“Mom, it will cost about ten thousand dollars to fly your body to Ireland. That includes the burial, transport, the hall rental, the blessing by the Monsignor, and all the food and drink for the two-day party afterward.”
“Then you can take that out of your inheritance.”
“But Mom, um, respectfully, you aren’t leaving that much money behind.”
“Oh, Joseph!” (That was Mrs. McDowell’s version of cursing.)
She winked at her youngest daughter and said, “I guess I was too young and naive and having too much fun to notice.”
Mrs. McDowell was one hundred years old and had five daughters and one son. She emigrated from Ireland when she was nineteen. She protested moving out of her two- bedroom apartment in the city but after the visiting nurse discovered that she wasn’t taking her heart medications, Mrs. McDowell was moved into her daughter Shana’s house. When I arrived at Shana’s, the family was in the kitchen having a lively debate as to whether they should honor one of their mother’s superstitions or just ignore it. Even though she was four feet ten inches tall, their mother caused quite a ruckus among her grown children. You see, Mrs. McDowell believed—among many other superstitions—that the souls of the dead that die abroad wish to be buried in Ireland. She believed that the dead wouldn’t rest peacefully unless buried with their forefathers and people of their own kind. Her children were trying to respect her wishes.
Her family was very respectful and quite funny. Mrs. McDowell wasn’t hesitant to sweetly remind them of what she wanted, and since she was so sincere about her beliefs, her family felt obligated to honor them. Irish-Catholic guilt may have had something to do with it too.
The superstitions of families seem to become more pronounced when a member is dying. I can’t tell you how many times I found them amusing. Family members feel a need to revive the superstitions, and since everyone is so vulnerable and tired, the beliefs take on a life of their own.
Among the Irish traditions it’s believed that if the nearest relative touches the hand of a corpse, it will shout out a wild cry if they weren’t quite dead. And the birds . . . if a bird acts strangely or if a magpie comes to your door and looks at you, it’s a sure sign of death and nothing can be done to avert doom.There are the New Age traditions where people burn wild sage grown from a specific area of the earth. It’s supposed to clear the air of negative energy and vibrations. This is called smudging, and it has sent a few people home with shortness of breath. The Italians, Jews, Buddhists, Muslims, and Native Americans—all the nationalities and religious and ethnic groups have some tradition, some prayer, and some ceremony that soothe the dying in some way. (I sometimes believe that the superstitions at the deathbed are mostly for the living, not the dying).
Shana had three teenagers. Her fourteen-year-old son volunteered to give up his bedroom for his beloved grandmother. Shana’s only instructions were, “Dismantle the bed and take it downstairs where you’re going to be sleeping. And I want everything off the floor. Make sure the dirty laundry makes it to the laundry room. Then you need to clear the top of one of your dressers so the nurse can put supplies there.”
My visit to Mrs. McDowell was the last one of my week. I was in a buoyant mood. It was senior prom night, and the happy noise of the teenagers and their friends made their house seem as though it were party central.
As I climbed the carpeted steps to the room that was prepared for her, Shana and her sister chattered quickly about how their mother was doing and what their plans were for the evening. There were three fifteen-year-old girls blow-drying their hair in one bathroom and three in the master bedroom putting on makeup.
Mrs. McDowell looked like a doll in the bulky hospital bed. She had bright blue eyes; thick, white, wavy hair and a toothless smile. She’d lost so much weight that her dentures didn’t fit any longer, so she just decided not to wear them. She smiled and sparkled as she spoke, and even though she was weary and weak from her worn-out heart, she learned to compensate by making all the emotion and expression come through her eyes.
When I entered the bedroom, I had to smile. Megadeth and Weezer posters lined the walls. Figurines of warriors and ninjas took up every square inch of space on the bookshelves and dressers. The grandson thought grandma might want to get inspiration from The Terminator and Rocky, so he taped posters of those movies to the ceiling. The crucifix that had hung over her bed all her life was hap- hazardly nailed on the wall above the head of her hospital bed.
There was a full bathroom next to the bedroom, where Mrs. McDowell’s granddaughter Moira and three friends were currently blow-drying their hair while singing along with a bubble-gum-sounding new artist. All the girls were in the high school chorus, and since Moira’s grandmother couldn’t attend their concert the night before, ten of the choral members came to visit Mrs. McDowell. They sang three songs to her. Three boys stood downstairs in the dining room, listlessly tolerating their mothers’ pinning the boutonnieres on their lapel and dodging attempts to finger- comb their hair.
“Hello, Mrs. McDowell. My name is Nina. I’m the visiting nurse. It’s so wonderful to meet you. I wish I lived here! How much fun is this?”
