Monday, June 26, 2017

At the Hinge: A Tribute to my Beloved Mom

I wrote this last week while traveling to DC, 10 days before my Mom died. I never posted it. But 24 hours after losing her I picked this up again. I never thought that when I was writing it she would be gone by the time I hit “post.”
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Hudson, my nearly 3-year-old nephew, sat next to me nestled under the crook of my arm while he watched intently, but not without concern, as my brother Michael, his, “Uh Uh” (uncle) suctioned my Mom. She was hyperventilating and he was trying to clear secretions with a suction machine, which entails a suction tube being inserted down her throat. She was on her BiPap (breathing machine), and I had given her morphine and other anxiety medications to try and calm her down. Her color was changing and her lips were turning blue. It was incredibly scary to watch.
Would this be The Moment?

ALS does not go quietly into the night. The end is not pretty.

It is awful.

Hudson turned to me, “Ah-Ah?” (What he calls me):

“Why-eee Uh-Uh shhh shhh?” as he made his best attempt to mimic the suctioning sound.

“Because Nana can’t breathe very well, so he is helping her.”

“Why-eee?”

My brother turned around, “Don’t worry, Hudson, I am not hurting Nana, I am helping her.”

“Why-eee?”

I explained to Hudson, “Grandma’s lungs don’t work very well, so she needs help to breathe sometimes.”

“Why-eee?”

“She has an owie in her lungs.”

I put my hand and then his hand over his lungs, and told him to take a deep breath. I tried to explain in an age-appropriate way how lungs worked and that “Nana” (he can’t say Grandma or Grandpa, so calls them Nana and Papa) needed help to have her lungs work.

“Uh-Uh help Nana” he said, more as a statement than a question.

“Yep, Hudson, Uncle is helping Nana.”

“Why-eee?”

“Because Nana has something called ALS, which gave her the owies in her lungs.”

“Why-eee?”

“I don’t know Hudson. Sometimes it just happens, and we don’t know why Grandma got ALS.”

“Ohhhh. Ohhkay.”

Her hand reached to touch his toes. An extraordinary act of love because it was an extraordinary physical feat. It is like taking a bullet each time I look at it.
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I sit here writing this from seat 6F; the bulkhead of an Alaska Airlines flight bound for DC. I wasn’t sure if I would make it here, on my way across the country to DC to see one of my very best friends, Erin, graduate from residency, and then onto Toronto for a conference. My Mom is not doing well; she is at the end by any measure. There have been untold times over the last 5-6 weeks where we thought; the moment is now, today is the day, this is the weekend.

She has surprised us time and time again, pulling through when even Hospice thought she wouldn't.

ALS is a tricky disease; it is hard to predict and doesn’t frequently adhere to the usual predictable patterns of death.

If being honest with you all, and with myself, when I planned this trip months and months ago, I assumed my Mom would be gone. We’ve always known we would never be able to predict when she would go, but we also never predicted how difficult it would be to tell when the end was near.
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My Mom was diagnosed with ALS in November 2013, and the road has been unimaginably long.

This long road has afforded us the luxury of time; but it has not come without a heavy toll. I, along with every member of my family, have been in active states of mourning for nearly four years. That is a long time to mourn and be sad; it is a unique state of being that most will never experience, thankfully.

Whether thankfully or unfortunately, depending on your individual take, many people die quickly. Perhaps they go without warning; maybe it is a sudden heart attack, a fall down the stairs, or a car accident. Even with a diagnosis like cancer, a prolonged state of dying with no potential of recovery is exceedingly rare. If it isn’t obvious, let me be clear:

It is hard. It is excruciatingly difficult to slowly watch someone slip through your fingers.
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I was at dinner with one of my dearest friends, Jessica, the other day. I was recounting the years of ALS. She asked when exactly my Mom had been diagnosed. Jessica and I have been friends for 2 years, and as such, my Mom was already sick when I met her. When I told her the length she simply, yet eloquently stated:

“You’ve been grieving for a long time. Almost 4 years is a long time.”

It IS a long time. I realized in that moment, that my Mom has been dying for approximately 12% of my life, which I blurted aloud.

My brain sometimes works in weird ways.

I rehashed each year of her ALS diagnosis, its own unique epoch; hard and beautiful in their own ways:

Year 1: 
Year 1 was simultaneously the most awful, horrific, life-flipping year of the disease, yet also wonderful and full of living life to the edges. We were all still in shock, actively mourning and actively reimagining our lives without her. It was also what is termed that, “Golden Year” in ALS – when you have the diagnosis and know you will die, but still have some time left to live life, say the things you need and want to say, do the things you always meant to do. In Year 1, I was personally a wreck. A professional Hot Mess if you will. I also am a person of action and a do-er. So I did what I do best and sprang into action to get her into the care of one of the world’s leading ALS doctors and started planning trips. In Year 1, just weeks after the diagnosis in November, myself, my Mom, sister, and two Aunts took a girl’s trip to Walla Walla for wine-tasting.
My sister announced she was pregnant around Christmas, which was such an incredible ray of light in the dark early days. 

The holidays in Year 1 were simultaneously disorienting and magical, no one could avoid thinking about how many more we might have and what they would look like when she is gone.
In January, I took my Mom to Disneyworld and Florida with Colin. 

In April, she, my brother and I gallivanted across Italy and Greece for over two weeks, visiting Santorini, Rome, Tuscany, Florence, Pisa, and Venice.

 In June, we celebrated my Mom’s 60th birthday with a massive 60th birthday surprise blowout and then as a family in Kauai and Oahu, which also marked my Mom’s early retirement.
=

Then we all experienced the joy of Hudson being born in August, giving my Mom a new title: Grandma.
Jennifer's Baby Shower
My absolute favorite photo of my Mom <3
In September, we participated in our first ALS walk and fundraiser, organized by my parent’s Shelby/Mustang crew of friends who raised thousands of dollars for ALS research. 
During my sister’s maternity leave  in October, she brought my Mom and little Beeb Hudson to Palm Springs where my Mom also got to experience a trip in First Class for the very first time!

