- The Doctor in the Family
There is a saying in the Talmud: "A man cannot say to the Angel of Death, I wish to arrange my affairs before I die." When swift and sudden, death gives us no time to sign papers and pack our bags. But sometimes, the Angel of Death loiters and lingers. He acts like an unwelcome house guest who takes over the spare room, but bides his time—even sitting at the family dinner table with a self–satisfied smirk.
That's how it was in my mother's final days, as she endured, over many months, the slow, choking off of life–blood that is aortic stenosis. Despite many discussions with me—her "son the doctor"—my mother refused potentially life–saving valve surgery. At the age of 88, she was not about to—as she put it—"let some surgeon put a piece of a pig inside my heart!" (This was in the years before the newer, trans–catheter valve replacement techniques had been fully developed). To make matters worse, my mother had developed severe rectal prolapse, which surgery was unable to repair and which caused her significant pain. "I'm like The Wreck of the Hesperus!" my mother said with her gallows humor, alluding to Longfellow's famous poem of shipwreck (" . . . the cruel rocks, they gored her side/Like the horns of an angry bull . . .").
My wife and I had flown down to south Florida and settled into our hotel, fully expecting that we would be present during my mother's final hours. Her physician—a specialist in geriatric medicine—had counseled the family that the end was near, and my mother's home hospice nurses had said the same. But after three weeks, the Angel of Death still refused to strike the final blow—or perhaps my [End Page E6] mother, with her native stubbornness, had informed the Angel that she was not ready.
Trained as a psychiatric social worker, my mother was a tough, strong–willed, independent woman. While raising three children, she managed to obtain her bachelor's and master's degrees by driving 50 miles twice a week to the University of Buffalo, often braving both dark of night, and the brutal, western New York winters. In short, my mother was no push–over. She was going to wrestle with malakh ha–mavet—Hebrew for the Angel of Death—and was in no hurry to depart the life she loved.
Unfortunately, her epic struggle put my siblings and me in a difficult position. For one thing, my mother would rarely accept the pain medication urged upon her by the hospice nurses, and, at times, by her physician son. This should not have surprised her family. Even during her many years of good health, my mother was reluctant to take so much as an aspirin for a headache. Though born in the U.S., my mother belonged, in spirit, to that generation of tough, Eastern European Jews who believed in enduring and surmounting pain—and who also had a healthy (and sometimes not–so–healthy) skepticism, regarding medication, no matter what the doctor advised. In my family, it was a blessing to raise a doctor, but not necessarily to listen to one!
Bearing with my mother's pain was hard on the family. Though she was resolutely stoic in her final days, there were occasions when we could hear her cry out, obviously in pain. The home hospice nurses did their best to cajole her into taking a tablet of hydrocodone, but they rarely succeeded. The nurses knew I was a physician, but I deliberately avoided second–guessing their interventions or trying to "micro–manage" their decisions. My mother told us she wanted her head to be "clear" and that the medication made her "foggy." So we comforted her as best we could with classical music and hand–holding.
We hear a great deal these days about "death with dignity." This has come to mean, for many people, a "right" to have a physician assist in a terminally ill person's death, by prescribing a lethal medication. One day, a month or so before my mother died...