Thursday, January 9, 2014

What Would You Do If You Had One Day?

Mom's keys
(Note to readers:  This is a rather long post, an exercise in reflection and healing, recounting a significant few days in my life.  It's okay if you don't want to read it, but please don't judge me for writing it.)

I've allowed myself some quality cozy time in January, I have to admit.   I've been catching up on subscribed magazine and books tossed aside since November (yes, I'm still reading about Christmas inspiration).  I watched the entire 5th season of "The Good Wife" last weekend.  With my daughter's wedding last October and holidays immediately following, I just never had time.  Hallmark Christmas movies are finally caught up.

Mr. P. and I have also started watching syndicated episodes of "Grey's Anatomy" since Christmas.  We began watching the show sometime in the 2nd season real-time (or close to it).  Anyway, in the early part of Season 2 there was the episode "It's the End of the World", where Meredith (Ellen Pompano) senses something bad is going to happen that day before going to work.  Meredith's first-person narrative at the beginning of the episode (standard for the show's writing) asks, "What would you do if you had one day?"

January 27 will mark the 7th year anniversary of a motor vehicle accident my mother had, at a spunky age 86, that led to her death four days later.  It was a very mild, sunny winter day (a Saturday), and Mr. P. and I had gone for a walk around noon.  He would turn 60 the next day.  I carried my cell phone, but when we walk, I usually don't feel the vibration in my back pocket.  That day was no different.

When we got home, there was a message on the land line, from my sister M, saying mom had been in a wreck, and sister M took her to the ER.  It was around 12:30 pm.  We hurried over to the ER where mom was, with sister M.

When I walked in, and saw my mom sitting in the waiting area, watch her take the ice bag off of her forehead, I just said, "Oh mom, I'm so sorry".  She had a huge hematoma in the center of her forehead, and her eyes were both black and blue.  My sister looked frustrated, and Mr. P. asked what happened.
Mom:  "I wrecked my car coming out of the bank".
Sister M:  "She refused to come to the hospital in an ambulance.  She tried to call you, but you didn't answer, so she called me.  When I got here, she kept yelling at me to call you (with mom's cell phone; sister M didn't even have a cell phone back then), but you didn't answer.  The ambulance driver tried to convince her to let him bring her, but she refused.  So I brought her myself".
Mr. P.:  "Where's the car?"
Sister M:  "At the bank on 38th Street, where it happened".  (The accident was six blocks from where I live).  "She was in the drive-thru lane, and her car accelerated.  She came across the road, hit a parked car across the street, and then her car made a u-turn toward oncoming traffic, and she hit the utility pole at the corner of the bank.  Thank God there was no traffic coming.  [Electric] lines were down over her car, and she was screaming, literally screaming, that she couldn't find her gloves.  I was looking for them on the floor, but couldn't find them, and then I lost it, and started screaming back." (We are Italian and we don't do calm.  We talk and others think we are yelling.  When sister M said she was screaming, I knew it was true.  I could tell by the remorseful look on her face.)
Mr. P. (to my mom):  "Norma, we're probably going to have to take your keys from you, you know".
Mom:  "Oh NO (while holding ice pack on forehead)!  How will I get my hair done?!  I have to go to Florida."  (She was planning a trip that coming March, to see her terminally ill brother, 11 years younger).

What happened during the next eighteen hours was pretty much the end of my mom's life, and none of us knew it until early the next morning, in the 18th hour, when the nurse on duty called to say mom had had a bad night.  Not even the four long-term medical professionals in our family - three pharmacists and one nurse - knew the consequences of the events that day until it was pretty much too late.

What would you do if you had one day?  

Back in the ER, I immediately went into business mode, my most natural and best way to be.  I had been going with my mom to all of her Dr. appointments for the previous year, taking copious notes, tracking blood results in Excel spreadsheets, communicating with family, and advocating for her, in general.  She had a near-death experience with a bleeding ulcer the year prior, and she had also been diagnosed with MDS - myelodysplastic syndrome (the blood disorder Robin Roberts of "Good Morning America" made famous before her bone marrow transplant in 2012).  In short, MDS causes a mutation in red blood cell production such that, instead of the normal 1, 2, 4, 8, 16, etc. cell division, you may get 1, 4, 5, 7, etc., and your red blood count decreases, causing low hemaglobin readings.  Mom had already received red blood plasma infusions at least twice previously for her low hemaglobin during the course of her MDS treatment.

I immediately advocated for my mom to get a speedier admission due to her blood disorder, and the fact that she was losing blood (the hematoma was growing).  It was around 2:30 pm before they got her into a bed, and a string of nurses and doctors filed in, each doing their own verbal intake.  I scrambled to contact immediate family members, one by one, on my cell phone (this was 2007, and not everyone had cell phones, and I certainly didn't have all the numbers in my "dumb" phone (no smartphone) at that time.  I have 8 brothers and sisters, and mom had 2 brothers).

By 5:30 pm, doctors ran a battery of test and x-rays, and later ordered a CT scan.  Nothing was broken, but there was an indication of a possible subdural hematoma, yet mom was still very alert.  She still kept asking about her gloves, and her car, and talking, in general.  Blood was ordered for mom, as her hemaglobin was dangerously low, and I kept updating family.

The weather turned snowy that evening, but sister J and her husband left their OH home to travel in, about a 4 hour drive.  Somewhere along that drive, J realized that if mom received blood infusion the combination of the subdural and underlying MDS could prove deadly - she would likely just bleed out any infusion.

