All of Mum’s Death
Edward Cranswick
16 October 2007
“Do not go gentle into that good night.
Rage, rage against the dying of the light.”
Dylan Thomas
[NOTE: This account of the death of my mother has many gaps and omissions and probably some errors of fact as it is based on recollections unsupported by notes and written in the period 1-4 weeks after the events described.]
My mum, Mrs. Isobel Hilary Cranswick, a.k.a., “Hogie” or “Hoagie” (nee Hogarth – her nickname from the Australian Army tradition of basing it on surname) died at the age of 92 in the Repat Hospital on Wednesday 19 September 2007 after four days of unwanted consciousness and nine hours of intense suffering – as required by law.
On Thursday 13 September I returned from Sydney where I’d gone to protest President Bush at the APEC meeting, and I walked directly from the Keswick train station to visit Mum at her nursing home, All Hallows Court, in Westbourne Park, a suburb of Adelaide, Australia. I only stopped by to say hello, showed her the Aboriginal flag I had been given by the Aboriginal Tent Embassy where I had stayed in Sydney, and told her I’d come by to have tea with her the next day.
On Friday, I bought some special biscuits, including some rum balls, and went to have tea with Mum in the late afternoon. She liked the rum balls but couldn’t identify the taste – she’s come along way since being a drunk and then giving up the booze in 1993, I thought. I spent about an hour with her, and we had a good time – she waved goodbye to me when I looked back at her as I walked out of her room.
On Saturday morning about 9 AM, I received a phone call from Lucy, the registered nurse (RN) on duty at All Hallows Court who said that Mum could not speak and had difficulty swallowing, probably as a result of a stroke sometime in the previous night. I told her I would visit Mum, and I arrived at the nursing home about an hour later.
When I saw Mum lying in bed, she was active and alert but could only make incoherent sounds instead of speaking. I sat on the bed and tried to comfort her but she was obviously frustrated and kept trying to get out of bed, putting her legs through the bed rails. It occurred to me that she could use some distraction, and so I got the nursing staff to put her in a wheel chair and I took her out for a walk. I pushed her up and down the street outside the nursing home and picked flowers for her from those that overhung the footpath (sidewalk), and she arranged these in her lap – she seemed fairly peaceful doing this.
We returned for her lunch at noon, and then her inability to swallow became obvious to me – she could not even drink water. A new RN had come on duty, Summer, a young Chinese woman, who seemed confused about how to get a doctor to examine Mum – being the weekend this would be a “locum” who would substitute for the GP, Dr. Ron Louis, who had been treating Mum for at least the past decade. Summer said she could not call the locum until sometime later. In the face of this confusion and Mum’s impatience, I took her outside again for another walk around the block. When we returned, Summer said that the director of the nursing home, Rozanne, had recommended we send Mum to hospital, but I initially rejected this and said we should try to get the locum to come into to examine Mum. However, when Summer said that the locum might not show up until 6PM, I changed my mind and said we should send Mum to hospital, preferably the Repatriation Hospital. About this time (2-3PM), Mum’s carer and friend, Philomena, and her friend, Pauline, who knew Mum arrived, and Philomena agreed that Mum should go to the Repat. I called the Repat and confirmed that Mum could be admitted to the hospital through the Casualty Department if she arrived before 5PM, and Summer arranged for an ambulance to take Mum to the Repat.
Mum herself had worked as a nurse at the Repat during WWII, and she had been a patient there several times since returning to live in Australia in 1980, most recently in June-July 2004 when she had had a fall at her home (she may subsequently have received outpatient care there for skin cancer). She was then in hospital for about a month (she moved from there to a nursing home and never returned to live home again), and at that time with the encouragement of the hospital, she and I (with steadying support of my friend, Ginny) had prepared and signed three forms relevant to Mum’s legal/health status (notarized by the hospital’s JP, Geoffrey Bloor, JP 10566) that gave me the following powers: “Medical Power of Attorney” (28JUN2004), “I DO NOT WANT TO BE KEPT ON LIFE SUPPORT AT ALL, EVER”; and the similar power, “Enduring Power of Guardianship” (28JUN2004), “I DO NOT WANT TO BE KEPT ON LIFE SUPPORT AT ALL, EVER”; and, “Enduring Power of Attorney” (05JLY2004). Mum had been a subscribing member of the South Australian Voluntary Euthanasia Society (SAVES) for at least a decade but I had let her subscription lapse in the last year. Since I moved to Australia in 2002, one of Mum’s favourite phrases was “I can’t wait til I’m pushing up daisies!”
