June 3, 2010

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A decision (amputation) no one should have to make

No one who saw me looking like an ordinary shopper at Super Fresh last week could tell that I was trying to decide whether to put my mother through leg amputation surgery or not. The gangrene in her foot was spreading rapidly, and she was in enormous pain. The blood flow to her leg is almost entirely impeded. She is too old for by-pass surgery and might not survive surgery at all. If we did nothing, we would definitely lose her soon.  Surgery was her only hope for a pain-free life; could I really choose to put her through it?

Mom had only two viable options: Put her on morphine to keep her comfortable and let gangrene eat her alive, or do the unthinkable, which was to have my mother lose a leg because of a choice I made.

Big people have to take care of little people. Complicating the decision was the fact that my mother has Alzheimer’s disease, making her incapable of deciding for herself. She isn’t much aware of her physical body, other than the pain. She has trouble talking, and her memory is gone. Nevertheless, she has been lucky in her 89 years. She married the only man she ever loved, had healthy children, worked hard and had enough money to build her dream house, where she and my father lived there until he died.

When I promised my father to take care of my mother, I didn’t count on gangrene threatening her life. I would be furious if only my mother were in danger, but everybody dies. Children expect to lose their parents. When things don’t happen in the natural way — that is, when parents lose children — it’s worse.

Perhaps her time has come. Or has it?  How can you possibly decide? Especially when it’s your mother? Mom still recognizes me. She is delighted to see me. I’m delighted to see her. When I look into her eyes and don’t say a word, she laughs.

“Stop it,” she says. “Don’t make me laugh ... makes me silly.”

We know one another. We love one another. How could I give that up? How could I do nothing and let her die? That’s what kept me going round and round, indecisive.

My sister and I decided in favor of surgery, she in tears, I determined to take the only chance my mom had to survive. All the weeks of talking to doctors about her as if she didn’t exist were a sham. “I don’t want to lose a foot,” she said in the wheelchair.

She understood what was going on at some instinctual level and didn’t like it — worse, was terrified. We had hoped she would be unaware.

“I want to go home!” she yelled, even under morphine.

There’s real time and then there’s hospital time. Mom’s surgery was scheduled for 3 p.m. but took place at 7 p.m. I saw her foot before nurses wheeled her into the Operating Room. Four toes were dead black, and red streaks were halfway up her leg — clearly time to step back and let the doctor do his job.

We didn’t see her until 10 o’clock that night. She made it through surgery, but was groggy and in pain. I stayed at the hospital with her overnight. She slept with her eyes open that night and cried out in pain every 15 minutes. I woke up every time I heard her.

“Look at me,” I said after a while. She looked into my eyes and calmed down a bit. “You’re in the hospital. You had surgery. You’re doing well. Go to sleep.” She did briefly.

In the course of that long night, I was compelled to ask the nurse what happens to amputated limbs. “No one has ever asked me that before,” he said. “I’m not sure.”

“I know,” said another nurse. “They’re sent down to the morgue in a bag and incinerated.” Now we all know.

Eventually I worked up the courage to look under the blanket at what was left of Mom’s leg. I felt sick to my stomach, even though she was still bandaged. Poor Mom. Old people should not have to suffer. My decision haunted me. She’s recovering at Rydal Park, in their medical wing. She’s not in much pain, and she’s more alert.

The big question in my mind is: Will the fog of Alzheimer’s clear long enough for her to look down at herself and say, “Wait a minute! Where the hell is my leg?” as if someone had swindled her while she was asleep? I hope she never realizes what happened.

Meanwhile, our family videos run backward. My lovely, healthy mother changes into someone who has problems feeding herself, then talking, then walking. I put a cup of juice to her lips, but she didn’t have the force to use a straw, so she blew bubbles instead, and laughed. She hits people when she’s agitated. She wakes up crying. I’ve become the grown-up, the parent.

I visited her yesterday evening. She lit up when she saw me, as I lit up when I saw her.

“Jankie,” she said, smiling and calling me by the old nickname only she uses.

Our bond is deep and true, and I can’t allow her to die while we have it — a bit muddier than before, but still strong. It wasn’t time to let her go quite yet. Maybe my decision was the right one, at least for now. “How did you find me?” she asked.

“I always know where you are,” I said. “We belong to each other; I’ll always find you.”

She looked at me intently and started to cry. “You’ll be okay, Mom,” I said. “I’m here.”

And I did the only thing I could think of. I took off my shoes, climbed into her bed, put her head on my shoulder, near my heart, and held her until she fell asleep. Big people have to take care of little people.


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