The Long Goodbye

by Meghan O'Rourke

  The next day, Liam and I took her for a follow-up visit with the neurosurgeon in Stamford. Her confusion had lasted longer than the doctors anticipated. She had a hard time locating the doctor’s office—I got lost driving her there and we were fifteen minutes late—and she struggled with finding the correct words when she spoke. She wanted to know if she could drive. This was clearly not possible, but the doctor was rude about it. “No, absolutely not,” he said unfeelingly, not acknowledging that this news might be hard for her to hear. Her face flushed and she slumped back in her chair at his words.

  I asked whether the confusion she was experiencing was a normal side effect, and he dismissively replied, “We didn’t give you any guarantees that this surgery would work.”

  “I’m not asking for guarantees,” I said, enunciating each word. “I’m trying to have a conversation with you that will enable us to understand just a little better what is going on.” Prick.

  My mother stirred and said, “Meg . . .” and I bit my tongue. She was never confrontational with her doctors.

  My mother cried on the way home, trying not to let us see. But as we walked into the house, she leaned on us to climb the steps and said, crisply, “That asshole would never have been so patronizing if you weren’t so small, Meg.” And then she said, “He doesn’t know that you’re big inside.” That night she seemed more herself than in weeks, joking with Isabel and Diana on the phone. Her locutions were slightly off, but poetically. When Diana asked how she felt, my mother responded, “I hurt less.” It was a windy night, and we sat and watched—as it happened—a particularly stormy episode of Lost. A gust of wind howled outside. Mom turned and said, “Is that our wind I hear?”

  Later, as I came out of my room, there she was, leaning on the stair railing, climbing one foot at a time. She paused. She looked more and more striking in those last days. Objectively, I know she was ill: I have photos on my phone that show her sallow and drawn. But not taking chemo meant her skin had some of its old glow. The lost weight made her appear young and slightly transparent. I often had the feeling she was passing into a liminal state.

  “Good night, Meggy,” she said, playfully, even happily. “I love you to death.” She used the voice she used when I was a child—that old good night.

  The next morning, she was delirious. Her mouth slack, she was twisted up in the sheets. My father hovered over me. We were trying to wake her. “Mom,” I said, shaking her shoulder a bit. She groaned in annoyance. “Mom,” I said, and her eyes opened, but they weren’t hers. She looked possessed. Instead of fear of what she couldn’t name, now there was hatred of all that she had once been close to. Her skin was hot to the touch.

  “Did you take her temperature?” I asked.

  “No,” he said. “She’s always hot when she wakes up.”

  “Not like this,” I said. I got the thermometer and tried to get it under her tongue, but she kept pushing it away. By now she was moaning and clutching her right side. When I touched her stomach there it was extremely warm, and the skin was distended.

  My dad was pacing. “We have an appointment with the pain specialist,” he said, “so if you could just get her dressed.”

  “I don’t think she needs the pain specialist,” I said. “I think she needs the emergency room.”

  “I don’t want to go to the emergency room,” he said. “Let’s just get her to the doctor.”

  Fine, I said. But I thought: This is not going to work.

  She had on only a T-shirt and underwear. “Mom,” I said, “we have to get you dressed. We’re going to get you dressed and then take you to the doctor.”

  She kept batting my hand away. Then she said, “I want to go to the bathroom.”

  I lifted her up and she cried out, seizing her side. I knew that one of the risks of her cancer—which tends to metastasize first to the lungs and the liver—was that the liver would begin to fail. It was, my doctor friend had told me, one of the two things that was most likely to kill her. The other was a hemorrhage in the lungs. I had been assuming the failing liver would be less awful than blood-filled lungs. Now I was questioning that assumption. She collapsed back on the bed and refused to talk to me.

  “Call the ER,” I told my dad.

  The paramedics came, three of them. In some obscure way I noticed one of them was good-looking. My mother was confused and angry and rolled her eyes at us like we had betrayed her, and it felt like we had. The paramedics kept saying, “Barbara, come on, we’re just going to get you on the stretcher.” I’d tried to get her pants on before they came, so she wouldn’t feel embarrassed, but I hadn’t managed to.