While we waited in Mum’s room in the nursing home for the ambulance to arrive, we observed that Mum was becoming increasingly hot and clammy – she had had little or no liquids or nourishment for nearly a day – and Summer took her blood pressure several times which was high. Summer also wheeled in a portable bottled-oxygen breathing apparatus and connected it to Mum. The two ambulance personnel, a man and a woman, arrived and strapped Mum to a gurney and put her in the ambulance, and I sat in the passenger seat and accompanied her to the hospital. On the way there, while the woman did an ECG of Mum in transit, I chatted to the male driver and gave him some variation of my usual spiel about my Australia/UK/USA background and Mum’s history of leaving Adelaide in 1938 to travel the world only to return in 1980 – but I don’t believe I mentioned Mum’s medical wishes.
When we arrived at the hospital, Mum was wheeled into the Casualty entrance and I was told to wait in the adjoining waiting room. A young Indian woman doctor, Nahrani, came out to take Mum’s particulars, name, date of birth, etc., and disappeared back into the Casualty room. About two minutes later, she returned and told me to go into the Casualty room because Mum was having a heart attack. I followed her in to behold the scene of Mum lying on her back on the gurney, chest exposed, and surrounded by about six people of diverse ethnicities actively doing various things and a cardiac/pulmonary monitor beeping whilst tracing her erratic heartbeat and breathing. I said something to the effect that Mum did not want to be brought back to life or have her life maintained – someone said that in that case they would switch off the monitor, which they did – but the damage was done, Mum was alive.
She was subsequently moved to her own room in Ward 2. She was given a prescription for 2.5-5 mg of morphine per hour (I believe) as required for comfort, and a valve was installed on her abdomen to allow morphine to be administered, and she was put on a subcutaneous saline drip to maintain fluid levels (“to keep her comfortable”), and she was connected to oxygen. I stayed with her there until about sunset when I left to eat dinner at the nearby residence of my friend, A. I returned about 9-10PM and stayed until 1130PM when I walked home.
The next morning, I arrived at the hospital about 10AM and talked to the doctors led by a young Adelaide woman, Anne-Marie, after they had done their rounds. I was quite confused myself about what had happened in the past day, and I asked them what the prognosis was but I don’t recall getting any clear answer. Shortly afterwards, my friend, A, walked into Mum’s room and spent some time with us (when I later asked A whether she thought Mum had been conscious, she said it seemed that sometimes Mum was there and sometimes absent), and A and I then attended a meeting of an alcohol recovery group that met at 11AM on Sundays at the Repat. As an alcoholic myself who was attending to my alcoholic mother who was in the process of trying to die, it was appropriate that I should attend the meeting, but I was not asked to speak and share my thoughts and feelings.
Afterwards, I rode my bicycle to All Hallows Court to pick up some clothes and other personal items for Mum. The nursing home staff had already been informed of Mum’s heart attack and expressed concern for her wellbeing. Lucy, the RN who had been on duty the morning before, was on duty again, and she told me that the Repat had already sent them a medical report that stated that Mum’s heart had stopped when she was admitted the day before and that she had been resuscitated by CPR. This was more extensive and explicit information than I myself had received from the doctors or other Repat staff, and it left me more confused about Mum’s situation and mine.
