A Son Faces Painful Choices at Mother’s Moment of Crisis

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

The World Federation of Right-to-Die Societies doubtless would find this an easy judgment, as would the Hemlock Society, which associates itself with the controversial subject of euthanasia. But my own case involved devotion to a loved one unable to voice her own preference. I was being asked to play God with the life of a human whose love, kindness and unselfishness over the years would be impossible to calculate.

Years ago I’d become familiar with the problems of the aged when I prepared a series of articles for this newspaper titled “The Old and Unwanted,” articles that dealt with families and the placing of loved ones in nursing homes that in many cases could be best described as shelters for the living dead.

Another time, as a young reporter, I covered a suicide on busy Vermont Avenue when a destitute old woman had gotten herself all gussied up in her finest nightgown and swallowed a handful of sleeping pills. Before losing consciousness she’d scrawled out a “confession,” a note telling how she’d “committed the crime of growing old.” She was lonely, she said, terribly, terribly lonely. Imagine, lonely on a busy, bustling boulevard with hundreds of people passing her door each hour.

There was just one problem: No one ever knocked.

Still agonizing over my mother’s condition, I spoke with the pastor of a church I had attended years earlier. He was sorry, he said. He couldn’t assume the role of God. It was my decision alone. But he had a suggestion.

“Perhaps,” he said, “it would help if you placed yourself in your mother’s position and asked, ‘Would I want to be an invalid?’ ”

Back at my mother’s bedside, I reflected on her final years. She’d been active nearly to the end. Her routine never varied. Each morning as I drove away she’d wave from the window and after this she’d tend her plants and dust and wait for the postman, who almost always brought puzzles, which she worked constantly because, as she kept repeating: “I want to win a car for you.” Her mind remained clear to the end.

Baseball and Popcorn

At age 96, she rooted for the Dodgers. Tommy Lasorda could do no wrong, and whenever he chewed out an umpire she cheered him on. Baseball, popcorn and chocolates were her narcotics. Her world was small, her wants simple. Her faith and courage were qualities I marveled over.

She was small, fragile, terribly fragile, but she refused to give up. I’d say, “Why don’t you just relax and do nothing today,” and she’d reply, “If I do that I’ll get to where I can’t get around and I don’t want to become an invalid. I couldn’t stand that . . . .”

In that instant of reflection I had my answer. Later, near her nightstand, I discovered a “living will” that she’d signed: “If the time comes that I can no longer take part in decisions for my own future, I direct that I be allowed to die and not be kept alive by medications, artificial means or ‘heroic’ measures. I do, however, ask that medication be mercifully administered to me to alleviate suffering even though this may shorten my remaining life. This statement is in accordance with my strong convictions and beliefs.” The document concluded with her wish “to live out my last days at home rather than a hospital.”

It was signed Elena B. Hulse.

I telephoned the doctor, asking him to prescribe sedatives should they be needed. Then I instructed the nurses not to move from her bedroom. After this I kneeled beside her bed and spoke to her, hoping she could hear my words, thanking her for all those years of devotion and sacrifice and love. Although she was unconscious, I believed she understood.

A few days later a young doctor who stopped by assured me that she was not suffering. Then only hours later, her breathing became labored and a few minutes past midnight she was gone.

We held a simple graveside service. Our former pastor, Ray Wallace, flew in from Texas to officiate. In keeping with my mother’s wishes, he repeated the 23rd Psalm. All this took place on a bright, sunny morning--a morning that suddenly was unbelievably empty.