“Okay, Jenny, but call me as soon as anything changes,” she pleaded.
“Sure thing.” We languished in the ER for the next several hours. My mother spent the entire time struggling to find a position from which she could breathe, while I rested my head at the foot of her bed without catching a wink of sleep. I was wide awake when a technician came to give her a bedside EKG around 11:30.
“I’m getting a positive reading for cardiac enzymes,” a nurse said after a few minutes. He looked up at my mother. “You’re having a heart attack right now,” he said. “We need to move you back to the ER.”
IT WAS JUST before dawn and the world hadn’t woken yet. I’d spent the entire night trying to get my mother to keep her oxygen mask on after her levels dipped precipitously, and she was finally dozing. It had been an epic struggle; without the mask they would have put her on a breathing tube. I heard murmurs just outside the curtain around our bed. Through the thin sheet I could hear that an old woman was being brought in. “The home has been called—her family should be here soon,” one of the nurses said in a thick Noo Yawk accent. I heard a bed being moved into the space next to us. It came to a stop. I heard the nurses’ footsteps padding down the hall. I waited a moment, listening for movement, but there was none. Slowly, quietly, I peeled the curtain back.
Her hair was long and white and she stared at the ceiling with wide-open eyes, eyes that had absorbed at least a century of living. I knew she was dead because she wasn’t breathing, but she looked as if she had expired mid-breath, right as she inhaled for the final time— her neck muscles were strained, skin stretched taut over collarbones. I tried not to breathe; it seemed unfair somehow, since she’d been chasing breath till it outran her. I released the curtain and stood, stunned, scared that this woman was a bad omen.
When midday rolled around, Sarah arrived with H&H bagels and, in typical fashion, began bossing the hospital staff around until a few nurses finally conceded that my mother would get a room around six. I’d been up for thirty hours straight and coffee seemed appropriate, so I showed Sarah the Hylan Boulevard Starbucks where Jeff and I had met a decade earlier. I ordered a gingerbread latte and sat on one of the comfortable couchlike chairs. Sarah sat across from me.
“I have something to tell you,” I said, and launched into the gory details of my mother’s near-deathbed confession from two weeks before. It wasn’t the first time I’d unloaded a morsel of our unsavory past onto Sarah, and even though she was one of my best friends, I felt shame every time, as if I was betraying my parents. But it was becoming more and more apparent that they were my past, and if I wanted to connect to my future I’d have to learn to trust outsiders.
“Well?” I asked. “What do you think?”
“Well, she does have a flair for the dramatic,” Sarah said. “And I’m not surprised.”
“Me neither,” I conceded. If he’d killed once, why would it be hard for anyone to believe he’d done it several times? The sun hit my face through the window, reminding me how exhausted I was, and also how close to hallucinating. I sipped my brown-sugar-covered whipped cream and said, “You’d better drive.”
Sarah vowed to stay until we got a room, and at 8:30 we finally did. I was pleasantly surprised by our accommodations and understood why it had taken so long to secure them: Each room was private and clean, with glass enclosures and state-of-the-art monitors. I gave my mother’s history to Philomena, the nurse on duty, who asked me what I’d brought her in the way of clothes “for when she checks out.” I felt a surge of joy: Philomena seemed to think that my mother was going to get out of this mess alive.
I kissed my mother goodbye and returned to her apartment. I was drifting off when I got the call.
“Ms. Mascia?”
“Yes, hello?”
“This is Dr. S., the attending at the Heart Institute. You’d better come down here. It looks like it won’t be very long now, I can tell by the way your mother is breathing.”
I shot up. “Excuse me? What do you mean, it won’t be long now?” I paced my way into the living room and fought the urge to fall to the floor the way I had in Dr. T.’s office.
“Well, she’s laboring now,” he said. “You really should come down.”
It was 2:00 A.M. I frantically dialed Arline’s number. “Ar-liiiiine?” I said, fighting tears.
“What? What is it?” She’d answered on the first ring, proving she was just as on edge as I was.
“Arline, they just called me to go down there,” I said. “They said they think she might die soon!” Did I really just say that word? “You need to come here, I need you. I can’t do this alone.”
