He was one of those rare doctors who still make house calls, and on this late evening, standing at my mother's bedside, he passed on to me the decisive role in a life-or-death drama that soon would be played out in the shadows of her room.
Calmly, he spoke of life's inevitable end with its welcome release for the suffering: "Your mother has lived a long time. She is tired and old and if she survives this illness her life style undoubtedly will be severely altered."
He went on to explain that she was suffering from pneumonia, having not yet totally recovered from an earlier attack. Survival would mean being bedridden; she'd be an invalid, a cruel punishment for a woman who until the last month had been active and bright, still eagerly serving others.
The doctor spelled out the options: We could resume the use of antibiotics, or she could be readmitted to the hospital with its sophisticated life-support systems. "Or," he said, "you can make her as comfortable as possible with medication and let her go peacefully."
The choice, the responsibility was mine. No one else could make the decision--a decision other families must face as aging parents reach their moment of crisis.
Kneeling beside my mother's bed, I held her hand. It was old and wrinkled and her breathing was labored. Studying her face I was reminded how through all the years of my life she'd been one of my best friends. Now, in essence, I was being told that she would live or die, based upon my decision.
I questioned the doctor about antibiotics.
He peered out the window at the growing darkness. "They could extend her life a few days. A month maybe. There is no guarantee."
And the hospital?
He shrugged. "Probably the same."
Two weeks earlier I'd ridden in the ambulance to the hospital, where I wanted to tell the admitting nurses to take particular care of this dear lady. While she was being wheeled to her room, the memories flooded back:
--I recalled the Christmas when I was 10 and my brother was 12 and we'd expected few gifts because of our family's financial circumstances, but there under the tree that morning were the two shiny new bikes we'd secretly wished for, one blue, one red. I could only imagine the sacrifices my parents had made for that Christmas miracle.
--I recalled how frequently my mother missed meals after my father's health failed, always with the excuse: "I'm just not very hungry, dears," so there'd be more for my brother and me. We lived in a duplex across from North Hollywood Park and we rode the streetcar to town because we didn't own a car. Growing up, I can't recall my mother ever owning a dress that wasn't handed down.
--During the Depression, my mother, a graduate of the University of Colorado, found it necessary to work as a maid in a hotel in order to help support our family. It was a job involving long, wearying hours and little pay, but one she carried off without complaint.
--And there was the night several years ago when the police knocked on her door and told her that her only other son was dead, killed in an automobile accident.
A Few Days or Weeks
Now it was my responsibility, my decision: a few more days or weeks--or surely death.
In these final years, my mother had kept house for me when I wasn't at our desert home with my wife. She had a dog she worshiped, a huge, friendly, female German shepherd who was her constant companion, and on Saturdays, whenever I was home, I'd take them for long rides to the beach or the mountains or the grocery. Although my mother's eyesight was failing and her hearing was impaired, she continued tending her garden and vacuuming the house and preparing meals.
The scenario began winding toward its end several months ago when we lost that wonderful dog and then my mother's sister. And with Los Angeles' flu epidemic my mother's virus turned to pneumonia. In the hospital she responded slowly, the i.v.'s passing fluid into her body.
One afternoon while the sun glinted against the window, a nun held my mother's hand and reflected solemnly on the preciousness of life . . . and the privilege of a dignified death.
Turning aside, she spoke in a voice of one who'd witnessed the spectacle of death and suffering: "Don't let the doctors try their heroics with your mother."
I asked what she meant, heroics, and she explained about hospital life-support systems that frequently prolong a patient's agony. "There is a time to live and a time to die, and when one is ready, one should be permitted to go peacefully."
Now, days later, her words surfaced again. The decision must be made: a few extra days or weeks or a peaceful death.
Asked to Play God