Shortly thereafter I took my Mom to see Oprah speak, it was an incredible 2-day experience.

We finished Year 1 with a trip to Disneyland, just my Mom and I.  It would be our final trip to Disneyland together.

The year was simultaneously magical, and heart-breaking. 

Life occurred at a dizzying pace. 

We all couldn't help but think, “Is this the last plane ride? The last trip to Disneyland?” It was also of course full of incredible, life-changing firsts: A lifelong awaited trip to Europe for my Mom, brand new grandbaby snuggles, and lots of new adventures, memories, laughs and love.

Year 2: 

Year 2 was probably the most “normal” and “easy” of each of the 4 epochs. My Mom was still relatively “normal” and mobile, and could get around with a cane, then a walker. 

She also was no longer working, so was able to care for and watch Hudson for my sister when she went back to work. At first, she was able to do it alone, and later,with the help of my Dad and Grandma to get Hudson up and down the stairs. I am sure those months of 1:1 time with her only grandchild were some of the best and most treasured moments of her life. I am so grateful she got to experience them.
One of my most favorite photos - on my sister's first day back to work, my Mom made this sign and sent it to her. It kills me now.  
One of my all-time favorite photos of my Mom.
"Oh, Hi Grandma!"

In January, my Mom and I went to New Orleans together, which was bittersweet because I knew it would be our last trip together as Mom and Daughter; it was getting too difficult for her to travel. 
We named her Ali.
Beignets!
Rebel.
We continued to mark bucket list items off for her, including glass blowing and a ride on the Ducks in Seattle. 

We celebrated her 61st birthday over a long weekend away as a family on Camano Island. She had just started using her scooter, so we had some fun scootie adventures.
Only the essentials

We took professional family photos in the summer, so we could have beautiful photos and memories to remember our Mama with, always. 


The holidays this year were the last where she could talk and help prepare food, something we always relied on her for and looked forward to. For Halloween, myself, my Mom and Dad went out as full-force HRC crew. I was Hillary, obviously, my Mom an ardent supporter, and my Dad was undercover secret service. At Thanksgiving, she shared her famous gravy tips of the trade with my sister.  
One reason Hillary's loss was especially painful for me was because I knew my Mom would never see a female president, and it broke my heart.




We were adjusting to what this new normal life with ALS is like, and were starting to understand the loses we would experience in the future. But mostly, we were just sucking the most out of life and love that we could.
I can still hear her old voice: "Mmmm behbaaay!"

 Year 3

In Year 3, we started to realize just how difficult and excruciating this disease is. She started using her electric wheelchair, and lost her ability to speak. My parents also bought their super cool wheelchair van. However, even with the heavy loses, there would still be happiness. 

I got engaged in Year 3, and my Mom was able to watch me try on wedding dresses and surprised me by buying my dress for me. A rite of passage I thought I wouldn't have.
The dress!





We celebrated what would be her last birthday, her 62nd, on the peninsula with her brand new sparkly wheelchair. Grandma and Hudson both had lots of fun.
 

Hudsons' 2nd Birthday
Hudson trying on his ring bearer outfit for Nana
And most significantly, in October, she got to watch me get married, which is one of the greatest gifts I will ever receive. It meant so much, particularly because when we got the diagnosis, I didn't think she would get to be a part of my special day, which was particularly soul-crushing for me.
My Wedding Shower



Michael and my Dad took on the heaviest caregiving load, along with my Mom’s caregiver, Debbie. ALS takes an army. My brother shouldered so much for us all, literally and figuratively. Steadfast, loyal, and always there. Oh, sweet Michael. 

Year 3 was hard. It would prepare us for Year 4.

Year 4: 

We are over halfway through Year 4 (*ETA: Sadly, I wrote this in the days leading up to my Mom's death, she made it 8 months into the 4th year of her ALS battle.)  This would be our last holiday season with her. We all knew it would likely be her last Christmas; it was such a bittersweet season. Oh, Mom, it will never be the same without you.  I just don't know how we will celebrate without you. My soul is broken at the thought.

Year 4 has been excruciating at times. There has been more pain and suffering than joy, which is hard for everyone. She lost her ability to talk, text, walk, stand, or really do anything without complete assistance.
Ever present Michael in the background

My Mom made it to Mother's Day; none of us thought she would. It was one of the most excruciating days of my life. Oh, the hurt was so raw knowing it would be her last. We all had many breakdowns. Mom, this day will forever be one of the hardest days of my life; I just don't want to do it without you.
Mother's Day Pedi Pop-up Shop!
It would turn out these would be the last photos of us together.

Yet, there was still joy to be wrung out.
A new room!

A few weeks before her death, my parent's wonderful group of friends in their Shelby and Mustang Clubs arranged for one last rumble for my Mom, known as a "Rolling Thunder." It was a wonderful surprise for her to see 20+ Shelby and Mustangs roaring and revving down the street. A parade in her honor. What a wonderful parting gift the club gave her.
Waiting for the parade!
Surrounded with L-O-V-E
Look at all those fancy cars!
This extended period of mourning has brought my family, my Mom, and myself so many moments of both incredible love, and incredible loss. They go hand in hand, you cannot separate one from another.

As I finished rehashing the last 3.5 years, I was again struck by that number:

12% of my life.

It is even higher for my younger brother, still in his 20s.

Almost unbelievable, really.

12% is a long time.

It has been a long, long road.
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I have struggled recently, not feeling quite “ready” to let her go. About a week ago, I got the 3rd call that week from my Dad saying, “You need to come up, she’s dying.”

I responded almost robotically. My first thoughts went to needing to pack some food to eat up there. There have been so many brushes with death in recent weeks that they have become routine.

When I arrived, my Dad and brother had gotten her calmed down, and she was asleep. A few hours later, she woke up and her breathing was relatively stable. She wheeled herself out, stopped her wheelchair next to my sister and held out her hand. My sister grabbed it, held it, and my Mom started to cry. I got up and hugged and held her, choking down hot tears.

