“Pull the plug. Why linger on? Will I have to know when I’m going?” were my mother’s final written words, scrawled on a sheet of yellow lined paper, on December 30, 2010. This was in response to the conversation that the palliative care physician and nurse practitioner were having with her in the hospital’s Progressive Care Unit (PCU); they were explaining what would follow once she was weaned off the Bilevel Positive Air Pressure (BiPAP) machine. This BiPAP machine with facemask made communication, eating, and drinking a challenge for her. However, her mind was alert and the written word was her preferred method of effective communication. The palliative care physician informed her that she would receive the appropriate medications to address any potential pain or anxiety issues as she was allowed to breathe her final breaths without the assistance of the BiPAP machine.
An avid walker of one to two miles daily at the Assisted Living Facility, just one month prior to her unexpected hospitalization, my mother now realized that she would no longer have quality of life, chair bound and tethered to this high level oxygen delivery machine. Her final journey started with a fractured hip, following a nighttime fall at the Assisted Living Facility. Successful hip surgery led to a stay at the rehab facility. It was there that she developed the pulmonary embolism that permanently compromised her lungs. She was back at the hospital’s Intensive Care Unit (ICU) for treatments, none of which would be effective. Now transferred from the ICU to the PCU, the four of us were having this end-of-life care decision conversation.
My mother was aware of my profession as a hospice and palliative care nurse and knew how I assisted other patients and families with their end-of-life care decisions. Although we had taken care of the usual Will, Advance Directives, and Power of Attorneys many years prior to this unexpected event, my mother would usually defer any other end-of-life care decisions, such as funeral arrangements or obituary writing, to me as the only child. I was totally surprised that day in the hospital by my mother’s self determined, written response to the removal of the BiPAP machine. I discovered another level of respect for my mother that day; and her decision also made the ensuing events of the afternoon easier for me, now able to be in the role of the son and not of the nurse, knowing that my mother had made this decision on her own and a decision that I could easily honor.
During that afternoon, I shared memories and photos of our life together and also those of my father, who had predeceased my mother four years prior. Throughout the afternoon, my mother received the morphine and Ativan that would assist her on her journey. Once the hospital staff and I decided it was time to remove the BiPAP, I sat at my mother’s side, supported by two close friends, as we spoke and sang her through her transition from this life. It was close to thirty minutes of non-labored breathing, without the assist of the machine, before she took that final, peaceful breath.
September 6, 2011 would have been Nathalie Martin’s 86th birthday. I honor my mother’s memory and her bravery on that day…and on every day. We keep those, who have died, alive in our hearts by sharing their stories with others. I will always keep that yellow lined paper, with her powerful statement and follow-up questions, as a testament to her honored, end-of-life care, self-determined, final wish.