Some thought that my mother, Alice Howell Friedman, chose to die in hospice after a severe spinal fracture because she believed that using medical technology to extend life when faced with a poor prognosis was wrong.
She did believe that. In August, 2010, she read "Letting go" by Atul Gawande in the New Yorker and proceeded to make sure that her children, her friends, the Applewood health care staff at the senior residence where she lived , and everyone else she could interest in it read it too. Dr. Gawande writes about a medical system excellent at starving off death but not knowing when to stop. He calls out the importance of building a health-care system that helps dying patients achieve what is most important to them at the end of life: avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others.
Some thought that my mother chose to die in hospice because she was tired of the daily fight against the pain of spinal stenosis and old injuries. She feared growing blind from macular degeneration. Having fought her way back to independent living at her beloved Applewood from quadruple heart surgery, an insidious flu, and a broken elbow, perhaps this was one incident too many. She was almost 92 and weary. Yet, on the night of the final fall, she had carefully arranged her breakfast tray with a note to the health aide to put blueberries on her cereal. George Elliot's Daniel Deronda was open on the table.
A fracture alone is not life threatening. However, my Mom, the public health nurse and a Professor Emeritus of Nursing, understood that three months in a full body cast in a nursing home, the medical recommendation, might have brought a slow death through pneumonia and almost certainly would have resulted in being bed bound the rest of her life. So, somehow- and this I do not understand- she and the palliative care doctor came to an agreement that she could choose dying and death over being kept alive in a nursing home. He signed the papers for her to go to hospice and then called her daughters to tell them to come home.
I think my mother chose hospice, not because of her conviction that medical technology needed to be kept in its place at the end of life or because of a fear of suffering and decline, but because she wanted to die, without pain, in a loving place cared for by her two daughters. She knew my sister Elizabeth and I needed the guidance of the hospice staff to give her comfort and company in her last bedroom overlooking a winter garden and birds at the birdfeeder. We learned how to spoon-feed her pureed food, how to stroke her to calmness when she hallucinated falling, how to soothe her parched lips when she could no longer swallow. Though the morphine took away her ability to speak; it never took away her presence and so we held her hands and talked into her eyes that gazed back peacefully into ours.
In ten years, my Mom's choice of hospice over medical intervention will be seen as the obvious choice, or so I hope. But on the day she made that choice, January 8, 2014, it was viewed as remarkable.
In dying as she lived, my mother did it her way and in so doing, showed us all how to leave. I miss her.