  “Fine,” she finally said, seeming to come to her senses. “But I have to go to the bathroom.” They had her by both arms. I shook my head at them. I knew she was just trying to get away. But my father said, “Let’s let her go.”

  “OK, Barbara,” they said. They led her into the bathroom and then they said to me, “Do you want to help her from here?” She refused to look at me. She went in and closed the door.

  Minutes passed.

  “I think we need to get her out,” one of the guys said.

  “No fucking kidding,” I said, full of a weird I-told-you-so anger at everyone.

  “Does one of you want to try?” they said.

  Did I want to try? No, I did not want to try.

  My dad went forward. “Kell,” he said, using his pet name for her. “Come on, Kell, we have to go. Let me help you.”

  “Go away.”

  Come on Kell, I’ll help you.

  I’d never heard my father’s voice like this before. It was his voice for her, intimate, direct, adoring—clearly the voice he’d used when they were alone together, in their tender moments. She refused to answer.

  “Meg,” he said, coming out, “I can’t get her, can you?”

  I hate you, I thought.

  But I was her daughter.

  “Mom,” I said. “Come on, we’re just going to go to the hospital so they can give you some medicine.”

  “Go away,” she said. “Leave me alone.”

  She wouldn’t look at me. She sat on the toilet, underwear (the underwear we’d just bought) at her ankles.

  My book of poems was on the toilet behind her, along with Darwin’s The Origin of Species, her favorite book. And a crossword she’d started two Sundays ago.

  I stepped forward to take her arm.

  She batted me away.

  “Dad,” I said, “we’re going to have to pull her out.”

  So I went in and I grabbed her under her shoulders and I lifted her up and she struggled and I collapsed a little inside and she grabbed for her underwear but couldn’t reach it so I pulled it up as my father took her other arm—the room was too small for both of us so he was reaching in awkwardly—and we hoisted her out as she went tense with anger and frustration.

  I thought of her when she was happy—her voice the night before when she said, “I love you to death”—and I wondered which was the real her. The other is, I thought. But her anger was so vivid, it was easy to believe this was the unmasked truth: She was dying, and she hated us.

  She didn’t stay in the hospital for long: they released her, because she wouldn’t drink barium for a CAT scan. I’d had to drive into New York for a business dinner, and my father was alone with her. He called me to say they were sending her home because her fever had gone down, and since she wouldn’t drink the barium they had “no reason for admitting her.” They can’t send her home, I said. What about the fact that she has terminal cancer? Is that not a reason? I’d just finished talking to the hospice people and they’d told me it would be forty-eight hours before they could get someone to us. “We’re not set up to take care of her,” I told my father, but he said, in a thick voice, “She wants to go home, I have to do what she wants,” and hung up on me. I slammed my phone shut. (At the time, I was so bent on her safety—or at least my idea of her safety—that I wanted to kill him; now it is much easier for me to underst
and why he had to take her home.) I’d planned to stay in Brooklyn but was too disturbed to do so; I drove back up to my parents’ house and fell into bed. Thirty minutes later, there was a horrible crash in the other room and I heard my mother screaming. The sound, at once piercing and soft, was like nothing I’d ever heard, and for a couple of minutes I couldn’t get out of bed. Then doors were opening. In my parents’ room, my mom was on the floor, crying, holding her head and her side, and Liam and my dad were standing, and Eamon was cradling her head, kneeling over, saying, “Where does it hurt? Shhh, it’s OK, where does it hurt, Mom?” Liam knelt next to her and was stroking her arm.

  “Let’s try to get her up,” Dad said.

  “Let’s just wait and see if she starts to feel better in a few minutes,” Eamon said, patting her head.

  “I think we should call the ER,” I said, pacing. “I don’t think this is getting better. I think something is really wrong.”

  “Then call the fucking ER,” someone snapped.

