Making My Mother's End-of-Life Decision

by Beth J. Leuders

Mom gripped my hand as we inched our way down the concrete steps outside the oral surgeon's office. "Honey, I'm sorry you have to take care of me like this," my mother said.

"Oh, Mom, you're no bother," I replied, fighting back the tears. "Think of all the years you helped me." I thought about all my scraped knees Mom bandaged and my countless diapers she changed, even though I was too little to appreciate her sacrificial care.

I never suspected Mom's battle with glandular skin cancer would rob her mouth of all her teeth. Repeated radiation treatments to her face did more than kill the cancer it killed the tissues of her jaw. But my ever-positive mother did not let a lack of teeth and surgery scars on her face and neck distort her outlook on life.

Before we left the doctor's office, she boldly declared, "I'm going to get dental implants, all new teeth!" We set Mom's next appointment for March 8 to discuss her implant options. Three months later, on that exact day, my mother made it back to the city, but not to the oral surgeon's. This time an ambulance transferred her to a hospital critical care unit.

Mom's compromised mouth led to an infection that settled around her heart and lead to a massive stroke. As I stood over her motionless body attached to a respirator and a menagerie of monitors, I wondered if she could hear us. I gently took Mom's hand in mine. She could not squeeze back, so I knew it was my turn to be the strength for us both.

Twenty-four hours later I telephoned the specialist handling Mom's care. "Is she brain dead?" Although I was numb and in shock, I stepped into the role of mediator between the doctors and my family. As the only daughter and someone whose career involves communication and digging for answers, I felt comfortable in my family "assignment."

"The stroke has caused irreparable damage. Your mom is not able to recover." All the textbooks in the world could not prepare me to bring the grim news to my family. If Mom lived, would she want to be a "vegetable" the rest of her life? What if she never came out of her coma? What would she want us to do?

At age 70 and in cancer remission, Mom left no advance medical directives. We never talked about the "What if you can't someday communicate your wishes for medical care?" In my rural hometown, people don't talk about last wishes, they've got too much work to do in the fields or are preoccupied with cattle prices.

Fortunately, while my family discussed what to do, we agreed there seemed only one appropriate option. We asked for the removal of the ventilator and then waited for Mom's final natural breaths.

We simply granted permission, to the wife, mother, mother-in-law and grandmother we all loved, to ease out of this life in peace, to claim her perfect set of teeth in heaven.

A few times over the last four years I've wondered if we did right thing. When I doubt the decision, I talk to my friends in the medical field who deal with patients' end-of-life decisions every day. Everyone reassures me that Mom's stroke was so severe her body could not rebound. Letting someone die with dignity is such a scared experience, and I'm convinced that God is ultimately the one who calls the shots. He orchestrates the precise timing when we leave this earth not doctors, not lawyers, not family members.

As I write these words, my family is stumbling our way through the final stages of my father's metastatic prostate cancer. As the cancer continues to weaken Dad's bones and cripple his once gung-ho energy, we are learning to open up about the inevitable.

Recalling how unprepared we were for Mom's death, I vowed to myself not to let our family repeat the angst of deathbed decisions again. During one of my recent trips with Dad for his weekly chemotherapy treatment, I asked his nurse for the durable medical power of attorney and advance medical directives forms.

"Dad, I've filled these forms out for myself a couple of years ago and it's important that you do too," I explained. "Whether we need to refer to these documents six months or six years from now, we want you to let us know your medical care wishes."

Dad simply nodded and tucked the forms in the tattered folder he carries with him to all his doctor appointments.

Two days later as we finished breakfast together, Dad asked me, "Well, where are those papers the nurse gave me?" In his own time, and in his own words, my 81-year-old father was ready to take care of business. He pulled out his thick brown glasses and asked for a pen.

At that moment I sensed a squeeze of my mother's hand and a flash of her new pearly whites.