While sitting one evening with my terminally ill elderly mother, she again asked me to help her end her suffering. This time it was, “Could you just go get the hammer and hit me in the head?” Her previous requests had included “Son, you are a doctor, can’t you do something to help me with this?” And then, “They treat animals better than this.”
On previous occasions, I had to remind my mom that we lived in one of the 48 states in the USA that does not have a death-with-dignity euthanasia law. Her response was, “Then can you move me to Oregon or Washington?”
While suffering several progressively debilitating physical ailments over the past two decades, my mother’s mind had remained razor-sharp. As an example, during one of her more recent calmer moments when her hospice nurse was present my mom stated, “Even trying to pronounce the name ‘lorazepam’ could kill a person.”
When your body is failing you more every day, every hour, every minute, retaining one’s mind is not necessarily a good thing near the end of life. And then the final insult. It is called “terminal agitation.”
The biochemistry of imminent death makes it impossible to find a comfortable position. You hurt all over. You insist on getting up out of bed, but that does not bring you comfort. You then quickly lay back down in bed, but that too brings no comfort. You become increasingly agitated and confused. Your family members may not understand what is happening and may implore you to stay in bed and rest. You may no longer recognize your family members. You may even come to curse them. Your family becomes fearful because it is becoming difficult for them to recognize you as they had known you to be before.
A recent diagnosis of inoperable stomach cancer had brought my mom and me together for such unpleasant nightly discussions. The modern health care system had failed my mother. Two extensive, invasive, uncomfortable and costly hospitalizations over the past year had failed to find the source of repeated episodes of bleeding from her gastrointestinal tract. Finally, after she began to have trouble swallowing food, a last such examination revealed a large bleeding tumor in the upper part of her stomach. By that time, only palliative treatment remained.
About a year ago I was struggling to help my mom with a household chore in her condo when she said to me, “Son you might need a bigger hammer for that.”
My mother was a member of the “Bigger Hammer” generation, alternatively known as the Ladies Auxiliary of the Greatest Generation. Through hard work, native intelligence and sheer will she moved on from high school graduation to becoming a single, working mother at 18 years of age. She went on to become a successful, independent small business person. Hard work became her friend, her mantra and ultimately her closest companion. Other men came and went in her life. But I was the only man there as she neared death.
And along the way she had generously supported her only child all the way to medical school. A mother never was nor ever will be born who could have loved and supported a child more than mine did. Thus, as a physician and grateful son, being unable to help her more at this most difficult time of her life was even more frustrating and saddening for me.
And when it comes to end-of-life care, perhaps we do need a bigger hammer. But that hammer needs to be wrapped in the softest and loveliest of velvets. And that gentle hammer needs to be made readily available to anyone whose mind remains sharp as they near the end of their final journey.
Several days following our last conscious interaction my mother passed away quietly wrapped in the comforting arms of Morpheus. The angels of Hospice were finally able to help my mother in her time of need when neither she herself nor I could.
They do shoot horses don’t they?
Rick Sontheimer is a dermatologist.
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