The Dying Process of my mother

The Dying Process of my mother

I believe that it was by God’s grace and mercy that my mother died peacefully, comfortably and painlessly on 30th November 2009.

My mother died at the age of 95 years. For the past 11 years she was on wheel chair and for the last 2 years she was bedridden, after a massive stroke. After her stroke, she could not talk and could hardly hear. She was in constant pain and had expressed her desire to every one of us that she wished that the Lord would take her back quickly. She has 6 sons and 4 daughters. Her eldest son and eldest daughter passed away some time ago. My father died at the age of 96 about 9 years ago at home and it was a very traumatic experience. During the last 1 to 2 weeks of his death whenever he had to be fed he threw up. He was in constant pain.

My mother was warded in hospital often and was warded again on 16th November 2009. Two days later she developed pneumonia and the doctor said that she might not pull through the night, and if we wanted to call any of her overseas children back, we had to do so urgently. We told the doctors that we did not want any aggressive treatment as she had expressed her desire to go quickly. All her children and grand children who could make it came home. She pulled through that night.

She was on antibiotics, intravenous drip, nasogastric tube feeding and mechanically oxygen fed. She kept pulling out the tube as it was uncomfortable for her and she was in constant pain. Whatever was fed to her was mechanically drawn out through the same nasogastric tube. We saw bags of greenish-black bile being removed. Both her arms were bloated by the intravenous drip until they were almost double their size. They had to be bandaged with gauze tape. After a few days of treatment the doctor called us on the 23rd for a family discussion. 

Since different people have different interpretations as to what is or is not aggressive treatment, I went to the Internet to find out what the dying process meant. I finally found a very good site under Care at the End of Life—Frequently Asked Questions. This gives me an idea regarding the critical decisions one has to make, which are:

“1. Should I receive artificial hydration and nutrition?

 2. Should I receive CPR and mechanical ventilation?

 3. Should I stop kidney dialysis?

 4. Should I stop receiving life-prolonging treatment?”

I also consulted my doctor friends as to what I could do. I was told that I can ask whether it is permitted to stop all medical therapy—that is to stop all the above processes. I was also advised that I do not have the facility to let the dying process take place at home, if there is not much realistic chance for her to get well. 

So, I decided that if my mother was not responding to treatment I did not want her to suffer any more. I wanted her to go comfortably and painlessly. I wanted nature to take its course and I didn’t want to extend her dying process. I have heard and seen patients being kept ‘alive’ for weeks. Medical science has now progressed to such a stage that it can keep a patient from dying naturally for several months. Who has the heart to stop all medical therapy for his mother? It would appear to be so hard hearted, careless and un-filial. The question I had to ask myself is—would I want the same procedure to take place should I be in such a situation. I consider it to be more kind to let a person die naturally, if there is no more chance of cure. I think it is more unkind and uncaring to continue with modern aggressive medical treatments to block the natural dying process.  

My brother, my sister and I discussed the situation before we saw the doctor. It was a very emotional experience. We finally agreed that if there was to be no cure, we didn’t want her to suffer any more and to let nature take its course. We saw the doctor and were told that the prognosis was poor. In theory it is very easy to say “stop all medical therapy” but in actual practice it is extremely hard and heart-rending to say it for your own mother. Who has the heart to tell the doctor we want all medical therapy stopped? To be extremely clear we wanted no artificial hydration, no nutrition, no CPR, no mechanical ventilation and no life-prolonging treatment. The doctor told us that he had to consult his medical team about it. We agreed to let the doctor treat my mother until all her antibiotics treatment for pneumonia was completed, which was three days later on 25th.  

My mother was not responding to treatment. Her stomach was not processing her feed. Greenish-black bile was withdrawn. Her vital organs were failing. All medical therapy was stopped on the 25th. I rushed immediately to the hospital to comfort and support my sister. I held her to let her cry until she stopped. She was very close to mother and it was extremely tough for her. 

The Palliative Department was informed and they advised us that there were 3 courses of action they could take, the procedure being:

1.     To leave my mother where she was for a few days, 

2.     After that she would be sent to the Step-Down Care Hospital for a few weeks and 

3.     Finally, after that she would be sent to the Hospice, if we could not take her home. 

We agreed to the above courses of action. A few minutes later we were told to make the necessary arrangements for my mother to be transferred to the Hospice immediately. We were shocked at the sudden change of procedure. 

Then, the nurse checked and found that there was no available bed in all the Hospices. So they wanted to know why we could not take my mother back home. They pushed very hard to get us to take my mother home. We told them that there was no one to look after her at home as every one was working. It would not be fair to the maid to look after her at this stage. After much discussion they saw our situation and they promised us that they would follow the above procedure. 