  I felt my inky heart spilling open everywhere. How could my father have allowed this to happen? I went down and called 911. The operator said the paramedics would be there in twenty minutes. And they were and so it began all over—the maneuvering of her body, the gurney, the screaming, the rolling of eyes. I got in my car and Eamon came with me. Liam went in the ambulance and my dad drove his car. We drove through the pouring rain; at the hospital—it was a different hospital this time—we were all bleary-eyed; it was extremely bright. The orderly on duty said only two of us could go back into the ER with her.

  “Look,” I said to him, “what’s your name?”

  He told me.

  “Look, you can understand, maybe—our mother has terminal cancer, and we don’t know what’s going on. We’re really worried about her. If it’s quiet back there, can we all be with her? We want to be with her together, in case . . .” I let the thought dangle.

  “What kind of cancer does she have?”

  “Colorectal,” I said.

  “Oh, that’s tough,” he said. “My mother died last year from that, it was rough, man. Yeah, OK, but I may need you to not all be there later.”

  “OK,” I said. “We’ll do whatever if you just help us out when you can.”

  At three a.m., the nurses got her settled and sedated and stabilized, and we finally left. Eamon and I drove back together. I was wondering if she’d still be alive in the morning. If she started to die, would the nurses know? Could they call us? How long would dying take, anyway? Eamon put in Pet Sounds, and as I drove slowly through the fog and pouring rain we sang along to “Sloop John B,” belting out, “Well, I feel so broke up, I want to go home.”

  EXHAUSTED, we took shifts. My dad went in the morning, then came home to take Liam and Eamon to lunch. Isabel was there when I arrived. Her eyes were blurred with tears and sorrow. But she and my mother had actually had a real conversation.

  “I got in the bed with her,” Isabel said. “She told me how much she loved me. She asked me to crawl into bed with her. She was funny, and clear. We lay together there, like sisters,” she said, wiping her eyes. I was cravenly envious. All night I’d dreamed that my mother had died hating us and wondered if I had become the emblem of what was killing her: the daughter taking over the mother’s life. Off you go, Mom! Off to the hospital! I’ll take over now! But I knew I should be happy for Isabel. And maybe my mother was back.

  I went in.

  “Hi, Mom,” I said.

  She looked at me indifferently. As I stood there, the nurse brought her a child-size ice cream cup. “Here,” I said, “I’ll give you some.” And I opened it and pulled off the tiny wooden spoon and offered her a bite. She took one, her mouth opening like a child’s; inside, her tongue and cheeks were coated with a white film. I wiped my eyes, holding the ice cream awkwardly.

  “Sweetie, I can do that,” Isabel said, leaning forward. “Give me the ice cream.”

  I clutched it to my chest. “It’s OK, I want to feed her,” I said.

  My mother was eyeing us. Scoldingly she told me, “Let Bel do it if she wants to.”

  A bolt of shame and anger went through me, as it does when you’re a child. My mother was dying and she had not, for one moment in the last twenty-four hours, acted like my mother; she’d acted like someone who disliked me. In all my various imaginings of the awful end I knew was to come, I had never pictured an estrangement such as this. Handing Isabel the ice cream, I left the room in tears and went outside to the parking lot, where I leaned against a chill concrete wall and wept. Then I wiped my face and went back inside. I was still here and so was she.

  Those were strange, delirious days. They’d give her morphine for the pain, but the moment they got it under control, it would intensify, and she’d begin moaning again. When she did wake, she was irritable. We made a point of all crowding into the room at one point, and Eamon was trying, in his brave way, to joke with her, and she said something like “That’s not funny” (could this really be what she said?) and I watched his face fall. I kept asking the nurses to give her more morphine.

  “OK,” the nurse said, “but she might just drift away.” And then she said: “You have to decide what kind of care you want her on. If she’s in hospice, they’ll give her more drugs, they’ll minimize her pain, but she might die.”

  I was all for more medicine, more comfort. My brothers and fatherwere not. “What if she gets better?” they kept saying.

