I woke up on a typical weekday, feeling like death, hungover on lack of sleep from my night shift. A travel nurse in the foreign land of Northeast America, I glanced at my phone as I thought about where I’d go exploring for the day. I checked my voicemail, the vibration that interrupted my half-sleep earlier. The unit clerk called, asking for me to come in. With a stressful merger and short staffing, this half-desperate phone call was an almost daily occurrence. I thought about the TV show I was binge-watching, the beautiful day outside, and my upcoming trip home to surprise my mother. I figured I could make the money instead of spend it. I had no solid plans anyway. I went in.
My assignment was beautiful. Two reportedly very nice patients and a nursing assistant to help me with cares. One patient was 54. The other was 97. Guess who was the no code, the do not intubate (DNI), the do not resuscitate (DNR), the one awaiting death?
At 54, Sandy was dying of pancreatic cancer with significant lung metastasis (spread of cancer to a non-related organ). After yet another admission to the hospital for uncontrollable vomiting and shortness of breath, she changed her code status to DNR/DNI. I walked into the room, not sure what to expect, but Sandy instantly put me at ease. She asked about her “candy,” her nickname for her IV pain medications. Before I knew it, Sandy, her kids, and I were joking about street drugs.
Amid inappropriate jokes and my initial assessment, I analyzed the family dynamics. Strong-willed, sharp, sarcastic, stick-like Sandy seemed comfortable with her decision. Her family was in varying stages of acceptance. Her oldest daughter was scared but accepting. Her youngest son seemed to be bargaining with her mother. Her brother and mother were in full-blown denial. That didn’t stop any of them from trying to set up my nursing assistant with Sandy’s brother.
As night crept in, her family trickled out. Sandy was at ease watching a reality TV show when I brought in her nighttime medications including an antianxiety medication. She cracked a little, fixating on when the nurse after me would be giving her steroids, breathing treatments, and removing her CPAP (external breathing machine). “I’m sorry,” she apologized, “I must be a pain.”
I smiled. “It’s OK. It must feel like everything’s out of control right now, and I want to give you as much control as I can.” I let a beat pass. I knew I was about to ask a loaded question, and luckily, I knew I had a good chunk of time to listen to the answer. “How are you doing with everything?” I asked softly.
“I’m OK. I think I’m making the right decision. I don’t want them to see me suffer.” Sandy took a breath through her nasal cannula (prongs in the nose providing oxygen), her bright, wide eyes starting at me intently. “They already went through this with their dad. He had diabetes, you know. One day, they come home, find him almost dead on the floor. When the doctors asked me about tubes and CPR, I was in denial about what was happening. It didn’t seem like my decision to make. But I had to make it, though.”
“That must have been hard,” I said.
“It was. Their father died at 45. I’ll be gone at 54. But they’re adults. My oldest gets it, but my baby is still holding on. My family is flying in, you know, saying their good-byes. My brother you met? I hadn’t talked to him in 5 years over a stupid argument. And even he’s here now.”
“They’ll be OK,” I offered, not knowing if her children, basically strangers my own age and older, would ever be near OK.
“I used to be such a traveler, you know. Now, I can barely get up from the couch to the bed. Taking a shower takes hours of planning. I feel so useless. I’ve thought about taking a hundred pills, a hundred of those pills,” pointing to her antianxiety medication. “If I wasn’t such a coward, I’d do it.”
“Do I need to tell someone about that?” I teased, knowing the full policy and procedure behind someone contemplating suicide.
“No, no,” she said with a dismissive head shake. “I’m such a coward. I could never do it. I just can’t let them see me suffer like their dad did.”
I gave a small smile. “At least you get to say good-bye. Not everyone gets that.”
“I won’t put them through a wake. I can’t. Imagine all the people saying they’re sorry for their loss. I can’t put them through that. Sorry doesn’t cover it. But there’ll be a Mass. I’m Catholic, so there’ll be a Mass. I’ll be cremated, buried next to their father. They’re adults. They’ll be OK.”
“They will,” I said reassuringly, knowing full well I would not be OK if the roles were reversed, if some stranger was the nurse taking care of my mom, if I had left the hospital wondering how much time my mom had left. Instead, I would leave that night thinking of Sandy’s family and what I was eating going to eat after work. “They’re good kids. They’ll be OK,” I told her.
“They will. They’ll be OK.” She took a deep breath in, shut her eyes on almost tears, and exhaled. “And really, I’m OK,” Sandy said to me with a semi-convincing smile.
Driving home, I thought about Sandy and my own mom. I cried as I thought about her daughter walking down the aisle, no parent to support her. I cried as I thought about her son, no parent to guide him through his twenties. I cried for Sandy, knowing she most of all will miss these moments and could not support her children the way her mother supported her through her life and life-limiting illness.
I never knew how lucky I am to have my parents by my side, loving and supporting me. I only wish we had more days to support parenthood in the calendar. Nurses and teachers get a whole week, and we get to clock out. Mothers and fathers never clock out, even when their children are grown and have children of their own. Working with a lot of mothers, I know their children, young, grown, never growing up, are always on their minds, even at work.
I could have not come home for that Mother’s Day, knowing my mom and I have plenty more together later. But I also know that’s not what always happens. Today could be our last Mother’s Day because tomorrow something could happen to one of us. I want to love my parents an ounce of how they love me while they’re still with me.
Thank you, Sandy, for gently teaching me to hug my mom a little tighter this Mother’s Day and appreciate her every other day of the year.