Cancer isn’t supposed to be good news. When you hear the word tucked up close to someone you love, the world is supposed to go dark as a curtain is drawn on the future. You’re supposed to collapse into a chair, slack-jawed and numb. But when Dr. Levine told me that my mother had cancer, my hand shot to my mouth to hide the smile that threatened to spread across my face. For Mom, cancer wasn’t bad news. It was her escape clause, her way off the island.
* * *
My mother had a steamer trunk stuffed with fears. Elevators, highways, airplanes, heights, gas leaks, lightning, electricity, bees. As a young wife and mother, she was strong, with a houseful of people to swat away the wasps, plug in the vacuum cleaner, and hold her hand when lightning struck the oak tree in the backyard, rattling the windows in their casings. But after my father’s stroke and six withering years as his caretaker, she was depleted, stooped, and too frail to withstand the volume of booze that was her nightly habit. Once alone, her alcoholism mushroomed as her anxieties circled her like thugs.
So, we talked on the phone—me in California, she in Florida—and our conversations were full of her loneliness. She was bitter and depressed but functioning until a new obstacle arrived—one that taunted her all day. Food. She couldn’t eat; she was hungry but couldn’t swallow. Was her infirmity real?
“I’m so empty,” she told me in a voice as gray and flat as a driveway.
“Are you taking the pills the psychiatrist prescribed?” Antidepressants and meds for anxiety and obsessive-compulsive disorder.
I heard the grinding of her lighter as she lit a cigarette. “Of course I’m taking them, but they don’t work. Nothing works.”
Despite her growing list of ailments, seeing a medical specialist was out of the question because among her bevy of fears was her fear of doctors. She would see them but only if they were willing to be hands-off. Her current doctor, Dr. Levine, was an affable fellow with a salt-and-pepper walrus mustache and a $1,500 a year concierge medical practice that bought Mom the service she wanted—no medical exams, no palpating, no probing. She allowed Dr. Levine to take her blood pressure and listen to her heart so he’d write her prescriptions. That was all. Tramadol for arthritis; Ambien for sleep; Valium for her next trip to the doctor.
I knew the stories of Mom’s early childhood traumas: her stay at Bellevue Hospital for scarlet fever where she was denied visitors and lost the hearing in one ear; her broken arm and the cruel doctor who set it incorrectly; her botched surgery after a dog bite. She came by her fears honestly.
Now at seventy-nine, the ache of hunger plagued her all day, yet she couldn’t eat more than a few bites. She was too light-headed to read her beloved New York Times. Her feet burned from neuropathy despite the Dr. Scholl’s foam she hand cut and crammed into her shoes. Her bowels were misbehaving. She napped when she never had before. “I’m falling apart,” she told me and it wasn’t hyperbole. It was the truth.
As the months passed, suicide slipped into our conversations. “This is no life,” she said into the phone. “What’s the point? I really don’t see the point.” I stood at the window, looking out into my garden, leggy and brittle in the winter, and raced through all the ways she could kill herself: jump from a tall building, stick her head in a gas stove, slice her wrist in a bathtub, asphyxiate herself in a garage, overdose on pills. With each option, I relaxed more. None of them were likely because I knew she was afraid of heights, her oven was electric, she had no bathtub or garage, she could barely swallow her Lexapro, and there was nowhere in her condo to hang a rope. “It’s good I don’t have a gun in the house,” she said, and I had to agree. That would be scary.
After a lifetime of being manipulated by her anxieties, I couldn’t help but assume her struggle to eat was a clever if subconscious trick to get me on a plane. Her ploy worked. For months, my brother Kent and I took turns flying cross-country to make her soft-boiled eggs and tuna fish sandwiches. But then, on one of those trips, I saw a different truth when I roasted a chicken, baked a potato, and brought it to her on a TV tray. She’d taken to eating in front of Everybody Loves Raymond—a practice so unthinkable in our family, it revealed how far she’d fallen. From across the room, I watched her chew and swallow. She took a second bite, but on the third, she gagged and emptied a mouthful of half-chewed food onto her plate. Her fork and knife dropped with a clatter, and she fell back into the pillows defeated. Her head hung heavy. My heart broke. She was broken. When she wiped her face clean with a napkin and looked up at me, I didn’t see frustration or fear. I saw guilt. I saw that she understood the burden she had become. I saw that she’d been struggling to eat for my sake. Giving her a little smile, I lifted the tray from her lap. “It’s okay, Mom. Maybe some ice cream will go down later.”
