My mother, Edna Arnold Yarberry, died on Saturday, February 23. She would have been 94 on May 6 . I asked to keep the vigil at her bedside for her last evening. and had the honor of talking her home. The compassionate nursing staff kept her safe and comfortable and gave me comfort as well during that night and early morning time.
I have been present at the side of the dying since I was a teenager working in a small rural hospital in Kentucky, as a medical student, and as an intern and resident in my training program in New York. I have witnessed peaceful deaths and have been present when interventions to prolong life caused suffering and often led to no increase in duration of life. I have always been comfortable with those who are dying when the person is older and ready enough to go on from here to the hereafter. It is much harder when the person is young, has unmanaged pain, or is unable to make peace with the inevitability of death. Mommie was ready for her soul to go on.
The mitral valve in Mommie’s heart had been damaged from rheumatic fever when she was young. It was replaced at just the right time when she was 81, with excellent surgical skill and an easy recovery. The problem was that she outlived her heroic replaced valve, which worked nonstop for 11 years, 7 months, 22 days, and 3 hours—more than 350 million heartbeats from the time of the replacement until the heart could no longer work. The sell-by date on her valve was just 10 years. She got an extra 19 months and a few days more.
When the mitral valve fails, blood pumps back and forth within the heart rather than pumping forward. Blood backs up and fills the lungs with fluid (this is called congestive heart failure or pulmonary edema), making it so very difficult to breathe; it’s more like breathing under water than just breathing air. Mother’s doctors were a geriatrician, a cardiologist, and a nephrologist. They worked miracles for about 18 months after the valve began to fail; then medical interventions provided only temporary relief of symptoms.
I had promised Mommie years before that she would not suffer needlessly and that she would not die without a loved one present with her. Palliative care was not available in the assisted living center where Mommie lived for the last four years and three months of her life. I had asked about hospice care when it became clear that Mommie’s kind of illness was not likely to be a sudden stroke or a heart attack. It was likely that she would linger and suffer, with a potential middle-of-the-night ambulance ride to the small local hospital where the death would take place. Hospice has not been integrated into this facility, nor is this unusual.
Mommie and my sisters were always ahead of the curve, however. Mommie knew when to insist that she be taken to the regional medical center in Bowling Green at 4 a.m. when the staff in the assisted living center could not provide any further relief for her breathing difficulties. My sisters knew to take her where her doctors would make her comfortable as long as medical treatment worked. As soon as she arrived in the Medical Center Emergency Room, respiratory therapy and drugs to remove the fluid from her lungs helped her to breathe. This medical team also knew when to discuss how to make her comfortable when there was no treatment left.
My sister-in-law is a volunteer in a hospice program in the same town as the regional medical center, and she helped my family understand the need for compassionate care for the dying. Mommie’s illness worsened too quickly for her to make it to the top of the long list of people waiting for hospice care, but the hospital medical team decided that palliative care in her hospital room would be the right thing to do, “while her name is on the hospice waiting list.”
I arrived on the Wednesday afternoon flight to Nashville and began my last journey to all I know as home as the sun was setting. Darkness was filling the open sky covering the long, long stretch of Interstate 65 as we drove north to Kentucky. Mommie was waiting for us. I have heard that the dying do wait for those they love, and this has now happened to me twice. Once, when my mother-in-law Natalie was dying, she, too, waited for us as we drove the eight hours from Kentucky to Orchard Lake, Michigan.
Mommie was so tiny and so frail. Her breathing was labored, but she let us know that she was glad that we had come to be with her. I took the first night vigil, and after two hours of alone time with Mommie, I asked the nurses to call her medical team to begin some medication to decrease her suffering. She had a peaceful night, then a noontime rally the next day with my brothers. They sent us a photo and called us to return to talk to her. The moments of awareness that they had seen did not last long.
The palliative care doctor had made an evaluation the day before, and palliative treatment was begun on the second day we were there, on Thursday afternoon. Just a bit of medicine to take away the anxiety that occurs when there isn’t enough oxygen going to the brain, and a little pain medication to ease the suffering. She had another 24 hours before I began my last vigil with her.
I brought the Episcopal Book of Common Prayer with me for this night. I first read the Evening Prayer service . As the long night progressed, I read the prayer for the sick, then the prayer for the dying. I told her how much we loved her and how she had given her children not only life, but hope that each of us could have a good life. I whispered to her not to linger, because her work here had been done. The nurses and aides who cared for Mommie were constant in their attention and support.
I had promised to call my sisters and brothers, my husband, sons, and stepsons, when Mommie approached death. There are signs that those who have spent time with souls who are leaving recognize. I knew it was time to make those calls around 3:15 in the morning. My husband and three of the four sons who had loved their grandmother came to stand watch. My elder son arrived with his 15-month-old son, Jack, and his wife just as Mommie was leaving us. They did get to say good-by. She had waited for them.
We read the Prayer for the Dead. We kissed her farewell. Mommie had a long life with many chapters. And she had a good death. We should all have this kind of leaving.