“I’ll come down first thing in the morning, okay?” she said, and I wondered if she already had a bag packed. “Gosh, Jenny, I didn’t think it was that bad!”
“Yeah, me neither,” I said sadly.
“Oh, Jenny, I feel so bad for you,” she said. “Are you okay?” It was a question I’d have to deal with for the rest of my life.
“Yeah, I’m fine.” My stock answer, signifying nothing. I raced to the hospital. When I arrived she was sleeping, but her breathing was heavy and labored and her chest rose up and down so violently it once again looked like she was already on a breathing tube. I stood in the hallway and stared at her distressed form through the glass doors of her room and emphasized again to the doctor on duty that she’d come in for a heart attack, one that should not be killing her, and all she needed was a stent. Dr. S., clearly the second string, told me she was too unstable for an angioplasty.
“Yeah, she is now,” I said, “after being neglected for thirty-six hours.”
“There is nothing we can do, Ms. Mascia, because she has signed a Do Not Intubate form.”
“Let me see it,” I demanded, holding out my hand. He showed me the form, and I gasped when I saw the signature: It was feeble and meandering and falling off the dotted line. I had no choice but to drive home and return during normal visiting hours when I could sort out the medical-directive mess.
Monday, January 9, 10 A.M.
As I crossed the hospital parking lot I spied two turkeys out of the corner of my eye, just wandering around the asphalt. I figured sleep deprivation and emotional exhaustion had finally caught up with me, until I remembered reading that parts of Staten Island were inundated with wild turkeys. “I hate this fucking place,” I muttered as I headed upstairs. When I arrived I had my first encounter with Dr. M., who would be coordinating my mother’s care for the duration. Which was fortunate, because the man was full of hope.
“I’m sorry, Ms. Mascia, but she’s signed a DNI. There’s nothing that can be done,” he told me in an accent that I pegged for Greek.
“Look, my mother was obviously not lucid when she signed the DNI,” I explained. “She did not understand what she was signing.”
“She requested the DNI,” he pointed out.
“After the nurses threatened her with intubation,” I countered, realizing that she’d probably wanted to avoid the same fate as my father’s uncle Joey, who was tubed despite being brain-dead. “Tell me, doctor, did my mother also fill out a DNR?”
“Did she?” he asked, reaching for her chart.
“No, she didn’t,” I answered before he could find it. “Don’t you find that a little odd? Aren’t those two forms usually filled out in tandem?”
He considered this. “Yes,” he said, “I will concede that is a little unusual. Look,” he said, sighing, “I take it you are her primary care-giver?”
“Yes,” I said, as if that wasn’t already apparent.
“I will have our legal team go over this situation, okay?” he said. I started to smile. “But I can’t promise anything.”
“Okay,” I said. “By the way, her doctor at Mount Sinai wants her transferred.”
He gave a wry chuckle. “Do you think, if she is not stable enough for angioplasty, that she is stable enough to get transferred?”
I decided against kicking him in the teeth. For no
w. “Could you please call her doctor?” I asked, in the most conciliatory tone I could muster. “He is very nice and wants to discuss her care with you.”
“Tell him to call me,” he replied.
With all this behind-the-scenes maneuvering I nearly forgot about the patient beyond the glass doors. My mother was still asleep, still rhythmically slumping with each breath. I suddenly didn’t want to be near her. Illness was transforming her into something else, something not quite my mother, and I didn’t want to meet this new Eleanor. I just wanted the old one back.
Arline arrived just as I drew up the courage to enter my mother’s room, and I was relieved to spot her rotund form wobbling through the halls. I greeted her with a hug and gently shook my mother awake. Her left eye opened and took in the sight of her sister.
“Hi,” my mother said softly. She smiled. I wondered if she realized how serious the situation was, that her easily exhaustible sister had trudged down from Connecticut in what must have seemed like a flash.
“Hey, honey,” Arline said. “How ya doin’?”
My mother shrugged slightly. “Back hurts,” she managed through the oxygen mask, apparently reduced to sentence fragments now. Unable to handle the scene for more than a few minutes, I ducked into the hall and called my mother’s doctor, who regretted that she couldn’t be transferred.
