Zen-ish Thoughts About Elevators & Deathbeds

Thick, solid ice where there were puddles just earlier the same day.

My mother was saying things like, "It's kind of you to forgo your inheritance so your sister and brother would get more, but if you won't take it yourself, I want it to go to your children." I don't recall her saying anything else so forcefully in all my life.

My sister and brother had said similar things when I told them of my plan, but due to geographical distance, they had done far more than I to take care of Mom in her later years. I wanted my share of her modest estate to go to them. Now I felt I had to honor what was coming across as a dying wish from my mother, even though I suspect she was heavily lobbied in this direction by my sister. My siblings kindly released me from my former promise to them. In hindsight, I am glad things turned out this way – my kids will definitely benefit from this.

Mom was saying things like, "This is what I want to be dressed in when I am buried."

At 97 my mother was still living in a way people found entertaining, interesting, kind, and inspirational. But she was two years past a six-months-to-live prognosis, and talking like she felt the end was near. You wouldn't know it to observe her only modestly changed behavior, but my sister, brother, and I took it seriously.

I met various people in the elevator at the hotel I was staying in, packed into their warmest coats, gloves, and scarves. Every face showed how keenly aware we all were of how cold it was. I often asked, "Did you come to town for the good weather?" I suppose it's the kind of thing my exceedingly gregarious mother would say, thinking she might make a life-long friend, but I was just looking for, and got, a friendly laugh among strangers. Once I heard that it was a little warmer than their hometown in northern Sweden. More often I heard something like, "Holy fuck, it's cold!"

I live in San Francisco where that expression means it's just less than 50 degrees. But I had grown up in New York so I knew to come equipped with outerwear I had used in years past when I went skiing. This included a light pair of gloves, and a heavy-duty pair. I didn't notice when packing, but the grippy fake leather on the palms of the heavier pair was peeling off. When I noticed later, I thought to discard them, but noting that their warmth remained uncompromised, I thought surely there is someone who will be glad to have them in New York in January. I put them in my backpack.

It might have been the second or third day I was there that I walked down a particular section of Broadway where three people were living in separate piles of personal belongings – in about 20-degree weather. I was in a sensitive emotional state to begin with, due to anticipation of my mother's death. Seeing these human beings in this state while we revere and refuse to tax so many ultra-wealthy people, I began to cry a little.

I approached one of them, a woman with a baby, or perhaps with some belongings packed into a baby carriage, and asked her if she needed gloves. The implied offer made her tear up. I apologized that the gloves were shedding their palms and assured her they would still keep her hands warm. She believed me before I finished explaining. I gave her the gloves and ten dollars, and she gave me God's blessing.

On the next block I passed a man begging for money for food. At first I walked past. There are so many people in such dire straits, and I can't help them all. Then I stopped.

I can't help them all, but I could help him. I found I had a few singles and another ten in my wallet. His face was already showing gratitude in anticipation of a dollar. When I gave him the ten he was clearly amazed, and moved, to receive "so much".

As I continued on my way back to the hotel, all I could think was, "In how many interconnected ways are we failing as a society that people end up living this way?" The cold wind pushed small tears down my face.

The first two days of my visit, my mother was pretty similar to her normal self. I wondered if I'd end up going home, and come back days or weeks or months later.

I can't recall the details, but I know she precipitously declined the next day. I came prepared for her likely death, but not for what turned out to be a week of mostly terrible pain, of Mom becoming non-verbal, of her neither eating nor drinking, of Mom reaching up with all of her trembling might, physically demanding to be helped to sit up, to get out of bed, even though she couldn't even stand anymore, even though just the sitting up part exhausted her. She grunted, and she gestured with so much urgency, and absolutely would not take lying down as an answer.

If she was conscious, she was either in agony, or not quite in agony. For me, this did not present a difficult calculation. Of the three states of mind available to her, being unconscious was her only friend. Both family members and facility staff stayed in a conservative medicine frame of mind, as if there was some future opportunity to be protected. She would be dead within days, two weeks at the most, no matter what. If she was somehow over-medicated, what'’'s the worst that could happen – she'd be not-tormented by terrible pain, and then die on a Wednesday instead of a Friday? This allegedly "horrible" outcome is the justification for her intense and completely avoidable suffering, 20 out of 24 hours a day, for an entire week? Holy fuck, it's cold.

I was polite until I was insistent. I was insistent until I was angry. I was then cast as the bad guy, or at least as the guy who was handling his grief badly and bullying people unfairly. I was told I was being unrealistic by people who were ignoring reality. My mother was being made to suffer intensely for no possible purpose, and I was the bad guy for trying to change that.

The outsourced hospice team agreed with me again and again, resulting in rapid increases in her medication, but we could not keep up with her pain, especially since the facility's staff consistently failed to carry out the hospice team's instructions in a timely manner. And I was the bad guy for becoming angry about this.

When called to attend a dying person in extreme pain, they routinely took 30 to 45 minutes to show up – one time an hour and a half – sometimes unequipped with what they already knew was needed, and then took another 15 minutes to come back with it. After her children, attending her round the clock, said she was thrashing around and grunting and agitated, in obvious pain and distress, some nurses said things like, "Well she doesn’t look agitated now [[ now that she had collapsed ]], and I won't medicate her needlessly." What bright future were they protecting for this terminally ill 97-year-old?

That we let people spend decades in a living death on our streets, like so much refuse, and that we mistake mercy for murder, are very different yet very connected illnesses in our society – we care about too many things more than we care about the thing that should be at the top of the list: human compassion.

We say things like, "It's just business" when we do something we think we can technically justify, not when we do something we are proud of. We say things like, "Well, if that person is living on the street, they should just pick themselves up by their bootstraps" when we should admit, "I don't have enough compassion to attend meaningfully to this other person's tragedy." We say things like, "This problem is too complex and large to be solved" when we should ask, "What can we learn from the places in the world where this problem is much better managed?"

If you think the idea of effective responses to these problems is unrealistic, please consider the several developed, democratic, and capitalist countries that outpace the United States by huge margins in drug treatment, homelessness, criminal recidivism, healthcare, mental health care, education, and happiness of their citizens. What we have is not the impossible challenge we pretend it to be. It is nothing more than bad policy. We repeatedly actively choose to not do what is demonstrably working in other countries.

We treat capitalism as if it is a complete system of governance while it is actually just a financial system that must be kept in balance with people's other, non-financial needs. We actively denigrate and punish those who need the most help – often because we have collectively screwed them over – and wonder why we have so much crime, so much violent crime, such bad returns on the investments we do make into social programs, and why we spend twice as much as similarly wealthy nations and come in dead last place by a wide margin. We are not well. When will we fashion a real cure, and take it? Everything we need to do is doable. We lack the will, not the means.

We have the money, mostly in the hands of the under-taxed ultra-wealthy. We have working examples to copy from in multiple other countries. What we tell ourselves is impossible is actually just unpopular with the people who fund American elections.

My mother, who would talk to anyone, who people found kind and inspirational at 97, spent her last week in unnecessary agony because we've convinced our collective selves that ensuring she would die in pain is better than letting her die in peace.

My mother was saying things like, "This is what I want to be dressed in when I am buried." She knew what was coming. She was ready. We, collectively, were the ones who couldn't let her go gently.

I gave the woman with the baby carriage some gloves and ten dollars. It was nothing, but it was something. I think about my mother talking to strangers in elevators. The norm is to say nothing, but she would say something. I think about all of us, what we will do next. It will probably be nothing, but it could be something. It really could be something.