“Be a smart consumer. A frugal life is a comfortable life.” When discussing such themes the usual emphasis is on life, and how to make a better one for yourself and the people you love.
But life eventually has to end, even for yourself and the people you love. It ended last week, for my mother-in-law. Hers wasn't entirely a bad death, by the miserable yardstick that measures such things — but she didn't have the death she'd wanted or planned for, either. A mistake here, an oversight there, and all her carefully made arrangements unraveled at the end, making things worse for her and for those of us she left behind.
Sandra -- “Sandee” to her friends and family -- spent her childhood and working adult life in New England before she and her late husband eventually retired to an “active adult” community outside of Myrtle Beach. Her health had been in decline for the past couple of years; generally active living punctuated by evermore-frequent hospital stays. She actually went into hospice last Christmas, though she recovered well enough that the doctors released her a week or so later. My brother-in-law Dave lived with and helped care for her, though he and my husband Jeff both knew that sooner or later, she'd probably have to leave her “active adult” community and move into an assisted-living facility.
That was the status quo until the weekend before Veterans' Day.
The phone rang while Jeff and I were making Sunday dinner; the nurse/social worker who helped care for his mother called to say she'd had a major setback and needed a full-time live-in assistant. Her insurance should eventually cover that, except paperwork problems prevented that coverage from kicking in immediately; long story short, Jeff called a sort of medical babysitting service down there and arranged for someone to stay with Mom overnight (at $18 per hour) so Dave could get some badly needed rest. Hopefully, by Monday morning the insurance paperwork would go through and she could get a permanent full-time assistant.
Dave called back a few minutes later to cancel the babysitter – Mom had gone into cardiac arrest and was en route to the hospital. She'd filled out a Do Not Resuscitate form, but Dave couldn't immediately find it, so of course the EMTs went to work on her. By the time he found the DNR six minutes later, she had a pulse again. (A doctor later apologized to him, saying that the EMTs “should have” respected his medical power of attorney without seeing the actual DNR. Still, you truly can't fault the EMTs here.)
When I first heard this story, I dared hope the DNR snafu would turn out for the best — she'd wake up, walk out of there and have another decade or so of rip-roarin' ahead of her. She'd beaten the odds before: how many ex-hospice patients do you see walking around, anyway? Jeff thought the same thing; some time that night he smiled wryly and said, “She's going to be really pissed to wake up in a hospital again.”
But she wasn't. She never regained consciousness.
Dave called Monday afternoon to say the doctors were taking her off the respirator; she'd shown no response except occasional finger-twitching. The next morning, Jeff and I drove down from our home in northern Virginia. While we were still an hour outside of Myrtle Beach, his brother called to say the doctors were doing something to her pacemaker with magnets, something to help ease her passage out.
But she still held on. She was alive – technically, at least – when Jeff and I got to the hospital around six that night. The second we saw her, we abandoned our previous hopes that the DNR mixup would have a happy ending. She remained unconscious, and thoroughly unresponsive except for the piteous moaning sounds she made with almost every exhalation.
“She sounds like she's in pain,” I said.
“She probably is,” the nurse replied. “I'll give her more morphine.” She spoke again, in a louder voice: “Mrs. P, I'm going to give you some pain medicine, okay?” No response. The morphine dampened the moans but didn't make them stop.
They moved her out of the ICU into a regular room an hour or so later. No change.
“The doctors don't know how long she'll stay like this,” Dave said. “They're amazed she's lasted this long.”
We three took turns holding her hands or smoothing her hair, in case any part of her still craved human contact. We said comforting things, in case any part of her could still hear them. We have no idea if this made any difference at all.
Finally, around ten, we all wished her good-night, and left for my mother-in-law's house. The night nurse promised to call us if anything changed. Just after one o'clock on the morning of Wednesday, November 12, it did.
We mourned as well as we could, but our grief almost immediately had to take a backseat to more practical matters. As soon as she passed, a clock started ticking – she had a reverse mortgage on the house, which had to be entirely emptied out in . . . how long did we have, exactly? Hard to say when we couldn't find where she kept the paperwork.
For homeowners of a certain age contemplating a reverse mortgage, there are many factors to consider: should you get one, are they a good deal for you, what are the financial downsides, and what about your eventual heirs? But here's two additional factors: how much stuff does your house actually contain, and how organized is that stuff — do you keep important paperwork (like your reverse-mortgage deed or Do Not Resuscitate form) where it's easy to find when needed?
Unfortunately, my mother-in-law did not. Her house by the end contained far too much stuff, hardly organized at all. She'd filled out a Do Not Resuscitate form specifically to avoid lingering in unconscious pain — yet still did so for more than two days, since nobody could find the DNR when it mattered.
Nor could we easily find anything else that mattered. Where'd she keep the key to her safe-deposit box? We looked in jewelry boxes and junk drawers, through countless envelopes and files she'd kept stacked in plastic bins — but eventually, purely by good luck, I found it at the bottom of one of four department-store shopping bags she'd had overflowing with half-used arts and craft supplies. Important documents from her life-insurance and pension companies were mixed in with files full of crossword puzzles she'd cut out of magazines. So we couldn't just throw away any boxes of junk, but had to go through every individual piece of it first.
We've all heard the jokes about evil or at least hyper-critical mothers-in-law, but none of those applied to me — my MIL and I had always got along spectacularly well. Until after she died, and I spent several days and collected several bruises helping to clear out the enormous piles of magazine articles, junk mail and loose beads interspersed with the very occasional important-or-valuable keepsake she'd stashed in there.
So, yeah: first I'd get annoyed with her, for leaving such a godawful mess behind. Then I'd get mad at myself for having such mean thoughts about a sweet old lady at this of all times, and likely as not I'd tear up again to remember anew just why I was here emptying out her house in the first place.
I take comfort in her son Jeff's observation: “If she knew you were writing an article with her as a Cautionary Example, or what a pain in the ass it was to handle her affairs afterward, you know she'd laugh and print out copies for all her friends.” He didn't exaggerate — I found the purple plastic file labeled Jennifer Articles in her handwriting.
Rest in peace, Sandee.