Old habits don’t stop. Once in a while, I still catch myself asking, what would Mommy say, she might not approve—only to remind myself in mid-thought that Mommy had died early this year, that her okay or non-okay would not be forthcoming, ever. And that, in truth, we buried Mommy and Daddy this year, within six months of each other.
That was my 2013.
But this year-ender of sorts isn’t about my loss. It is to share and to echo perhaps what many others have gone through and realized—that death sometimes isn’t sudden. It is not a split-second moment.
In some cases, it is a drawn-out process that stretches over a period. My mother was in a coma for almost four months.
In cases such as Mommy’s, death entails a series of decision-making, much like living—whether to pull or not the life-support plug, and when. I thought this crossroads happened only in the movies, that it was only cinematic drama.
I was wrong.
Uninitiated
“Have you and your brother talked about DNR?” the neurologist asked me the morning after my mother fell into a coma. The day before, January 2 (a year ago, how time flies), Mommy suffered a heart attack and stroke, and flatlined. She was revived after more than 10 minutes, but had slipped into a coma. The damage to her brain didn’t show good prognosis.
“No,” I said. “Don’t worry, Mommy will let us know, somehow, what to do. She’s always been in control. She will decide.”
Huh? What do doctors make of that answer? The neurologist didn’t see the need to remind me that the “decision maker” was in a coma. She merely nodded her head, and the internist, an old trusted friend of mine, and the head doctor who assembled this team of specialists, immediately understood how uninitiated I was to such a situation.
The neurologist briefed me on the protocol the team would follow in the next few days: more tests (brain, heart, blood, lungs—the latter to be proactive against pneumonia—and other vital organs).
What they made clear yet again was that Mommy’s age, 89, was a considerable factor in her recovery.
Mommy, who was so active only a week ago and who never saw the need to visit a doctor, was attached to the necessary tubes—for feeding, breathing, intravenous medicines.
That was not the first time I heard of DNR (Do Not Resuscitate). Earlier that day, two friends asked me if we signed a DNR form. Almost nonchalantly I told them, no need, because Mommy was breathing on her own and was merely being helped by a ventilator.
“But are you allowing them to intubate some more?” my friends pressed me. Clueless, I told them the doctors hadn’t yet offered us a DNR form.
But now they just did, and my brother and I had come face to face with the form. We didn’t sign—not yet.
Medical devotion
In the weeks and the months that followed, we saw medical expertise and devotion at its best. My internist-friend assiduously worked with the specialists round the clock to address brain seizures, monitor strokes, prevent pulmonary infections, among other proactive procedures. The doctors and their cocktail of medicines were prolonging her “life” as she remained in a coma.
Yes, she breathed, but with the pulmonologist calibrating the ventilator.
I was taking the cue from the doctors who were going through every step to keep her alive, at least alive. I don’t know if medicine/science could really wake you up from a coma. Looking back, I now realize that the doctors could also be taking the cue from us children who were not letting go. Doctors live by the oath of their profession.
After some time, however, my brother and I started to ask them, “Is Mommy still there?” Our cardiologist would say, “Yes,” meaning her heart was beating.
My parents didn’t have a living will or DNR; their generation didn’t look into post-death scenarios. My generation, in general, isn’t into DNR as well, although I’ve been told that there are those who carry their own DNR in their wallet so that kin and doctors will be guided during an emergency.
In the early months of my mother’s comatose condition, however, my brother and I were too much on the roller-coaster ride to revive the DNR issue.
Quality of life
However, after two months, another friend of mine, this time a doctor who heads a hospital different from where my Mommy was, said quite bluntly, “She no longer has the quality of life, and given her age… We already know where it’s headed.”
After some more time, he said, “Those medicines are just more toxins in her body.” We are merely delaying the inevitable, he said. I knew he was right.
Another friend, a retired doctor from New York and UP-PGH, told me the case of his own mother who was in her 90s when she was on the brink of death, and whom he brought home, from the hospital, to die.
Indeed, one could be conflicted over advice from friends who truly cared.
What helped me was that the head doctor looking after my mother was and still is a very good friend I could talk to and who could literally hold my hand.
“We’re not doing anything heroic,” I remember her assuring me when I told her about my concern that we could just be artificially prolonging Mommy’s life. “Our treatments are not aggressive, just normal procedure.”
Through the ups and downs, and the plateaus, my brother and I realized more and more that we would have to make decisions sooner or later. Again, our good rapport with the doctors indeed helped. More than that, it helped that the doctors cared as if ours was their own mother.
Series of decisions
It was becoming apparent that what little time Mommy had on earth would depend on a series of decisions—ours, mainly. The doctors would never pull the plug—“We’re not giving up,” they told us in so many ways—but still I feared that that decision was imminent. The burden wasn’t only heavy, but also daunting.
But the burden became bearable mainly because I’d cocoon myself in the hospital chapel, in prayer. The daily Masses and rosary recitation had a calming effect on me, to the point that the hospital chapel became my go-to place even long after Mommy died; the priests have become family friends.
The chapel was a sanctuary from the ICU, where deaths came one after another—a few-months-old chubby baby who didn’t survive pneumonia; a female executive who had aneurysm; a mother who succumbed to breast cancer and whose husband never left her bedside. Mommy outlived her neighbors in ICU—without ever waking up.
On the third month, the doctors respected our decision to stop the blood transfusion and not to prop up the pulse or heart rate anymore. It was at this point that I realized that there was no one DNR, but a series of “DNRs” we had to sign. We had to sign a document for every procedure or medicines withheld, in her case, only the intravenous antibiotics.
Unfinished business
And curiously, our doctors would ask us now and then if Mommy had unfinished business or if we had unfinished business with her that could be holding her back. (But every business is unfinished, come to think of it.) They would also ask us if Mommy, before she got sick, had told us anything that would indicate her stance on intubation.
“Yes,” I said, “she would tell us, ‘Ayokong bubutasan’ (no tubes), not even dextrose.”
Towards the fourth month, the doctors allowed us to bring Mommy home and do home care, with her hooked on the ventilator and feeding tube, and under the care of private nurses. Her breathing was machine-aided, but still she could breathe.
She never woke up. One early morning, about a few minutes after my brother whispered goodbye to her, assured her that everything would be all right, and prayed for God’s compassion so that her mortal body would suffer no longer, her blood pressure plummeted, her hands turned clammy and her face was emptied of color.
The Lifeline doctor and paramedics printed out the life graph to show us the flatline. They asked if they could already unhook the ventilator tube. Odd, but it slipped my notice that she was still hooked to the tube, and that her chest continued to heave as if she was still breathing. This was more than an hour after she had died. The machine functioned way beyond its designated function. The nurse and we forgot to unhook it.
Complicated process
Life is simple, but dying could be a complicated process. Sometimes you are made to decide when and how your loved one could die. Could anything be more daunting than that?
Usually, it helps if there’s a doctor in the family, on whom the family relies for medical decisions, and who can discuss procedures with the other doctors.
In general, Filipinos are not into DNRs. But more and more people now tell me that people should be—if not a living will, at least tell your loved ones to what extent you would want to be revived or be kept alive.
In Mommy’s case, even as we listened to helpful and forceful advice, we took it one day at a time. We literally listened to her heart, if it was beating still. “Are you still there?” “Can you hear us?”—we talked to her incessantly. But we also gradually reduced interventions or the artificial means, such as that for the pulse rate.
I had to believe over and over that there was Mama Mary I could lean on. And there was.
Actually, we didn’t have to pull the plug. We just had to let go. After that, Mommy let go.
