Left in the Ashes

 The night my mother died started out like any other. I called her home in Florida around 7pm to catch up on the day and see how she was feeling. 

“Not great honey,” she whispered. “I’m heading to bed early.” 

This would be our last conversation. 

I didn’t realize it then, but I’d been preparing for this night for some time. My mom, Diane, had been in a downward health spiral for years. Smoking was her vice, her constant companion. The habit finally caught her by the tail in the form of COPD and it had been pulling her under for the better part of ten years.  

She had bouts of cessation here and there, but she never really gave up smoking. Like most addictions, it was always in the wings, doing pushups in the corner, ready for showtime. I could tell when she was lighting a cigarette over the phone, trying to hide it from me. That familiar draw, the soft crackle of burning tobacco and the almost silent breath it was taking from her. 

“The first puff is always the best,” she used to say when I was a kid. I loved it when she blew smoke out of her nose like a dragon. I’d beg her to blow smoke rings so I could try and stack them on my little fingers. She actually loved the act of smoking, and I often wondered if the cigarettes were a crutch for her confidence. She spoke louder with a steadier tone when she had a cigarette in hand. 

When I knew better, I campaigned hard for her to quit. As a kid, I hid cartons of cigarettes in our backyard and crumpled packs into the garbage. As a teen, I wrote maudlin letters about her death. As an adult, I sent her anything that supported her quitting, from the obscure to the obvious. Once I was pregnant, she finally stopped with the help of hypnotism and acupuncture. It worked for a minute. And then that moment passed, and the cigarettes returned with a vengeance. I called it passive suicide. 

I’d exhausted our relationship chipping away at her resolve. The more I begged, the worse things got between us. Our once strong connection faded. I couldn’t accept her choice, she couldn’t fathom the quitting. The topic dropped from conversation, and we respected each other’s space. She didn’t smoke in my home, and I didn’t bitch about it when we were at hers. This worked for a while. 

And then came Covid, the virus with a laser-like focus on the lungs, the weaker the better. During the worst of the pandemic, she landed in and out of different rehabilitation facilities. A few bouts of respiratory failure were followed by a broken hip when she tripped over her oxygen tank. Then, a fall in the shower left her with a shattered arm and wrist.

Each stint in rehab was more hellish than the last. There were no visitors allowed, not even her private care nurse. Communication was limited to second-hand reports from an overwhelmed staff.  

When we did speak, she was usually “snowed in,” a phrase used to describe the effects of the Fentanyl patches they layered on her back to keep her quiet. The only time I was able to see her during those months was through a window. She stared back with a flattened expression, her eyes vacant as if she was looking into a blank wall and not at her family waving frantically, holding signs in the bright sun. 

She returned home from that final rehab a different person. Physically wrecked, she was unable to walk without a walker, unable to breathe without constant oxygen. But it was her cognitive slip I noticed the most. 

Her voice had dulled into a hoarse whisper of what used to be her signature roar. She told me she didn’t want to go through any more testing or see any other specialists. Then she asked me to be her advocate, to speak for her during doctor visits. 

“You’re so good at it honey. They listen to you. I’m just another old lady to them,” she sighed from her chaise lounge, wine glass in one hand, a cigarette dangling from the other. Her husband agreed and I took on this new role. She handed me the reigns, a silent shift that hit me like a train.

From there it was all downhill. She was back up to a pack a day, despite the oxygen tank leashed to her side. She ate less and slept more. During my last visit, she put her hand over mine as I buttered toast. 

“Don’t be upset if I don’t eat the whole thing,” she said plaintively. “I don’t need that much fuel anymore.”

I nodded, “Sure mom, but you know, if you eat a little more and smoke a little less, you might start to feel better…” I couldn’t surrender, even then. 

“Let’s change the subject…”

“Can’t you see what’s happening?"

“Please stop with this fucking shit, it’s enough.”

Her words bit me as they landed. 

