Dr. Al-Hashani is standing at the foot of my mother’s bed. By the clock on the wall, I see it is 6:04 AM. Beside it are a variety of “prompts” – a calendar with a cartoon pumpkin and the word OCTOBER, a flip chart saying “Today is…


Extraordinary Measures

Dr. Al-Hashani is standing at the foot of my mother’s bed. By the clock on the wall, I see it is 6:04 AM. Beside it are a variety of “prompts” – a calendar with a cartoon pumpkin and the word OCTOBER, a flip chart saying “Today is… Thursday,” my mother’s name – Devorah Esther Davies – each word printed-out on legal-sized paper, and tacked to the board above her bed.

I’ve since learned these are tools to help confused patients “stay grounded in the real world.” Only in the “real world,” it isn’t Thursday – it’s Saturday – and my mother is unconscious. She is at the end of her life, dying, after 45 years of smoking – “enjoying,” she would say – the long slender brands of “women’s cigarettes” – Capri’s, Virginia Slims, Camel No. 9’s. Thursday, Saturday, what’s the difference? By Wednesday, the specialist, Dr. Goldfarb, has told me that my mother, not yet 70 years-old and with a head of still-dark, still-long hair, will “likely be gone.” On Thursday, I will turn 30, and – if Dr. Goldfarb turns out to be right – be well and truly alone in the world.

I am startled awake at 6:14 – I’ve drifted off. Dr. Al-Hashani is next to me, in my recliner, writing in a chart. Behind him are three surprisingly alert-looking students – a young East Indian man and two young Asian women. As Dr. Al-Hashani writes, his trio observes me pleasantly, quizzically. And why not? Their mothers aren’t dying. I close my eyes.

“I am Dr. Al-Hashani,” he announces formally. “And how was the night, for your mother?” He is a serious-looking man, short in stature, no more than 5 feet, 5 inches in height. He is sharply dressed, in a brilliant blue shirt, which is new or freshly pressed. He wears his name on a tag affixed to his shirt – Dr. Mohsen Al-Hashani – as do his companions. I read them silently – Tarek, Emily, Jacqueline. Students, I gather, do not have last names. I struggle to sit-up, pulling the handle on the recliner. What’s there to tell him? “She can’t breathe,” I say, “Each night it gets worse.”

Dr. Al-Hashani nods, sympathetically, it seems. He pulls up the chair my Aunt Eliza sat in just last night, when she visited my mother for the final time, before returning to Saskatoon and to her life. “I can’t stay indefinitely, Pamela,” my Aunt Eliza told me emphatically, after being here just four hours. She is the only person who calls me Pamela. “Anyway,” she said, “You can’t just put your whole life on hold.” “I understand that,” I told her, and I do. But the truth is, I have put my life on hold, these last months, and certainly these last weeks, as my mother’s condition has rapidly declined.

“May I ask,” starts Dr. Al-Hashani, “What has Dr. Goldfarb, explained to you, regarding your mother’s condition?” He brings his chair close to mine, leaning forward in it. Yesterday, a physician I’d never met – a woman with a Celtic wrist tattoo – sat on the edge of my mother’s bed, as though she were already dead, or part of the furniture. I see my mother’s chart is in Dr. Al-Hashani’s hand, but it’s closed.

“She’s dying,” I say, “I know that.” I sound angry. I am angry. My mother is dying. She’s only 69. My friend Rachel’s mother is 69 and just re-married. Dr. Al-Hashani nods supportively, as though I’m dealing with this well. I know this is just his training – to know what to say, and when to nod – yet I’m surprised to find it oddly comforting. “Yes,” he nods, “Yes, this is so, unfortunately.” I realize that English is not the doctor’s first language. Still, I am struck by his professionalism, and even his good manners. Yesterday, I overheard the doctor with the Celtic tattoo tell a nurse that my mother was going to “expire.” Dr. Al-Hashani makes some notes in the chart, and departs the room, followed in single file by Tarek, Emily and Jacqueline. I look at the clock, at the calendar, my mother’s name on the wall. It is 6:37, still October, and still not Thursday.

