By the time my mother-in-law reached her late eighties, we lovingly began to refer to her as “the Q-tip.” The tight white curls that sprung up from her scalp gave her another inch in height, particularly, when the curls were styled by her hairdresser. Then she could possibly pass for four feet eight inches and top the scales at almost ninety pounds soaking wet.
Yet her lengthy stride often gave a stranger the notion that she couldn’t possibly be as old as she looked. But to me, she looked every bit her age and then some.
Always aware of the lines of time, she surprised me when she asked to have a special picture taken of her on her ninety-second birthday. I wondered why, after all the years we’d taken snapshots, she’d want something special. It took a little while to get the truth from her.
At age ninety-two, she knew she was likely to look better than she would at age one hundred, as she asked if I would use the special picture to send to Willard Scott on NBC TV, when she became a centenarian. When she faced front, she appeared hearty, but when she turned around, her severe scoliosis was strikingly evident and made her appear to be S same Street's “Sammy the Snake” who looked like the letter, S.
Now in her mid-nineties, she sat at the crossroads between elderly and ancient. We all began to fear for her future. Clara was simply too vibrant to sit in her condo’s garden with a cane by her side and a book she could barely read because of newly diagnosed macular degeneration.
“Whattalydoo now?” was a frequent plea to me and the rest of us. We had tried for many years before to involve her in senior citizen groups that met at the local “Ys,” but to no avail. All it would take for her to get to one was a 10-to-15-minute cab ride, but she said she hated cabs. Our family didn’t live close enough to take her there, so her choices were narrowed that much more.
When Clara, who had been slender all her life, developed a pot belly, she complained to us that she wasn’t overeating and didn’t know why she looked pregnant. It was obvious that a trip to her internist was needed and we made an appointment with her primary doctor for one week later.
After her check-up which was completed with urine and blood tests, her doctor called all of us into her office to say that Clara’s liver was failing and she had a form of cirrhosis, called, primary biliary liver and pulmonary hypertension. We looked at each other—my husband, her son, and our daughters as she turned to the doctor to ask exactly what that meant. Clara, upon hearing the word, cirrhosis said with voice rising by the second, “I never drank a drop of alcohol in my life; and they can swear to it--pointing at us--not even sacramental wine at Passover.” And with that remark, she shoved her back to the top of her chair and nodded in confidence.
Her doctor reached across the desk for her hand and reassured her that the illness was not caused by drinking, but by a potential viral or parasitic attachment to her liver, possibly years before. We could all imagine that to be true, since in middle age, while still married to the love of her life before he died, they traveled to every continent in the world. Some of their stops were for business—places like Korea and Vietnam--but other sites were for pure pleasure, and the bug she must have picked up could very well have caught her while she reveled in the pristine sands and waters of the South Seas.
“So what will you do to get rid of it?” she asked plaintively, moving closer to the doctor’s desk so as not to miss a syllable. The doctor shifted in her seat and said, “Well, there are several medications I can prescribe to reduce the amount of fluid in your belly,” she said pointing at Clara’s middle. "That must be very annoying to carry around” –Clara chimed in, “So that’s what it is—water! “
The doctor smiled and said, “It is fluid composed of water, enzymes and toxins that are being secreted from your liver as a result of the cirrhosis.” Clara mumbled, “I really wish you wouldn’t call it that. Somebody might think I’m a drinker.”
We all laughed at that point and it felt like great relief to let some of the stiffness we felt as we hung on this dialogue.
“Ok, Clara. We’ll call it Liver Disease and I will begin treating it with two medications—one that will help drain the fluids that will make you urinate more and the other will help support the balance of enzyme production for now. “ “That’s all?”
“For now,” the doctor said. “I bet the fluid puts a lot of pressure on your back and causes you more pain.” Clara shrugged. “How would I know? I'm always in pain.” She looked around at her entire audience and shrugged again. I was sure at that moment that, at halfway to through her nineties, she had met every illness that would likely take her down and she would overcome it. She did so with breast cancer. After all, she was fifteen years out from her mastectomy that required no further treatment. She always knew she’d beat the odds; and we believed her.
Throughout the year after that first doctor visit. On a biweekly basis, we, as individual members of our family, took her back and forth to checkups and routine admittance to the hospital for drainage of the fluid. She also received new prescriptions to reduce the buildup of fluids and meds to quell the pain. Finally, when she was too weak to walk, we had an ambulance sent to the condo to bring her to the hospital ER for admittance.
A week in the hospital led directly to a five-week stay in a rehab, where there was no real help. She ate t here times a day, if she could swallow and sat in a wheelchair or lay in bed. She cried. Our children cried. I cried and I begged her son to get her into hospice.
“Then she’ll know that she’s dying," he replied, knowingly.
Later that day, he reluctantly called Clara’s internist to ask if his mother was a candidate for hospice. The doctor asked why it had taken us so long to figure that out. I wondered by she hadn't suggested it earlier. Within an hour, Clara was taken by ambulette to her doctor’s office where she was told that there was nothing more that could be done to keep her alive. And as the doctor planted a kiss on her forehead, they both cried in each other’s arms.
By the next day, Clara was admitted to Calvary Hospital, in Bronx, New York. Calvary is known for its exemplary care of the dying and we were determined to see that she was placed there—soon.
For the next two and a half months, Clara received kind and soothing care, free of pain and loneliness. Her hair was gently washed and her nails were polished when she asked. Each team of professionals at Calvary offered the finest nursing care, social workers to talk things out with us and Clara, clergy of every denomination to guide us through this enormous change and choice of doctors who knew just how to help the her feel as well as possible before she said goodbye to the rest of us.
She died on March 14, 2008, just minutes before sunrise. The attending staff members who were with her said she peacefully drifted away. It was the best way for us to think of her last minutes as we tried to tack that on to a woman who almost made it to 100, and recognition on TV by Willard Scott.
Clara marched through life with inordinate strength, determination and yet died with such ease. Much of her comfort was due to the incredible hospice workers who know the secrets of the dying that we will learn only when we get there ourselves.