Two billion. 

That is the number of heartbeats; on average, a human heart pulsates per lifetime. Typically that means 70 years. 

Thump, thump, thump.

I hold her hand and lay my other hand on her chest. I listen, mesmerized, as her breathing begins to diminish in sound and depth. I just stare at her. I am paralyzed. My sister Carrie comes down the hall quickly. She rushes to the other side of the bed. “I couldn’t hear her breathing,” she whispers.

We watch her chest slowly rise and fall and then stop. We freeze. Tears spring to our eyes. Silence deafens us. Our faces crumble. Our lips quiver and our hearts break. We hesitantly look at each other. 

And then she breaths again.

I have often tried to imagine life without my Mother. I imagined all the scenarios of how she would… go away. Weird right? As a child, I watched Shirley Temple play an orphan in 11 of her 20 movies. I believed I would be orphaned too. I started acting aloof and detached as much as a five-year-old could. I felt I needed to learn how to take care of myself. My Mother, ever observant, stopped me in our hallway and asked her precocious youngest child,

“Why are you behaving so odd. What’s wrong?”

We only have one rule in our house. Don’t lie to your Mother. I had to come clean.

“You aren’t going to be around forever, so I have to learn to take care of myself.” 

Much laughter ensued. 

“I’m not going anywhere soon, so you can relax! It will be years before you have to take care of yourself. YEARS!” Her shoulders shook in giggles as she walked down the hall. 

And it was years. My Mother began fighting cancers in all their varieties early in life. And she won every battle. Six months ago, she received a new diagnosis, kidney cancer, MDS, and spine cancer. She would lose the war. 

After reviewing her extensive medical history, the radiation oncologist entered the consultation room. 

“Wow, Mrs. Green, you should win an award for beating multiple cancers and medical issues. You are an inspiration,” he commented.

He was impressed. And my Mother was pleased to receive such accolades. 

“I’m recommending radiation on your spine. If successful, it will prevent your spine from collapsing. That would be an unfortunate result we want to avoid, especially over the next few months. We’ll make arrangements for the procedure once we receive the insurance approval,” he explained.

And so it began, again. 

Eight weeks later we are told that the radiation did its job. The spine cancer near the tail bone was arrested. She is able to stand, sit, and strut around as usual.

The usual doesn’t last long. Every day her energy diminishes. Every day her memory fades. Every day her frustration increases. 

At five months, she resentfully begins using a walker that has a seat. This helps her get to the bathroom quicker. She eventually appreciates that. 

At seven months, I convince her to try out the wheelchair. “Just sit in it, Mom. Let me see if I can push you in it.” I wheel her around the house. “See, Mom, it isn’t so bad.”

“Easy for you to say. Put it in the other room. I don’t like it.” She said firmly. 

She tires easily, and she often doesn’t remember what is wrong with her.

“Can we call a Dr. and find out why I am so tired? There must be something I can take. I need some energy because I need to clean out my closet. It’s time to pack up my summer clothes and bring out my winter clothes.”

Some days requires leaving the house. Blood transfusions, Dr. appointments, and her bi-weekly cleaning ladies. They request an empty house so they can do their job. Acquiring cleaning ladies was a new experience for her. She is or was a meticulous house cleaner. She adjusted well. 

So today is cleaning lady day. I wheel her out of the house, help her stand, and get her in the car. My father helps me collapse the wheelchair and place it in the back of their vehicle. My father is hungry. My mother is not. He drives to the restaurant. She gets agitated. “Can we just drive around? Let’s show Pam, Lodi. We can drive by the lake.” I have been here often and am familiar with their town, but my parents don’t seem to remember. “Did you know that Lodi is known as the city of trees?” I want to say, Yes, you told me that yesterday, last month and last year, but I don’t. We drive around the lake and down my father’s favorite tree-lined street. “This is my favorite street,” he says.  

I know this. 

“Okay, we can go eat lunch now,” Mom announces.

I wheel her into the restaurant as my Dad parks the car. She looks at me with frustration and sadness. 

“I am just so tired. I can barely lift my arms. I don’t want to do this anymore.”

“It’s okay, Mom. We don’t need to eat lunch. Let’s go home. “

“No, no. It’ll be fine.”

But it wasn’t fine. 

No one tells you how hard this is. Is it a taboo subject? Or is it something that no one can adequately quantify? Or is it so painful, so awful, so devastating that one can not share the feelings of despair? I don’t know, but a little warning and maybe some preparation would have been nice. Maybe a class, how to prepare for your parent’s death. Even an online chatroom would have been helpful. Let’s get real, I wouldn’t have watched. 

I have two sisters and no brothers. This has become a shared experience that has redefined our sisterhood. My 92-year-old father has cared for “his bride” for the last sixty-six years. In the last six months, he has gone above and beyond, but now he can’t. He just can’t. 

