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An Indomitable Ending


The air was cold, sterile even, as I rounded the corner and entered room twenty-two of L&M Hospital’s Emergency Room. Nurses and orderlies bustled busily up and down the hallway behind me, their brightly colored scrubs covered cute animal prints clashing violently with the somber, worried atmosphere of the ER. Monitors and machines in every room and at the nurses’ station beeped constantly in maddening dissonance. The crisp, sharp smell of disinfectant and impersonal care hung heavy in the air.

My mother lay to the left, in bed one of ER room twenty-two; tangled in a hopeless mass of wires and hoses. Before I even approached her bedside, I knew it was bad. Her reddish-brown hair, once a vibrant red, is thin and matted down by the heavy straps of the bi-pap mask that obscures most of her face.

Mom’s eyes are closed tight, the skin at their corners wrinkled and tense with concentration or pain. I wasn’t sure which. Head lolling to the left, her breath comes in short stunted gasps through her cracked lips. Her entire upper body heaved desperately with each inhalation, drawing in as much precious oxygen as she possible before she had to exhale to purge what CO2 she could.

My heart broke to see her like this, struggling for every breath. Just like it did every other time I’ve walked into this emergency room to find her over the past ten years. I sat down heavily in the chair beside her. I took her hand. She didn’t seem to even notice.

Her skin felt thin and fragile; like century-old, yellowed parchment that might crumble at my touch. Dark purple bruises covered her arms and hands so thickly from the blown veins and Prednisone that her natural skin tone was only visible in small splotches. The constant courses of steroids have also added small, alien growths, like hard, scaly warts, in random places all over her.

Momma’s head shifted limply with each gulp of air as I stroked the back of her hand with my thumb.

“Momma,” I called out gently, placing my other hand on her shoulder, “I’m here.”

No noticeable response. Blinking back tears, I gave her hand a gentle squeeze, some part of me paranoid that her skin would crack under the pressure and tried again.

“Momma? You’re not alone. I am here.”

I feel the barest of squeezes back, as though it was all she could manage.

I hear you, the squeeze said softly, and I am glad you are here, but I can’t spare any energy for anything else but breathing in and out.

One of the nurses bustled up to the other side of her bed, a friendly half-smile fixed to her face. I don’t remember exactly what she said, a lot of the details are missing from those three days, but it was some kind of placating report on how mom was doing. Still waiting for test results; x-rays of her lungs and blood work, I think; and for the doctor to come in.

I asked how long my mom had been so unresponsive. The nurse didn’t know.

“She was talking to me earlier, a little panicked and confused, but we were communicating. Since then I’ve been trying to let her rest.” (Or something along those lines)

I have never seen my mother this far down before.

Once, about seven years earlier, she had been close; delirious from lack of oxygen and CO2 buildup, “hypoxic” they call it, but incredibly chatty. My sister Melissa and I could barely understand what she kept trying to tell us through the gasping, slurred speech, muffling of the bi-pap mask, and the constant hum of its compressors. We joked that she sounded like Boomhauer from King of the Hill.

It’s odd how humor is our first line of defense when we are standing in deaths shadow. Mom recovered that time, as she has countless times before. Thumbing her nose at her disease and climbing slowly back to her feet.

This morning when my phone rang, I almost didn’t answer. I was rushing around getting ready to go over to the nursing home. I had been to see her the day before and knew she was struggling. She had talked about how scary it was to be alone in the nursing home, especially at night, unable to breath. I had stayed all day, just holding her hand or sitting beside her while she slept and had promised to be back the next morning. I picked it up and answered just before it rolled over to voicemail.

It was the care manager from the nursing home. She told me they had found my mom in a hypoxic state this morning and had called an ambulance. I had been half-expecting the call based on how mom had looked the day before, but a tight, squeezing fist of fear wrapped itself around the pit of my stomach none the less. We’ve been here countless times before, but despite the familiarity of the situation, it was always terrifying.

My wife, Trish, asked me if I needed her to come with me. I had told her not to worry about it, I would be fine. I was wrong.

She was in the back yard getting ready to clean out the chicken coop when she answered the phone.

“It’s bad. I need you.” That was all I could think to say. No matter how long you’ve watched death slowly overtake someone, you’re still never truly prepared.

