"In the midst of life..."

In the midst of life we are in death;
of whom then may we seek for succor,
but of thee, O Lord,
who for our sins art justly displeased?

Yet, O Lord God most holy, O Lord most mighty,
O holy and most merciful Savior,
deliver us not into the bitter pains of eternal death.

Thou knowest, Lord, the secrets of our hearts;
shut not thy merciful ears to our prayer;
but spare us, Lord most holy, O God most mighty,
O holy and merciful Savior,
thou most worthy Judge eternal.
Suffer us not at our last hour,
through any pains of death, to fall from thee.
(BCP p. 484)

Sunday and Monday: October 10 and 11

“You'd better come right away,” my sister said. “I don't think she'll last more than another day or two.” Kathy, my sister, had been trying for several hours to contact me. I was at the church, Sunday services complete, tying up loose ends. Our mother had suffered a stroke several days previous, and I had already planned to leave for home Monday morning, to arrive midday Tuesday. Mother had been stable as late as Saturday, but her condition deteriorated overnight, leading to my sister's anxious efforts to contact me. Now I would have to leave immediately. But I had not packed, and our apartment was a quarter-hour's drive in the wrong direction. By the time I got home, my wife had done most of my packing. She loaded the Honda as I ate some lentils and rice. It was 4:30 before I was rolling.

Haste or not, I stopped for Evensong, singing it at a deserted roadside park in northern Missouri. The sun was behind thickening clouds, but the thin crescent of the new moon peeked through the clouds during the Magnificat. I munched on a chunk of bread and an apple as I drove on, traversing St. Louis and the Mississippi crossing well into the night and rolling on into Illinois. I slept for a few hours at a rest area and pressed on, stopping for Matins and fuel, eating the rest of my bread and cheese as Indiana and Kentucky rolled by.

Hardly twenty miles from home, the traffic slowed to a crawl, then a full stop. There was a truck accident ahead, blocking the highway. Eventually they got one lane open, and we all crawled forward in stop-and-go fashion. At last I was home, in twenty-five hours' time, a record time for a trip I have made many times. My sister was waiting, impatient for my arrival. But there was, after all, no need for haste; Mother's condition had stabilized. We headed out for the hospital.

Monday evening and Tuesday: October 11 and 12

“Mother, I'm here. It's me.” She opened her eyes and perhaps was aware of me. Or perhaps not.

On Wednesday, I had again been unavailable when Kathy wanted me; my wife tracked me down in adult choir rehearsal by calling J.'s cell phone. My sister, who had the medical rights,was being pressed to have a feeding tube installed to see if Mother might improve. In accordance with the promises Mother had extracted from both of us, Kathy at first refused, the doctor responding with “How can you do this, and watch your mother starve to death?” At this, Kathy started trying to reach me for my opinion. The idea was to install the tube “just for a few days” in hopes that she would improve enough to go to a nursing home and, my sister thought, perhaps begin rehabilitation and regain the ability to swallow. I agreed with Kathy's decision to go ahead with the feeding tube; we both regretted it later, and we bear the guilt of betraying our Mother.

Perhaps because of the food and the IV fluids, Mother was now in a stable condition, her vital signs strong and steady – though paralyzed and unconscious, living in her worst nightmare. And it was clear that she could survive indefinitely in this state. The physician had gotten his way.

Through the entire process, we rarely encountered any physicians. One of them stuck his head in Mother's room once while I was there and spoke with me for a total of five seconds. Kathy interacted with him hardly any more than that except for the time when he was laying guilt on her about the feeding tube, long enough to pressure her into agreement. Despite his lack of interest in the patient and her family, I have no doubt that he will collect the lion's share of payments from Medicare and private insurance.

Physicians roam the hospital corridors like demigods, demanding complete subservience from the nurses and other staff. Despite appearances, I believe that many of them mean well. I think that they would like to have more time to interact with patients and families, or at least evaluate and treat patients without Medicare and the insurance companies watching over their shoulder and the specter of malpractice suits always in the background. To be fair to our specific physician, he was of Indian descent, living in a prejudiced small town -- one of the "foreign doctors" about whom Mother frequently complained. It must be a difficult existence, and he can be forgiven for his haughty demeanor; I suspect that he despises the community and all of the unwashed and ignorant hicks who are his patients as thoroughly as they despise him.

Thank heavens for Nurses, and their assistants. They were the ones who cared for Mother, and they were unfailingly excellent, except for the Hospice personnel.

Much of Tuesday was devoted to waiting for them. The Hospice case manager made an appointment with us for 11:00; she appeared about noon. The nurse who performed the admittance evaluation said she'd show up about 2:00; it was 5:30 when she arrived. Neither of these ladies had the courtesy to call Kathy's cell phone to tell her that they were running late.

In my innocence, I thought that Hospice was a work of mercy, involving volunteers and supported by donations. Not so; they are simply another corporate vulture gnawing at the carcass of the American medical system, having found a niche by living on the 100% Medicare reimbursements for Hospice care. When I finally returned to the Midwest, my wife said that her parents wanted to make a memorial donation to Hospice. I said “Not Hospice. They can give a donation anywhere else, but not to them.”

But for all my griping, I am grateful to these gatekeepers of death for admitting our Mother to Hospice, which stopped the feedings and IV's and provided morphine for pain. That was well worth the day of waiting. [Edited to add: After reading this, M.W., whose mother died not long ago, told me that Hospice was wonderful in caring for her. I am glad that my family's experience with Hospice was not the way it is everywhere.]

Wednesday through Saturday: October 13 through 16

They moved her to a nursing home on Thursday. At the hospital, I had read poetry to her for hours, and quietly sung Evensong in her room, on the chance that she might hear it. At the nursing home, she was in a double room and I did not wish to disturb her roommate. In any event, Mother grew increasingly more distant and was probably beyond hearing anything I said.

My father died suddenly. For various reasons, I was far away and absent when my other relatives of that generation died. This was my first experience of sitting with someone, day after day, as they shed all earthly bonds. The nursing home room was cramped, so my sister and I took turns, an hour or so at a time through the day, leaving her alone for hours at a stretch as we ate meals at home and worked at the task of clearing the house of sixty years of Mother's life therein.

Aside from the Psalter, the Episcopal Book of Common Prayer was less helpful than I expected, at least in any obvious way. There are prayers for the sick, but they presume a recovery. There is a “Ministration at the Time of Death,” but it is in cheesy Rite Two language, mostly dumbed down from the Great Litany. This latter in its proper form (page 147) was better. Several of the Additional Prayers at the end of the Rite One burial service (page 487) are excellent, as is the Anthem “In the midst of life we are in death”(page 484, quoted at the beginning of this post). Silence, with only my breath-prayer (“Deo gratias”) was good. Best of all was the Ave Maria; I wished for a Rosary.

Ora pro nobis peccatoribus
nunc et in hora mortis nostrae. Amen.

I thought much about the intercessions of Our Lady for her children at the hour of their death, beginning with her own Son. On that day when the universe hung in the balance, it may be that her prayers were heard by the Father, as well as the Son.