“You know, I think it would be a tragedy if Eleanor came in for a heart attack, of all things, and didn’t make it out,” he said.
“Yes,” I agreed. “Especially since it was caught so early.”
By mid-afternoon the DNI had been successfully rescinded. The medical team would intubate my mother to raise her oxygen back to normal functioning levels so she could be eventually transferred to Mount Sinai. Arline and I tentatively approached my mother’s bed with Dr. M. and a respiratory nurse in tow. This was it—the hardest thing I would ever have to do.
“Mom,” I said, bending over the left side of her bed and speaking gently to soften the blow, “they want to tube you, but it won’t be forever. They want to improve your oxygen so you won’t have to keep taking that mask off.”
She shook her head. “No,” she said.
“It’s. Going. To. Be. Just. Fine, Eleanor,” Arline said, taking the slow-and-loud approach, “Everything. Is going. To be. Okay.” I silently prayed that my mother didn’t say anything that would cause her DNI to be reinstated. She didn’t realize that this was her only chance, that even with the oxygen mask her numbers were—85? When did her oxygen drop to 85? The mask was securely fastened, but it didn’t seem to make a difference. How could I articulate how dire the situation was? As each hour separated her from her heart attack, the more lethargic she became and the less she seemed to understand. I’d have to try my best. Dr. M. stood behind me, allowing me to finesse the consent.
“Mama, do you remember how Aunt Emma had to be on a breathing tube after her open-heart surgery?” I asked. “They took her off it after a day, and she didn’t feel anything, she was asleep the whole time. It would be like that—it would only be temporary.” I was speaking in kindergarten tones to a woman who’d read Dostoyevsky for fun at the age of twelve. It was surreal.
Dr. M., standing on the other side of her bed, chimed in. “We just want to get you over this hump,” he said. I looked up, struck by his sudden enthusiasm for invasive treatment. He seemed to be relying on me for cues. “It will only be temporary,” he echoed.
“Is this okay, Mom?” I asked her one final time. At this, she said nothing, didn’t nod or shake her head, perhaps sensing that intubation was what I wanted and she didn’t want to contradict me in front of the doctors. She stayed silent at the exact moment that a “no” would have spelled the end of her life. “Ma, if we don’t do this,” I added, “something bad will happen. Are you ready for that?” She shook her head vehemently.
I reached for her hand. “Do you love me?” I asked. She nodded.
“Do you trust me?”
She shook her head slowly, melodramatically, and attempted a faint smile. Arline and I laughed. Always cracking a joke at my expense, my mother was.
That was the last exchange we ever had.
Arline and I were ushered into the hallway and the staff hastily closed the curtains to obscure the view through the glass doors. As soon as the tube was inserted, doctors began shoving consent forms in my face: for a cardiac catheterization, for a urinary catheter, for a femoral line because chemo had collapsed all the veins in her arms. My hand was barely off the page when a cardiologist wheeled in a giant X-ray machine and an EKG and finally performed a cardiac catheterization. He determined the location of the blockage to be the left anterior descending artery.
A single artery. I was relieved for a moment: That could be easily fixed! Then I became infuriated: One lousy artery had caused all this? That was a problem that surely could have been solved three days before with an angioplasty. In the space of thirty minutes, my mother had been hooked up to tubes and machines in at least five places, à la The Matrix. What had I done?
“She can’t stay this way,” I said to no one in particular. I wondered what thoughts were running through her coma-ridden brain. Was she dreaming? Did she know what had happened to her? Was she angry with me for tubing her?
“She’s not mad at you, Jenny,” Arline said. I must have vocalized that last part.
“How can you be sure?” My mother’s eyes were half-open, like the Sphinx in The Neverending Story. I feared she could see me.
“Jenny, she would have wanted you to do everything you could,” Arline said. “This had to happen. She needs this breathing tube.”
