Handicapping

Three weeks ago, I was working on a new blog post about handicapping the Nicholl Fellowship. I don't know a thing about picking winners, but I thought it would be provocative and fun to check into past winners and see if there were any predictors to be found, a way to gauge what's likely to win and what isn't.

I was a couple of paragraphs in when I got a text from my brother. Our mother had been rushed to the hospital.

My mother, aside from her many fine qualities, was a dedicated smoker, as most people from her generation look to have been from her photos of parties and nights at the Copa. She had started in her mid-teens and continued for 45 years or so until her lungs were so wracked that she often spoke through coughs and we could understand.  Twelve years ago, she started having serious breathing issues that eventually turned out to be chronic obstructive pulmonary disease with a congestive heart disease chaser. She was prescribed a prolonged steroid treatment that went on longer than it should have and one day her body just flat out stopped working. She was on a bed in the hospital with no time to get her parish priest to her side, so the hospital chaplain read her the last rites as we, her children, watched in stunned silence. Then we waited and waited for an end that didn't come. She finally stabilized and within two days was sitting up and ordering us around. She had a long rehabilitation and returned home after several months. Over the years there have been returns to the hospital followed by increased needs at home; an oxygen tube, a part-time aide, a walker. Some days we'd show up at her door to find her full of pep; some days she'd just sit, unable to get to her feet without help.

The years in between were very good to me. I met my wife, we had our two children, I moved from a creative but stagnant career into a few more interesting and worthwhile fields, all things I could not picture for myself at the point when my mother first fell ill. Had my mother died twelve years ago, she would not have been able to see my bride walk down the aisle toward me; would not have answered my calls when I needed to vent as my wife and I butted heads with hospital staff during the labor process when my son was born; would not have seen how much my daughter resembles herself at the same age, a curly blond with piercing blue eyes.

The years since her initial crash have had so many medical interventions that my mother decided a year ago, once she was determined to be worthy of hospice care, that she did not want to be revived should she falter again. She spoke with us all, her five children, then to her teen and adult grandchildren. She gave us each tokens from her life and started us on the road to prepare for her death, which she believed would come within weeks if not sooner. It came as no surprise when she somehow graduated from hospice care to just needing a part-time aide again. Her aide would share movies with her (I was floored this past Easter Sunday to find a bootleg copy of Avatar in her bedroom) and help her with sewing projects. On Easter, Mom presented us with a blanket she'd finished for my daughter. We weren't expecting to visit her for Easter, we had plans elsewhere, but we drove over to her house afterward as a surprise to her and the rest of the family, some of whom also had not planned to be there but somehow changed their minds at the last minute.

Three days later she was in the hospital, having collapsed in her living room. Her aide, although familiar with my mother's wishes, having read the DNR and placed it with the rest of her medical information, called an ambulance anyway. Once at the hospital, she was tubed and sedated. We were shocked, but hoping there might be some hope that with minimal intervention from that point on, Mom would have a chance at recovery. When the sedation was ramped back to gauge her capabilities, she took the opportunity to non-verbally request that the tube be removed. The doctors convinced her to allow them two days to process how she'd respond to minimum treatment. She had severe pneumonia in both lungs and looked to have had a heart attack that was curbed by the internal defibrillator she'd been given a couple of years back.

After the weekend passed, the doctors crunched the data. They called my oldest sister, my mother's health proxy, and asked to meet us all the next morning. We didn't need to stretch to figure out what was going to happen next. We met at my mother's bedside the next day to hear that she was not recovering and they had determined she was capable of deciding whether to allow or deny further treatment. A short time later we met with the hospital's risk management specialist to see whether we had any objections to this plan. We didn't.

For all the hospital dramas you've seen, you'd think there were more doctors than nurses. Everything happens with at least one doctor there, usually two or three. When someone dies like my mother died, surrounded by family hoping the patient will be comforted by their presence and touch, there aren't any doctors. There isn't an improvement to life to be made, nothing to be saved. Doctors don't dally in the intensive care ward, they move like butterflies, alighting briefly before disappearing into the sunlight. The last medical professionals to help my mother were two nurses, one of whom had been tirelessly helping her since her admission. They moved her up on the bed, sitting her up as best they could, then removed the breathing tube, replacing it with a mask providing oxygen, the dial for which the nurse turned up to the maximum. My mother had collected nurses in her previous hospital stays, often getting visits in one ward from personnel from another ward, leading to our confusion when we'd arrive to find nurses there on a social call alongside the nurses assigned to her care. My mother collected people from all over her life. Since I'm the fourth of five kids, I thought the people I'd see along with her in school or at a doctor's office or in a supermarket had known my mother from past visits or from an old neighborhood, but she usually had just met them and was already laughing and sharing stories. I meet new people like I'm administrating a leper colony, so my mother's gift for making strangers her own remains a phenomenon to me.

Just like she had done before, my mother stayed in the game, leveling off and breathing on her own, able to communicate with us, her eyes opening a bit to take us in, her five children expanded to nine with the sons- and daughters-in-law there, all of them embraced by her as though they were her own. Her levels remained the same for two hours before they spiked and then fell suddenly. Alarms were pinging urgently, but instead of a few people running in to intervene, one nurse came in to switch the monitor into Comfort Mode, silencing the alarms, hiding the readings, and she left without a word to us. When my mother died, we each had a hand extended to touch her. Skeptics will tell you there is no way to tell without instrumentation when a life passes. I can only say that we felt her leave, and I can only hope we helped as she left.