Hope for a Cool Pillow. Margaret Overton

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      Hope for A Cool Pillow

      by Margaret Overton

      Outpost19 | San Francisco

      outpost19.com

      Copyright 2016 by Margaret Overton.

      Published 2016 by Outpost19.

      All rights reserved.

      Overton, Margaret

       Hope For a Cool Pillow / Margaret Overton

       ISBN 9781937402907 (pbk)

      Library of Congress Control Number: 2015919193

      Cover art by Alex Nowik

      For Larry

      Author’s Note

      This book is an exploration of end-of-life care based on my experiences as a daughter and as a physician. It recounts the gradual evolution of a viewpoint regarding an important and complex issue. All patient information has been altered to protect individual identities and respect privacy.

      The story does not follow a traditional chronological course; rather it follows the path I took in figuring it out. Which means I wrote it slightly backwards, looping about, side to side, and with the considerable use of retrospect. Things rarely work out as we plan; but without a plan, where would we be?

      —Margaret Overton

      One

      On the first day of my first clinical rotation in the third year of medical school, I was assigned my first patient. Her name was Esther. An internal medicine resident told me to insert a urinary catheter into Esther, who hadn’t peed in a day or so.

      Placing the catheter would mark another first. But the problem proved murkier: how to make the transition from a normal social interaction to elbowing apart the knees of a stranger and mucking about in her nether region. The whole concept seemed intrusive, certainly an invasion of her privacy. I hadn’t learned the necessary etiquette from gross anatomy, physical diagnosis, or Emily Post. So I called my mother from the nursing station. Her knowledge of decorum was encyclopedic.

      “You got me, honey,” Mom said. “I can’t help you with this one.”

      Esther was a hundred and two but she looked lovely nonetheless, sitting up straight in her hospital bed, her hair a white halo surrounding a gently grooved face. I recognized the “Q” sign pretty quickly: open mouth slashed at five o’clock by a protruding tongue. I had read that this usually indicated deathi. I looked for some movement of her chest but it remained perfectly still. Was it possible that the resident might have sent me to place a catheter in a dead person? Apparently it was not only possible.

      Scrambled eggs marred Esther’s otherwise tidy hospital gown. Someone must have tried to feed her, not noticing she couldn’t swallow, not recognizing she had passed.

      That morning, on rounds, her geriatrician had announced: “All my patients are do not resuscitate unless otherwise specified.” So I did not perform CPR.

      From the end of the bed I marveled at her quiet aplomb. This is the way to go, I realized. Nobody stomping on your chest, zapping you with excessive voltage, shoving tubes this way and that. A quiet death without fuss or muss. Esther, wearing a pink satin bed jacket, had slipped away peacefully; she had gone doggedly gentle into that good night.

      ~

      My own mother died on September 22nd in the year 2010. I like to think she chose that particular day for reasons of her own—it was the birthday of someone who had displeased her immensely—but death makes it impossible to verify my hypothesis. She was a disciplined and principled woman who stayed true to her beliefs throughout a long life, which ended consistent with her trusted maxim: enough is enough. Had there been a coupon for a coffin—and she’d had her wits about her—I think she would have clipped it. I loved her for that and so much more.

      The funeral proceedings took place in the traditional Roman Catholic fashion, with a mass and burial on the day following a wake complete with open casket. I used to think the open casket a barbaric tradition that should be consigned to the past, much like bloodletting for consumption or trephination for mental disorders. It seemed a creepy holdover from a different century. When my father died in 1998, he was almost unrecognizable from the ravages of cancer. Something in me—either doctor or ad hoc decorator—wanted to cover it up. I had suggested to Mom that perhaps we close the casket.

      “No,” she said firmly at the time, “I want to be able to see him just one more day.”

      I never understood the open casket until Mom died. Then I needed to be with her, to gaze at her face one more day.

      Gibbons Funeral Home, the stalwart if temporary mainstay for the recently departed that graces my hometown of Elmhurst, Illinois, had done a terrific job preparing her hair and make-up. Mom didn’t look a day over eighty. My sisters Erica, Beth, Bonnie and I had chosen a suit she’d particularly liked, one that complemented her coloring. We added a cheerful scarf that I had bought her. We picked out her favorite rosary and a pair of coordinating earrings. She looked good, if not well. She certainly did not seem ninety-three. My sisters and I felt confident that Mom would have been thrilled with her posthumous appearance. I’d never given too much thought to cosmetizing, which is the art of making the dead appear better than dead, almost alive really, just kind of still. Or perhaps I’d thought of it in terms of outcome, not in terms of process. It must be a difficult profession, certainly not for everyone. I don’t think I’d want to do it, but I’ve learned from experience that I can do just about anything if I have to.

      A surprising number of people showed up for the wake and the funeral. When you’re ninety-three, you can’t expect too many mourners unless you’re famous. Most of your contemporaries are long gone. But Mom still had a few friends who paid their respects. Those who couldn’t attend had their children come in their stead. Friends of mine, friends of my sisters’, even friends of our kids came to say good-bye to our mother, Lydia Overton. She’d left an impression. I’m not sure you can ask for more than that.

      The wake was odd in the manner that wakes usually are, but nothing truly weird happened. Not at the wake anyway. Nobody grabbed any dead body parts or fell to the floor in prostration. I’ve been at wakes where some distant relatives hauled the dead person up and out of the casket, hugged him, and carried on. I’ve attended wakes where the family hired a professional to wail. That was definitely awkward and personally discomfiting. My family, for certain, doesn’t emote much. Our funerals are civil affairs; the weeping is silent, mostly contained. But still, there we were, standing around a dead body in a casket, making polite small talk about this and that and it was unnerving and frankly pretty damn exhausting trying to pretend it was all just normal, not too devastating really. People I hadn’t seen in ages—people I didn’t even like—came by to say hello. Or good-bye, as it were. Some hugs and kisses. I kept glancing over my shoulder at Mom. It would be my last day with her. Forever. I studied her profile surreptitiously in between visits with other mourners. What if I developed facial agnosia and forgot what she looked like once she was buried? How could pictures ever prove adequate? I wasn’t ready for this, and yet she was more than ready. And she was so much more than her image, right? How could a two-dimensional figure evoke the full magnitude of the woman? I was glad to have that one extra day. I needed it. But what I really needed was the mom I’d had years before, when both she and her mind were present in the same room at the same time and we could all have a meaningful discussion. That’s the woman I wanted, right here and right now. I wanted her laughter and wisdom; I wanted her insight. But those were long gone.

      I kneeled in front of the casket and pretended to pray so I didn’t have to talk to anyone. I wanted time alone with her. Mom looked the same in repose as she had each day in recent memory—a slight, beneficent smile affixed to her face. The smile was her default setting, placed there more to reassure than to signal underlying happiness or contentment. Dementia misleads you that way. It’s the great teaser, using the expression of equanimity