In Mom’s Memory

Today marks the fourth anniversary of the day my mother died from a hard fall at a local hospital in Northern Virginia, the day before she was supposed to be discharged from the hospital to a rehab center.  She was a poorly controlled diabetic who suffered all kinds of complications from her surgery.  Routinely, patients would go home three to four days after the same surgical procedure.  Instead, my mother was in the hospital for two weeks before that fatal fall.

My mother lived her life to the fullest, within the capacity and limitations she often faced during her turbulent life.  My husband and I took my mom and dad with us on what would be her last cruise just two months before her cancer was discovered.  We travelled together with two of my siblings and our families.  She had such a difficult time ambulating on the enormous cruise ship, but she did not miss many family activities.  She could no longer go into the ocean which she loved, but she patiently marched slowly with my brother to an area where she could see its aqua-blue color whenever we got off our ship.  At that time, nobody knew she had lymphoma; although we noticed she was getting weaker and more fatigued.  We blamed it on her diabetes and old age.  I only suspected she really wasn’t well when she didn’t want to go out to the balcony of her hotel room in Miami on the last day before we went home.  I wish she had at least looked at the ocean for the last time.

My younger brother and I were still in the hospital when our mother fell.  I stepped out of the room for a few seconds to get her a washcloth, something I still wonder about four years later why it was not there for her.  How could a patient wash her face with paper towels?  The nurses were outside at their station, as they had gotten used to her children taking turns to be with her during the weekend.  Maybe they didn’t notice there wasn’t any washcloth in her room.  It was the thunderous sound of her fall, combined with my brother’s scream, that got everyone’s attention.  Shortly after the fall, she slipped into a coma, and I had to make an emergency decision for the neurosurgeon on call what we should do with my mother.  After reviewing the CAT scan and performing a physical exam, he gently told me, as I was in a daze, how my mother had lost significant brain function, might die in the operating room, and even if she survived, likely would have to live like “a vegetable.” 

Would you want to see your mother living like a vegetable?  I still didn’t know what to do.  I was frightened and confused and didn’t know what I should do.  I had to call my husband at home so he could speak with the neurosurgeon to make sure I understood him.  Was there any hope left?  We all decided subsequently to avoid subjecting my mother to further surgery given the very poor prognosis.  Later, the surgeon showed me how her CT scan after the fall also revealed some possible chronic changes which may well have contributed to her fall.  I thought he was trying to comfort me, knowing how guilty I felt for having stepped out of the room when she was brushing her teeth.  Maybe she had a “blackout,” he said, causing her sudden fall.  Nobody could have prevented it, he implied, as nobody can prevent death forever.

I always believe no death is in vain.  We all can learn from somebody’s death.  Whenever I read about another homeless person having been found dead somewhere on the street, I feel gratitude for my life.  Nobody can guarantee how he or she will die, in peace or in pain, alone or surrounded by loved ones, at home or in a hospital, but I know that because of my good fortune, it is unlikely that I will die as a homeless woman without friends or family members close by.  Whenever someone dies of his or her illness, I am grateful for being alive and healthy.  Whenever I see a fallen soldier’s face in the newspapers, I cherish my freedom because it is not free.  

My mother’s death has taught me so many important lessons and made me a better physician to my patients.  I now counsel them more vigorously on the risk of falling.  I urge the obese and diabetic patients to exercise more, to learn activities that improve their flexibillity and strenghth such as Yoga.  I encourage them, no matter how heavy or how old they are, to initiate weight training to increase their muscle mass which will give them more strength.  I even demonstrate moves that would make their legs and arms stronger.  I remind them to have more frequent eye exams, to declutter their home so they won’t trip and fall.  I ask them to have close follow up with their primary care physicians if they have hypertension or if they are diabetic.  I advise those with hospitalized family members to involve more nursing care.  It’s good that family members help care for the patients, but not to replace the nursing care.  Somebody on the nursing staff should closely monitor the patient’s actual intake of nutrition and fluids, I tell my patients, rather than assuming she ate the whole meal just because the tray is empty.  A family member could have helped himself to the meal if the patient was not interested in eating.  I have become my patients’ health advocate. 

My mother’s death has also made me more aware of the “right to die” issue, which ironically, Maryland citizens are facing, with both sides emotionally and vigorously debating.  I am glad I knew my mother’s wishes as I watched her live.  She often expressed her full awareness of being mortal, the notion of “Song nay, chet mai” in Vietnamese, or “Live today, die tomorrow.”  She often expressed how she only wanted to live her moments if she could live them fully and functionally. It was difficult for me to carry out her wishes (set forth in an official document) of preferring to pass on than to living an “inactive” or “nonfunctional” life prolonged by extraordinary measures.  It was an emotional struggle to not let the neurosurgeon take her to the operating room that night, but it was the right decision for her.  Wouldn’t it be easier to let a person decide how she should die than for someone else to do so for her?  As a nurse in the neuro-intensive care unit told me, one of the patients had been on life support for months with family members no longer coming to visit her.  Who was playing God to keep her alive?  Was it God’s will, or our inability to let someone we love transition to her next phase of life, meaning death?  By withdrawing someone’s life support, as in my mother’s case, after all my siblings arrived the day after to be with her, we were carrying out her “right to die” wish.

My mother’s death reminds me how important mothers are.  No matter how rebellious we were as teenagers, we tend to mold ourselves after our parents.  My mom taught me kindness and gratitude.  She used to tell me how she could feel a heaviness in her heart every time I told her stories of the unfortunate.  She had little, but she gave to those who needed help whenever she could.  Her life taught me how imperfect or even unjust life circumstances can be, but she taught me not to give up.  She always reminded me not to underestimate people, as life can go up and down.  She advised me neither to marvel at those who are considered more powerful or more wealthy, nor look down on those who are not “in our league,” as all can reverse in position as the wind of life blows.  Losers or winners are relative given the vicissitudes of time and circumstances.  Her role as a wise mother and mentor taught me to take time now, to mentor those who lack that important mentorship.  She helped me to have a “soft spot” for underprivileged children without mothers or whose mothers lack the knowledge or education to propel them to a better life. 

Most of all, my mother’s death reminds me of what a meaningful life should be.  It’s not wealth, fame, or power that creates and leaves our legacy.  These superficial criteria do not linger in the memories of time.  It’s the joy we bring to others and our families that seal our essence.  All the shoes, hats, clothing, jewelry, and money she left behind did not define my mother.  It’s what she left in my and each sibling’s heart, a sense of tenderness whenever we think of her, that truly shows the importance of her existence.   

Yesterday, in a parking lot, I suddenly thought of my mother when I passed by a car with a big sticker on the back with the words “Love Wins.”  That would be my mother’s advice for her children.  It’s not what we do for money that gives us a good life; it’s what we do for love that sustains us.