She Never Met a Stranger—Death is No Stranger

How do stories from an individual’s life impact their death? How do they influence a healthcare system designed to deliver care? How do they impact a family? Who really knows an individual’s values and goals? How are these values and goals linked to death?

Mom was outgoing. Behind her back and to her face, we often joked she could find out how we were related to a random inanimate object, even a “rock”. She was a ball handling guard on a six–person girl’s basketball team during the depression, well before women widely played the game. It was small town Iowa. After graduation, she married her high school sweetheart during World War II, while he was stateside on leave being treated for malaria. The Solomon Islands and Guadalcanal were a long way from their small town wedding.

She raised five children while her husband practiced veterinary medicine in the Midwest. She answered the farmers’ calls for him and transmitted their requests to him over a two–way radio. She knew everyone. She often shared directly how our family values impacted decisions to be made. She came from a farm family of eight children who learned to work, and work hard. She was proud of her heritage. There was a right way to conduct one’s life. Family was central.

Tragedy did not pass over this woman’s life. Her oldest died at 21–years of age in a car accident three weeks short of her wedding. Her daughter’s death changed things; a sadness was closer to her and the family. The four remaining children speak of two distinct families, before and after our sister’s death.

Time passed, and her husband, our father, began his series of heart attacks and recoveries. Mom became protective. Dad was fiercely independent and cross country skied after both heart attacks, that is, up until his left ventricular function deteriorated and he underwent removal of part of his left ventricle. Mother became his nurse, helping with medications and trying to bound his activity.

Dad called me when his angina was becoming increasingly severe and painful, at this time his ejection fraction hovered near 15%. He had an automatic implantable cardiac defibrillator (AICD) placed during his heart surgery. His cardiac rhythm problems occurred every day and the device shocked him daily. He asked me, “do you think its ethical to ask them to deprogram the AICD?” I was in a busy hall way at our medical center, and I said, “Sure, just think, you wouldn’t be asking this question if it weren’t implanted.” He listened, yet I knew he called me only to warn me. Two days later we were planning his funeral service. He had always said, “I’m not afraid of dying, I trust the Lord, I just wonder a bit about the process.”

My mother was strong during this time, there was a sense of relief that her untrained nursing career was over. She could return to the activities she enjoyed. She carried out her duty to her husband even when things were hard. Those were the values in our family. Family always came first. Duty was honored.

Mom’s shortness of breath was attributed to idiopathic pulmonary fibrosis. She didn’t complain, just carried on while walking slower. Then began her eye trouble. She lost the vision in her right eye. An arterial thrombosis in the eye destroyed her vision. She still drove, just more slowly and deliberately. She was fiercely independent and yet always did her duty.

Then began the complex regional pain syndrome (CRPS) in her left wrist. It really hurt. Finally, the specialists tied everything together, it was scleroderma in an eighty–plus year old woman. That just does not happen. I reflected on what we learned in medical school; look for a unifying diagnosis. Ockham had something to say about this. Mom had scleroderma, a disease of small blood vessels throughout her body. Pulmonary hypertension, visual loss, and CRPS were unified by her scleroderma.

The phone call came; Mom was in her small community hospital with a...