When I returned to the Repat, I told the ward desk that I wanted to talk to someone, a doctor, about Mum’s situation, and I went to Mum’s room. I had brought Mum’s copy of “Kings in Grass Castles” by Mary Durack to the hospital, and I alternated reading that aloud to Mum with holding her hand and singing the songs she used to love: Negro spirituals and Irish songs of rebellion; sometimes I sat quietly and tried to meditate, sometimes I dozed. The doctor, Anne-Marie, came in to talk to me, and when Mum heard the beginning of our conversation, she sat up in bed and deliberately looked at us with her intense blue eyes – she was very focused and alert. Ann-Marie confirmed that Mum’s heart had stopped and restarted after CPR the previous day. When I asked her what could be done for Mum as she wanted to die, Anne-Marie said morphine could be prescribed to ease the pain but not in lethal doses.
After Anne-Marie left, I went back to reading and singing to Mum, but she was agitated. All of my life with her, she had had a characteristic way of expressing intense frustration, grabbing my wrist with the points of her fingers like a cat with its claws or a bird of prey with its talons, and she started doing this to me – but she’d now included an added twist, biting my arm. I, of course, felt I was being justifiably chastised for my failure to ensure her demise, or perhaps I had it all wrong and she wanted to be saved, she wanted her suffering relieved by all the life-support techniques available. Caught in the impotent dilemma, I was hoping that she would forgive me and stop biting me. We were found that way by two nurses, Rebecca and Katy, who came in to turn her in bed, check her drip and oxygen, and administer morphine. It seemed to me that the nurses were treating me with aloof disdain – as if from witnessing my mother’s biting me that they had concluded that I had done awful things to her, and I felt correspondingly wretched, an outcast of the ward.
Philomena called me up and asked me over for dinner. I rode there on my bike and had some excellent vegetable soup while I spent an hour talking and watching the TV news with her and her partner, Walter – I returned to hospital feeling cheerful and refreshed. After several hours of singing, reading, and dozing, I went home at 1130PM.
I got to the hospital early next morning, just after 8AM, so I could talk to the doctors during their rounds and also talk to Lisa(?), the speech therapist/pathologist about Mum’s inability to talk and swallow. This time the doctors were led by a man, Mahomet, and I belatedly recognized Anne-Marie was also a member of the group. I asked the same questions about what had happened and would happen to Mum and received the same answers. Someone added that Mum would probably succumb to pneumonia as was frequently the case of terminally ill or dying patients (in retrospect, it is difficult to distinguish the conversations I had at various times with various medical personnel, and I have probably ascribed some statements to the wrong time and person). I went home to talk to a man who was installing rainwater tanks at my/my mother’s house and do the laundry.
When I returned to the Repat in the early afternoon, I encountered Lisa, the speech therapist, who confirmed that Mum could not speak or swallow but that she could possibly recover her ability to do so. Her remarks contributed to the spiritual dissonance I experienced: if Mum had had a stroke, then a heart attack and been resuscitated in error, and was now being left to die, why was I being told that she might recover from the effects of the stroke?
That evening my friend Ginny came in to see Mum at 930PM. Ginny had known Mum since 2003, and she told me in retrospect that Mum seemed to have been “at peace” when she visited – Ginny and I left together about 11PM. I had decided that we were all in for the long haul of slow death, and not feeling the imminence of events, I went off to discuss my mother’s consciousness and impending death with my friend, A, whose mother had died some years before. One of A’s girlfriends was visiting her, and the three of us discussed addiction and relationships and the balance of attraction and repulsion in relationships – between the tip and the berg of the iceberg – I got home about 1AM.
I arrived at the hospital the next morning about 10AM and talked to the doctors after they had made their rounds. This time they were led by a woman I had not met before who made the interesting remark, in response to my synopsis of Mum’s heart attack and resuscitation by CPR, that only one electrical shock had been administered – neither then nor now do I know what she meant by this qualification. I also saw Lisa again who said that Mum had not made much progress.
I was also told that Mum would be moved from Ward 2 to Ward 1. Flowers from Ginny’s mum, Pat, were delivered and Sean, Philomena’s son, arrived to say hello to Mum and me. Mum was restive but calmed down after receiving some morphine. Philomena arrived, and Sean and I went to the hospital café for lunch. When we returned, Mum was moved from Ward 1 to Ward 2. Philomena reports that Mum was aware of the process of moving. The three of us left shortly after.