 Early the next morning, we were told to bring my mother’s Identity Card by 11 am and to transport her to reach the Hospice before 1.00 pm. We were all in shock by the unsympathetic and brusque way we were treated. Why did they break their promises so immediately? Why didn’t they tell us from the very beginning that there was no bed in the Hospital or at the Step-Down Care Hospital? Why give us such great hope of what they can do? I was extremely angry and upset—Why such hypocrisy? Why such insensitivity to the grief and pain of our family? Why was she to be sent to the Hospice immediately? Why such speed? Couldn’t they at least leave my mother in the hospital for a day or two more before telling us to move her to the Hospice? As all deaths in hospitals have to be presented and discussed at the monthly mortality rounds, were they more concerned that she would die in the hospital? There were many Whys? Would they treat their loved ones in this absolutely heartless way? Didn’t they understand that we were grieving and under enormous stress? I didn’t feel that they were treating us like human beings but like digits. 

By the grace of God, I was set free from being imprisoned by my anger and bitterness when I came to the conclusion that there are some 5 million people in Singapore with only 5 public hospitals to treat all the ill patients. I consoled myself that my mother had sacrificed her bed to save a young patient. Thus, I think that hospitals need to refine their procedures and to educate all the hospital staff to treat the terminally ill and their family members like human beings and not like “lump of meats” to be shifted about with such promptness. The whole process can be done more humanely.

We arrived at the Hospice and the doctor examined my mother. As all medical therapy was removed, my mother was relaxed and at ease. We could see that she was so much more comfortable. When asked, the doctor said that it usually takes a week or two before a person dies but it could be months also, if all medical therapy was stopped. We wanted some family members to be around her, holding her hands, when she passed away, so we drew up a family duty roster for someone to be present at her side. We told her we love her and that it was OK to let go. I had made it a point never to discuss our mother’s impending death with my brothers or sisters in front of her.

The next 2 days my mother looked so much better that some of us thought that she would pull through. When asked, the doctor said that we could boil some chicken soup for her. She could only take 2 tea spoonfuls. All the time at the Hospice she did not have to be given any morphine at all as she was not in pain.

Meanwhile I kept thinking—have I done the right thing; what could I and should I have done differently and better. There were lots of questions and past guilt and neglect that came to my mindand I prayed to God for forgiveness, mercy and grace for my mother and for me and all of us to go through the dying process. Most nights I woke up at 3 to 4 am praying and asking for strength and guidance. The thought came—“trust God and His timing.” I am to trust that He is in charge of my life. He knows my anguish and trouble. In my simple trust in Him, I was more at peace and could feel that Christ would give me the strength to guide me through. 

The day before she passed away was a Sunday and I was praying in Church all the time for mercy and grace to see me and all of us through. When we went to see my mother, my daughter was holding one of her hands while my brother the other. My daughter was also reading the Psalms to her, which seemed to calm her. So unconsciously I sat beside my brother and asked whether he had made all the funeral arrangements with the Pastor. Later, my daughter questioned why I had discussed her death arrangements in front of my mother. I told her I did not know as I did make it a point never to discuss her death in front of her. 

My mother passed away the next morning on 30th at 7.05 am. She died peacefully and painlessly. I am not the crying type and I was able to console my sister-in-law who was crying. She, my brother and family had looked after mother in their home for the past 11 years. Many relatives including the maid were crying. Suddenly, I sensed a very light touch on my left shoulder of the unseen Hand of Christ comforting and healing me and I burst out crying and howling uncontrollably like an animal in pain. I am glad I was able to cry. I needed it. It washedthe hurt out of my heartIt cleansed me. I was at peace.

That night I prayed and the thought came to me that my mother must have heard about the funeral arrangements with the Pastor and she was satisfied and comforted. She was then able to let go. God in His mercy and grace let her go back to Him peacefully, comfortably and painlessly. I thank God. 

Pastor Lim showed, by his caring way, what it was like to do the work of God and not make his ministry become only his job. He shepherded us through my mother’s death. He comforted us, supported us, prayed and gave us hope of resurrection. He was there during the whole process:

a.      He blessed my mother with the anointing oil before my mother passed away.

b.      He was there praying for her and us the morning of her death

c.      He conducted the services during the wake

d.      He conducted the service at the crematorium

e.      He personally drove our family to the crematorium to collect the ashes and prayed for my mother and us; placed the urn at the columbarium and again prayed for us and drove us back home.

Yes, one can say that this is the normal work of a clergyman but it can become a chore, a burden, a drudgery and an obligation. And the attitude can be—Oh no, not another phone call, another letter to write, another troubled person, another death! How tiresome it can be when there is no more joy in Christian service or ministry. 

But Pastor Lim did it with such dedication and love that it demonstrated that it was the work of God, depending clearly on His strength. Here, I am reminded by what Pastor Ed Miller says in his Bible expository of the last book in the Old Testament—Malachi. In tape 3 below beginning at 13:15 and ending at 42:30 minutes, one can hear what it means to do the work of God rather than the work of man in His ministry or service. It is so vital to understand the difference between my work, our work and His work.

One can download the MP3 Audio Sermons of Pastor Ed Miller in his website into one’s computer and listen or burn them into CD for later easier listening by clicking on the download links below.

1   Malachi 01 Introduction    (download)
2   Malachi 02 I Have Loved You    (download)
3   Malachi 03 Defiling The Table Dividing The Redeemed    (download)
4   Malachi 04 The Ways, The Faithfulness, and The Glory Of God    (download)

                                                                        [6th December 2009]

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