At this moment, as I type – my mum is in hospital awaiting a triple heart bypass. She is seventy-five years old, ten years ago she had a series of small heart attacks and had two stents put in, and gained a new lease of life.
She is now ten years older, and the operation is a lot more invasive… I don’t know what I thought a heart-bypass was, but I’ve learned that it involves taking a vein (or two) from the patient’s leg (or occasionally arm), cutting open the rib cage, and sewing the working pieces of vein in place of the patches of those arteries or veins round the heart that are blocked. Once the veins are sewn in place, all the other bits inside the rib cage are put back and the rib cage is wired shut, and then the huge chest wound is sutured shut, as is the long scar on the arm or leg – where the donor vein came from.
My mum doesn’t know this in detail.
I’ve been reading a book recently: Atul Gawande’s ‘Being Mortal‘ – it is a superbly thoughtful reflection on the circumstances of growing old and infirm, or becoming mortally ill, and facing the approach of death.
Looking at innovative and life-giving care homes, and less imaginative solutions to elderly living; considering the way that hospitals and hospices respond to the needs of those who come to them for care, and considering the modern way that the end of life is physically and mentally approached (or infinitely, painfully avoided).
Atul Gawande is a surgeon and Harvard lecturer (I think) and has written other books (which I have not read), but I thoroughly recommend this one. Above all he considers the way in which accepting our mortality, and discussing our declining abilities and what makes us love this short and precious life, are all important to how we live, age, grow old or ill, and ultimately die… at best – but more and more rarely these days, peacefully and at home, with loved ones near. He shares the personal stories of a variety of people as they approached infirmity and ultimately death.
Gawande is very frank about the way in which surgeons and consultants are not always good at approaching the difficult discussions which really ought to be had very gently with their patients, and have a tendency to offer any do-able ‘fix’, no matter how painful, unpleasant, or unlikely to succeed, rather than share their own concerns and ask the patient what matters to them in life. Gawande practises in America – but most of the reflections apply equally this side of the Atlantic.
My mum doesn’t know the specifics of the triple heart bypass operation because she did not want the doctors to tell her in any detail what the operation involves… but she chose it over an experimental attempt to stent the three awkwardly-placed blockages, which would have likely taken more than four hours, and would have required her to be conscious. Understandably, she couldn’t face that. But she didn’t want to think about what she is facing. And she has been waiting now in hospital, rigged up to a heart monitor, for five weeks – for a place at the ITU in the other hospital to become available.
So for five weeks I have been going back and forth to see her- taking her news, fruit, digestive biscuits and drawings from my daughter every two or three days. My father has travelled in to see her every day. We do crosswords, talk about the other patients, discuss the family and the weather and the view from the window… but we are not allowed to talk about the operation – as she does not want to think about it – it is too frightening and painful, and the only way to cope for my mum, is denial.
It is very hard. It was especially hard today – a handsome young hospital radio volunteer came round to ask for requests… my mum’s mind went blank but I remembered two of her favourite songs – Ronald Binge ‘Sailing By’ which always comes after the shipping forecast and which used to help her go to sleep when she lay awake in the night for hours listening to the radio, and Neil Diamond ‘beautiful noise’ – which my mum used to put on the CD player and turn up really really loud and dance around to when I was a teenager and she was angry and unhappy but wanted to be joyful. Perhaps it was a mistake to ask – but I just thought of them and she agreed.
The lovely DJ said he’d play them between 9pm and 10pm… and I left to make the long journey home at 7.40pm. I thought of his kindness, and the memories that music awaken and said as I left ‘I hope they don’t make you cry’. And at 9.40 she sent me a text ‘I cried a little bit’.
And I cried too.
My mum and I haven’t always had the easiest relationship – (that is such a stock phrase that I’m sure you’ll understand the understatement dear reader). I realise that denial has always been her way of dealing with things that are too frightening or painful to face… and the more afraid she gets, the more she gets short-tempered with the people close to her… about random things, as though their very presence, and their kindness, were a wicked enticement to face the rude monster that she has determined to politely but firmly ignore.
I don’t have a solution about how to deal with difficult truths, or how to help other people to face their fears; and I don’t even know if that is always the best thing to do – perhaps not in these particular circumstances. But I know that the fear doesn’t really subside or back off if you ignore it – I can see that she is afraid and unhappy, but she has decided not to be afraid, and so she can’t talk about it, it just seeps out in little tears and anger.
Well I’m afraid. I’m afraid first of the post-op recovery – of how demanding and depressing it will be for her – of how my father will cope with her fragility… I can be there to look after her – but it will be volatile and I am afraid of that – I have not lived at home since I was 18. I am afraid of how afraid she will be when she comes round and has not thought about the consequences of the op, and is not really ready to work hard to live again, let alone to face the suffering. I am afraid that she might die, and that my whole family would then have to move from her denial and glib conversations about the weather, and judgements about “thewomaninthenextbed”… To loss and total bereavement, without any preparation. I am afraid that although I think I am in some ways the strongest in the family – ready to tend wounds, hear confessions, even prepare services… that in fact I am perhaps the weakest of all. I am afraid that my father will wear himself out with the methodical busyness that passes for emotional concern in his partitioned life, and that he might manage to accidentally die before mum does!
But I am also hopeful.
I am hopeful that a bed will soon become free and that mum will be able to go ahead and have the op. I am hopeful that the experienced surgeons will manage well, and that the operation will be a success, and I am hopeful that my mum’s good lungs and muscles and strong mind will all help her to physically recover well. I am hopeful that she will not contract an infection, and that we as a family will be ready for her when she comes home several days later. And I am hopeful that I will be able to care for her for those first few days, as dad cares for the house, and I am hopeful that, though I may not be able to take the pain away or stop her feeling low – still I will be able to gradually ease things emotionally and physically, and rub along cheerfully with my dad. I am hopeful that she will regain her health and improve, supported by her family, and live to become an interfering old pest for many years, and will see my sister’s new baby safely born, and my own family all settled in a new house and job.
Yes – I think that is the way to cope with fear… voice it thoroughly, and then see what’s really left, what lingers. And what lingers on is hope…. not optimism, but hope,
HOPE, because no matter what – God loves us, and one day, when my fleshly clothing has been destroyed, then I will see God – and my own eyes will see him – and not another… and perfect love will cast out all fear. Hope because we will all die eventually, but God has sorted that out, and it’s not as bleak as all that, but it is fair… very very fair. And even though I rarely think of heaven, I think of eternity a lot, and eternity is already underway… so somewhere, on some level, I am already dead, and God has not abandoned me… and I have a sneaking suspicion that, that is where a lot of the hope is seeping through from.