We all realized the same thing without saying it aloud: it was time. 

Maybe not today; but it is time.

The end is near.

Later that evening, when it was just she and I, she motioned for her word chart. I brought it to her and she spelled out that she thought she was going to die earlier.

I looked at her and said,

“I know. That must have been so scary. Were you afraid?”

She nodded yes.

“Are you afraid anymore?”

She moved her head side to side.

No.

I wasn’t sure if she meant she was no longer afraid in that exact moment, or if she was no longer afraid of death in a larger sense. I didn’t feel like I could engage her in an esoteric discussion without upsetting her.

So instead I asked through the guise of a calm face which belied my inner agony:

“Are you ready?”

She again nodded her head, side-to-side.

No.

I swallowed what felt like hot daggers.

I thought: I am not ready. I am going to miss her so, so much. I am just not ready.
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A few days later, the family was all assembled again for our now normal weekly family dinners.

I decide to massage her hands. I wanted a way to feel close to her, without making it so obvious to upset her. The problem is, when she cries it becomes dangerously difficult for her to breathe, and as of late she gets upset at almost anything so we have to tread cautiously for her own well-being. So rather than just holding her hand, I massaged them for a long time. Tracing the outlines of her fingers, rubbing my hands along her palms. Etching into my memory what her hands feel like, look like.  Filing it away in my heart, desperately trying to hold onto those features to be able to recall in the future.

I LOVED the movie Beaches when I was young; it was a movie my Mom and I loved to watch together. I don’t know how many times I’ve seen it. I remember thinking that my Mom dying would be the worst, most horrific thing that could ever happen to me. How would I deal with it? Perhaps it was the universe preparing me. A scene that always stood out to me, even prior to her diagnosis, is when Barbara Hershey and Bette Middler are at the beach house when Barbara Hershey is nearing the end. She starts a frantic search for a photo of her mother’s hands, anxiously explaining that she can’t remember what they look like. They find a photo of her hands, and she suddenly remembers them. I thought of this scene in the first few days following her diagnosis. I think of it again in this moment.

File away.

File away.

Don't forget.

Her eyes were closed and she was clearly relaxed.  I looked up at her, and for the first time really saw her experience.

I thought: She is acutely suffering. There is little if no joy left. It is time for her to go.

Hot, silent tears rolled down my cheeks.

It was time.

File away.

File away.

Don’t forget.
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I oscillated for weeks whether to take this trip. It has been one of the most difficult decisions of my life, truly. I realize some people may judge me for leaving her at this time or not understand.

Jessica told me,  “No one who truly knows you and knows what you’ve been going through will judge you.”

I was slated to leave on Wednesday. On Tuesday evening she was having a “bad day.” I had already made the decision I was going to go, with the consent of my family and of my Mom.

I was rife with guilt. What if she died while I was away? What if I didn't get to say goodbye?

Something I’ve been working on and talking about with my counsellor for many months is becoming comfortable and accepting of the fact that there are many minutes and hours in the day, and many days in the week, and weeks in a month. I cannot possibly hold vigil at her bedside at all hours. I must sleep, eat, work, and exist as a human.

She has reminded me that the reality is, most people die without people holding vigil around them, and that just because I am in the same zip code, or even in the same house, does not mean I will necessarily be there at the moment she takes her last breath.

She recounted her own experience with her sister's death, her entire family held vigil around her bedside at the hospital for weeks.

Her sister ended up dying alone when they all stepped out for coffee.
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 We can’t control or predict death; and if we think we can, we are deluding ourselves.

As I left on Tuesday evening after putting my Mom to bed, not knowing if that would be “The Last” time I saw her, I cried and was so unsure of my decision. I told her, “I will see you next week,” more as an order than a question, but the question hung in the air regardless of my delivery. I looked to my Dad and brother, who live with her:

“Will she die while I am gone?”

My brother didn't think so.

My Dad said, “I don't know, I’ve stopped trying to predict. She keeps surprising us. But you gotta let it go, girl. Let the guilt go, you've done all you can do,” and gave me a hug, and the tears came down.

Ultimately, I changed my trip so I left a day later and returned many days early, cutting my trip in half. I didn't feel like I could comfortably leave with her like she was on Tuesday, so I moved my flight 24 hours later and spent that next evening with her. That extra day with her, which happened to be a “good day,” made me feel more at peace with my decision. I have also been given express permission by my boss to do whatever I need to do, even if that means getting on a plane, landing, and turning around and getting right back on a plane to go home. ETA: I am so grateful I trusted my gut, had I not, I would have been on a plane when my Mom died. I am oh so grateful for those last few days with her.

I’ve been holding vigil, we all have, for weeks.

In case you’ve never done this, while it is an honor and privilege to hold this sacred space, it is also exhausting. It wears on you mentally, emotionally, and physically. I am exhausted in mind, body, and spirit.

So here I sit, in 6F.
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I posted a few posts back about a Moth Hour talk on NPR by Kate Braestrup that I heard while driving. She is a Maine State Wildlife Service Chaplain, who lost her husband while she had four young children. The piece was entitled, “The House of Mourning.” It has become a security blanket of sorts for me, having listened to it many times. It never gets any easier; the tears stream down time and time again. However, I none the less hang onto the words, feeling some peace that other people have felt what I feel now, that I am not alone.

I started reading her book, “Here If you Need Me” while in French Polynesia, and just finished it on this plane ride. An unusual choice of reading for a self-described, “Agnostic-atheist” to be sure. As a God-believing Christian Chaplain, she is not exactly an author I would have chosen on my own accord.

It, however, has been one of the best and most important things I have ever read in my life.  It has taught me so many valuable lessons, including that I can find solace in unexpected places.

In, “Here If you Need Me,” Kate Braestrup discusses her relationship with death; both as a widow, and as a chaplain where one of her primary functions is to respond to the recently bereaved, who she describes range from the, “Faithful to Faithfree.”