In the kitchen, as I swept the gnawed chicken off her plate and watched it tumble into the garbage disposal, it occurred to me that maybe she was starving herself to death. She may not have had a gun, but she had this.
* * *
I was home in California when I got the call. “Mom broke her hip.” I shot out of my chair, envisioning the woman in the Help!-I-can’t-get-up commercial. Kent’s voice was calm and in control. “I’m with her. An ambulance is on the way.”
I booked a red-eye to Florida. I gazed out my window seat through the fog that covered the tarmac. A broken bone meant rehabilitation, and for a heavy smoker and active alcoholic, it wouldn’t take long for the hospital to become a prison. Rehab would be an internment she wouldn’t endure quietly. As the plane cut through the fog into the dark, I dropped my chin to my chest, closed my eyes, and sent up a prayer—for both of us.
I drove directly to the hospital and spent two days running for ice chips, making banal conversation, and clearing away untouched food trays. All she wanted was a cigarette, and all she got was a Nicorette patch. On day three, I followed two orderlies as they wheeled her rattling bed into the elevator for surgery. Four hours later, with a three-inch incision and a titanium and stainless steel compression screw holding her together, Mom was back in her room—hollowed out and semiconscious.
Kent and I were staring out the plate glass window onto a rooftop studded with whirring air-conditioning systems when Dr. Levine arrived. That’s when we got the news that they found cancer. “In a pre-operative x-ray, the surgical team discovered a mass…” Mass—a euphemism for cancer. I didn’t flinch. I went still. The last year rearranged itself before falling into place. Now it made sense. Her not eating. It only took a moment for the insight to dawn—this was grace. I lowered my head to hide the flush of gratitude that rose up from my belly. I knew an answered prayer when I felt it. It came with goose bumps and fresh air that was crisp and unencumbered. This was Mom’s ticket out.
Shoving my hands in my pockets, I turned back to Dr. Levine, who was describing the dark stain on Mom’s x-ray. Lungs and liver. Of course. Perfect. God’s Rorschach for the smoking alcoholic. I listened and nodded as he talked of biopsies, treatment options, rehabilitation, even the viability of electroshock as a way to address her underlying depression and anxiety. Electroshock? I stood speechless as Kent asked appropriate questions that we both knew were a charade. The doctor didn’t know her like we did.
Mom’s end-of-life wishes had always been clear—when the time came there would be no hospitals, no biopsies, no chemo or radiation. Her idea of the perfect death was to be hit by a Mack truck. An eighteen-wheeler going ninety snuffs out any possibility of IV drips, feeding tubes, and the inevitable no-smoking policy. But barring that good fortune, her plan was to hire twenty-four-hour home care and die as quickly as possible. Kent and I knew what she wanted; we had her medical directive; we were her advocates. It was time to call hospice.
* * *
In the days after her surgery, Mom grew more troubled. For her first round of physical therapy, she clenched her fists and fought. When the two therapists pivoted her legs over the side of the bed, she let out a scream so powerful, so guttural and primal, my mouth dropped open as I stumbled out of the room. I could still hear her howling from the waiting room. Embarrassed by the shrieks that rolled down the hallway, I paced, heartsick that this was her new reality. Please, God, make it stop. From the window, I watched pigeons pick at gravel until she finally went quiet. When I peeked my head in the door, she was slumped in a chair, twisted at the waist, arms limp at her sides, head lolling forward. Hot and sweaty from her struggle. One of the therapists placed a blanket over her legs and gently arranged her arms in her lap. “She wasn’t quite up for PT today.” And she never would be.
