We never thought my mother would die.  Now, don’t get me wrong.  I’m not saying that we (her five children) were so naïve that we thought she was immortal.  We just never thought about it – never prepared for it or asked her about her end of life requests. 

So, when immortality shook its ugly fist in our faces, we could do nothing but volley blank stares of disbelief at one another.  Just hours before, we had all been communicating via text messages about a rather ugly Oklahoma City Thunder basketball game.  Now, we all stood around her bed in the emergency room hearing the doctor bandy about terms like “chronic kidney failure” and “a few days to live.”  He might as well have been speaking a foreign language.  We knew the literal meaning of his words, but the full import of his diagnosis just wouldn’t quite gel. 

The one thing upon which we all agreed was that we needed my daughter, Jaymie Wilson, a nurse practitioner who dedicated herself to the study of palliative and hospice care at a hospital in Tulsa, to provide input and serve as an interpreter, so to speak. 

Because it would take Jaymie nearly two hours to get there, we all tried to drown out the clinical sounds and actions of the E.R. by resorting to familiar behaviors – sibling rivalry over silly, inane things like solving the day’s crossword puzzle and which NBA team would make the finals and how long would Mother be in the hospital.  As I mentioned, we had yet to fully realize what the E.R. doctor was trying to tell us.  We couldn’t quite grasp the fact that Mother was not going home.

When Jaymie did arrive, she received permission from Mother and the medical personnel to view the chart.  She was able to glean valuable information about our mother’s condition that no one in the E.R. felt inclined to tell us.  Jaymie was able to determine and convey to us that Mother, a lifelong asthma sufferer, had had a significant heart attack and that her kidney damage would require dialysis –a taxing procedure that would simply prolong her physical frailty until her enlarged heart finally stopped beating.  As painful as these words were to hear, they served as a catalyst to force us to have difficult conversations with Mother and with each other. 

The decision was made to move Mother to the Intensive Care Unit where she would undergo dialysis, a mere stop gap measure to determine her body’s ability to tolerate the invasive procedure.  It was soon very clear that the dialysis procedure was futile in her case.  She was not getting better.  Quite the contrary was true.  Her weakened condition after each treatment was manifested by the fact that she was struggling to breathe.  Each breath, more painful than the last, was torturing her body by its inability to provide her lungs with any oxygen.  Were we really willing to push her body to the point of needing CPR and risk the breaking of every rib just to restart her heart when its failure was already imminent?

It was in the ICU that the obvious philosophical difference between the hospital doctors and a palliative care nurse practitioner became clear.  They wanted to keep throwing life-saving measures at us, even though they knew, without doubt, that nothing was going to save her body at this point.  She was exhausted.  My daughter, the palliative and hospice care specialist, wanted to see her grandmother experience peace.  My 91 year old mother, a concert pianist and violinist, who had lived through the Great Depression, Oklahoma’s Dust Bowl, World War II, giving birth to five children via Caesarian Section, the Civil Rights Movement, the bombing of the Murrah building, etc., was tired.  She had fought for oxygen her entire life – for us!  You see, she knew we needed her.  It was time for us to say, “Thank you, Mother.  Let us do something for you now.  Let us earnestly pray for your peaceful transition to your next life, where you will be reunited with your husband and parents and the many loved ones who have gone on ahead of you.” 

In stepped Jaymie.  She crawled into bed with my mother, took her wrinkled cheeks into her hands, and asked her if she was ready to quit fighting.  My mother, gasping for the breath it took to even nod, said, “Yes, Jaymie. I’m ready.” After a brief consultation with my mother, with the doctors, and with us, the decision was made to ask Jaymie to take off her granddaughter hat and don her palliative care nurse practitioner hat to orchestrate Mother’s peaceful transition.

This is where my memory of the medical details starts to fog.  I paid very little attention to the clinical side of things at this point - to the names of the prescriptions Jaymie requested to help my mother relax.  Instead, my memory is poignantly clear with the feelings, emotions, prayers, and peace that filled the room.  I watched Jaymie beautifully orchestrate my Mother’s peaceful transition from one world to another.  Occasionally, Jaymie would slip off into a corner and turn her back to us, hoping we wouldn’t see her put her granddaughter hat back on long enough to grieve, to sob uncontrollably.  These moments were very brief. Before she would turn to face us, she’d again don her nurse practitioner hat to resume control of the room. 

With rocket science precision, Jaymie described where we were in the process each step of the way.  There were no surprises whatsoever.  Mother was lucid enough for several hours to have genuine, private conversations with each of us – including with some of her grandchildren – and to make certain requests of us.  When the time finally came, when Mother was finally relaxed enough to quit fighting her epic battle with life, we were all there – hand in hand, arm in arm, to watch her soul leave her frail body. Literally, not figuratively, her body that lay in the hospital bed, was just an empty vessel.  My mother – her soul, her beautiful spirit – was gone.

To say that my mother’s passing was an experience rather than just an event is, indeed, an understatement.  Jaymie’s palliative and hospice care philosophy is that the experience doesn’t end with the death -- the passing of the soul and spirit.  Instead, she believes that the intimacy of the experience extends to the bathing of her body in preparation for the funeral home.  At first, I was a little hesitant, but as I recalled Biblical stories of family or friends bathing the bodies of their deceased loved ones, I embraced the opportunity.  Jaymie spoke softly to me as we gently bathed my mother, and Jaymie warned me that as we rolled her from side to side, the air that remained in her lungs might pass over her vocal cords which would allow me to hear mother’s “voice” again.  This experience provided me with a therapeutic closure that few people get to experience.  I am very grateful that Jaymie offered me this opportunity. 

Not a day goes by that I don’t wish I could talk to my mother again, to hear her stories, to ask her questions, to feel her comfort, to soak up her wisdom.  But I am eternally grateful that her farewell was orchestrated by someone who has been trained to ensure that this transition is as peaceful as possible.  How blessed am I that this trained, skillful, compassionate person is my daughter, my mother’s granddaughter.  

PDC Rx Contributor: Joanna Rasp