She elaborates at length throughout the book about people’s varying reactions and responses to death, from the, This is all a part of God’s plan // God needed them // This all happens for a reason that only he understands to the, Where is God? // Why would the death of a child be a part of God’s plan? // Why would God do this?

I have over the many years of my Mom’s prolonged dying experience, had time to think about how to make meaning, if there is any, of this awful ALS experience. I have struggled to come up with a narrative that resonates with me on some level. Lots of well meaning individuals have tried to console me about my Mom’s diagnosis somehow corresponding to, “A Plan” with a capital P that we just cannot understand.

But, I don’t believe that narrative. I just don’t.

I truly mean it when I say it is wonderful if that helps get you through the day and the tough times, it just isn’t something for me that resonates with me on any kind of level.

I don’t believe that a room full of kindergartners were shot at Sandyhook because there was some preordained Plan, or that all of the awful, horrific suffering throughout the world, or fucked up things done to humans by other humans, occurs because there is some Plan that is just beyond our comprehension. I don’t say this just because I am not a religious person, I just feel like if there is a God, and he is a Just God, why would he allow for such awful, fucked up shit?

I have never had an eloquent way to answer my own question, until I read this incredible excerpt, from a clergy member of all people. When one of her children asked her why their Dad had to die, she (Kate Braestrup) offered them this:

“It was an accident. There are small accidents, like knocking over your milk at the dinner table. And there are large accidents, like the one your Dad was in. No one meant for it to happen. It just happened. And his body was too badly damaged in the accident for his soul to stay in it anymore, and so he died. God does not spill milk. God did not bash the truck into your father’s car. Nowhere in scripture does it say, ‘God is car accident’ or ‘God is death.’ God is justice and kindness, mercy, and always – always – love. So if you want to know where God is in this or in anything, look for love. “

She then goes on to reference a previously told story of a little girl who drowned in a lake:

“The death of the little girl with the red mittens is not God’s will or plan. It is physics and biology, the bearing capacity of frozen water, the point at which hypothermia causes a small body’s systems to fail. Don’t look for God in the breaking ice or the dark water. … Here is my answer to the theodicy problem in a nutshell: Frank took the child out from under the ice with his own hands, tried to give her his breath, and his heart broke when he could not save her life. Frank is the answer.”

Thank you, Kate Braestrup, for so eloquently giving me an answer that resonates with me, even without sharing a belief system with you.

We, as humans, want to tidily tie up uncomfortable or sad or horrific events by assigning meaning to them – because if there is NO meaning, if it was just random, what is the point of the suffering?

As I explained to Hudson, while we watched my brother suction my Mom:

“I don’t know Hudson. Sometimes it just happens, and we don’t know why Grandma got ALS.”

We just don’t know.

Sometimes it is just a super shitty lottery. The proverbial short end of the stick. It just sucks. There doesn’t have to be a deeper meaning attached to the WHY she got ALS.  WHY did it have to be MY Mom?

I don't know.

We don't know.

We will never, ever know.

Does that mean beautiful things have not risen from the ashes? Of course not.

Of course not.

Oh, the beauty. It hurts so good.
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Watching Hudson’s unconditional love for his grandmother throughout this harrowing journey, particularly the end of this journey, has been a source of incredible joy and learning for me as an adult.

Hudson, at not even 3 years old, is able to look at my Mom in a truly pure and unadulterated way. By his essence of being innocent and NOT being an adult, he can see past the chaos, tubes, awful sounds, and her appearance. All he has ever known is THIS Grandma.  His Nana.

He has shown wisdom far beyond his years. Throughout his hours of play and digging and banging and following Uh-Uh or Papa around the yard doing cool stuff, he pops in to check in on Nana, sometimes just to say, “Hi, Nana!” and goes on his way; other times he hugs her legs, lets her pat his head before barrelling out to the next patch of dirt to dig.

His simple way of saying, “I love you. I am here. I see you.”

He lacks the ability to project his future grief onto that moment. He of course can’t conceptualize the fact that she won’t be at his kindergarten graduation, let alone his high school graduation, like my grandparents were. He can’t think about the future impending loss, it doesn’t come rushing down on him in those moments. He is just fully present in the now, and the moments are full of love.

He has taught us so much.

Hudson and his love is the answer.

Trust children with the truth about grief, dying, and mourning. They can handle honest information when presented in an age-appropriate way. I know the automatic response is to shield and protect their tender and innocent hearts and spirits, to pretend like you know all the answers to the questions they ask, but you don't have to because they can  handle it -- 
Hudson helping Nana with some Chapstick - a common occurrence. 
 I promise you, they can.

Children are remarkable with grief and dying. It seems to be us adults who muck it up by leaving the present and thinking about our future losses.
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 “It doesn't matter how educated, moneyed, or smart you are: when your child’s footprints end at the river’s edge, when the one you love has gone into the woods with a bleak outlook and a loaded gun, when the chaplain is walking toward you with bad news in her mouth, then only the clichés are true, and you will repeat them, unashamed.  Your life, too, will swing suddenly and cruelly in a new direction with breath-taking speed, and if you are really wise – you will know enough to look around for love. It will be there, standing right on the hinge, holding out its arms to you. If you are wise, whoever you are, you will let go, fall against that love, and be held.”

Thank you, Kate Braestrup. Thank you.

And thank you, Hudson, for showing us how to love unconditionally at this incredibly painful hinge.


Friday, May 19, 2017

The "W" Word

If you ask anyone who lived through 9/11, they can recount the exact moment, the exact location of where they were when they learned or saw the Towers get hit.

For me, it was early on the West Coast, I was still at home getting ready for school, eating a bowl of cereal in our still dark kitchen, with the Today show on the TV as it was every morning growing up. I heard my Dad start freaking out and yelling, “another one, another one! There’s another plane!” I watched live as the second plane hit the tower. My Dad came rushing out of his bedroom and into the kitchen, and my Mom came out of the bathroom into the kitchen as well. I remember we were all just frozen, in shock at what we were seeing. Even though both of them were in view of a TV where they had originally been, it was like they needed to see other people seeing what they were seeing to believe it was real.

