Bread. 23 December 2007
My mother's Christmas
Phone calls before dawn can only mean one thing.
5:45 a.m. "I'm sorry to disturb you," the nurse said, "but she's not responsive to anything but pain stimuli. Her vital signs are stable, except for her breathing, which she seems to be having trouble with."
I asked her to read me my mother's heart rate, blood pressure and temperature. Except for the last, they were normal but even her temperature didn't surprise me for I had known that she had a mild infection and had been started on antibiotics a few days before.
Despite putting her on oxygen, the nurse and her supervisor were nonetheless concerned that it would not be enough, and wanted my permission to send her to the emergency department of a hospital. I agreed, telling the nurse I'd meet the ambulance at the hospital itself.
By 7 a.m., I was there, and she arrived soon after. She didn't look conscious, which didn't alarm me, but even with the oxygen mask, she was gasping for air, which most certainly did.
"Huuh-huh, huuh-huh," she went, desperately pulling oxygen into her flooded lungs. It's extremely painful to see someone you love in that state.
It must have been a very recent development, perhaps while she was in the ambulance. If she had been gasping even while at the nursing home, the nurse would have said so.
"Pneumonia," said the doctor, who promptly ordered an extra-powerful antibiotic. "Because of her age, you need to know she may not leave this hospital."
"I know," I assured him.
But the crisis passed. This afternoon, six days on, they discharged her and she was sent back, in another ambulance, to the nursing home.
* * * * *
Pneumonia is a common complication for people in their advanced years and is often the proximate cause of death. It's the price humans pay for being able to speak.
Our gullet and windpipe join at our throat. The air that we pull in to or push out from our lungs doesn't have to go through our nose. Above our voice box, It can be diverted through our mouth and while there be shaped by our tongue, teeth and lips to make speech.
The problem with that arrangement is that once in while food and saliva can go the wrong way too, down into our lungs instead of the stomach. And there, they'll cause an infection. When we're young, our reflexes are good and our swallowing works flawlessly. Past 70, especially when one is ill, these reflexes slow, and tiny amounts of saliva or food end up at the wrong place. But a microscopic amount is all that's needed to seed pneumonia.
Her underlying condition, however, is Parkinson's disease; she has reached the end stage. When did it begin? It's been so long ago, I can't even remember. I think symptoms first appeared about 17 or 18 years ago, maybe 20.
Parkinson's disease begins with a degeneration of a part of the brain called the substantia nigra which produces the essential brain chemical dopamine. This chemical is critical for communication with another part of the brain, called the corpus striatum, which plays a role in coordinating muscle movements.
With the reduction in dopamine supply, muscle control gets impaired; at the same time, the typical tremors of Parkinson's present themselves. While these tremors are very uncomfortable and fatiguing, they can be controlled by drugs that compensate for the lost dopamine. With medication, my mother had many good years, though she occasionally complained of cramps or weakness in her limbs.
There is no cure, however; the degeneration of the brain cells continues. For some, it's quite fast, for others, like my mother, relatively slow. But the disease progresses nonetheless, and while her medication was gradually adjusted upwards, it also got more complicated, for the drugs that gave her locomotor control and suppressed the tremors also caused hallucinations. In the middle of the night, she'd see burglars in the room, causing much panic. Strange dogs appeared out of nowhere as she watched TV, and since my father sitting next to her did nothing to chase away the dogs -- in fact, didn't even notice them -- it frustrated her no end.
"Why aren't you chasing the dogs out?" she demanded of him.
I don't know whether it was the drugs or the steady progress of the disease, but she also grew disoriented. Once, I passed her a slice of cake on a paper napkin and a minute later found that the cake had been abandoned on a plate and she was eating the napkin. Another day, she dipped her biscuit in a sidedish of chili sauce.
A third day, my father found her happily wielding a pair of scissors, blithely cutting up everything in sight, including precious documents he had left on his desk.
Then there were the mood swings, which worried me the most, because they caused severe stress for my father.
Clearly, these powerful new drugs that made her active and that helped her maintain muscle control had all sorts of side effects. So another set of drugs was added to her regimen: Downers, to counteract the uppers. And my father, who insisted on taking charge of her medication, soon learnt to manipulate her chemically.
When he wanted her awake and active, he would increase her uppers; when he himself wanted to rest and not be disturbed by imaginary burglars or worry about his books and documents being shredded, he would dose her with downers, so she'd sleep.
If you've never seen the future of mind control, this was worth watching.
And still the disease marched on. Her facial muscles began to fail and all the expressions we take for granted when one communicates, she lost. Her speech became slurred. Her sense of balance got worse, and the risk of her falling and breaking her hip increased to worrying levels. By the first half of 2006, she needed assistance in moving about.
The first big crisis came in the second week of September 2006. My father called me 3 minutes before I was due to speak at a conference in Bangkok. "I can't wake her," he almost shouted over the phone.
She was rushed to the hospital, and has never been home since. After that crisis we put her in a nursing home where she could get round-the-clock care. Since then too, she's been fed through a nasal tube leading into her stomach as she cannot swallow, and she's been bedridden ever since, often curling up in a foetal position.
* * * * *
I think the last time she and I had a prolonged conversation was in February this year. I sat beside her bed and asked her what she thought of various people in her life -- her parents, brothers, husband and children. She had a lot to say, but she wasn't really speaking to me. You see, by that point, she no longer recognised me; I was just a friendly face like so many friendly faces she sees coming by her bed.
"Who's Waipang?" I asked her, never one to pass up an opportunity.
"My son, my offspring. He looks like his mother. He is a good boy and he's quite generous. Sometimes."
"What does he like?" I pressed.
"He's trying to play soccer. Now, he's trying to be a good boy and a good man."
"He can guess what I think. One day, somebody was talking to me... I don't know whether he was male or female.... anyway, Sonny took a step forward to pass me a pencil."
"I needed a pencil to take some notes."
"Does Waipang -- Sonny -- have a lot of pencils?"
"Oh, he has a lot. He likes to draw, but he leaves his colour pencils all over the place."
Further on the conversation, I changed the subject. "Are you happy, Susan?"
She sang to herself; she often did when left alone.
* * * * *
This week, while in Ward 78, through one nostril was her oxygen tube, through the other nostril her feeding tube. Through a vein in her hand was a saline and antibiotic drip. This is no way to live.
Modern medicine has done wonders to give us a longer life, and a much better quality of life than previous generations ever imagined. Most of us are or will be active in our seventies, maybe even eighties, something few historically could dream of. But just as the good portions of our lifespan have lengthened, so has the lingering between life and death. If watching suffering, bearing anguish and struggling with dilemmas help us fathom the meaning of life, then we should be wiser than all of past humanity put together. Yet somehow, I doubt it. Somehow, like generations past, we only know to take each day as it comes, sometimes making the most of it, more often the least of it.
My mother is a Boxing Day child, having been born on December 26th, 1927, and for as long as my family can remember, Christmas was always tied up in some way with celebrating her birthday the following day. This year, the day after Christmas, she will be 80 years old. But she won't know it. I hope at least she knows she's happy.
© Yawning Bread