow phlegm come up through the translucent plastic tubing.

“Thank you, Alice,” said the RT cheerfully.

My mother reached her sausage fingers up, trailing a wire that was clamped to her forefinger, and her hand came within inches of the breathing tube before it was stopped by the wrist restraint.

My brother and I took the elevator down to the hospital café for a break. There was no getting out of this situation—wherever I went I was always in it. Still, it was a relief to sit in the café downstairs, surrounded by the hum of strangers' voices and the clacking of food trays. “I feel like I've lived in this hospital all my life,” I said.

“Yes, it seems like time has stopped,” my brother said. The skin of his tired face looked like soft flannel.

“Well, she's going to get better or she's going to get worse,” I said. This was an oddly comforting thought.

One morning when we came into the room, the breathing tube was attached with tape to our mother's chin, and there was a bandage on her upper lip. The nurse said, “I have bad news—the clamp made a hole in her lip. I'm terribly sorry. I've called down to plastic surgery—someone will be up later to look at her—I don't think it will seriously disfigure her.” She lifted the bandage to show us a hole in our mother's lip the size of a dime—a window with a bloody frame, through which I could see gums and teeth. “Remember,” the nurse said, “she's been heavily sedated, so I doubt it feels as bad as it looks.”

On the ninth morning, a Tuesday, she looked paler and more remote than ever. Discouraged, we told Dr. M. we didn't know how much longer we could put her through this. “We're thinking about asking you to take that tube out now, whether she's ready or not.”

He took us seriously. “I understand that you want to honor Alice's wishes, and I respect that. I won't stand in the way of whatever you decide. But she still has a good chance.” He straightened up and spoke with a burst of fresh energy. “Give me until Friday! I'm making it my goal to get her off the ventilator by Friday.”

Encouraged by the vigor of his new vow, we agreed to hang in there for three more days.

In the meantime, with Dr. M.'s support, we had an exploratory meeting with Dr. Z. from palliative care, in case the time came that we decided to withdraw life support. He was tall and thin, an angel of death in a white coat, and he described some possible scenarios in answer to our questions, but it was hard to absorb the information—it was so hypothetical. “Feel free to call on me again,” he said as we shook hands all around. “I'm here to help you with your decisions, not to persuade you one way or the other.”

As our mother's spirits went up and down, so did ours. We were adults in our fifties and sixties, parents ourselves, and yet our moods depended on whether our mother blinked at us when we spoke to her. I brought my laptop into the room and tried to attend to some business, but I couldn't concentrate on anything in the unreal world beyond the hospital. So I worked on crocheting a shawl for my mother—zigzag blue and green stripes, colors she liked.

Friday came and she still had a tube down her throat. She stared unblinking when I came into the room, and she didn't even wiggle her toes when the nurse asked her to. She still had
pneumonia, and the numbers on the monitor had not improved. We didn't see Dr. M. all morning. This was clearly not the day she'd be liberated from the ventilator.

The four of us met in a windowless cubicle down the corridor called the Family Conference Room. “This is exactly what she never wanted,” my sister said.

“He keeps saying just a few more days,” my other sister said, “and then a few more days go by and she's worse, and then he says give me just a few more days.”

My brother said, “She's
tied
to the bed—you know what I mean?” His voice broke. “We're her children, and we're
choosing
to put her through this.”

Huddled together in that stuffy chamber, exhausted beyond all reason, we agreed it was time to let her go. We left word at the nurses' station that we wanted to talk to Dr. M.

We telephoned our children—her grandchildren. “We have to let her go,” we sang, like sailors preparing to loose the mooring line from its bow cleat and drop it into the salty water.

My older son, the first grandchild, far away in Texas, said, “I thought she was getting
better
. Yesterday you said she was getting better.” I was curled up on the floor under the pay phone in the waiting room.

“We thought she was,” I said, “but today she's worse. If you could see her, all full of tubes, with her hands tied, just staring out with one eye open . . . She asked us not to put a tube down her throat. She's counting on us.”

“But maybe the antibiotics just need more time to cure the pneumonia,” he said.

“We're going to ask the doctor about that,” I promised him.

Dr. M. came around at last, and we went out into the corridor to talk. When we told him we thought it was time to let her go, he seemed surprised. “Why today?” he asked.