By 10:30 pm that evening, mom was being admitted on a floor, and the night nurse did a full intake with me, sister M, and one pharmacist brother and his pharmacist wife (who both worked at that hospital and knew that nurse).  Mom seemed to be resting comfortably, getting sleepy.  Her conversation was getting a little tired, too.  I remember her saying, "He'll know what to do".  When I asked her "who, mom?"  she only repeated the statement, "He'll know what to do".  I asked if she meant brother J, the other pharmacist, who normally filled her prescriptions (he was in retail pharmacy and had not been to the hospital yet).  Mom just nodded.  The nurse stated she would call us if anything changed significantly for mom through the night, that the nuerosurgeon would be consulted in the morning.  We went home to regroup.

What would you do if you had one day?  

At home, Mr. P. said she (mom) would be fine when he could see I was visibly upset.  The next day was his birthday, and I had planned to cook dinner for all of his family, ten of us in total.  I immediately got on the computer and googled "subdural hematoma".  Not good.  Acute subdural hematomas are among the deadliest of all head injuries, with a greater than 60% mortality rate in people age 60 or over is what I read.   Mom was going to die.  Needless to say, dinner was canceled.  So was Mr. P.'s birthday.

 What would you do if you had one day?  

Sister J arrived late that Saturday of the accident, and stayed at sister M's house.  They called me around 5:30 am that next morning (after the nurse on duty had called them in the 18th hour).  We got to the hospital by 6 am, and went in to see mom.  

By morning, Mom couldn't speak.  It appeared she had had a couple of mild strokes in the wee hours of the morning, just before we got the call, and her left side was affected.  Sisters J and M let me go in (they arrived before me and had already been in), and when I sat next to mom, I took her right hand in mine.  Her forehead looked frighteningly misshaped, and when she looked at me, her eyes looked as if they had some weird, prosthetic contacts on them.  I was scared, and upset, but didn't want her to see me cry so I tried my best to hold back the tears, lips quivering and swelling, eyes welling.  I tried to be calm while I said, "I'm not very good at this".  What she did next left an indelible mark on my brain that I will never forget, and always cherish.  Mom raised her right index finger to my cheek, and grazed it downward, from my temple down to my jawline.  She spoke to me with her eyes, we both spoke, silently, heart to heart, soul to soul.  She slipped into a comatose state almost immediately after.

The neurosurgeon arrived shortly after, and upon a quick responsiveness exam, came back to the hall to confer with sisters J, M, and me.  Sister J (the nurse) took the initiative to engage with the Dr., and then translated to us.  Sister M was the legal and medical power of attorney, and a decision would soon need to be rendered.  Meanwhile, mom was being transported to ICU while results of the CT scan from the night prior were delivered.

The diagnosis was confirmed as an acute, subdural hematoma, and mom's brain was almost entirely engulfed in a flood of blood. Given mom's age and her blood disorder, the neurosurgeon did not recommend surgery.  The decision for palliative care was made (easily), because we knew mom did not want extreme measures to stay alive.  Additional family members arrived by late that afternoon (a Sunday), and the priest was called and administered her last rites.  Mom was moved to a semi-private room, and the hospital staff moved the 2nd bed out, and more chairs in for the family to stay with mom.

Mom was so strong otherwise - her heart, lungs - and she rested rather comfortably for the next 24-48 hours while we all kept vigil.  Other siblings were making inevitable arrangements for bereavement time, traveling home, while we waited and watched mom slip away.  We kept applying her lipstick (she always dressed to the nines, and wouldn't be caught without her lipstick!), and it became a quirky family thing, later memorialized by one sister who bought us each this little plaque:
Mom's skin and manicured/pedicured nails continued looking better than most of ours, but by Tuesday, other signs were beginning to surface - her urine output was less and getting darker, she was experiencing labored breathing more frequently, and her legs began to have a mottled appearance - all signs of the end being near.  Mom was made comfortable in her last days, with the help of Ativan and Morphine drugs, in rotation, to ease pain and labored breathing.  We kept written notes on the whiteboard so we could know when to alert the nursing staff.

On Wednesday morning, a nurse aide gave mom a sponge bath, and washed her hair.  It was Wednesday afternoon, just minutes past 3:30 pm that mom passed.  We lightheartedly said she waited for "General Hospital" to be over (which she loved and watched until it went off air).

Mom's funeral was a beautiful celebration, put together in collaboration by almost all her nine children.  We selected everything from the casket, her clothes, the readings, and the songs.  The choir sang "Be Not Afraid", "On Eagle's Wings", "Ave Maria", "Bread of Life" and "Let There Be Peace".  As a prayer of commendation, we had a special tribute song, "Mama", by Il Divo, played in our co-cathedral at the end of the funeral mass over the speakers.


 What would you do if you had one day?  

Having the four days post-accident was time borrowed to help each of us wrap our heads around the fact that mom was going to die, but if I had only had one day, I would not have left mom's side that first night.  It saddens me greatly, still, to listen to "Mama", to remember the vision of mom touching my cheek that last time, to write this, to read this.

My dad passed away when I was 28 and, although it was also very sad, it is just different when one's mother dies.  Or, maybe it's the fact that she died after dad, and now there are no parents.  Love transcends time, though, so to have just one day is irrelevant.  I know I will see them both again.

Mom, (with her long-time companion), wearing the dress we buried  her in, dressed to the nines
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