The “code team” has arrived at my mother’s bedside, looking confused. There are two nurses, a respiratory therapist, and a red-faced resident named Albert. The reason for the confusion, I gather, is my mother’s “code status” – which is DNR, or “Do Not Resuscitate.” This means that should she reach a point where she would need “extraordinary measures,” that these should be withheld. But in reality, I’ve learned, this rarely happens. It’s just hard, I gather, when someone’s lying there, as my mother is now, to do nothing but let that someone “expire.”

I remind Albert, “My mother didn’t want extraordinary measures – doesn’t,” suddenly guilty, aware that I’ve spoken of my mother in the past tense. But my voice is small, overpowered by a persistent beep from a panel on the wall. Albert has disabled it twice, but it’s tenaciously restarted, now for a third time. I’m relieved to see Dr. Al-Hashani arrive, in a crisp, maroon-coloured shirt. I’ve come to admire his wardrobe, his array of brightly coloured shirts. In the week, or almost-week, that he’s been in charge of my mother’s care, I’ve yet to see the same shirt twice.

“What is happening, may I ask?” starts Dr. Al-Hashani. Albert looks especially relieved, I think, to see someone assuming authority. “It’s Mrs. Davies,” says Albert, stating the obvious, “She appears to be failing.” “I see,” nods Dr. Al-Hashani, calmly. He moves to the wall panel, and again silences the beeping, this time permanently. He thanks Albert, and the others, acknowledging their efforts, and dismisses them from the room. Then, it is only he and I, alone with my mother.

“Your mother,” he nods, “I believe she is getting ready to leave us.” He comes around to where I am, and stands next to me. “She’s had a very difficult journey, your mother” he says. “But there are things we can do now to ease her passage.” He places his hand on mine, where my hand grasps the bed rail. I’m surprised by the gesture, and by the warmth of his hand, and I find myself wondering if doctors are allowed to touch patients or family members, and if not, why not?

“She didn’t want extraordinary measures,” I offer-up, but my voice is barely audible, like a soft, cracked thing. “Of course,” he nods. “What happens now, is that there is a part of your mother’s brain that is compelling her to breathe. But because of the disease this is hard – perhaps not even possible anymore. And this creates anxiety, if you will. But there is medication I can give your mother that will ease this. And without this anxiety, your mother will be able to go.”
“Isn’t that killing her?” I ask. For the first time since my mother lost consciousness two weeks ago, I feel tears in my eyes. For weeks, I haven’t allowed myself to cry, but have instead simply waited, observing things – the names of students, the days of the week, the colours of doctors’ shirts. “Perhaps,” nods Dr. Al-Hashani, “But in truth, a disease is killing your mother.”
I can’t recall if anything else is said between us, or if I only nod. Dr. Al-Hashani removes a vial from his pocket and a packaged syringe, which he opens and inserts into the vial with the familiarity of someone who has done the task a thousand times. He inserts the syringe into my mother’s IV port and in a matter of seconds, empties it of whatever substance he’s assured me will ease my mother’s anxiety and allow her to die. But nothing happens.

“Why don’t we sit?” asks Dr. Al-Hashani. He pulls-up the chair to sit beside me, just as he had when we first met, nearly a week ago. Perhaps ten minutes pass. My mother’s breathing becomes less-laboured, less-frequent and at some point, ceases altogether. I look above my now-dead mother’s bed, to the sign that says Today is… Thursday, and realize, with some irony, that it finally is. Dr. Al-Hashani remains seated beside me, though he must have other places to go, other patients to see. The clock on the wall shows just past six – just as when we first met – only it is six in the evening now, and the light has mostly gone. In a moment, I feel a dozen different things – exhaustion, relief, hunger, the need for a bath. I am 30 years-old and motherless, but finally – gratefully – able to cry. It grows dark, but Dr. Al-Hashani sits with me. He is a stranger, really, but I am grateful for his presence. I am not, perhaps after all, so well and truly alone in the world.

Story by: Jenn Rae

Source: thewritepractice.com


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