A finger, my finger, traces her face, her nose, her lips, the curve of her jaw. I gently touch her sacred, tender temples pausing to see and feel the heart pumping rapidly, steadily, and consistently.

Her soft hand clasps one finger and hangs on tight. The ride is rough, and holding your Mother’s hand is never a bad idea. 

I place my hand on her chest just to feel what I see. How can a heartbeat that fast? How can anyone sustain such quick intakes of breath for any extended length of time and not hyperventilate? But she does, and I marvel at her strength. 

It is painful to watch and to hear the constant breath through her drying lips.

I can’t stop looking at her. We share the same nose, full lips, and long face. Her high cheekbones and her wide-set, soft brown eyes are uniquely hers. Does every child believe their Mother is beautiful? Probably. 

She sleeps now. I know this because one eye is open and one is closed—just one of her quirks.

Her soft and gentle hand still holds mine. Her skin, hardly a wrinkle for 87 years, is smooth and young. Maybe it is gravity from lying flat on her back for a week now. Her facial bones, so pronounced, are embedded in my mind. I think they always were and always will be, but I don’t know. 

“Mom, the nurse said to tell you that it’s okay for you to go, but I don’t know how to say that. I don’t know if that is what you really need or want to hear. I just don’t want you to be in pain. Are you in pain?”

Thump, thump, thump goes her heart. Two thumps per breath. In and out through her white caked lips. I apply vaseline. Carrie drips water between her lips from a washcloth. 

Today is Monday. Priscilla, the hospice caregiver, will be here soon to bathe her. 

Priscilla began coming over a month ago. Mom was not pleased. Priscilla sat at the kitchen table that first Monday with my Mom sitting in her walker. Carrie and my father sat at the table to help my Mom understand and accept Priscilla’s purpose. 

“I don’t need help. Your father helps me get up out of my chair, and that is all I need. What is there for her to do?”

“Mom, she is going to help you shower and get dressed. Just two days a week. It will give Dad a break,” Carrie explains.”

“Help me shower? No, I can shower by myself. I don’t need anyone to help me in my shower!”

Priscilla reassures her, but my Mother is determined. She is always determined. She anxiously looks at Carrie.

“Carrie,” her voice trembles. 

“Mom, what’s wrong? Are you alright?” Carrie asks. 

“No. Oh no! I have to go to the bathroom. I have to go right now!” She says.

Priscilla and Carrie push her in her walker down the hall to the bathroom. 

“Oh, no! I’m not going to make it!” She cries out.

“It’s okay, Mom. We’ll help you,” Carrie assures her. 

Priscilla tells Carrie to leave the bathroom. “I will help her alone.” And she does—baptism by shower. Priscilla is quick and thorough. We like her. And my Mom, after such an intimate encounter, likes her too. Every Monday and Thursday, Priscilla comes and helps my Mom take a shower. The other days, my Mom proves more to herself then anyone that she is still capable. She takes a shower by herself. 

We have taken turns in her care. Carrie lives an hour away. She retired early to help care for my Mom. I come for a couple weeks stay every couple of weeks. During my latest two-week stay, Carrie said, “after you leave, I’m moving in. Mom needs care around the clock.” Unfortunately, she was right. 

The nights are the worse. The night before I left, Mom was up every hour to use the bathroom. During the day, she slept. It was exhausting. 

My father moved into the guest room. For almost two-weeks, Carrie slept in my parent’s bed. My Mom would wake up every hour or so, but she couldn’t get up by herself. Her water retained legs were too heavy. It is difficult to get her into a sitting position on the edge of the bed then pull her up. It is emotionally exhausting and physically difficult. Sleep deprivation occurred.  Carrie said she could manage, and she did, but come on. Everyone needs sleep.

My other sister, Joan, five hours away, called to say she is driving down at the end of the week. She calls me. “It’s my birthday. Maybe you could come when I am there? It would be good to be together.” 

Should I make another trip? It is a 12-hour-drive for me. I just barely got back 10 days ago. 

I hesitate. I am that little girl again, in the hallway, knowing someday my Mother will go away. She said she wouldn’t go for a long time. Has it been a long time? 

Everyone suggests I should fly this time. I don’t want to. I rather enjoy the drive—time to think or not think.

What is true is I am not sure I want to go. Actually, I know I don’t want to go. I don’t do well in medical situations. I anticipate invasive care will be required. This is my Mother. I know she is a really private person who has taught me to respect her space. And I’m not a touchy-feely kind of gal. 

What other justifications can I come up with? Many. I confide my feelings with my friends.

My friends, people whose mothers have already gone away, assure me that I would regret not being there for the end. I’m not so sure. I am a firm believer that it is easier to live with regret than remorse. You know, regret having done something as opposed to remorse for not having done something.

I face my fears, inadequacies, and selfishness and suck it up. I make the reservation. 