“I know. I didn’t give up on her,” I said, remembering that quote from Seabiscuit. “I don’t want her to think I gave up on her.” It was suddenly very important to me that she knew what I was trying to do to keep her alive. I didn’t want her to think I passively sat around while a bunch of doctors called the shots. We headed out of the building and toward the parking lot to get something to eat. We had nothing else to do until the next visiting period. Visiting period. I chuckled bitterly at the thought. She was down for the count; we’d only be visiting her doctors now.
“Ooh!” Arline exclaimed, pointing at something moving toward us in the distance. “Jenny, oh my god, what is that?”
“A turkey,” I said bitterly as I crossed the lot ahead of her to fetch the car. I drove without any clear direction, just accelerated up Hylan Boulevard. I stopped when I saw an automotive shop. I pulled in. “Where are we going?” Arline asked.
“We’re going to replace her tires,” I said. During one of our last conversations, she had complained that two of her four tires were bald.
“Actually, they’re all bald,” the mechanic informed me. I laid $260 on the counter. “Replace them,” I said. I wanted her car to be ready for her when she came home. I wanted her to see that I had taken care of everything.
Next we stopped at the Victory Diner on Richmond Road, a boxcar-shaped relic. From our crusty window booth I called each of my mother’s doctors and a few of her friends, all of whom were horrified at this latest predicament. I couldn’t believe I was discussing my mother like she wasn’t here. I half expected to turn around and see her sitting next to me. How could she not be carrying me through this, just as she had carried me through my father’s death? Her absence was becoming a permanent fact now; I could feel it begin to take shape in the shadows around me, where it still resides, and always will.
“Jenny,” Arline said when we returned to my mother’s apartment that night, “can you believe this is happening? I can’t believe she was so sick.”
I smiled evenly. “I guess she was.”
“I just don’t believe it,” she said. She glanced at a framed photo on my mother’s baker’s rack, a Polaroid of the two of us in the hospital after she gave birth to me. I’d blown it up and put it in a frame for Mother’s Day. She’s got me in her arms and she’s looking proudly into the camera. I’m clutching the neck of her hos
pital gown for dear life and trying to bury my head in her chest.
“She was so beautiful, Jenny. So beautiful. It’s so unfair.” Arline’s voice sounded weepy but I knew she wasn’t breaking down because of me.
I nodded. “Yep.”
I climbed into bed and closed my eyes, and there they were:
My parents and I are in the kitchen of a house we’ve never lived in. My father sits at the table with his hands folded while my mother faces the sink, her back to me. “Mom,” I say, “you have to come with me. You simply can’t miss this.” Although I don’t say what “this” is, I am dressed for a cocktail party. “I’ll help you get dressed,” I volunteer, “and help you put on some makeup. Come on.”
She turns and looks at me helplessly, shaking her head. She is wearing a long white tunic and sports dark, slicked-back hair. “Mom, please!” I say, growing desperate. “Please come with me!” She isn’t fighting me on this, as she would have in real life; she simply shrugs calmly, expending as little emotional energy as possible. While she seems concerned that I am so frustrated, her serene demeanor conveys the impression that her inability to attend is something that cannot be changed. She can’t go, and there’s nothing anyone can do about it.
“Mom, we must hurry if we’re going to go,” I warn. Her eyes widen and she finally speaks, at last appearing animated.
“I can’t,” she says, shaking her head from side to side, trying to make me understand. “Jenny, I just can’t.” I look to my father for an answer but he doesn’t say a word, merely stares straight ahead. She doesn’t engage him, either, only me, as if I am the only one who doesn’t understand, as if I am the only one who needs an explanation.
“I can’t go with you,” she says one final time.
Tuesday, January 10, 10:00 A.M.
Arline and I approached my mother’s room just as the alarm on the adjacent wall was blinking red; she was crashing. I peeked through a gap in the curtain and saw a team of doctors on top of her, working on her, frantically trying to bring her vitals back up. I watched as her bed was adjusted up and then down to get the best access, and she seemed like a rag doll, bending to the whims of others with no fight of her own. Arline and I sat down in the chairs by the nurses’ station and shot each other worried glances. At any moment our lives could change direction depending on what happened in that room, and once again I felt the jittery sensation of being suspended uncomfortably in the present.
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