I think that is something unique about the human condition. In moments of absolutely overwhelming emotion, whether they are happy or heart crushingly sad, you need to see that another human is also seeing and experiencing what you are to believe it.

 “Can you believe this?”

 You want some kind of confirmation from someone else that this magical, or tragic moment, is indeed real.

A few weeks ago, I was standing in my kitchen, hard-boiling some eggs.

I work from home, and hadn’t gotten dressed yet, even though it was nearing noon. My phone rang, it was an unknown number. Historically, I’ve ignored unknown numbers, but in recent months, I have become accustomed to receiving countless phone calls from healthcare providers about my Mom whose number I don’t have.

Even a year ago, I might not have answered, but today, in my kitchen, I picked up the phone.

“Hello?”

The voice on the other end told me it was the nurse in my Mom’s pulmonologist’s office returning my call I had made earlier that morning.

The previous week my Mom had a pulmonology appointment that I was unable to go to owning to my being on my honeymoon. She had received some test results on her forced vital capacity (effectively the measure of how well your lungs work, a rating of 0-100%), but my Dad hadn’t wanted to know them.

I like numbers.
I need tangible information to help me plan and place my expectations. I wanted to know her numbers.

I explained this all to the nurse and she proceeded to look up my Mom’s records on the computer. I asked what her FVC (forced vital capacity) was, and she said:

“It looks like it was 14.”

“Did you say 40, as in 4-0?”
“No, 14, as in 1-4.”

“Wait, she went down 14%, or she is at 14% FVC?”

I asked these questions even though I perfectly well knew what she meant. But part of that being human part of me needed another human to confirm that I was actually indeed hearing this awful and unbelievable truth. The emotional part of my brain said, “This can’t be true, I am clearly not understanding her.”

“No, she is at 14% FVC. I am so sorry.”

I paused for a second. Letting those numbers roll around in my brain, and then my heart, and then at the pit of my stomach. I swallowed hard, I needed more information and I didn’t have time to breakdown on this phone call.

I’ve been seeing a counsellor since my Mom’s diagnosis, on an almost weekly basis, for the past 3.5 years to help deal with all of this. She’s remarked on numerous occasions how surprised she is that the healthcare providers I speak with treat me as a medical colleague – not that they shouldn't respect me, but that they don't bring anything “down” as I am talking to them as a daughter. Most of this is likely owing to the fact that I speak the right “language”, I ask the right questions, with the right medical-ese words, to which I receive medical-ese responses. This requires me to stay very grounded in the analytical part of my brain. I very often play the role of the medical receptacle which must take in all of the important medical information, interpret it, and spit it back out in a way that makes sense to my family. There is very little room for “daughter” in this taking-in-of-medical-information.

As I rolled this information around in my head, I thought about this conversation with my counsellor. I swallowed hard again. I don’t actually know for how long I was silent.

“Based on these numbers, what is her realistic life expectancy at this point?”

She himmed and hawed, and I asked her to give me her best medical guess.

“A few weeks to a few months.”

At this point, my medical-receptacle status overflowed.

My head spun, I felt like I couldn't breathe.

My hard-boiled eggs boiled over.

I watched them boil over and did nothing. The flames on our gas stovetop started to go up over the sides of the pan.

I remember I looked around my kitchen, noticed my robe was agape, and the belt was on the ground.

“Where are the humans around me to confirm that this is real?” I thought.

I swallowed hard, but the tears leaked out anyways, and my voice broke.

I allowed myself to be a daughter on the phone, and not just the medical receiver.

The nurse offered me comforting words, said it is so hard to predict with ALS.

I knew she was right. I also knew my Mom had been declining, rapidly. I, however, had not anticipated the “W” word.

Weeks.

What the fuck?

We said some things, which I don't remember, and then I hung up.

My eggs continued to boil.

It felt like time was standing still, and I was immediately transported back to the moment when I was told by the first neurologist that my Mom saw that he suspected ALS. My first question to him at the time (My Mom was in the hall, she didn't want to know what was wrong at the time) was:

“How long?”

 “1-3 years.”

The sensation I had at that moment, like the world was caving in on me and that I couldn't breathe, or make sense of what was up or down, was exactly the way I felt standing there in my kitchen.

In both situations, I was, for a brief moment in time, the only person other than medical professionals, to know the truth.

Being the human that I am, I felt immediately compelled to let my siblings and Dad know; I couldn't be alone with this information.

I steadied myself on our island, with my back to the stove. Still being cognizant that my eggs were boiling over. It was like the only shred of reality I could hold onto.

When I finally felt like I could breathe and that I wouldn't crumple over if I let go of the island, I turned off the stove.

As I pulled the pan off, I distinctly remember thinking; “I will remember this moment forever.”

I got a hold of my siblings and Dad. They were all shocked.

My Mom’s FVC was 55% in December, so an incredibly rapid decline in 4 months. We all knew it would be low, maybe 30, at worst we had guessed. And none of us thought we would hear the “W” word.

I futzed around attempting to work for a few more hours, accomplishing absolutely nothing. I found myself just blankly staring at an open email, knowing I was supposed to do something, but being unable to remember what.

I closed my computer when Cris woke up, as he had worked the night before.

I told him, and I broke down as I did. I had been able to stay strong when telling my siblings and Dad, knowing exactly how hard it would be to hear the first time, but knew I didn't have to be strong for Cris; he could be strong for me.

“Is this real? Is this actually happening? Please fellow human, confirm this isn’t real.” My brain thought.

I shortly thereafter drove up to my parents. I just needed to be with my Mom. We decided not to tell her, because she hadn’t wanted to know, and we thought it would result in her, “giving up.

This has been a long, and agonizing road. 3.5 years of loss and grief and sadness.

But also 3.5 years of unbelievable joy and love and life and laughter and living.

I have been thinking in recent weeks of one of my favourite quotes:

“I am strong. But I am tired.”