Carrie warned me that my Mom had seriously declined during the last two weeks.. “Most of the time, I can’t even understand what she is saying,” she confides. I understand. Often, in the morning, her words are gibberish because her mouth is so dry. So I prepare for the worse. 

When I arrive, it is nighttime. I walk into my parents’ bedroom and see a smaller version of my Mother. She lays so still in the hospice bed. 

“Mom, Pam is here. You want to say hi?” Carrie asks loudly. 

She says something. Her words are unintelligible. I take her hand, and she holds mine. We are all home again, for a moment, for a memory. 

The three of us take turns caring for her.  And then the weekend ends. Joan knows it will be the last time she sees our Mother. She sits on the chair next to the bed and holds our Mother’s hand. Joan is her firstborn. She has known our Mother the longest. She has memories we do not have, but don’t we all? 

“Mom, I have to leave. I want to stay longer, but I can’t. I want you to know that I love you and it’s okay to go. It really is. You’ve lived a full and happy life. It’s okay to go,” Joan softly talks to our mother.

From the other room, I stand up and take a walk. 

Two hours later, Joan, crying, drives north to her Oregon home. Now it is just Carrie and me.

Today is Monday. Priscilla comes today. It was just three days ago Priscilla gave my Mother a shower in the shower. Not today. Today, Priscilla is giving my Mother a sponge bath. 

“I have never seen anyone decline so quickly,” Priscilla says sadly. “Before I come on Wednesday, I’ll call you. Please give her a dose of morphine before I get here. She moaned a lot today, and her brow furrowed. That is a sign of pain. I don’t want to hurt her when I bath her.” She pats my Mother’s arm and leaves. 

Takes a special kind of person to offer this kind of service. I don’t know how she does it. I am just grateful that she does. 

My sister and I hover on each side of the bed. We each hold one hand and feel her weak clasp. That is a good sign, isn’t it? What is it a good sign of? She is still here, holding us in the only way she still can, with her thin, graceful hands. We filed her fingernails two days ago, and her toenails too, sort of. My sister curled her hair. She wore the blue and white striped summer dress my father just bought her. We think she liked it. It is lightweight and one of her favorite colors. 

She can no longer get out of bed, not even to shuffle to the bathroom or use the port-a-potty. Her bathroom needs are distressful for her. In the wee hours of last night, I played a game with her. In doing so, I broke my Mother’s cardinal rule. I lie to her. 

“Mom, it’s okay. You are sitting on the toilet. You really are. Just relax and go.” She believed me and relaxed. The yellow line turned blue. And if you don’t know what that means, you are lucky, and your beloved parent still has their dignity. 

One eye closes, and Carrie and I fall into my parents’ bed, hoping for an hour of sleep. We try to sleep, we really do, but her breathing is so loud and rapid. I go to sleep on the floor in the den for just a few hours. I keep getting up and checking on her. I can hear her breathing down the hall. I go back to the floor. 

We decide to change her every three to four hours.

Just a week ago, she was still arguing with us. She sat at the kitchen table while my Dad cut up some cantaloupe and toasted her bread. Her two-week pillbox sat in front of her.

“I am not taking that pill. It makes me go to the bathroom too much.”

“Yes, it does. It is supposed to help your swollen feet and legs.” I tell her. My sister tells her. My father tells her. We are all on a different patience spectrum. 

“I don’t care. I will not take them today. I will take them tomorrow.” Okay, Sam I am. Her lips pursed closed. I know better than to argue.

Sometimes we try to enforce the doctors prescribed medicine, but what at this point is the point? It is difficult to admit defeat and wave the white flag. We look for the positive. It’s always there, somewhere.

We are happy she still eats. Sunday morning, before Joan left, she fed her cantaloupe. She bit down and savored the fruit. “Oh, that is sweet candy.” 

Sunday night, after Joan left, she stopped eating because she stopped chewing. 

We have a routine for changing her. I lay out all the necessary items on the bed, diaper, moist washcloth, a dry towel, and sometimes a clean shirt. 

Carrie speaks loudly, like a public service announcement. “Mom, We are going to change you now. We are going to move you to your side. Ready?”

She moans loudly. Our hearts break. We speed up the process. Moisten towel, roll up diaper, lower bed, remove side pillow, roll her to the left using the extra sheet under her.  

She yells out in pain, and we fumble and hurry and hope we aren’t rushing her away from this life.

“Mom, we are so sorry. We are trying not to hurt you.” Carrie yells. 

More moans.

We roll her to the right. I try to give her back a soft massage and scratch. She seems to like that. Carrie quickly washes her with the moist towel, squeezing out some warm water. We dry her and match the yellow line up with her belly button if she still had one. One of her surgeries required closing up that button. We tease her about it as we rotate the bed sore prevention pillow—more moaning. Together, we grab the extra under sheet and lift her higher onto the bed-another moan. We check her feet, lay her arms by her side, cover her, then slowly exhale.  