I returned in the early evening intending to stay until 11PM. I read and sang to Mum and chatted to Mum’s nurse, Di, who seemed very energetic and capable. About 10PM, Mum’s breathing became laboured and loud – it sounded awful – and I sought Di for advice and assistance. She was not surprised by Mum’s breathing and said it was caused by mucosal secretions that were not expelled from the lungs. This could be treated in two ways: administering the drug atropine which would reduce the rate of secretion or use “suction” to remove the secretions. The atropine was administered, and Mum continued her awful rattling. The nursing shift change was taking place, and Di said one of the nurses on the next shift, a man, was expert at “suction” – however, no suction was performed. It became clear to me that I was going to stay with Mum who was so dramatically suffering and also that I was not going to receive any significant advice about what was happening or would happen.
A year before Mum had contracted pneumonia, and it was then thought that she would soon die. Mum was very tough and brave, but as she struggled to breath, I saw her afraid for the first time in my life. The build-up of fluid in the lungs that keeps one from breathing is what occurs during drowning and it is terrifying. Mum was at that time in low-care in the nursing home but her Australian Army veteran gold card entitled her to special treatment. During that time of crisis she had someone to assist her to eat and someone to stay in her room and monitor her breathing – she was not left alone. I then pre-paid for funeral arrangements in advance in case Mum were to die while I was away.
The next nursing shift consisted of three middled-aged people, two women (Elizabeth and Ray) and a man, and a young woman. Mum’s agonized breathing was loud, I could hear her down the hall, but sitting with her, between her gasping breaths, I could hear chit-chat and laughter from the nursing station. I found myself caught in a feeling of contradiction. Mum’s deathly rattle kept me in a state of life-or-death crisis but the casual murmur from the nurses sent the signal that everything was OK, everything was under control – and yet Mum’s cardiac arrest four days before had provoked a frenzy of medical activity – I was at a loss as how to respond. Since Mum was obviously suffering I wanted her to get more morphine but when I went to the nursing station to ask for it, I was first told that she was not due for a few hours and I had to remind them that Mum had a prescription for morphine every hour, “as needed” – and certainly, impending death by drowning suggested that need – but maybe she wasn’t dying, I didn’t know, I’d never gone through this before except with one of our cats who died in my arms when I was in high school, and nobody was telling me what was happening or what to expect.
At some point, in response to my asking for answers and assistance, the doctor on duty, Russel, a tall and large-framed young man wearing a dark T-shirt emblazoned with something like an intense green dragon wrapped in a circular motif, came by about the atropine or something – but the situation did not change. Mum lay on her right side, gasping and rattling, and sometimes her right hand grasped the bed rail, sometimes her hands were held against her side, the fingers clenched – she was white-knuckling it, as we say in alcoholic recovery. Mum was deprived of her beloved booze, the gin, and had not been given enough morphine to compensate – she was dying, going through withdrawal from life, ending her existence cold turkey, in some agonized, full-on, white-light consciousness …
The young nurse was solicitous of my well-being, and we rummaged around for a reclining chair on which I could sleep and she also got me a blanket. I lay down near Mum and eventually fell asleep for a few hours until about 6AM. I spent the next hour fuzzily trying to wake up, I think I made myself a cup of coffee, as the nurses attended to turning Mum over in bed as they prepared to handover to the next shift.
Like Mum’s previous room, this was a single room with a toilet in the corner of the room, and at about 7AM on that morning of 19 September 2007, I went into the toilet to pee, wash my face, and otherwise make myself presentable to the next shift. I was only in the toilet for about three minutes, and when I came out, it was quiet – it took me several seconds to register this change and as I looked at Mum not breathing, she gasped twice and some mucous ran out of her mouth – she was dead.
I can’t remember what I did to confirm she was dead but I informed the nursing station. Elizabeth and Ray came in to attend to her. I called Philomena. The doctor, Russell, came by in order to examine her so he could issue a death certificate. Philomena and her granddaughter, Taylor, walked in and walked directly over to Mum’s body lying in bed, and they filled the room with an ancient Irish sureness about life&death.