We all are, my family as a whole, each person individually, and especially, my Mom.

While I’ve known for years that she was terminal, it always seemed a few years away. But since that call with the nurse two weeks ago, the heaviness of it all has weighed on me heavily, at times feeling like it will crush me.

The Saturday a few days after this call, I was at my parents all day, helping to take care of my Mom. I ran out to Target, remembering I needed a Mother’s Day card.

I was perusing the cards, trying to find a card that would somehow let my Mom know what I needed her to know. I finally found one that felt right. I turned it over, mostly by force of habit, to look at the price and I scoffed:

$7.10??!?

I realized in that moment, that this would be the last Mother’s Day card I ever bought for her.

I threw it in my basket, and broke down in the card aisle at Target.

This unfortunately wasn't my first breakdown-in-the-target-card-aisle experience. I had been here almost exactly three years before that, the first Mother’s Day after her ALS diagnosis, knowing that this yearly ritual would be a part of my life for far less time than I had ever imagined.

I sent the same text out to my net of best friends and sister, detailing what had just transpired at Target. They all have all carried me through the last 3.5 years. I am not sure honestly how functional I would be without any of them. I don't think any of them will ever know how grateful I am for them helping to sustain my weight when life has been too heavy to carry myself. They are the great loves of my life.

I sobbed all the way home from Target. There was a beautiful sunset as I was driving back to my parent’s house. It’s beauty juxtaposed to my raw and immense grief just seemed cruel.

How can such beauty exist with such pain?

I mourned the future sunsets she would miss.

I howled in the car as I got back on I-5 about the babies she will never hold, who’s tiny fingers she will never clasp, who’s sweet little cheeks she will never kiss.

The fucked up injustice of it all just seems too much.

I am strong; but I am tired.

The waves of grief and pain and realization pelted me over and over.

I was trying to gain composure, I didn't want her to see my so upset, because I knew it would upset her.

When I got off the freeway, I knew there was no hope. My face held all the tell-tale signs of someone who had been sobbing.

I walked into the house, and she immediately looked at me, cocked her head to the side, and gave me an expression as to say, “what’s wrong?” the only way she can, as her words were long ago robbed from her.

I gave her a hug, and she started to cry.

I decided I needed to be a daughter mourning in that moment, and I pulled away and I said to her:

“I know this is going to make you sad, but I need you to know these things, if you've ever worried or doubted:

I am so afraid of what I am going to do without you.

I am going to miss you so much; I am so scared.

I want you to know, that I will love you, for forever;

And I will miss you, everyday, for the rest of my life.

Always.”

She broke down in deep, heavy sobs.

We went out to the porch in hopes that the fresh air might help to calm her down.

Instead, we both sobbed, and hugged, and held each other tight. With her one arm she can still move, she wrapped it around me, and gently patted her hand on my back. A feat that I know was incredibly difficult for her to do physically.

I let my daughter bucket be filled up with love, compassion, and motherly tenderness. It was the first time in a very long time I felt like a daughter, being comforted by her Mom.

I will never forget that moment, nor the feeling of her hand on my back. It felt like she had reached into my heart and was smoothing down some of the jagged corners of all the broken pieces.
On Mother’s Day, a friend sent me this incredible birth video, of lots of different women giving birth, showing the raw and real emotions surrounding those minutes of transitioning to motherhood.

Of course, none of this is new for me, I’ve seen around 50 babies come into this world, so I am intimately acquainted with the raw moments of birth.

But nonetheless, I watched it through a new lens:

Knowing I will make that transition to motherhood, without my Mom by my side.

I let myself fall apart watching the video. It penetrated a deep level of pain I don't often allow myself to tap into.

I wept for me, for my Mom, and for the babies that will never know their Grandma.

My nephew Hudson, I can say with confidence, is the human my Mom has loved the most in all of her life. To watch her be a Grandma, the unconditional love she has for him, for the absolute joy he brings to her, has been one of the greatest privileges and truest joys of my life.

It has also been one of the most painful, knowing she will never know any of my children.

Make no mistake, I am oh so grateful that she’s had this magical experience, and that Hudson will walk through life all the days of his life with that imprint of his Grandma’s love, even if he doesn't remember her, but it doesn't lessen the pain for me.

It’s so hard.

And so sad.

I am strong; but I am tired.
For however much time is left, I will wring every bit of love and life left out of the time we have.

I am starting to make peace with the fact that it will always hurt. That I will always miss her. And I know that my grief and longing for her will change shape in time, sometimes being harder than others. Her absence will never be easy, and it will be particularly prominent in life’s most defining moments where she would have played a central role.

I will always miss her.

Always.





Monday, April 3, 2017

Grief and Goodbyes.

Travel allows for a kind of intimacy between two people, a kind of immediate knowing that I have found is impossible to replicate in any other life circumstance. 

When you are stuck with a person, for weeks or months on end with them at your side every waking moment, sharing long rides in a car or a plane together, sharing every meal together; you get, perhaps sometimes by force, to know someone on a deeply intimate level. You can meet a perfect stranger traveling, and a special kind of bonding very often ensues at an accelerated pace and level of depth, which, in day-to-day life, might take months, or even years to develop.

You have no distractions except each other, and perhaps in many cases, no internet or cell service, so you pass the time talking with your travel partner, day in, and day out.

If you are a traveller, you know what I mean.

Nearly three years ago, I went to Kenya for work for two weeks, and a new trainer a midwife, who’s name I will leave out because she was a deeply private person and I am not sure she would want her name out there, was the clinician who travelled with me.

I had never worked with her before, and I actually hadn’t even ever met her. We had spoken on the phone twice, and she came highly recommended from my fellow colleague and trainer, and now dear friend, Karen.

I had a photo of this new midwife trainer, and I literally picked her out of the crowd at the Nairobi airport.

She was hard to miss: She was a tiny little lady, with big, beautiful curly brown hair, and wore heavy, dark rimmed glasses. She would be easy to find anywhere, but in Kenya, she was impossible to miss.