  Eamon said, “She’s confused because of the drugs, we shouldn’t give her more.”

  “It’s not because of the drugs that she’s confused,” I said, insistent, rigid in my certainty. “It’s because of her liver.”

  My father wiped tears from his eyes. “I guess you’re right,” he said. “But let’s just think about it. We don’t have to decide right now.”

  Alone in the room with her while she was sleeping, I slowly pulled her shirt up and looked at her liver, or what they kept saying was her liver, somewhere under the skin. The belly was distended. I put my hand on it lightly but was too nervous to press—though for some reason I needed to feel it, the liver that was failing, hard as stone.

  The strangest thing was that the whole time she was impeccably polite and charming to the nurses. I was proud of her but also jealous of the attention she gave them. As soon as a nurse walked into the room she opened her eyes and smiled. Late Thursday, they moved her to the cancer floor, wheeling her bed through the hallways as we trotted to keep up. She had a suite with a pullout couch and a potted plastic plant and a Zenith TV that looked like it was from 1962. She went straight to sleep; Liam stayed with her, and the rest of us went home to sleep.

  The next morning, Liam called. “Mom is better,” he said.

  I could hear relief in his voice. “She’s eating some food, and she’s totally clearheaded.”

  Thank God we hadn’t medicated her to death. I got there as soon as I could, using the proper entrance instead of the shabby ER doors, and took the elevator up to my mother’s room. She was sitting up, a plate of eggs and pancakes on her tray, and Liam was next to her, on the phone. She waved. Her eyes were bright. Part of me still didn’t trust her.

  “I’ve been enjoying some pancakes,” she said. (She’d had about three bites, by the looks of it.) Then she laughed. “Did Liam tell you what I did? I was reading the hospital menu, trying to order, and I guess there are all these special menus—the low cholesterol menu, the heart-healthy menu, and when I opened it I went straight to the ‘Deathbed Menu.’ And I thought: That’s grim!” Tears of laughter ran down her cheeks. “I didn’t have my glasses on. It’s really a diabetic menu.”

  Her fever had broken. The doctors conjectured that two things had caused her delirium. The doctors who had done the radiation surgery had put her on too high a dose of steroids, causing not just “irritability” (a common side effect of steroids) but actual delusion and dementia. At the same time, she had a urinary tract infection, which was exacerbating everything, and the first h
ospital had missed it. What the doctors also said, when I pressed them in the hall outside her room, was that her liver was probably experiencing “necrosis.” There’s no ammonia building up in her brain, they said, but soon there probably will be.

  While Liam and my dad went to work, I tried to organize her release from the hospital. “I just want to go home,” she kept saying. We’d arranged for hospice, and all that was needed was for the hospital to approve her discharge. But they wouldn’t do it until there was a hospital bed at home, and the insurance company was dragging its feet.

  “I have to warn you,” the head nurse said, standing in the doorway of my mother’s suite, “I don’t think this is going to happen today, which means it won’t happen till Monday, because the insurance companies are closed over the weekend.”

  “They’re closed ?” I hissed. If the deli could be open twenty-four hours, surely an insurance approval line could be, I thought. And I was struck by how much control over these most intimate decisions—decisions about when and where and how my mother would die—we’d given to doctors and insurance companies. I knew, of course, why this had happened, why I had put my mother in circumstances she desperately disliked. Morphine, painkillers: these are good things. When she first went back into the hospital, I had felt reassured: She was getting fluids! She was hydrated again. She would be OK. But it pained me to think that she would have to spend extra days, precious days, in the hospital because we could not get permission to bring her home. Whose death was this, after all?

  “Meg?” my mother called from the bathroom. “I just fell.” I went in and lifted her up. She needed someone to lift her from the toilet each time she used it now; Liam had warned me. I was already getting used to doing it. It made sense. It was what she had done for us, back before we became private and civilized about our bodies. In some ways I liked it. A level of anxiety about the body had been stripped away, and we were left with the simple reality: Here it was.