Waxing philosophical

Sitting at my Mom’s bedside and dealing with both her death and the day after her death, I’ve had the opportunity to wax philosophical. In no particular order, here are the thoughts that have been running through my head:

There are wonderful people working in the health care industry. I know that NPR and Harvard confirmed what most conservatives assumed would be the case: Obamacare is a failure by every metric. It took an imperfect system and made it much worse.

However, even though the system may not work, the people in the system do. And in my little corner of the world, that’s not because of structural incentives and monthly employee awards and all that other stuff. It’s because the people with whom I’ve been dealing want to do their jobs well and are fundamentally kind.

My mother’s care started in the hospital. The ER wait was endless, because her vague symptoms (which eventually consolidated into acute congestive heart failure) were low on the triage list. That’s the way things are in an emergency room. But when it was our turn to get care, every person — the clerks, the techs, the nurses, the doctors — was kind. Mom was fragile, hearing impaired, vision impaired, and increasingly confused, and they were patient and gentle with her.

When Mom was finally admitted to the hospital so as to rule out pneumonia, the nursing and other support staff at Marin General were extraordinary. Even with me keeping watch, Mom was a high maintenance patient. She was confused, combative, frightened, and completely unable to do things for herself. They handled her body gently and efficiently, and addressed her failing mind with kindness. I’m glad she didn’t die there, among strangers, but I will always be grateful for their caring professionalism during those two confusing days.

The real star quality, though, was at the skilled nursing facility in which Mom lived for so many years. As people who have read my blog regularly know, Mom was a tough cookie. Life had taught her that you need to fight to survive. Lessons learned in concentration camps are lessons learned well.

Much as my mother desperately wanted to be cared for, after a lifetime of fighting and working for her own survival, she wasn’t willing to cede power to her caregivers. She fought with all of them, over medicines, over blankets, over cleanliness, over noise, over any thing and every thing. The more important specific staff members were to her care, the harder she fought with them, desperately trying to hold on to her little beach head of power. While her life — which once included work and family and sometimes just basic survival — may have shrunk to a small room and a hospital bed, she was going to be queen of her domain.

Sometimes Mom was so awful, I was surprised that the nursing home staff didn’t smother her in her bed at night — or, at the very least, slack off when it came to maintaining her increasingly precarious health. But they didn’t. They fought for her and with her to keep her alive. At no time ever did anyone in that skilled nursing facility compromise Mom’s care, no matter how horrible her behavior was. That’s not just true professionalism; that’s true human decency.

When Mom was discharged from the hospital to die at the skilled nursing facility, she knew she’d come home. I don’t just say that, I know that. Before the discomfort of drowning in her own fluids from congestive heart failure became so great that the blessing of morphine was needed to help her transition from this life to the next, Mom had some interesting and colorful delusions that she invited me into. For quite a while, she and I were driving around in a car, at least in her imagination.

When Mom got tired of driving her fantasy car, she handed the wheel over to me, and told me it was time to take her “home.” I was at a bit of a loss, since she’s called so many places home over the span of nine-plus decades. I asked carefully, “Do you mean to San Francisco?” which was the place in which she lived longest. She shot a stern glance at me through eyes growing rheumy. “Don’t be stupid. I mean to the [nursing home].” After five years in that little room, it was the one place she wanted to be when she went home to die.

For the majority of the last two days of her life, Mom was deeply sedated, which not only aided her breathing, but also kept her from the agony of drowning internally. When the staff came in, though — every time they came in — they spoke to her, with affection and respect, telling her that they loved her. They preserved her dignity, making sure that she was clean and comfortable.

Those with whom she had fought the fiercest battles, knelt at her bedside, took her hands, and told her how much they enjoyed their time with her, and how much they respected her spirit and energy. These were not automatons doing a paid job. These were incredibly decent human beings being incredibly decent. I was deeply moved and, indeed, quite awed by their kindness.

Even the big, bad insurance company came through. Two weeks before she died, Mom got a scary notice in the mail: My dad’s pension fund, without telling Mom, had exhausted the funds in his account, which had been used to pay for her Blue Cross, and simply stopped paying. Mom’s been an expensive insured.  The insurance company could have sent a letter cancelling her policy and daring us to engage in the fight to reinstate it. Instead, the company gave us two weeks to reinstate it and, when I called to ask for more time, gave me that time too. When I spoke to the woman in charge of the account, she explained that she was doing everything possible to ensure that people in the same position as my mother got a chance to keep their insurance, even if it meant entering into a payment plan with the company.

So yes, as a whole, America’s health care system has problems. But the sum of its parts — the people who work in hospitals, nursing homes, doctor’s offices, and insurance companies — are good human beings who do the right thing, not because they have to, but because it wouldn’t occur to them to do otherwise.

Incidentally, none of this changes my mind about the fact that Anne Frank was (sadly) wrong to believe that most people are inherently and naturally good. People are not naturally good, they have to be taught to be good. I’m dubious about the up-and-coming cry-bully generation’s virtues, but the people with whom I’ve dealt, all of whom pre-date the cry-bully generation, were taught to be good and it shows.

We are responsible for our own happiness. A point I’ve hammered home relentlessly every time I’ve spent extended time with my Mom is that we are responsible for our own happiness. My mother, bless her heart, wanted me to be responsible for her happiness, and I couldn’t do that. I could give to her and be there for her up to a point.  After that point, though, my time was used up and my emotional well was dry.