My mom had fought, suffered, triumphed, and fought some more on a perpetual rollercoaster ride of emphysema, COPD, diabetes, anxiety, hypoxia, and lung cancer for more than twenty years. No matter how bad things got, no matter how much the simplest of efforts cost her towards the end, she never gave up. She held onto her faith in God and her love of her family and just kept going. Breathing in and out, living the best life she could with what time she had left.

I often marveled over her strength of character and the power of her will to live; to fight. She had always been a fighter, even as a kid from what I understand. To get up and face the day - every day, though, knowing that she would be battling for every breath, that she would have to weigh every task against her dwindling stores of energy, was incredible. No, she wasn’t always in perfect spirits, and sometimes she wanted to just give up. Who wouldn’t? But she never did, not even on her last day.

Watching her over the years, I have often marveled over how much we take the simple ability to draw air into our lungs for granted. We don’t even think about it most of the time, it just happens unconsciously. To slowly lose even the most basic of life’s functions, betrayed by your own body as it is overcome by disease, must be utterly terrifying. People suffering from lung disease, people like my mom, face this horror every minute of the rest of their lives. To keep going in the face of such insurmountable odds, knowing that no matter how long or how hard you fight, death draws inexorably closer, is the definition of heroic.

Trish arrived while we were still waiting for the doctor to make his rounds. Just her presence eased my worry slightly; at least I wasn’t alone. Mom was still unresponsive, and I was warring with myself over whether to start calling people. In the end I decide to text Melissa and my niece Lizbeth. They both lived out of state, but if this is it, they would both want to be here.

When the ER doctor finally comes in, he is brisk and matter of fact; impersonal. They don’t know what’s causing this exacerbation, her x-rays don’t show fluid in her lungs and her flu test was negative. He had another doctor from the ICU coming down to consult.

The ICU doctor was awesome. I wish I remembered his name. He took me out to the nurse’s station to talk about end of life treatment and what steps we wanted to take. He was one of the few that were thoughtful enough to take the conversation out of the room. Mom was dealing with enough just trying to breath, she didn’t need the added stress of listening to us discuss her death.

The ICU doctor was gentle, but direct; the next steps would be to intubate and put her on a ventilator in the ER while waiting for a bed in the ICU. I expected this. Mom and I had talked about it again just yesterday. Intubation was ok for a few days at most, and only if they felt she would be able to pull through with the extra help from the vent.

I wasn’t prepared for him to tell me he wasn’t sure if she would ever come off it.

Then he asked me about other lifesaving measures. Would we want to use suppressors? I had no idea what those were. Apparently, mom hadn’t been this far down before, so no one ever asked me before. The doctor explained that it was medication to keep her pressure up and her organs functioning, but it was only a delaying tactic and it would cause her extremities to ‘whither’ as pressure was maintained in her core. No thank you.

Would we want electrical cardioversion (shock paddles) or CPR to try to prolong life. Let me tell you, even if you have talked to your loved one in advance and know their wishes, it is hard to tell the doctor not to try to save their life. But mom knew that when the time came, she was ready. Again, I told him no, but inside I was screaming.

I did give consent to intubate. I could tell he truly didn’t think she was going to recover and get back off the vent, that he was phrasing it as “he wasn’t sure” to spare me, but I did it anyway. I just wasn’t ready. I felt horribly guilty and selfish. Guilt was an odd addition to the churning maelstrom of fear, pain, and loss in the pit of my stomach.

I rationalized the decision by telling myself that it was to give Melissa time to get here from Maryland. She was already getting ready to come, but not planning to leave until later in the evening so she had time to get her own family settled. As soon as I was done with the ICU doctor, I texted Melissa to leave now.

I didn’t want to talk on the phone. I texted Aunt Sherry in Texas to let her know, trusting her to spread the word to family down there. I sent messages to a few other people to get the word out. Then I gave my phone to Trish. She fielded the rest of the calls and texts asking for updates and expressing condolences. Trish was amazing through it all. I am not sure I would have made it through without her.

Thank you, Trish, I love you. I am so grateful to have you.

The phone tree did its job though. Todd, one of my best friends, walked into the ER room before we ever thought to tell him. Trish’s sister had told his sister, his sister told him, and he just got in the car and came. Todd was a rock for us all to lean on through the whole process. He worked in the background, never leaving until it was over, doing he could make things easier or more comfortable. Food runs, coffee runs, running interference when emotions conflicted, anything we needed.