The three of us left a few minutes later, about 8AM: Taylor had to go to school; Philomena took the flowers and Mum’s personal effects with her; and I rode off on my bicycle to the sea about 6 km (4 miles) away to the west. On the way I called the funeral director and I stopped at a liquor store and bought a 375-ml bottle of gin, Mum’s favourite drink.
When I reached the shore, I sat down and, following the Russian tradition of drinking 100 ml of vodka when going for a swim in frigid water, I drank about a quarter of the bottle, my first drink in 15 years, and then gave the rest to Mum – I poured it into the sea, La Mer, the Great Mother. Taking off my clothes except for my undershorts (it didn’t even occur to me until now to take those off, too), I went for my usual short swim, and when I came out of the water, the tide being high and there being no beach, I lay on the concrete ramp walkway. After some time, I felt warm and relaxed in the sun and I heard the murmur of the quiet sea and I felt optimistic about new possibilities …
Some time after, I got up and dressed and rode back towards home – though alert for any signs of it, I was not conscious of any intoxication. On the way, I stopped at the nursing home, told them that Mum had died, and picked up the few pictures she had in her room, including the Terry Dintenfass Art Gallery poster. I rode my bike into the driveway of Mum’s/my house.
I carried my bicycle around the corner of the house and on to the back verandah and there encountered my friend Susan. I told her my mother had died and within a few minutes we were arguing about our relationship. After about 45 minutes, I could stand it no longer and asked her to go away – she left (not long after, I sent her a text message on her mobile [cell] phone which included the phrase, “the bitch is dead, long live the bitch”).
That afternoon I continued the process of making phone calls to notify people of Mum’s death. After a short rainstorm passed, I sent a phone text message to the two young men, Cameron & Drew, who had installed the rainwater tank, “My Mum died this morning … This afternoon it rained … and the water flowed into the tank – life goes on, oh blah di, oh blah dah …” That night I went to my alcoholic recovery meeting and told them the story of Mum’s death and how I’d drunk the gin that morning. Afterwards, I visited A and talked about Mum’s death and the meeting – I got home about midnight.
The next morning I went to see the solicitor about Mum’s will. Afterwards, as we had previously arranged, I met my mother’s gardener, Heidi, and her husband for lunch. Heidi is a young woman who had worked in Mum’s garden a couple hours a fortnight for several years whilst she was studying agronomy at Uni – like so many people who met Mum in some mundane manner, Heidi became friends with her, baking and bringing her hot-cross buns on Easter morning – the garden has grown wild since Heidi moved to her husband’s farming property two years ago.
I had an appointment that afternoon at the funeral director’s office to identify the body of my mother before cremation as required by law – when I looked up the address, I realized it seemed familiar. A bit more than a year before, Susan and I had met and become involved, and about a month after that her father had died and I had accompanied her when she had taken a photograph of her father to the funeral director’s office to be used in the memorial programme – by coincidence, this was the same office as my mother’s. I called Susan and asked her if she would accompany me to identify the body of my mother – she agreed to come.
Shortly after 4PM, Susan and I walked into the office of the funeral director who remembered us and presumed more about our relationship than we did ourselves. Susan and I went into the chapel and saw Mum’s body lying in the cheapest coffin available – the metamorphosed expression on her face was unlined, sweet and empty. We rejoined the funeral director, and the three of us, mostly me, composed the following notice that was printed in the next day’s paper:
CRANSWICK, Isobel Hilary
“Hogie” (nee HOGARTH). —
Died at the Repat Hospital
where she had worked as a
nurse during World War II, on
Wednesday, September 19,
2007, aged 92 years. Wife of Ted
(deceased). Mother of Edward.
Sister of Betty Tapp (deceased).
A woman who travelled the
world and left her mark in the
hearts of so many people that
she met all around the Earth.
Private Cremation
ELLIOT FUNERAL SERVICES
Everard Park 82971544
Susan and I said goodbye to the funeral director and rode off on our bicycles to swim in the sea and see the sun set.