Every day I talked to Dr. Levine about hospice, and every day he insisted on rehab. In the bed next to us, a nurse struggled to pry Mom’s fingers loose from the oxygen tube she kept yanking from her nose. “She hasn’t eaten in weeks,” I told the doctor. “Is this a woman who’s going to make it in rehab?”
“Heartland Rehabilitation is like a hotel. I sent my own mother there. You’ll like it,” he said, as if it was the décor I was objecting to.
“I’m sure it’s lovely, but look at her!” Did he think I was a monster? Was I?
When Dr. Levine left the room, the nurse sidled up to me and lowered her voice. “Doctors always fight hospice. Keep at it. You know best.”
On day nine of her hospital stay, I settled for rehab. Dr. Levine’s warnings of virulent hospital-born germs, and the promise of more privacy, persuaded me to sign Mom’s discharge papers. I gathered her few belongings—glasses, purse, the clothes she was wearing when she fell—into a plastic bag. Two attendants lifted Mom onto a gurney and wheeled her down the hall as I grabbed the only bouquet of flowers worth saving. With the yellow roses and purple irises in the passenger seat of my car, secured with the seat belt, I followed the ambulance to Heartland.
As advertised, her room was spacious and homey. Soft light from the setting sun fell across her contorted body as the admitting nurse filled out paperwork. Mom lay there, limp, curled on her side, so weak she couldn’t lift her head. An hour later, when a chipper occupational therapist asked her what she liked to do for fun—play bridge, walk, ride bikes, swim, hike—I let out a hysterical, maniacal laugh. Something inside me snapped. I looked at Mom. Her eyes were opened but dull and unblinking. Her neck was kinked at an awkward angle that made me want to wrap her in a blanket and take her home like an injured bird. She couldn’t save herself. I had to.
I pulled a chair up close, fingered her hair away from her eyes, and gently held her hand. “Mom, I’m going to get you out of here. This place sucks.” She stared at the floor, unresponsive. I kissed her dry forehead, grabbed my purse, and headed for the door.
It was 5:00 p.m. Dr. Levine’s office was half a mile away. With adrenaline pumping, I jumped in the car, drove the few blocks, rode the glass elevator, stormed past the empty receptionist desk into his office, and stared at him over his massive desk. “I want my mother out of Heartland and into hospice. I don’t care what you have to do, but I can’t have her in that place one more day.” My voice sounded unfamiliar. I was channeling my mother.
He offered me a bottle of water and a chair. I remained standing and spread my feet a foot wider. The water sloshed in my trembling hand. “I’m her medical advocate. I have the paperwork. Call it lung cancer, call it failure to thrive, call it whatever the hell you want. I don’t care. I want her out of there and into hospice now!”
He stared back at me. After a moment, he leaned forward. “Okay, kiddo, I get it. Hospice it is.” He reached for the phone and arranged for her to be admitted to an acute-care hospice facility. “Your mother is lucky to have you.”
I drove back to Mom’s condo feeling giddy. The image of her in that bed, listless as a spent balloon, had exposed a power I didn’t know I’d had. After a dinner of cold pizza, I sat on the patio with a glass of wine and watched the moon jump on the water. I was proud of myself, but my triumph was far from sweet. When I crawled into bed and closed my eyes, beams of doubt punctured the darkness until exhaustion took me like a wave.
* * *
After two weeks in the hospice acute-care facility, Mom came home. For two and a half months, with the help of the round-the-clock home care she wanted, I cared for her. She never walked again, never read again, never ate again, but every few hours, at her request, I took the oxygen tubing from her nose, moved the tank across the room, and gave her a cigarette. Too weak, I flicked the lighter for her. She lay propped up in a mountain of pillows and puffed on her Marlboro Lights, the smoke hovering over her head until floating west on the salty air. Sixty-eight days after she broke her hip, she slipped away, calm and at peace.
I drove to the beach. It was nearly midnight. A strong easterly wind was stirring the sea into a tumult of swells and crashes. The moon eased out from behind the clouds, and I stood at the warm water’s edge and cried. She was free. And so was I. Later, I would wrestle with the tangles of complicated grief. But that night, as the palm fronds clapped in the wind—a sharp, distant applause—my tears were clean, falling unsullied in the sand.