My Mother died this Monday, April 14th at 2pm. My brother, wife, and I were with here and witnessed her last moments. Her heart beat its last while I was holding her hand.

This comes at the end of eight years of congestive heart failure. Her first collapse was due to water retention, she had about two gallons of fluid in her chest cavity, which crushed her heart. She managed to recover from that episode and remained fairly active despite the death of 25% of her heart’s tissue. Although diagnosed with congestive heart failure she remained active, traveling frequently and independently.

Four years ago she suffered a massive heart attack. She managed to call me at 6am and asked for me to come over and be with her when the ambulance picked her up. Once we got her to the ER room of the Kaiser Permanente on Geary Street in San Francisco she slipped into a coma. She spent the next four days in room 3205 of the ICU unit at Kaiser Permanente. The doctors spoke to me with tears streaming down their faces that she was very likely not going to make it. They described the severity of the attack as “one step below just falling over dead.” I spent many hours of each day at her side supported by my amazing wife, Daisy. On the fourth day, as I walked quietly into the room her head popped up, her eyes snapped open, and she pointed a finger at me vigorously as if to say, “It’s you!” She was not able to speak that day, but by the next she was very animate and giving the patient nursing staff a serious run for their money. They say that doctors make the worst patients. After seeing my Mom’s behavior I think that whomever coined that phrase had never treated a career nurse. My mother was a psychiatric nurse for the Veteran’s Administration hospital here in San Francisco for 20 years, and she damn well knew the best way to do things, and she was not afraid to tell everyone.

My Mother was moved to an assisted living facility where she lived for 18 months. Her heart had suffered no further damage as a result of the attack, but the strength, and circulation, of her legs was very impacted. She slowly progressed from wheelchair to walker. We renovated her house and got her moved back in. Although she could not be as physically active, her mind was still sharp, as was her tongue. Many were the times that she closed the subject of me cajoling her about working to improve her health (and watch what she ate) with a wry smile and a hearty, “Fuck you, asshole!” I think that became her pet name for me for the last few years, which was something of an improvement over, “Travee-poo.”

A couple of weeks ago my Mom suffered an infection in her left leg which caused a large blister. The circulation in her legs had become worse, and her feet were often purple. We got her back into an assisted living facility (ironically, the same one that she first went to after her heart attack) where they treated the leg for a week and a half before sending her back home. The color of her legs was a great deal better. She now had an assigned living assistant that visited her four times a week. My Mother spoke highly of the woman, and Mom was glad to be home and in good spirits.

I had a phone conversation with my Mother on the evening of the 8th, and although she seemed a little tired, she reported nothing amiss.

Last Wednesday, the 9th, I got another morning call. This one was from the agency that had gotten my Mother her assistant. The assistant was outside of the house. My Mother had not been able to let her in, and had yelled something incoherent from up the stairs. I rushed over, went in, and found Mom. The TV was blaring, all the lights were on, and she had obviously been struggling, unable to rise from her bed all night long. Her fists were clenched as she fought for breath through cracked dry lips. All four feet, nine inches, and 240 pounds of my amazing Mother were shaking with the effort to breathe. She looked up at me, recognized me and a pleading came into her eyes.

I said, “Mom, it’s Travis.” I put my hand on her shoulder and she swallowed and nodded.

She said, “Finish it. Finish it.”

I said, “I’ll do what needs to be done, Mom, but we have to try. I’m going to call an ambulance and get you help. Okay?”

She nodded again and went back to breathing.

We got her to the ER of Kaiser Permanente where she quickly lost consciousness and was unable to speak any more words. They transferred her back up to ICU, room 3206. I stayed with her that day until 1am the next morning. The doctors asked me how much treatment I wanted to pursue. They explained that with the level of treatment that would be needed to support her she would never return to the level of quality of life she had previously had. I consented to them applying blood pressure medication, told them to attempt resuscitation if she had an arrest. Her breathing quickly weakened and I decided they should intubate her.

My Mother, and I, had an ongoing dialog over the last eight years about how she was to be treated during a life threatening situation. She had said that she did want attempts made to resuscitate her if that should become necessary, but under no circumstances did she want to be kept on prolonged support. She feared life in a vegetative state, or suffering a stroke. Mom spent the last ten years of my grandmother’s life caring for her, along with her sister, when grandma had a stroke. Mom, also watched the last days of my aunt’s life with a breathing tube, and did not want that either.

I decided to stay with the spirit of my Mom’s wishes more than the exact letter, and allowed her to be intubated. Without that she would have died on the evening of the 9th.

As the days went on my Mother’s condition showed only slight signs of improving amidst a general slow deterioration. At the end she was on two of the most powerful blood pressure elevators, or “pressers”, at very high dosages and still her blood pressure dwindled. The doctors explained that the risk of keeping her long term on pressers was that what they did was constrict her circulation to keep it focused in the central systems of her body, allowing her heart to beat strongly. That meant that her already poorly circulated limbs were getting even less blood flow which gave rise to the increasing possibility of amputation. The blood flow was also restricted to her brain, raising the possibility of brain damage, the extent of which would only become known if she ever recovered consciousness.

During the days I was at the ICU, I had conversations about my Mother’s wishes with over a dozen of the staff members. They all took pains to not give advice, to let me be clear with Mom, but at some point every one of them mentioned how they would not want to be kept alive forcibly. This was a profound experience for me. To me it points to a basic intuition that life is meant to be lived, and not merely preserved. This lesson never came home as much as it did for me over the last week, and I consider it a great gift that my Mother gave me.

