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Oncology Times:
doi: 10.1097/01.COT.0000294401.36759.58
Simone's Oncopinion

My Mother—Final Act

Simone, Joseph V. MD

Free Access

My mother died peacefully last night. It had been only three weeks since the diagnosis of pancreatic cancer. It has been a memorable three weeks not because of sadness, pain, and anguish, but because of the joy of the family celebrating her long and eventful life with her. She directed the action in typical fashion from the time of diagnosis until the last day.

First, she declined any therapy or further diagnostic tests and insisted on going home from the hospital. The first week home was a happy one for her as she made preparations. She had no symptoms until the end of the week when she became jaundiced, which I had alerted her and my sister to look for.

She had the home health nurse take away the monitoring equipment (cardiac pacemaker). When I visited with her the next weekend, I told her she did not need to take any of her medications, which made her very happy. I then told her she didn't even need to take her insulin or test her blood sugar anymore; she was ecstatic. This worried my sister, “What will happen?” I said nothing would happen except she might pee more.

Her home health doctor had visited just before we arrived, and because the jaundice was causing some itching, he had suggested that a stent be put in via endoscope. She said she would talk to me about it and when I arrived, said, “I will do whatever you say.”

I knew this was not true, unless my advice happened to agree with her decision, but I called Dr. Chiang (a saint who cared for her for years) and got the details of what would be involved. I then explained to my mother and sister without editorial comment that she would go to the hospital, have anesthesia, have a tube inserted, and that they might need to make small cuts to enlarge the orifice, etc. She said, “Why go through all that for some itching? I have had bad back pain every day for years (osteoarthritis); this is nothing.”

I told her that I agreed with her decision, which made her happy. So we got various forms of Benadryl lotion and pills to control the itching, and they worked pretty well.

My sister and her husband, my wife and I spent the whole day with her discussing her wishes. She was laser-focused on who would get her furniture. She offered it to all of us, knowing we would decline. But following her protocol of tradition, she then wanted to know if any of our kids (her seven grandchildren) wanted any of the furniture, and insisted we call and find out, which we did.

All declined except one niece who wanted to restore the “antique” bedroom furniture and another niece who wanted the cedar chest. After the family had its chance, she decided who would get the rest among long-standing neighbors and friends.

I had told my mother she could eat anything she wanted. She ate ice cream, which she loved but hadn't eaten because of her diabetes, and yogurt every day until the last few days.

As I was leaving that evening to sleep at my sister's house, she said, “Don't forget to bring something for lunch tomorrow.” I asked what she wanted, and she said, “Kentucky Fried Chicken…dark meat.”

Before we left, she asked (ordered?) that her four great-grandchildren who lived nearby come to her apartment the next day. She wanted them to open the two piggy banks she had and divide the coins there in front of her. Needless to say, they came the next day.

Finding the piggy banks was a challenge; her directions (or memory) were not very clear. We sifted through tons (not much of an exaggeration) of old papers, utility bills, greeting cards, clothing, religious artifacts, etc. and finally located them. The kids (8–12 years old) had a ball helping us look and dutifully sat on the floor in front of her and sorted and distributed the coins.

My mother was very happy. She had taken care of the furniture and the coins, and she said, “The rest is junk,” meaning she didn't care what we did with it.

It was a great weekend for her and for us. She did pretty well for a few days but her appetite declined steadily and she said she was tired.

We had arranged for home hospice care. When I returned a few days later, she had declined noticeably and was sleeping a great deal without medications. However, when aroused her memory and mind were sharp as ever, which remained true until the last 24 hours.

I spent three days with her and before returning home to take care of some business, I spoke with her and told her I was leaving but would be back. Two hours after I arrived home from the airport, I got a call that she had died peacefully.

Figure. Joseph V. Si...
Figure. Joseph V. Si...
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We will have a traditional wake and she will be buried next to her husband and with her baby son who died in 1943, just as she had planned for years.

In another age, my mother would have been a leader in business. She was bright beyond her meager education. She had the kind of independence, strength of will, and confidence in her judgments that make good leaders. I see a bit of her better traits in me, my sisters, and my daughters, and I am grateful for that.

© 2006 Lippincott Williams & Wilkins, Inc.

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