“I think we just took another day off her life.” I would say. Carrie would ask, “Do you think so?” I would respond, “Yes.”

We start her on morphine. Her brow smoothes out, but her breathing stays loud, even, and rapid. 

“How can anyone breath so much? I ask out loud. 

“I don’t know!” Carrie exclaims. 

On Wednesday, Priscilla returns. 

“You guys need to leave the room while I sponge bath her.”

“Are you sure? We are happy to help,” Carrie says. 

“I know. Go get something to eat, take a break. We will be fine.” She pushes us out and closes the door. 

Thirty minutes later, Mom is clean and tidy. She has on a clean shirt. Her hair is brushed back, and her well-moistened skin shines. She looks beautiful and peaceful. Her breathing is quieter. Is that a good thing?

“Her furrowed brow lets me know she is in pain. You need to increase the morphine.”

“Are you sure? We keep asking her if she is in pain. We don’t want to overdose her.”

“Yes, I am sure. I brought you some sponges for her mouth. Just dip them in some water and moisten her mouth and lips. Her breathing really dries out her mouth and lips.”

“We’ve been putting vaseline on them,” I say. 

“That’s good.” Priscilla’s states sadly. She doesn’t make eye contact with us today. 

“I’ll see you Friday morning,” Priscilla says. She reaches out and pats my Mother’s arm. One eye is open, the other closed. “I have never seen someone sleep with one eye open.” Priscilla smiles. And she leaves.

My father comes down the hall. “JER!” My Mother yells. Both my sister and I jump when we hear her voice and a word we understand. He doesn’t hear her. “Dad! Mom’s calling you! Come talk to her,” Carrie insists. He walks quickly toward the hospice bed to his bride of 66 years. He looks lost and scared. He doesn’t know what to say because he knows he can’t help her. She stares at him. I think she is angry that he isn’t fixing this. Her breathing gets heavy and quick. Then one eye closes. “I can’t stand to see her like this,” he mumbles. Dejected, he turns and walks away down the hall.

That was the last coherent word my Mother spoke.  

Thump, thump, thump. Breathe in. breathe out. Moaning.  

Carrie and I sit on each side of her bed. We each hold a hand that no longer holds ours. 

We use the sponge sticks to moisten her mouth and lips, but the mouth sores are getting worse, white and crusty. We worry that the water stings the sores. We don’t know if we are causing more harm. We notice she doesn’t moan as much or as loud. 

We maintain our 4-hour routine, trying our best to change her quickly and not cause pain. 

The nights are long. Every movement brings us to her bedside, offering her comfort in any way we can. We stroke her hands, massage her feet, and talk of memories.

“Mom, remember when we got lost while camping and you found us? Remember when you couldn’t stand up when you fell down skiing? Remember when you had “a feeling” and came and found us on the side of the road because the police were giving us a ticket for illegally riding motorcycles? Remember when…”

During the day, we play her favorite music, Engelbert Humperdinck, Frank Sinatra, Doris Day. Que Sera Sera. What Will Be, Will Be.

Thursday morning. The days are more manageable. We move between rooms and moments with the sunlight guiding our way.  

“Carrie, listen. Her breathing is different. Can you hear the catch after every third or fourth breath?” I ask.

“Yes! That’s weird,” she says.

Today my Mom has visitors. Two grandsons and three great-grandchildren come to visit. I go for a walk. 

 When I come back, the visitors leave. I sit on my parents’ bed and watch and listen, and I know. 

I move to the chair next to my Mother. I hold her hand and lay my other hand on her chest. I listen, mesmerized, as her breathing begins to diminish in sound and depth. I just stare at her. I am paralyzed. Carrie rushes down the hall and sits in the other chair on the other side of the bed. “I couldn’t hear her breathing,” she whispers.

We watch her chest slowly rise and fall. And then stop. We freeze. Tears spring to our eyes. Silence deafens us. Our faces crumble. Our lips quiver and our hearts break. 

And then she breaths again.

Carrie runs out of the room and down the hall yelling, “Dad! Come quick! Hurry!” He follows her into the room. He stands behind me, and I know I have to let go of her hand and let him hold it. I don’t want to, but it is the right thing to do. 

And I do the right thing. 

I walk to the end of the bed. Carrie holds her left hand. My father holds her right. I touch her feet. Each breath becomes more shallow than the last. Each intake, a welcomed surprise. Her chest rises and falls, then rises and falls again. 

I glance at the clock. It is October 22, 2020, at 2:40 pm. 

With one eye open, we witness the impossible. 

Her two billionth heartbeat. 

There is something I feel, something unfamiliar and terrifying. 

Disbelief. 

And

I 

can’t 

breathe.