Faced with the burden of “you’re the only thing that makes me happy,” I too often ran away. That meant that I didn’t have that lunch with her or take her on the shopping trips she loved so much. I knew then that I’d feel guilty when she died, and I do feel guilty, but the reality was that I kept drawing lines lest I get sucked into her overwhelming unhappiness.

My mother certainly had reason to be unhappy. Her parents had a miserable marriage and, when they divorced, left her to raise her sister in a home with minimal money. She and her sister spent almost four years in a Japanese concentration camp. After surviving WWII, they were pitched into the Israeli War of Independence. Then, when life was settling down, my Dad got restless and dragged her to America, when she would have been perfectly happy staying in Israel.

Despite spending the largest part of her life in America, Mom always felt like a foreigner. My Dad, a good man, wasn’t a good breadwinner, and my mother chafed endlessly under the restrictions of genteel poverty and, as she got older, the fear of a truly penurious old age. The fact that, when old age came it was not penurious but, thanks to her scrimping and saving, comfortable (though not lavish) couldn’t assuage those deep fears. A mixture of serious health problems and acute hypochondria magnified her fears. No wonder my Mom was always miserable. . . .

Except that . . . Mom could have seen her life through a very different prism. It was a life of epic adventures, triumph over adversity, the love of family and friends, and a financially pretty-darn-secure old age, with the best medical care available in a country that offers the best medical care in the world. Yes, bad things happened, and yes, she had pain, but she always landed on her feet to great applause.

Mom was born in the age of Flappers and died in the time of smart phones. She lived in Europe, America, and the Far East. She saw empires rise and fall. She had a knack for making friends. She had children and grandchildren who loved and respected her. If only she could have appreciated the happiness spread before her.

Facebook is perfect for condolences. As a conservative, I have a love/hate relationship with Facebook. I love the way it keeps me connected with people, allowing me to follow the stories of their lives and learn through their interests (even if I often disagree with what they’re trying to teach me). However, I hate, hate, hate the way Facebook is getting perverted by its management’s Progressive policies. But I still use it, because it keeps me connected. Which gets me to those condolences….

After Mom died, I did what everybody does nowadays: I put up on my personal Facebook page a lovely picture of my mom, along with a simple statement notifying people that she had died. In the 16 hours since then, I’ve gotten more than 50 condolence messages, in addition to many “likes” and “sads.” Most of the messages are short, especially because many of those writing know me, but had never met Mom. To the extent they “know” her, they do so through my stories about her. Some of the messages are a bit longer, with charming reminiscences about her epic life, her charm, her beauty, and her style. All of the messages are heartfelt.

In the old days, when someone died, it could take a while for the news to spread. When news reached them, people would sit down and laboriously write a condolence card, which was often stilted and formulaic. Those who didn’t write would pass you on the street and, stricken by social embarrassment or deeply uncomfortable with the notion of death, pretend that they didn’t see you to avoid that awkward moment of saying “I’m so sorry,” and that terrible fear that, upon hearing their voice, the bereaved person would collapse in a helpless puddle of tears. How very unnerving.  And of course there was the “should I telephone her or not?” debate that raged in every person’s heart.  Was that a gift or an intrusion?  And could the phone call be mercifully short or would it be painfully long (especially with a talker, like me)?

Facebook, however, is the perfect medium. You learn immediate about your friend’s loss and you can just as immediately pen a truly heartfelt message without impinging on the friend’s physical or emotional space. Meanwhile, the bereaved person can read the messages at her leisure and be grateful that so many people, in this busy, busy world, took a moment of time to send their love and prayers.

Incidentally, the same holds true for those of us who blog. I’ve lost count of the number of people who have taken time out of their days to send me blog comments, Facebook messages, and emails, all telling me that Mom and I are in their thoughts and prayers. I haven’t yet gathered myself together enough to send personal thank-yous for this, but I am deeply touched and grateful. Every one of you needs to know how much it matters to me that you took the time, made the effort, and said something that made me feel better.

The day after someone dies is a busy day. I was grateful today that I’m not a religious Jew sitting shiva. For one thing, idleness wouldn’t suit me but would, instead, depress me. For another thing, there was so much to do.

I called Mom’s closest family members and friends around the world (those who weren’t already aware of what was going on) and that was bittersweet. I’ve known most of these people my whole life, and it was very painful to tell them about Mom’s passing. (And no, I’m not using “passing” as a euphemism for “dying.” My rather inchoate spiritual beliefs don’t include any specific belief system about the afterlife, but I do believe that the energy that makes us who we are passes from this life to somewhere else.) On the other hand, because I’ve known these people for so long, I was able to talk to them about their role in Mom’s life, and how much they mattered to her, and that felt good.

I also had to call the insurance company, the lawyer (who’s also the executor), and all the doctors with whom she has upcoming appointments, so that I could cancel and clear their calendars. I also had to go to the funeral home to make arrangements.

As we did with my Dad, I turned to the Neptune Society. In my family, we view the body as a vessel.  My sister and I believe that Mom’s essence, her life force, is elsewhere, and the vessel, while deserving of respect, does not require great expense — and, because we’re not practicing Jews, we don’t have a problem with affordable cremation, followed by having the ashes scattered at sea.

What’s also taken time is friendship. If it weren’t for the fact that death brought this about, my day today has been the most awesome social day ever. People have reached out to me in so many ways, all of them good. I am grateful indeed for the community I find myself in. Lucky me.

Incidentally, you’re my community too, and I’ll stop boring you with my probably quite hackneyed ruminations. Thanks to all of you for your support. It meant (and means) a lot to me.