Thank you, Todd, I love you. It meant the world to me.

People kept arriving throughout the rest of the day and Melissa made it in around eleven o’clock that night. Mom had made the move up to ICU and we were only supposed to have two visitors in mom’s room at a time. So, the other twenty-odd people took over the ICU waiting room while waiting for their turn to visit. Unfortunately, as inappropriate humor is a staple in my family even at the best of times, we did drive the one other person in the waiting room out. I saw him later in the maternity waiting room down the hall. I still feel bad about that. Sorry whoever you were.

The stark contrast between the two rooms was weird. In the ICU things were somber and quiet, voices low as though too much noise would disturb mom even through the fog of morphine. The waiting room, on the other hand, was vibrant and active. Family and friends gathered together joking and laughing, telling stories about mom, reading Cosmo quizzes out loud like a poll, making light of death with a rambunctious celebration of life.

It became easier to be in the waiting room. I told myself I was staying outside because there were so many people waiting to visit. While this was true to an extent, I was also hiding. Smiling and laughing with the raucous crowd helped drown out the anguished sobs of the terrified little boy I had shoved into the back corners of my mind.

I didn’t sleep much that night on the foldout chair-cot. I knew this was the end, and as the waiting room emptied out and quieted, I could no longer ignore my sorrow. Mostly I just lay there with my eyes closed, numbly waiting for Melissa to have time to visit with our mother. Knowing her heart and mind would need time to assess and process the situation before I could talk to her about what must be done.

I climbed stiffly to my weary feet at six in the morning. I had to go get ready for a surgical consult for my back that I felt I couldn’t miss. I should have rescheduled. I was so exhausted and distraught I barely remember what we discussed. Good thing I brought Trish with me. Of course, that was partly because I didn’t think I should drive. After the appointment, I took a four-hour nap in my own bed before going back to the hospital.

Yet another thing to feel guilty about. How could I possibly choose a few measly hours of sleep over my mother’s final moments? I realize logically that my guilt didn’t make sense, that everyone has limits, even me. Logic loses to loss though.

Almost as soon as I got back, Melissa told me we needed to talk. The haunted look in her eyes told me we were on the same page even before she spoke. She had been talking to the ICU doctor, a different one this time, and she felt that we should extubate and switch to comfort measures only. I let her finish explaining why and agreed immediately. I don’t think she realized I was already there and had just been giving her time to catch up. Together, we went into the ICU and asked to speak to the doctor.

This was the real reason I had agreed to intubate, I realize now. I needed mom to hang on long enough for Melissa to get here so I wouldn’t have to face this alone. I had spent years praying that mom would pass away in her sleep, terrified that it would come down to me having to tell the doctors to let my mom die. I used to wake up in cold sweats, still shaking from the nightmares about having them “pull the plug”.

Thank you, Sis, I love you. I was so glad to have you beside me.

We waited until later in the evening to make the switch to comfort only. We wanted anyone that needed to say goodbye to time to come. We also took calls from distant family, holding the phone to mom’s ear so she could hear them say goodbye and that it was ok to let go. I think we waited a little longer than we needed to, just because we weren’t ready.

At roughly nine pm on February 13, mom’s morphine was increased, and the tube was pulled from her throat. There would be no more medical care beyond comfort measures. We were officially waiting for her to die.

They had told us that it could take minutes or weeks, no way to tell. It was all a matter of how long she chose to fight. I knew it wouldn’t be long, that she likely wouldn’t last the night. I also knew it wouldn’t be minutes. Mom had been fighting for so long she didn’t know how not to. Her body and mind were spent and ready to lay down arms, but her soul had always burned brightly.

The ICU nurse, Natalie, lifted the limit on visitors and the room grew crowded while we sat with her. The energy in the room was charged and expectant, like it was going to happen any second. Mom fought on.

We read to her; passages she had underlined in her bible and notes she had taken while studying the scripture. Melissa played gospel music for her on her phone, and we sang along with the songs that we knew. Mom’s favorite was That Old Rugged Cross. We laughed and cried together until the hour grew late and the crowd around us began to thin out.

