MY MOTHER'S PROMISE:
Like many of us, one of my biggest fears was always that of losing my mother. Life without her was not conceivable.
When I was a little girl, and I was exposed to the idea of death for the first time, I remember asking her, “Amma, will you die too?” My mother sat me down, looked me in the eyes, and with complete confidence told me “I will be here as long as you need me. I will go only when you tell me that you do not need me anymore”. In my childish mind, that was all the reassurance I wanted. I would always “need” my mother, and that meant she could not leave me.
Life went on with my relationship with my mother evolving and changing as time went by. By the time I was 44, my mother was older and frailer, and my relationship with her was that of one between two close buddies. It was a two-way relationship with my relying on my mother for advice about raising my kids, and seeking comfort when some worldly affair troubled me. My mother started relying on me to discuss her innermost worries about her health and the family. The two of us settled into a very comfortable symbiotic relationship.
This was until January of 2013 when my mother was diagnosed with cancer. I was now in the US teaching at a university and raising two kids under the age of 10. The news hit me like a ton of bricks. I applied for a sabbatical from work to make the most of the time I had left with my mother. The year was spent shuttling between India and the US and trying my best to stay present wherever I was. In March 2013, I was in India for my mother’s 74th birthday. I got a cake, invited some neighbors, and had as normal a party as possible. My mother and I both knew but did not acknowledge the elephant in the room – that this could be my mother’s last birthday with us. My father was not aware of the gravity of the situation, and none of us had the courage to tell him the harsh truth.
One of my brothers and I took turns to be in India to help our parents. When I went back in June 2013, my mother who by now was a lot weaker still made trips to the local market with me. Shopping for kitchen goods was our shared passion and in a typical Indian steel kitchenware store, we both behaved like kids in a candy store. I could tell that my mother was pushing herself to make the most of the time she had left. When we sat down in a coffee shop, I could no longer hold the sorrow inside. I blurted out to my mother – “Amma, I cannot live without you”. My mother looked deeply in my eyes and said “I will leave you only when you are brave enough to let me go”. I responded “Amma, that will never happen”. In my vulnerable mind, if my mother has promised not to leave me until I was ready to let her go, she can’t leave. She always keeps her promises.
September 2013. I traveled back to India to give my brother a break from caregiving. My mother was in the ICU. Her condition came as a shock to me. She could barely talk, and she could not see it anymore. We did not know this then, but cancer had found its way to her brain. The two weeks following that was a blur. My mother faded into a semi-coma. Her body was still there. But, we could no longer communicate with her. It killed my brother and me to see her stare into space even with us next to her calling her name.
Then, the bad news arrived. It was confirmed that the cancer was in the brain. Our family doctor visited my father, my brother, and me to tell us that this was the end and that we should not try any more life-saving measures. The next day, when I was in the hospital, I told the resident doctor in the ICU that we had decided to sign the “Do Not Resuscitate” order. He pulled out a form and had me read through it. From where I sat at the doctor’s desk in the ICU, I could see my mother – eyes taped shut, and all kinds of tubes going into her to keep her alive. The doctor explained to me that when she fails to breathe on her own, her throat would be punctured to insert a ventilator. Those words punctured my heart. I looked at my mother feeling fiercely protective of her and told her in my mind “Amma, I won’t let anyone trouble you anymore”. Without any hesitation and without any tears in my eyes, I signed the form. I walked over to my mother and whispered in her ear “Amma, please go. This body is not working anymore. Don’t worry about Appa. I will take care of him. Look at me, I am not crying. I am fine. Please go”.
My mother hung on for a few more days giving my other siblings the opportunity to see her before she passed away on October 9th early in the morning. I felt numb. But, I also felt a strange peace. My mother was no longer suffering. She had escaped her cancer-ridden body. She was free.
A few days later, I remembered my mother’s promise to me - “I will leave you only when you are brave enough to let me go”. I cried. My mother had kept her promise.
I returned to the US back to my husband and my children. My 9-year-old son snuggled up with me one night and asked me “Mamma, will you die too?” I said to him “I will be here as long as you need me. I will go only when you tell me that you do not need me anymore”. My son heaved a sigh of relief, hugged me tight, and fell asleep.
Symbiosis. What an important description of her relationship with her mother. one of the great misnomers related to our field is how “caregiver” implies a one-way street. You the caregiver give care. In truth, caregiving only works for so long until the caregiver needs care too. Looking deeper into the dynamics of giving and receiving care you’ll find an exchange happening on some level. The giver receives, and the receiver gives. Sometimes you need to look for that reciprocity—maybe even create it—but it’s critical to do so. That’ll help keep burnout at bay and enrich the experience for everyone involved.
One of the most precious and heart-wrenching moments to happen at the bedside of a beloved person dying is when family or friends, sensing the time is right, manage to find the strength to tell their person it’s ok to go. For the person dying, who almost always seems to know deep down that they are indeed dying, concern for others whom they must leave behind is top of the list of barriers to letting go. A final wish that a loved one, otherwise feeling so powerless, can make happen. To have a loved one tell you they’re are going to be ok is exactly the music most needed.
Such a promise! It scares me to read that final line, as though it’d be a tempting appeal to the crueler side of the fates. How can anyone promise to stay alive, with so much of death outside our control? But then I realize the writer’s point: that she promises to raise her son to know that death is a part of life.
-BJ Miller, MD