Her son was dying. Yes, we were keeping him alive in that moment, but he was dying anyway. We could not fix what was killing him; it was simply too progressed. There was no way out except death. We knew this and, perhaps, he knew it too as the soul peeking through his eyes became more distant and the fear that had been there was replaced by blankness. He was too sick to make his own decisions. The decision about what to do fell upon his wife. Having to make decisions about the end of her husband’s life tormented the patient’s wife. He was a fighter and he had always told his wife he wanted to live. The patient’s wife could not imagine life without her husband. She felt alone. She feared past demons reemerging when he left her. Yet, the fact remained that this wife’s husband, this mother’s son, was dying. As the plan stood, he was dying slowly.
It was under these circumstances that the mother and wife sat down to talk with us, the patient’s care team, to discuss how the plan could change to reduce suffering. We described the options. There was the option to continue forward as we were; using every medication and intervention we could to keep the patient alive. We explained that this would be futile and would still result in death, but the decision was theirs. The second option was to stop the medications and interventions keeping the patient alive and replace them with medications and interventions to keep him comfortable. We could not predict the future. We guessed he would die within days if we turned off the medications currently keeping him alive. He would die more quickly without medications to raise his blood pressure and transfusions to replace his red blood cells and platelets, but he would not suffer because we would treat every symptom he had from pain to breathlessness and anxiety to insomnia.
After we described the above options, the wife began crying. She accused the healthcare system of missing something. Of not doing everything. If emotions were tangible, then this wife was the physical manifestation of agony. That’s when the mother spoke.
“This is not their fault. I believe them… I believe that they have done everything they can.” The mother paused. “I have cared for my son his whole life. I have loved him and fed him. He is my son. I will not see my son suffer. I do not want my son to suffer like this.” The mother paused again. “My son is already gone. I see it in his eyes. He is not there. It is time to let him go.”
The conversation unfolded between the mother and wife. The care team was there as witness but it was not our conversation. It was not our right to decide what happened next.
“I am all alone. I am afraid,” the wife said.
“You are not alone. You have me,” the mother said. “And if you have me then you have my people because they do what I say. I will stand by you.”
The patient was one of this mother’s children. The mother was old enough to have grandchildren and great-grandchildren. In the days leading to this conversation, it became clear how large her family was from how many visitors the patient had. The mother sat tall and confident. She spoke with sadness and wisdom. She spoke as someone who had seen others die before.
“I will not see my son suffer. Let’s do this together. We will do this together. Let him go,” the mother said. “I know my son. He is gone. You can decide, but I will not visit again because he is already gone.” The mother paused and held the wife’s hand. “We will do this together. We will mourn together.”
The patient died less than a day after he was transitioned to medications to treat only his symptoms. Most of his family had seen him prior to his death. I will never know how the story of the wife and the mother unfolded after the patient’s passing. Yet, I believed the mother when she said she would be there for the wife. From the conversation I witnessed it was evident that the patient’s mother knew more about life and death than most people; she had a knowledge gained over her lifetime. She also knew her son as only a mother could. The guidance and support the mother offered the patient’s wife as the patient died were some of the bravest acts I’ve witnessed.
Connecting the Dots 