Melissa and I held her hands almost constantly from either side of the bed, and my dad, Glen Sr., stood beside Melissa near mom’s head. They had divorced when I was eleven but had reconciled their difference in the past few years. He still loved her. I could see the heartbreak in his tear-filled eyes but had no room to comfort him around my own grief.

Near midnight, with only a few of us left in the room, Melissa and I felt the beginning of the end through mom’s hands. Her energy was different, more subdued, and there was more and more time between breaths. Melissa leaned over to press her finger into the back of mom’s hand as I was holding it. The white spot she pressed into mom’s skin didn’t flush back to pink. One of us asked someone to go get Lizbeth from the chair-cot in the waiting room.

At twelve thirty-four am on Valentine’s Day, my mom, Alma Lurlene Madsen, took her last breath. My sister and I were holding her hands, I was stroking her hair with my other hand, my father was holding onto her shoulder, and others were crowded around the bed, some reaching out to touch her legs. She was not alone. She was surrounded by love. She finally let go.

I felt her leave. There was a sudden, soft rush of energy through my hands as her spirit went to greet the loved ones that had gone before her. As nurse Natalie, who had been watching her vitals from the nurse’s station, came in, I told her mom was gone before she made it past the foot of the bed. Natalie listened for a heartbeat, then confirmed what I had already said out loud.

My mother’s life was over.

Barbara Karnes, a hospice nurse and author, wrote that the dying still maintain some awareness of what’s going on around them, that a protective parent might deliberately wait until their child leaves the room before letting go to spare them the pain of their passing. I think she was right. Mom knew that some of us needed to be there. I had promised to hold her hand and make sure she was not alone in her final moments, but she didn’t want it to be a spectacle. I feel that she waited until the crowd had thinned, until there were just a few of us there to bear witness. She wanted a little more privacy, not just for her final moments, but also for our grief.

My mom is gone. The world seems dimmer without her light. To lose a parent is to have one of the cornerstones of your foundation ripped out from under you. Before I even had conscious thought, she was there. Even in utero I could hear the hum of her voice through her body before I heard any other sounds in the world. Yet, somehow, I must grieve and learn to carry on without her.

I am not certain that grief ever “gets better”. How could it? If you cherish their memory, you will always feel pain over their absence. Sometimes the burden is heavier than others, but I think we just get used to carrying it.

On the days when it’s hard, when I struggle just to get out of bed and face a world without my momma, her memory is what lifts me up. If she could face each day, so can I. I have to, to honor her.

I must roll over, put my feet on the floor, and stand up. I know it will be hard, but I just focus on breathing in and out. Some of the task before me will be taxing. Sometimes I will want to give up. My mom taught me not too, though, leading by example. So, I will go on, as she did, fighting every step of the way if need be.

Of all the lessons my mom taught me, her last was the greatest, and I hope I can manage to manifest it in myself. Like the Chinese Proverb, “Get knocked down seven times, stand up eight” she never gave up. She always climbed back to her feet. She was strong. She was brave. She was powerful even in at her weakest.

She was Indomitable.

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A beautiful story, beautifully written. From my heart to yours, Glen, thank you. Thank you for sharing in such detail these special moments with all of us. Clearly your mother raised a remarkable son, and we are grateful for your presence here as you mourn your loss. ❤️

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Glen, thank you for your sharing here. I am so sorry you have lost your mother and I so thankful for you that you have your wonderful Trish and dear friends with you. Your heartfelt account of your mother's last days is truly touching, and gives us all the opportunity to share this time with you. Your mother was a remarkable and determined woman, and you have, with your beautiful recounting of her struggles, brought her alive her for us all. Peace be with you as you go through this time of grief. You have my deepest sympathy, from my heart to yours. 

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I am so sorry for the loss of your mom...I love your last line, it shows what your mom was made of, and now she's passed the baton to you.  I'm glad you have caring people about, your wife, sister, best friend.  I think your mom waited for your sister to be there.  My heart goes with you as you go through this.

As for "gets better" that's a relative term.  I felt the times I lost someone close to me...those were the hardest but it doesn't "get better" in that we have to learn to live in a new way, with their physical presence gone.  Maybe I'm a little crazy but I still talk to my husband, mom, dog, etc, so many losses...

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