The Wheel of Life and Death

Its been a rough few weeks lately. The kids went to New York for the holidays as it wasn't my year to have them, so I was working hard to fight off some alone for the holiday blues, compounded by the fact that I was quite broke from moving and had no money for gifts for them anyhow. Well, on Christmas day I recieved a phone call from Mass General Hospital informing me that my mother had been run over by a car while crossing the street in her wheelchair. She was in the ICU on a vent. The social worker placing the call had no more details than that, but the vent in and of itself meant it was very serious indeed. An hour later the neurosurgeon phoned, informing me that she had sustained bilateral leg fractures and a huge subdural hematoma. Her intercranial pressure was an astronomical 97 and if her brain hadn't yet herniated, it soon would. In short, her injuries were not survivable. My mother has not been well for years now, the result of years of self neglect secondary to schizophrenia--she's been hit by a car before, also while crossing the street, although that time she was fortunate and just injured her right leg. The news hit me hard--much harder than I expected actually.

I told the surgeon to make my mother a DNR but asked her to leave her on the vent until my brother and I could get there, at which time we would maker her comfort measures only and extubate her. Given the nature of her brain inury, extubation would result in death within minutes, since she no longer had an intact brainstem, and without that, no respiratory drive. I managed to hold it together fairly well, considering the news, but also knew I didn't want to drive to Boston alone. I intially called my friend Bhinder, and he said he could go with me, but he phoned back a few minutes later to back out as family was flying in from Toronto. A dozen calls later, I managed to get in touch with Rich, our pastor, and he and his wife agreed to make the trip with me. This ended up being a very good thing on numerous fronts.

We arrived at Mass General just before midnight on the 25th and found our way to the Neurosurgical ICU. After a fairly lengthy wait to be buzzed in (frustrating as they were expecting us), I spotted my mother's room quickly, and went in, to find my 18 year old brother sitting there all by himself. The nurse never actually told me which room was my mother's, but I somehow turned in the right direction on my own. She was propped up in the bed, vented, with a foley and what appeared to be poor urine output. Her SpO2 was good, but her blood pressure was crappy, only in the 80s/40-s despite two different pressor drips. Looking at the tombstone T's on her cardiac monitor, it looked like she was having a MI on top of everything else. She actually looked suprisingly young--like a child of 10 or so, without a single wrinkle on her face or hands. I think it was because she was no longer fighting the demons that she had battled for so many years.

Sometimes when you are in a room with a dying person, after they die you can feel their presence in the room. With my mother it was different--she was no longer there...just her body, and a body only animate because of the drugs we were pumping into it, and the vent forcing oxygen into her lungs. It was very sad, and all the more so because my brother was simply devastated--he wouldn't speak more than a word or two, though he was aware of the severity of her injuries and the fact that they were simply unsurvivable.

The nursing staff never once came into the room to see if we needed anything--never offered us tea, water, tissues, pastoral care--nothing. I sat there for an hour and a half, watching her blood pressure dip lower, and hoping it would just crash--I didn't want to feel like I was rushing my brother: "OK, I'm here now, lets pull the tube and get it over with.", but by the same token, I got the feeling he would have sat there for days if need be, and I needed to say my goodbyes and release her body from the prolongation of her suffering. I guess I felt like it was unfair to force her body to remain in a semblance of life when her spirit had already left--just a shred left behind that couldn't leave until her body was allowed to stop functioning. I left the room and tracked down the nurse myself, and finally spoke with the surgeon in person.

My brother left for the actual extubation, but I wanted to be there. Once the tube was removed, she actually died very quickly. The nurse had shut off the monitor, ostensibly so we wouldn't fixate on it, but they neglected to shut off the alarms at the nurse's station right outside, and I knew bloody well the screaming alarms were for my mother. It would have been kinder to silence those, since we knew she was dying. It was a good thing I had come with Rich and his wife, because they provided a huge amount of support for my brother and myself--support that simply would not have been there otherwise.

Once she had died, I wanted to wash her body, to cleanse her spiritually. The nurse informed me that I could not bathe her because "it is against hospital policy and besides, she's clean--I bathed her at the start of my shift." I was stunned--a huge city hospital serving multicultural populations and they were refusing to respect my spiritual practices around death? What would it have hurt? She was also missing the fact that this was not a bath for physical cleanliness, but a spiritual bath. I hadn't thought about it much before that night, but bathing her was something very important to me, and being denied that left me feeling unsettled. Its simply something I must do to ensure she is properly prepared for her journey.