Please Talk about Me When I'm Gone

War and Peace

(August, 2002)

The end of my mother's life was as peaceful as possible, but only because we took deliberate measures to ensure that it was as peaceful as we could possibly make it. Being in the relative-and comparable-comfort of her own home was a crucial start for any sort of positive ending. Having a supportive hospice nurse dropping by every other day guaranteed that she would not be distracted by noise, bureaucracy, and other patients.

I didn't know until I had to know, so I wonder how many people know (and I hope they don't know if they never need to know) how end-of-life pain management actually works. In addition to the professionalism and experience hospice brings to any situation, there are the drugs (morphine, to be precise) administered to alleviate pain. Here's the catch: the more pain the patient feels, more drugs and higher doses are required.

We quickly understood the stakes: the more morphine we used, the less lucid my mother would be. The more aggressively we managed her discomfort, the less coherent-and present-she would become. This, for a short period of time that lasted entirely too long, was territory my father felt uneasy entering.

"You could be getting more medication than we're giving you," my sister explained.

Our mother looked confused.

"We could give you more..." my sister started.

Our mother nodded, then closed her eyes.

"But Dad is concerned...well, he wants you to be as lucid as possible..."

Our mother opened her eyes, then shook her head. "For what?" she said.

...

A few words about my father. His compulsion to be in control is what enables him to function, it's what made him successful, it's what makes him reliable, and it is, on occasion, what makes him intolerable. But this is how certain men, particularly men of his generation-especially Irish Catholic men from Boston-operate. There simply is no concession for half-measures: if you betray a single soft spot, this weakness exposes a fault line that cracks open and swallows your entire being.

And so, we found ourselves in an untenable place where morphine, which represented compassion, common-sense, and, ironically, control, was clashing against religion, which represented fear, impotence, and, worst of all, negligence. My old man, in short, was still taking orders from a force that my sister and I no longer respected. It was a force we'd found conspicuously absent, a week before, when my mother pleaded, first with God, then with us, to do something, to try anything in our power to take away her pain. That was the person-and the imperative-I intended to comply with.

Fights, fortunately, had been infrequent during the last five years. Few things can rally (or, I reckon, splinter) a family faster than terminal illness. I could hardly recall the last time I'd even exchanged unpleasant words with my father; mostly I'd said "Let me know what you need" and "I love you." This is what we all said to each other, implicitly, in almost every conversation over the course of five years.

And here I found myself, as my mother got busy with the business of losing the biggest battle of her life, realizing I had to square off with a man who was finally confronting the one scenario he couldn't control.

...

A few words about this fight. It was a minor miracle that it hadn't already happened. It could have happened, and under less extreme circumstances would have happened, ten days before. That was the morning my mother sat in her kitchen, agitated and unable to stop shaking, with what little indignity remained boiling to the surface. She had gone from tolerating, then loathing, to finally dreading this alien presence that kept kicking her when she was down. Alongside the feelings of betrayal about a system that had already checked out on her, amongst the confusion and exasperation that made a mockery of time and sense, underneath the ticking of the bomb her body had become, above all these competing concerns was the onset of a sustained and suddenly irrepressible sense of foreboding.

My sister and I looked at each other, nervous and unsettled: this was new territory, and we had no clue how to negotiate it. Neither did our father, and it was apparent, in this precise moment as the four of us sat around the kitchen table-a family routine frozen in time-that he wasn't following this new narrative, our personal War and Peace that came without CliffsNotes. He grabbed his keys and my sister glared at him: Where are you going?

Where do you think, he said.

And we knew: he was going to church. It was Sunday morning so he was doing what he'd done every Sunday morning, without a single exception, throughout his life. And I knew: his wife needs him but he needs his routine. He needed it more desperately than any of us could even fathom. And in that moment I despised him for it.

"Can't you just stay?"

This was my mother. She looked at him, incredulously, more angry than sad. "Can't you just sit here and hold my hand?" To which this good man-this loyal husband who had thus far done everything he could, who had walked with her every step of the way from day one, who could not fairly be described as anything but fully committed-smiled (it might have been imperceptive, it may have been ambivalent, it could have been complacent, but it was not in any way guilty) and walked out to his car. I wanted to follow him into the garage, hold him down and force feed him pages from the bible. And the one thing that stopped me was the realization (clear in that instant) that he was not okay. His flight was not (merely) answering the call of ritual and obligation. He wasn't ready, yet. He was, in fact, very aware of what was happening. He was scared and he was running for his life.

...

Fuck that, I said, finally ready to fight, the day he protested the boosted dose of morphine. Pray all the accountability onto me, I don't care. We can't afford to defer to a bunch of magical thinking right now. You may be worried about going against God's will, or you may have your own preferences, but we're more worried about our mother. We will not allow her to be afraid and in pain.

I wanted to say this, and my father needed to hear it. But the circumstances were too severe for misplaced passions. Instead, I did the only thing I could to make my case in a way that authority (his or His) or arguments could not lightly counter: I wept. I held my sister's hand and we told him we couldn't abide seeing the woman upstairs suffer. Still, it was his call, so we implored him to authorize the level of medication our hospice nurse saw fit to provide. That's what she's here for, we cried.

It wasn't easy for our father; he had been there for everything. Even the things he hadn't been there for, because nothing we saw when he wasn't around was anything he hadn't already seen. But he hadn't been there the week before, when my mother couldn't keep still in her bed, the cancer slithering around her insides like an eel. He hadn't heard her say what she said or seen us promise what we promised. And so it was our obligation to convince him to take that last step and join us on the other side, where our mother was already waiting.