She was from Norway, and had moved to the US in her young adulthood, and married an American man, and they went on to have a son together. While she had been in the US for quite a long time, she was still firmly Norwegian, which I loved.

We spent two weeks together in Kenya, conducting clinical site visits. The travel days were long; sometimes we would spend 6 hours in the car a day, with just the two of us to keep each other company. We shared every meal together, spent hours talking about our global health work, life in Seattle, marriage, children, love, my Mom’s ALS diagnosis, women’s health, politics, and just life.

She very quickly became a ‘kindred spirit’ to me. It was still relatively early days in my Mom’s diagnosis – less than a year from when we found out, and I was still coming to terms with the diagnosis and how my life was being radically reshaped from what I had always imagined it would be. I spoke to her about my fears for the future regarding my Mom. I talked to her about deeply intimate things that I had never talked about with anyone at that point:

That I deeply wanted my Mom to see me get married.

What my life would look like when I had a baby without my Mom being able to be a part of my own transition in becoming a Mom.

What it would be like for my future children to not have a grandmother.

Maybe it was because she was a mother herself, but I felt such an incredible connection with her in such a short period of time. She seemed wise beyond her years, and was I think the best listener I had ever met, in my entire life.

When I talked about my fears, hopes, dreams, and anxieties for the future, she didn’t offer advice; instead, she would look at me in an all-knowing way, and just nod. 

She got it.

She had worked in Afghanistan as a midwife during the war, and had extensive experience living and working around the globe, so we were able to speak candidly about some of the enormously difficult things we’ve seen and experienced while engaging in this work. She had such a sage wisdom about her.

About ten days into the trip, one night at dinner after I had gotten off of a call with my Mom, she asked me about my boyfriend.

I was at the time dating someone who I was deeply unhappy with, but was just plodding along with because around 6 months into my Mom’s diagnosis, I became consumed with the idea that my Mom must see me get married. I threw myself aggressively into dating.

I was on a mission: Not to find a boyfriend, but to find a husband. This individual wasn’t a bad guy by any stretch, just not the right one for me.

We were seated outside at our hotel, poolside, in the early evening. She reached across our candlelight table, grabbed my hand, looked at me and said,

“I never hear you speak about your sweetheart. I don’t even know his name. You don’t seem happy.”

I immediately collapsed into heavy, deep, and painful sobs.

She was right, I was not happy.

I wasn’t happy; I had become deeply committed to my mission. My mission was watching my Mom see me get married, and not to be in a happy and fulfilling relationship. This guy seemed totally game, so there I was, trapped in an immensely unhappy relationship.

When I regained a little bit of composure, I looked at her, and I just nodded. I told her about my “mission.”

She squeezed my right hand, which she was still holding, and told me the single greatest piece of advice I have ever received, and may ever receive.

She looked me in the eyes, with such an intense compassion and knowing emanating from her, and she said:

“You cannot be intentionally unhappy just because your Mom is dying. She would not want that. You will suffer enough.”

I broke down; violently sobbing at the table. Sat by the pool, at a romantic candlelight table, at a crowded restaurant.

It was such a release that I wasn’t even aware I needed. I think I was looking for someone to give me permission to let go of my mission.

Maybe it was because she was a mother herself, that I could finally hear and take her advice to heart, advice that others had given me, albeit less sagely or eloquently. Or maybe it was because she was wise beyond her years. I didn’t know.

I eventually regained composure, and blew my nose into a shitty rough, red fabric napkin, as one does when at a nice restaurant. It made us both laugh.

I was resolute that I would end this relationship. And I did. I literally went from the airport to his house upon my return home, and ended it.

She and I continued our friendship in Seattle, meeting for lunch and coffee over the next few years. Sometime last summer, Karen and I, the friend and colleague who introduced me to this woman, were working in Kenya together. The topic of our friend came up; Karen asked if I had heard from her in awhile. I said that my emails had been unreturned for quite some time.  She sat with the information for a few moments, and then said,

“She must be sick again.”

My face clearly gave me away, because she immediately said, “Oh god, you didn’t know?”

I found out that she had a brain tumour, which was terminal, and had known for many years.

I was suddenly spinning, thinking about our time together, her not mentioning it. I was absolutely shocked, I thought we had shared so much, how could she have not mentioned it?

I then realized, she probably didn’t disclose this for many reasons, but almost assuredly due to the fact that very quickly learned that I was a daughter currently losing her mother. 

It likely hit too close to home to her – her son, under the age of ten, would someday experience all of these things that I was voicing out loud to her. Things I am confident she had thought of, but I was embodying them, right in front of her. 

A living, breathing, grieving, crying, daughter.

How will I be able to go on without my Mom?

What will I do without her?

Had I known my friend was sick, I don’t know if I would have said as much as I did. Perhaps I would have felt like I needed to be more sensitive, guarded, and compassionate about her own situation.

In that moment, I realized that not only had she given me the best advice I may ever receive in my life, but also she did me an incredibly unselfish kindness:

She let me be a daughter losing her Mom, instead of she being a Mom losing her life.

She listened, and consoled, and looked at me in her all knowing ways. Her eyes spoke volumes; they seemed to understand my pain in an intimate way. I thought, well, that was just because she is who she is.

I realized it was because she did understand my deep, raw, grief, only in reverse.

How incredibly selfless of her, to just listen, encourage, and affirm my deep pain.

I will never be able to repay that incredible kindness she showed to me.

I found out a few weeks ago, from Karen, that our friend died while Karen and I were recently in Kenya in February, and the funeral had already been held while we were away.

I was going through a lot of my own turmoil, in part from the traumatic accident we were in, and in part my Mom and other issues, so I couldn’t totally process the information she gave me.

Later that same day, I was at my parent’s house for dinner. My Mom, for the first time I had ever seen, had to be in her bed hooked up to her bypass breathing machine because she was struggling to breathe without it.

My Mom’s sole form of communication now is through text, and when she is in bed, she cannot do that.