Her two daughters introduced me, then left the room.
She smiled. “I know. Isn’t this fun? Now why are you here?” I closed the bedroom door so we could hear each other’s voices and so I could understand her slight Irish brogue.
“I’m a registered nurse with the home care and hospice team. Your doctor wants a nurse to come in and check on you a couple times a week to make sure you’re comfortable and safe. How do you think you’re doing?”
“I’m quite weak. All I seem to do is sleep. I’m getting old.” She smiled.
I conducted an assessment of her heart, lungs, bowels, kidney function, mentation, nutrition, and skin. Her heart sounded like a raspy old engine. It wheezed and spurted.
For the last ten years, she had had a pacemaker, but she had it turned off when the doctor told her that it would keep firing for a little while even if her heart wasn’t working any longer.
“How long are you going to be here?” she asked, her voice barely above a whisper.
“You’re my last visit of the day. I have all the time you need.”
“Did someone say I was on hospice?”
“Yes, you’re on the hospice program. Do you under- stand what it is and why you’re on it?”
She looked at the rosary in her hands. She was reciting her fifth Hail Mary. “Will you open the door and get my granddaughter, please? She’s the pretty one.”
The bathroom was as hot and steamy as a sauna. The music was blaring. “Which one of you is Moira? Grandma wants to see you,” I shouted.
Moira bounced in to the room, her hairbrush still molding one of her curls. “Hi, Grammie. What’s up?”
Mrs. McDowell’s voice was weak. “Will you please sing that song that you sang to me last night? The ‘I love you’ song?”
“Oh yea, sure.” Moira began singing the song written anonymously by one of the students, “Take My Heart With You.” She held the brush in place as she sang a capella. Her voice was beautiful but I could tell she was rushing it:
Mrs. McDowell closed her eyes as she listened to Moira sing. “Thank you. Just like an angel.”
Mrs. McDowell’s daughters came back into her room, stood next to the bed and listened to me as I reviewed her plan of care.
While I was talking, Mrs. McDowell looked at her daughters. They placed their hands on her forearms.
“What is it Mom?”
Mrs. McDowell’s eyes looked clear and bright and the look on her face was soft and ethereal. “I think I just heard the mailman. Why don’t you girls go outside and get the mail?” her charming accent soft, her voice stronger than before.
The daughters began to scramble. “You go, Mary Alice. I’ll stay.” Then the other responded, “Why don’t you go? You need a break.”
Mrs. McDowell interrupted. “I want you both to go. I need to talk to this nice nurse.”
Then Mary Alice said, “Okay, listen. I need to get the camera ready, so I’ll do that while you two are talking.”
Both daughters left the room. Mrs. McDowell looked lovingly at her right palm where the indentation of a crucifix was. Decades of daily prayer soothed her and gave her the strength through the challenges of raising her five children in near poverty.
As I watched her, I noticed that her countenance was intimately calm and relaxed.
Then I thought, Oh shit.
She closed her eyes and took that very deep last inhalation that has that grab at the top. Then her head tilted to the side and downward as her lifeless body exhaled lightly.
I ran out the door and called to everyone, “You’d better get in here now!”
The daughters, teenagers, mothers, fathers, and neighbors who were sitting in the kitchen or helping their kids get ready ran in from their locations. I was standing next to Mrs. McDowell.
“She’s gone.” I was a bit embarrassed. I knew this could happen, but I really didn’t think Mrs. McDowell would choose this timing. I don’t know why; it’s just that there was so much life going on in the house that I couldn’t imagine she would want to leave during all of this fun.
“What? Gone? As in deceased? Mom?” The daughters stood at the foot of the bed, holding each other. I waved my hand to ask them all to move closer, as I aligned their mother’s head, closed her eyes, and then stepped away from the bed. You could hear a pin drop. The only noises in the house were the radios and CD’s now playing without audiences in the bathrooms and downstairs. Everyone simply stood and stared at Mrs. McDowell’s lifeless body.
“Yes. She saw an opportunity to leave, and she took this one for some really odd reason.” Nervously, I added, “This happens.”
Whenever patients are expected to die, and then die outside the “script,” I really hope that families remember when I mentioned this detail during the admission inter- view. Everyone is in such disbelief and I know they can’t hear me, so I move slowly, happy to be invisible.
I gently and slowly unfolded her fingers and took the rosary out of her hand. The impression of the cross and rosary was deeply indented into her palm.
“Go open the window Moira.” Shana numbly instructed her daughter to fulfill the first of many Irish traditions.
Then Shana took the rosary and wrapped it around her mother’s hands and took the cross off the wall and laid it on her mother’s chest.
Welcome everything. Push nothing away.