Death In A Nonprofit Hospice

I didn’t know much about hospice until my mother was close to death. My father honored a promise that he would never put her into a nursing home (although there are lovely ones to be had). And so she lived in their home until four weeks before she died. She experienced a good death: pain-free and relatively serene. I came to believe that her death was a model for how all hospice patients should be able to die.

In fact, I was so inspired by her compassionate and professional care that I decided to become a hospice chaplain. It wasn’t until years later that I learned the truth about too many for-profit hospice providers – that dying well is not always guaranteed (which is why I write for the hospice consumer). My father died in an inpatient, nonprofit hospice residence and had a beautiful death and my mother died in the same type of residence. This is her end-of-life story.

She was restless that day . . . more agitated than usual. As we looked out across the golden meadow cuddling amidst tangled sheets, my chin rested upon wisps of her silky hair. I pointed to the field swallow standing guard over her young brood. Mom whistled their song. Even then, she could mimic any bird call. I smiled at her melodic trill; still, tears trembled beneath my lashes. A sob caught in my throat threatening our tranquility, so I tried to smother the sorrow impatient to erupt. I didn’t want to upset her; we were on a sacred mission.

With feeble effort, she tried to tighten my already firm grip around her. She shuffled with fallen arches and stooped shoulders. Bunions rubbed raw the edges of her woolen slippers – slippers so tattered they barely contained her nylon-enshrouded feet. Dementia devastated her brain and cancer ravaged the one drooping breast and beyond. But in my mind, she stood as stately as the silver birch that shaded the woodland stream outback.  

As the hours wore on, her breathing became labored. I imagined her soul – full-term – yearning for freedom from its earthly womb. Antsy. A looming instinct that the confining space was only meant to be temporary, that a mysterious magnificent world lay within reach. She quivered beneath my arm: “What would I have done without you?” Those were the last words I would ever hear from her.

The dying process had progressed and I felt her increasing unease. My inclination to hinder its headway was no match for its muscular resolve to be released. It would’ve been easy to continue hovering and doting over her, but mothers don’t surrender easily with a child clinging to their hip. So, my role as a daughter transitioned to that of a midwife – helping to birth a soul.

I changed tactics and tried to relax my grip on her life – quietly singing the Quaker lullaby she once sang to me: “Tis the gift to be simple, tis the gift to be free, tis the gift to come down where you ought to be, and when you find yourself in the place just right – you’ll be in the valley of love and delight.” My voice stumbled on the lyrics . . . ‘when true simplicity . . . is . . . gained . . . to bow and  . . . to bend’ . . . I couldn’t finish the refrain.  

I gently pried her from me and positioned a pillow beneath her head. Settling into a chair, the hours of dusk disappeared holding her hand. Sunlight waned and shadows danced across the floor as strains of Schubert serenaded our souls. The room filled with the fragrance of lavender as I anointed her hands and feet. Prayerfully, I nudged her toward the “fertile valley” – envisioning purple petunias (her favorite), angelic singing (a former alto), and Divine wholeness.

My eighty-year-old mother had become unresponsive, but the staff asserted she could still hear me. “I love you Mom,” I announced with conviction, testing their assumption. Her eyelids quivered. I remember how long the night seemed to linger. I filled its solitude with the flickering of candlelight and the monotonous recitation of a rosary. Midnight passed and the nursing schedule shifted, as concerned faces had come and gone with morphine in hand.

Standing to stretch, I crossed the room to take in mom’s view. Shards of starlight graced the garden: a labyrinth of sleepy flowers and boxy hedge where lightning bugs darted and flashed . . . where chalky-white angelic sculptures and stone benches glowed in ghostly repose. I turn to concentrate on mom’s wedding portrait that my father placed on the bedside table. I puzzled at his choice. Perhaps he wanted to focus on the memories of her as an innocent beauty of twenty-four; instead of the unrecognizable form lying in that bed – all wrinkles and shriveled husk.   

The dated sepia photograph featured her dark shoulder-length curls – framed by a modest chiffon veil – secured to a halo of lilies-of-the-valley. I looked nothing like her: she was olive-skinned and French. I am blonde, fair, and Norwegian. While I resemble the physical likeness of my father, a great deal about me stems from her. 

The accumulation of hours sitting sentry propelled miles of memories forward – until nearly spent, they dribbled to nothing. And then we were left to that solitary room. Suddenly, loneliness and exhaustion overwhelmed me as the painful truth settled in: our memory-making was finished.   

Searching the shadowy space, I wondered if our ancestors were present, waiting to escort mom home. I fantasized that her four sisters, my favorite aunts, were fussing over us like a clutch of chubby hens – bobbing and clucking. That comforting reverie was an unexpected respite and caused me to lose track of mom’s decline for a time. 

For the final three hours, her breathing had ceased for forty-five seconds at a time. I’d think it finished, only to see her snatch erratic gulps of stale air to prolong the vigil. Her skeletal shoulders heaved inward with each inhalation and the breathy discharge gurgled and crackled its way into the room. The nurse said she should’ve been totally relieved of this earthly life by now; but, she was always a fighter – that one. Stubborn too.

I began the tedious count once again and by the time I reached fifty-five seconds – my heart was pumping harder. I waited and waited. But she did not struggle to inhale this time. Finding no pulse, my hands began to shake. I stood to pace . . .  I still need you . . . I’m not ready . . . I thought I could be. “Mom, don’t leave me,” I wailed into the night. Daring to turn and confront fate, I recognized that my “bird-whistler” was no longer in this world.

She lay pale and still. Her eyes were closed. Her jaw hung slack. Wracking sobs took hold of my gut and a torrent of tears could no longer be restrained.

A good mother should never die.

I tried to convince myself that she simply waited for me – just beyond my vision. Eventually, the long minutes of anguish finally washed a calm over the room. I sensed the crowning of her soul: palpable with lilies and kindness, lilacs and grace – bursting forth from every pore.  Her labor – concluded. Her face – peaceful and proud. Triumphant even.

I placed a kiss upon her warm, familiar cheek. Gathering her to myself, I memorized her smell . . . rose-scented shampoo, bitter breath, salt, and musk. Her final essence – my new cologne.

I gently laid her down upon the silken sheets and gathered the knobby afghan firmly to her chin – tucking it in tight – as if bolting a door against the chill and stiffness of the approaching winter. I desperately tried to preserve her before the searing flames of cremation consumed the arms that held me and that I held onto.

When I glanced out onto the lawn, I noticed the emerging dawn had announced itself with a rosy hue. On that fresh morn, she did not rise with the Lark. I should’ve called my father, but I wanted her for myself just a few moments longer. It was selfish . . . I know. But, she was my mother . . . my sister . . . my friend. Grabbing my make-up bag, I reapplied my ruby-shaded lipstick to my mouth and placed one final kiss – an odd gesture perhaps – performed in grief. I didn’t care.

Because there, for all to witness was the mark of affection emblazoned on her forehead – like the Hindu Bindi – the feminine embellishment that signified the achievement of one’s earthly purpose.

I left the hospice residence for the last time and stumbled back into my life without her. Suddenly, a burst of energy seemed to rush through me and I shivered. I recognized my mother’s final, glancing touch. A harbinger? I felt her soul take flight: effortless and robust once again. On course and confident – “to a place just right.”  

I gazed into the flaxen meadow – and there, birds gathered and fluttered and sang.

And from somewhere, I heard her mimic their song.