So I went into the room, sat in her wheelchair that was next to her bed, and just sat with her. She laid on her right side, and she suddenly looked so fragile to me, so mortal.

I sat in silence, and listened to the rhythmic pattern of her breathing machine.

In. Out.

In. Out.

Whoosh. Whoosh. Whoosh.

I sat there, and was overcome with an incredible wave of raw, painful grief.  I swallowed the tears down before they bubbled up.

She pointed to her phone; I figured she had typed out a message prior to getting into bed. I opened it, went to the notes section, and scrolled down to the most recent note.

She had typed out that she needed my sister and I to help my Dad setup payment for his health insurance, because it was too hard for her to use the computer anymore. She wanted us to set it up on automatic payments.

It felt like the wind had been knocked out of me.

I struggled to keep my composure, but assured her we would do that tonight.

There was more subtext between the lines of that text, than anything I have ever read.

It was:

The end is coming. I need to get all of my affairs in order. I won’t be around or able to do this soon.

A few days later, I was getting a massage, to treat some of my injuries from my car accident. As I lay on the massage table, face down, I suddenly thought about the enormity of everything that had happened in the last few weeks. My friend’s death, the car accident, my Mom’s rapidly deteriorating condition, the reality that I am going to lose her, but also about the incredible kindness my friend showed me while in Kenya years ago, and the powerful, literally life-altering advice she gave me.

It all came crashing down on me like waves. The tears began to fall.

I was able to regain composure enough so it wasn’t obvious, and thankfully my massage was about to end.

I rushed out of the office, into a literal torrential downpour, and broke down on the sidewalk.

The tears poured out, and the pelting rain washed them away.

I was grateful for the rain; it felt cleansing.

My car was two blocks away, and for the two blocks, I sobbed, heavy, loud sobs, and continued to have my tears washed away by the rain.

Letting everything out, everything go.

When I got into my car, the crying continued.

Heavy, heaving, sobs.

I had tapped into my pain and grief that I hadn’t allowed myself to do in a long time.

I thought about my friend, and her son. The things he and I share. What I could tell him, if I could talk to him, what I would want to say to him, perhaps when he is a little older?

I would tell him, that I understand what it is like to lose your Mom, a little bit at a time, the passage of time stealing tiny parts of her everyday.

That I am acutely aware of not always remembering what it was like before she was sick.

That I understand that permanent demarcation of before, and after, in my life.

That I too, am intimately familiar with a long, long goodbye.

Even though I haven’t lost my Mom yet, I have lost so much of her, and know that every future milestone, no matter how happy and filled with love, will always be rife with loss, that she isn’t there, when she should have been.

That this club, the club of children who lost their mother too soon, that we will soon both unfortunately find ourselves a part of, is super, super shitty.

And that I am so sorry that you had so little time with your incredible, compassionate, and kind mother.

That the loss and the grief you feel won’t just be at her death. That it will be forever, at every lost moment that should have been.

While the mourning will change, softened by the tincture of time, it will never end.

That if he has children, that the birth of his babies, particularly given the fact that his Mom was a midwife, will likely be an incredibly painful experience because she would have been such a monumental part of that transition

That he will always miss her; but so much of her is within him as my Mom is within me.

I would tell him the hopes and dreams she had for him, as her son, as the son of a Norwegian, and a midwife. How she wanted him to hold onto his Norwegian roots, and for them to be just as foundational in his life as his American ones. That she wanted him to grow up and respect women, and be a fierce feminist. That he better always wear a condom, and that he could always come to her with any questions about sex, or otherwise. She hoped that her being a midwife would open the door for many of those conversations that don’t always occur naturally between parent and child, but particularly mother and son.

In reflecting back, I am sure she shared so many of her hopes and dreams for him with me because she needed to say them out loud, even if I didn’t understand the context in which she spoke them at the time.  

Mostly, I would like to tell him, that his Mom was an incredibly kind, compassionate, passionate, and wise woman beyond her years.

And that she saved me in a way, she saved me from myself.

She mothered me, even if for a few moments by that pool, and freed me from my misery of my own making. It must have been so incredibly and deeply painful for her to hear my fears about my future, knowing her own, with her own son.

To tell him, that the many gifts she left on earth will continue to touch and impact people far beyond her death. Including the kindest, and one of the most life-altering gifts she gave to me.

I would tell him, I will remember your Mom forever, and that even though I didn’t get to say goodbye or tell her directly, I will carry a piece of her with me, always.

Always.

And for that, I will be forever grateful.

For her, for her friendship, for her sage words of wisdom.


In the last three and a half years since my Mom’s diagnosis, my grief and sadness has come and gone in waves. The wound that was created the day I learned my Mom was going to die has seemingly scabbed over and split open a million times over. Currently, it feels split wide open, suddenly raw and fresh. I am so viscerally aware of this impending loss. It feels like a deep chasm that will never close.

It feels so much like the beginning, but yet so different.

People often ask me since my Mom’s diagnosis if they think it is better for someone to die suddenly, or have them go slowly, and experience a long goodbye.

I would say:

Both are impossibly hard.

Both come with regrets. Both come with unimaginable sadness.

I have said a million goodbyes to my Mom, sometimes all at once, and sometimes a little at a time, and will continue to until she is gone, and beyond her death, for the rest of my life.

I didn’t get to say goodbye to my friend, but I feel at peace and confident that she knows what she meant to me and the impact which she had on my life.

I was listening to Kate Braestrup on NPR last week, on the Moth, in a piece called, “The House of Mourning.” She spoke as a chaplain, about her experiencing with people who have lost love ones, and their need to actually see and say goodbye to their loved one’s dead body. I wept listening to it, particularly at this passage that was so heartbreakingly real for me:

“You can trust a human being with grief. Walk fearlessly into the house of mourning, for grief is just love squaring up to its oldest enemy. And after all these mortal human years, love is up to the challenge.”

So my answer to people? Losing someone, no matter the manner, is never, ever easy.

With deep love, comes deep grief.