“You can stop now honey,” she softened her tone when she saw my face. “It’s OK.” Then she took a bite of toast and left the table. 

Within a few hours, she’d be settled with her Kindle and a chilled glass of Kim Crawford’s Sauvignon Blanc by her side. She’d read and smoke for hours on her lanai, what Floridians call a screened-in porch. I emptied her ashtrays and kept her wine glass full. She’d raised her glass to thank me each time, a tacit acknowledgement of my defeat. Without the interference I’d been running my entire life, she was free to make her way to the end zone. From there, she never took her foot off the gas. 

When I left Florida, I held her tight one last time. She had lost nearly 40 pounds in three months. I felt as if I were gathering her bones up in my arms. As we stood in her living room, the quiet of the moment stung my eyes and closed my throat. I missed her already. 

Our last conversation happened just a few days later. She woke up hours after our call, writhing in pain so severe, she was unable to speak. I tried to calm her husband down, yelling over her guttural wails and the sheer panic rising between us when the ambulance arrived. Within minutes, she was swept out of her home into the black night. 

We were told by the EMT’s that she fell asleep as soon as she was medicated. We were then told she was turned down by the local trauma center for being too complex a case. She was turned away from the local ER for the same reason. Nearly an hour after the was picked up, she landed in a hospital outside of town called Marion West. 

“Can you repeat that?” I asked the person relaying transport information. 

“Marion West,” she said. “I know, it sounds like someone’s name but it’s not. It’s right outside the county line.”

In fact, it was someone’s name! Marion was my grandmother’s name. What are the odds, I thought. And then a slow chill made its way up my back, and I braced for what was unfolding.

I spoke to her husband Joe, who was told to sit in the hospital parking lot and wait for a nurse to call. 

“I told them to put her on a ventilator,” he said. “I didn’t know what else to do. I can’t be the one to let her go.” His voice was full of emotion, a tearful plea from her 83-year-old caretaker. 

“You won’t be,” I said. “Mom will be the one to let go. She’s ready.” I cracked as I heard myself say those words out loud. 

I told Joe to go home and wait on the couch instead of in his car. He wouldn’t be allowed inside the hospital, no one would, and the idea of my mother alone on a gurney filled me with horror. I was finally able to talk to the head of her trauma team at 11pm. 

He introduced himself as Michael Madson, PA.

“Like the actor?” I asked, because nothing soothes anxious panic like a little small talk. 

“Yes, like the actor but we spell it differently and… ah, I’m not as handsome. Call me Michael.” 

“Ok Micheal Madson with a different spelling, tell me what you’re seeing. How’s my mom?”

He explained that she had been ventilated to save her from flatlining when she arrived. We didn’t have a choice, he said. Her paperwork hadn’t arrived. But it was abundantly clear to him and his team that she was a very sick person. 

“Can she survive the night?” 

“We can keep her alive with technology and medicine,” Michael said carefully. “Is that what she wanted?” I felt myself stiffen as he asked the question. 

It wasn’t. She had been ventilated once before when she lost consciousness during one of her rehab stays. She didn’t remember much about those rehab visits, but she remembered the ventilation with excruciating detail. 

“I’d rather die,” she’d say without any irony. “Never again.” 

“She shouldn’t be on the vent," I explained. “She’s a DNR. Her health proxy is very clear.” His tone shifted from urgent to calm within the space of that sentence. He steered the conversation to her final wishes, the verbal release he would need from her husband, the next steps in letting her go. I was silent as Michael walked me through the procedure of removing her from the ventilator, while inside I was screaming, clawing at the images of her flashing through my mind. 

“She can’t be alone,” I interrupted. “You can’t just put her in a hallway and leave her…” Another flash to my mother, holding court at a dinner table, basking in the laughter of the people around her. No one loved an audience more than she did.  

“She won’t be alone. All of our rooms are private, and we have her set up with extra pillows…”

“And blankets,” I croaked, “She likes piles of blankets on her legs, piles Michael!”