My brother, Port, was with me for several of the days, as was my wife, Daisy. I also managed to get a hold of all of my extended family, which was a process of getting numbers from them and chasing after answering machines. All of my numbers are packed away SOMEWHERE due to the recent renovations my wife, and I have made to our apartment. My Mother had an address book by her side when I found her, but most of those numbers were out of date. Despite the handicap, everyone was reached, and both of the children of my aunt were able to visit.

My wife, and I, had been planning a housewarming party for weeks, for Saturday the 12th. We decided to go ahead with the event, but Daisy had to take on the brunt of preparations as I was rarely away from my Mom’s side. The party was one my Mom would have loved, lots of joy and good cheer. We raised a toast to her in the middle of the evening and the party went on into the wee hours. We finally shooed the last of the guests out at 3:15am and cleaned for over an hour before crawling into bed at 4:42am. At 4:46am the phone rang. It was the hospital. My Mother had had a heart attack and they were struggling to resuscitate her. We scrambled into the car and broke a few laws on the way over. When we arrived she was still alive, minimally. It had taken them 10 minutes to get her heart beat back, further raising the specter of sever brain damage. I remained at the hospital for the next 33 hours.

As Mom’s condition worsened, I had a conversation with my brother. We came to an agreement on the morning of the 14th that it was time to honor my Mother’s wishes. Her body was retaining water and she was no longer absorbing food through her stomach. Despite the presser medications now on massive dosages, her pressure was still critically low.

Since I was named as my Mother’s executor, and the recipient of her durable power of attorney, the final call fell to me. At 10am on the 14th I told the attending nurse to discontinue the pressers. Daisy, Port, and I sat with my Mother for the next four hours. We held her hand, and each other’s. I put my iPod headphones into my Mom’s ears and played the song that she wanted played at her funeral, “At My Funeral” by the Crash Test Dummies. (Yes, I know Mom, I will still play it then.) Daisy had also brought a copy of the Tibetan Book of the Dead. I had previously read it for my Grandmother, and my Aunt, after their passing, and Mom wanted it read for her. I did. As we waited I played more songs for my Mom, Pink Floyd and Creedence Clearwater Revival, both of which she loved in life. At 2pm, as I held her hand, and played the songs from the album my wife, and I, had listened to when we planned our wedding (another of Mom’s favorites), my Mom’s heart finally stopped. We asked for the breathing tubes to be removed and said our goodbyes.

My Mother’s passing was without pain, and thanks to the blessing of the clarity she provided me with our many conversations about the possibility of her death, I am completely confident that she left this world the way she would have wanted.

The official cause of my Mother’s death was an infection that festered in her leg from the infection she was treated for a few weeks ago. The advanced vascular disease in her legs caused the infection to worsen. The type of infection she got from that, according to the doctors, had a 50% mortality rate in a healthy adult. My Mother was far from healthy. That’s the official cause. The actual cause was obesity. Like me, my Mother had struggled with morbid obesity for many years. She watched as the disease got to me. Despite her efforts to help me with my weight issues I got to 396 pounds by my 21st year. After a moment of clarity I began to lose weight, and with Mom’s support lost 200 of those excess pounds. The disease of compulsive overeating continues to be an issue I face, but for the moment I am winning the battle against it. Through all my years of struggling with the disease my Mom was steadfast in her support of my efforts. But, she never quite came to terms with it herself. One of the foods I no longer eat is peanut butter. It was a frequent comfort food for me, and binge food during my many years of compulsive overeating. One of the forms of it I frequently used was Peanut Butter Wafer cookies. They come three sheets to a package, each sheet having 12 cookies you break off. I never broke them into individual cookies, I just ate them by the sheet. For the last year, while my Mom lived happily at home, I did her shopping. Every week she asked me to but those cookies, amongst her other not so healthy foods. For many weeks I tried to gently suggest that she should not be having cookies until she lost some weight. I always met a wall of resistance, and being my Mom, she won. Knowing Mom, she would have just found some way to order them behind my back, and the last thing I wanted was for her eating to become secretive. That is a painful shame that I am more than intimate with. So, I bought her the cookies. On the morning I found Mom, on her bed with the TV blaring as she struggled to breathe, a package of those cookies was by her side, and her front was strewn with their crumbs. In my day I often went to sleep the same way. Before April 14th I knew that compulsive overeating could kill. I have heard stories. But, now I have seen it. One of my Mother’s parting gifts to me is a greatly strengthened resolve not to succumb to the disease myself.

My Mother asked me to do six things for her around this situation. Two remain, her cremation and the splitting of her inheritance between my brother, and I. I am very proud to be fulfilling her last wishes with the amazing support of family and friends. I will do what you asked me to, Mom, no worries.

For the last four years, my Mother and I were engaged in a protracted argument. Since her retirement from the VA hospital was giving her about $2,000 a month, and the mortgage on her house was $1,400, I argued that she sell the place and we move her out of the city and to a cheaper apartment where she could live in more style. She resisted saying, “But, it’s your inheritance.” She won that argument, which just gives witness to how stubborn she could be. And, how loving.

A tremendous space is opening for me in the space were my Mother was while she was alive. I feel her presence more strongly than ever, and can only recall good times with her. Even the bad times are revealing themselves to be lessons she was struggling to teach me, or gifts from her heart. She continues to give to me so incredibly, and I can see no end to the generosity of her spirit.

I love you, Mom, always. You gave me the best of what you had. I promise to live out my days living up to the gifts you gave, and continue giving. Be well.