Embracing life, befriending death

A year ago, my mother Bienvenida stared into death’s eyes, and death blinked.  She came back to life after losing her pulse and heartbeat, her glassy eyes searching for the familiar faces of her children among the crowd that circled her bed.  At once she realized she had not left, and maybe it wasn’t her time yet.

The other day, death came for her the second time around, and she embraced it like an intimate friend.  She had prepared for it the whole year, measuring its terror and its pain against the relief it offered. This time, she knew she was ready.  She had said all there was to say, seen everyone she wanted to see, and visited all the places that formed the circumstances of her active life.

Since September she had lacked sleep, she said.  There was a dull aching in her bones that she could not quite figure out, and it kept her awake.  That sensation alternated with an unbearable itching that plagued her entire body.  She fought it with prayers during the night, and during the day she worked herself to a gentle stupor by watching television.

There was nothing much we, her family, could do for her except to appease these sensations through a variety of anti-histamines, sedatives, sleeping pills and pain-relievers.  Her doctors explained to us that the toxins that the body produces on a daily basis, which should have been normally expelled by our kidneys, are causing these symptoms.  My mother totally lost the functioning of her kidneys last year; she had since been on peritoneal dialysis four times a day. But dialysis does not completely eliminate these body wastes.  The toxic residues find their way into our tissues and bones, unleashing untold sensations at the slightest provocation.

Had her pain threshold been lower, her body would have given up sooner.  To my mother, however, pain was but a minor distraction in the business of living.  She taught all of us her children the meaning of willfulness.  It is the mind, not the body, that was, for her, every person’s true weapon.  “If there is a will, there is a way” was a line we often heard from my father, but it was my mother who showed us how it worked. Later in life, I realized it was actually the pragmatist’s credo.

Last Sunday, she made one last attempt to take full control of her body.  She decided to stop dialysis.  She knew the consequences. She had been there before. Yet she resisted dialysis from the start. She thought it was just another artificial breathing machine designed to delay death, offering a moment’s relief but not recovery.  She had allowed it mainly because she wanted to please us.  We had wanted it for her, and she took our insistence as a command.

It was a bright Sunday, and she was in my sister’s house, among her grandchildren in Pampanga.  Apart from her own, these are the kids who grew up under her careful watch.  They lived with her at the old house after my father died.  She started the day with dialysis.  As she planned it, however, it was also going  to be her last.

“Please,” she said, “tell your brothers and sisters that my time is up. You’re all grown up now.  Let me rest.”  My response to her request probably surprised her.  I told her that I understood her situation, and that I would not attempt to argue against her wish.  I asked her if she had talked to my brother, the priest.  She was serene, and I had not seen her like this in a long time.  She had no doubts whatsoever about the purity of her intention.  She was just a little worried that I might try to dissuade her.  That same day I brought her back to Manila.

It was not difficult for me to support her decision.  On her 78th birthday two weeks ago, I gathered my brothers and sisters – there are 13 of us but 4 live abroad – and we talked about mother.  Without anyone dissenting, we agreed that our primary concern should be her comfort.  She always bore her suffering with dignity, but we saw the deep sadness in her eyes that day and it disturbed us.  We agreed that we would visit her as often as we could and cheer her up constantly.  But we also resolved not to place the burden of our own needs upon her.

We don’t have a euthanasia law in our country.  Our legal and religious sensibilities frown upon any mention of mercy killing.  But I think our culture is far more humane than the existing institutional prohibitions might at first suggest.  As a people, we are respectful of life, and of the meaning of the pains and struggles that mark our journey in this world.  We do not seek escape from these pains; we try to find our worth as human beings in them.  But we do not fear death as much as other cultures do.

We were fortunate to be helped by doctors who understood the rights of patients to their own bodies and were ready to act within the constraints of current medical practice.  When they saw that it was my mother’s wish to stop dialysis, they offered to give her comfort care rather than leave the family to deal alone with the consequences of the patient’s voluntary withdrawal from dialysis.  However, to the last moment, they were faithful to their mission of prolonging life rather than ending it.  This was visible in the quality of their prescriptions. But they did not tell my mother to continue submitting to an intervention she no longer wanted.

Like most Filipinos, my mother never understood the logic of a medical mindset that extends life by sheer technical inventiveness, but does not improve it.  To her, prolonged dialysis was not only a waste of resources, it was also a violation of life’s basic ethic.  She was sure she had lived a full life, and was conscious she should not ask for more.


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