“Got it, I’m writing this down, so I can make a schedule for the nurses. Someone will check in on her every ten minutes.”

“Make it five,” I said as if negotiating prices at a flea market. 

“She’s not in any pain and I can assure you, she is not alone on a gurney in a hallway.”  Alone on a gurney was my biggest fear for her.  Apparently, I let Michael know this every 13 seconds.  

I hung up feeling a vice grip of pain in my chest tighten. I tried to slow down my breathing, repeating the mantra in my head, “Don’t be scared. She’s trusted you. Don’t fall apart Lex, you got this.” But I felt like a spool of thread, unraveling by the second, my courage winding down with every turn. 

When the hospital called back, it was to let me know they were setting up to remove the vent. “Most likely, she’ll slip away from there,” Michael said. “It might be a few minutes; it could be a few hours. There’s no way for us to know, but there will be a nurse with her the entire time. She won’t be alone.” 

“I’m getting a little hysterical right now,” I was talking into a wad of tissues. I can’t believe this is fucking happening, I thought to myself, and I'm not there. 

“You’re carrying out your mother’s wishes. She’s ready. You’ve said that to me more than once tonight.”

“I did?”

“You did. I’ll call you as soon as we start taking her off the vent. I’ll have the phone to her ear, so you can talk her through…”

The image of her dying with a phone next to her head threw me into my next spiral. 

“Will she be in pain? I can’t take that, I can’t hear her scream, I can’t…”

“She won’t be in any pain, we’ve taken care of that. She hasn’t been awake since she’s arrived.”

“I can’t believe I’m not with her…” I was sobbing, as if Michael and I were best friends, as if he’d been on this journey with me for weeks instead of just hours. 

“Your mother is sleeping peacefully. She has layers of blankets keeping her warm and there’s holiday music being piped into her room.”

“She’d love that,”

“You mentioned it to one of my nurses earlier.”

I thanked him and hung up, a soggy rag of a human. I was completely spent. My head was pounding, my chest in a knot. I swallowed some Aleve before putting my head on the pillow. It was 3:30am when I closed my eyes.

When I woke up, I saw my phone blinking. The sun was just warming up the horizon. I had missed three calls, two from the hospital and one from Joe. Only Joe left a message. 

She passed away during the early morning hours, very soon after they removed the ventilator. She went quickly, as if she were already in motion, engine roaring, pedal to the gas. 

I don’t know why I didn’t wake up to those calls. I’m a hopelessly light sleeper but somehow, that night, I slept as if I’d been drugged. It took me hours to shake off the haze of slumber, to slowly face the world without her in it. 

I never spoke with Michael again, but I did text him. I thanked him for everything he did that night. I sent a picture of her and me together, from years earlier. I wanted him to know she was more than just the husk of a human who rolled in and out of his ER during a busy shift.  

“It was a crazy night,” he replied. “There was so much going on. I’m glad we could make her comfortable.”

He wrote that he didn’t recognize the woman in the picture. The person he met that night was someone else entirely. He encouraged me to remember her from the picture, instead of who she had become. 

I took his advice and put out photos of her as a child, dressed in plaid taffeta, as a teen wearing a double strand of pearls, as a new mother with a baby on her hip---me. 

It’s the smile that stops my heart. It’s all hers, open-mouthed, ear to ear with eyes wide open.  I can hear the infectious laugh that follows, the hearty “you got that right!” after the punchline. 

It’s her smile I think of now, a year later, as I write this. I’m afraid of forgetting the details of that night, like so many painful memories, those sharp edges are fading into a background blur. So I write about that night, to hear her voice again, if only on the page. I write so that I don’t forget about Michael Madson, PA, who spells his name differently than the actor, but just like St. Michael, the archangel of death, the carrier of souls. 

In some ways, I feel closer to my mother now than I did when she was alive. Without the friction, without the constant worry and ache, I have a peace I never knew. 

And maybe this is what she was driving toward all along.