The End is a series about end-of-life issues.
Ingrid Bergman famously died on her birthday. Shakespeare is said to have died 52 years to the day after he was born. Tidy and distinct enough on Wikipedia, I suppose — but this was not what I wanted for my mother. And certainly not for me.
So when my mother entered her small Iowa town’s hospice facility less than a month before her 87th birthday, I couldn’t shake the image of bookend dates on her tombstone. And how there wouldn’t
be a single day on the calendar, ever again, reserved just for my thoughts of her living and loving.
I’m not saying this was an entirely rational fear. And certainly not a selfless one — what would my mother care? But for nearly a month the specter of that possibility hung over her room like all the shimmery Mylar balloons that poured in and mocked my angst.
Mom went to a local hospice facility, a place called the Greater Regional Hospice Home in Creston, Iowa, via the emergency room, a trip brought on by the most pain she’d experienced since her lung cancer diagnosis nine months earlier. By September, her oncologist had deemed her cancer no longer treatable and had referred her to hospice service. This meant she could be at home, and hospice nurses would stop by a few times each week. As time went on their visits often included draining a liter of the fluorescent pink fluid that rushed into the lining around her besieged right lung.
So hers was not a house brimming with optimism. But she was home. Eating every day, working her crosswords, getting her mail, watching “The Mollie B Polka Party” on the RFD Network on Saturday nights. At that point she was unflinchingly clear with my three siblings and me: Having hospice nurses visiting her was one thing; leaving her cocoon was quite another. Nearly five years ago, my father had been so similarly resolved on this point that he died at home the very day he was to be moved to the hospice center.
So when my mom went in, in her mind it wasn’t a question of if she’d be going home, but when. Barely a day later that decision was snatched from her hands.
Of all the bizarre phrases your mind twists into normal — and there are more than you can imagine in hospice — “We see signs she’s progressing” surely is the most pervasive. We knew she’d been getting weaker, eating less by the day. Her coughing and breathing episodes grew more frequent. And my sister — Mom’s primary caregiver — was noticing occasional lapses of coherence.
So we all got that. Still, in those first upside-down days I hated every nurse and aide (they worked 12-hour shifts in pairs) who uttered that phrase: “We can see she’s progressing.” First, as an editor, I found it ridiculous: Google the word — she was not progressing. Yes, her hair is coming back an adorable salt-and-pepper, but by every other measure she was regressing. Failing. Vanishing. My mother was dying.
And I suppose I hated them for the very reason my dad had fought against this place with literally his last breath: for the way their certainty so effortlessly pierced our thin membrane of denial.
But hospice days are long. Between my waking in the cozy anteroom off my mom’s room and her taking her last meds for the night, my perspective could travel far. Thus somewhere around Day 10 I realized where once I’d held disdain for the staff members, I now had a burgeoning sense of reliance. My siblings and I found ourselves hanging out at their station after Mom fell asleep. More and more coffee sorties to the sprawling kitchen included stops for chats with Michael about sleeping meds or blood pressure discussions with Natalie. Before long we knew without asking who was on the next 12-hour shift and recognized the way each nurse and aide singularly brought calm and light into Mom’s room. The certainty we had so abhorred was becoming the comfort we craved.
Well-known family lore had it that many of my mother’s Depression-era birthdays passed without mention of cake. But her often-elaborate confections were the most anticipated centerpiece of her children’s birthdays. When we suggested cake for her last milestone, we hadn’t expected much reaction, but her hazel eyes flashed and her eyebrows arched — by Day 26 her preferred means of letting you know you’d connected. “With candles,” she mouthed. And, after a beat: “If we don’t start a fire.”
Two of many hospice rules: The patient’s jokes are always funny; the patient’s wishes are always followed.
So early the next day we picked up a cake at a local supermarket bakery: chocolate, of course. We had the baker ice on “Happy 87th Birthday.” But Mom wasn’t much with us that day. She slept till almost noon and faded away again an hour later.
We’d decided to leave the cake in the fridge until Donna, the aide that night, stopped me at the nurse’s station. “When is the party?” she asked. “I don’t think it’s happening,” I replied. “We just don’t think Mom is here enough.” “There’s really no harm in trying, is there?” she asked. And, of course, there was not.
It was after 9 p.m. I ran into Mom’s room and told my sister we should reconsider. “You think?” she asked. “Yes. Let’s not wish we had,” I replied, essentially paraphrasing Donna.
We brought in the cake, opened three boxes of candles and feverishly planted all 87 in the lavender frosting. Lee Ann, the head nurse on duty, scurried away to turn off Mom’s oxygen — as one does when one lights 87 candles in a hospice facility. And we lit ’em up. As we rolled the tray table over to Mom’s bed, her face perceptibly brightened — not just from the 87-candle salute but from within, as well. She was with us as Lee Ann, Donna, my sister and I sang “Happy Birthday” and smiled as the four of us blew out the candles. Then, the most remarkable turn: She asked for cake. Our mother ate once in the last four days of her life — and it was three bites of her 87th birthday cake.
My sister slept there that night, and two hours later we gleefully texted each other when 12:00 flashed on our phones and delivered us all past Feb. 6. But by 5 a.m. Mom’s breathing was horribly labored and all four of her children were at her bedside — where we would all stay for the next 15 hours.
My mother made it not just past her birthday, but through the entire next day, too. At 12:30 a.m. on Feb. 8, with my sister sitting up with Mom, Donna woke me in the anteroom and hustled me bedside. My sis and I held Mom’s hands and told her we all loved her. We soaked her comforter with our tears as the gaps between her breaths stretched. And Donna and Lee Ann — whom I’d so fiercely resented 28 days earlier for their stone certainty over this very moment — hovered softly over the two of us, their own tears falling on our shoulders.
Dan Davenport is a writer and editor who lives in New York City.