When Few Options Remain


Robert was thrown from his metal ladder as 60,000 volts of electricity surged through him. He had been asked to cover for the warehouse foreman that humid morning, and to reboot the plant’s faulty electrical system. His heart likely stopped before he hit the ground, never to beat again. They reached his wife, Tasha, at home. She was stoic at first, numb and protected by shock. That would pass.

A week later, in mourning and now deep in grief, Tasha met with her doctor. He attempted to console her with the unexpected news that, at thirty-five years old, she was pregnant with her first child. Her shock only deepened, compounding a loss that would shadow her for life.

Eight months later she gave birth to Trevor, a beautiful and energetic boy, born with developmental disabilities. He became the love of her life.

The arc of a lifetime defies simple description. It was fifty years later when I met Tasha at the Hospital, after her nurse had suggested a pastoral visit. Tasha was eighty-five years old, feisty, and cantankerous, and spoke her mind. I liked her right away. Over the course of a few visits, at the hospital and at rehab, a bond developed between us. She asked for my help at a time when she “had no one.” I told her that I would do my best.

Eventually Tasha was discharged home to her small third floor apartment in subsidized housing next to the oldest volunteer fire department in our country. It was rarely a quiet neighborhood. Tasha had rallied time and again, from heartbreak and widowhood to heart attack and resuscitation by CPR and a 500-volt defibrillator. She lived with renal failure and arthritic knees, which created wicked bone-on-bone pain. Between neighbors and good Samaritans, Tasha managed to cobble together one or two visits a week to a nearby dialysis clinic, which kept her alive.

One evening, exhausted from a day at the clinic, Tasha went to sit at her kitchen table, but misjudged the edge of her straight back chair. She landed on the bare floor and heard her hip crack beneath her. She screamed out, knowing immediately that her cherished independence had come to an end.

The fire department responded quickly and got her to the hospital. By the time she remembered my phone number, she had been x-rayed and was awaiting a verdict from the hip surgeon. When I reached her bedside, she was heavily medicated but awake enough to recognize me and to reach out her hand. The very motion shifted her position, and she cried out in pain. Her nurse came in quickly, and asked what I’d done, to elicit a smile. Humor continues to be an effective medicine, but only surgery would stem Tasha’s internal bleeding at the hip and assuage the knifing pain. Physically and emotionally broken, and unable to find a comfortable position, Tasha was furious with herself for having fallen.

She directed her anger toward her caregivers. It wasn’t pretty. She needed skillful pain management—which takes time to fine- tune. Hip surgery was postponed to allow for her next dialysis treatment, which only deepened her misery. There was no easy way out. As is so often the case with frail elders, her fall marked the beginning of Tasha’s final chapter. Talking about her loss of mobility was upsetting, but it needed to happen.

Sitting at her bedside, a week after the operation, I asked, “How are you doing?”

She frowned and shook her head from side to side. She was still in considerable pain, more so from her arthritis than from her hip. In addition, she was suffering from a feeling of profound loss. The doctors were saying that rehab, if it was even possible, would take one to two months. “What do you think we should do?” she asked.

I paused a moment. “I’m afraid we’re running out of options.”

Her reply was honest and direct. “I may not be able to walk again. I think I need to let go of my apartment. Will you help me?”

“Of course. I’ll do whatever I can.”

And that was that. The next stop was a brief rehab, which was called short because Tasha couldn’t bear any weight. Despite her new hip, the trauma of her fall combined with the resulting entropy would not allow her to walk again. A Hoyer lift was used to transfer her to a wheelchair to get her to dialysis. After a few months, there were days she just couldn’t stand the pain and refused to get out of bed. She called me to talk.

“I think I’m ready to throw in the towel. Is that wrong?” she asked.

“No, it’s not wrong. When I put myself in your place, I think I’d feel the same way.”

There was a long pause before she spoke again. “If I stop dialysis, how long do you think I’ll have?”

“Normally, just a couple weeks.” I paused, wanting to give her time to respond. She was quiet. “Tasha, tell me what’s most important to you.”

“To see my son again… To not be in pain… To not have to struggle anymore.” Through her tears her voice was clear and unwavering. I could tell she still had her wits about her, and that she’d had enough.

The next two weeks went quickly. One morning, Trevor was brought from his group home about an hour away to the nursing home. I met him there and walked him to his mother’s room. He had gotten a fresh haircut and was neatly dressed, wearing new sneakers that his mother had ordered for him. He appeared anxious, and no wonder. There were many disturbing sights, sounds and smells. It was a heart wrenching visit for them both. He was silent most of the time, looking down at the floor.

At one point he asked, “Mom where will you be buried?”

“Next to your father,” she said. “Will I be there someday, too?”

She nodded yes and reached out for him. He gently held her while they cried in each other’s arms. She reached to her bedside table and offered Trevor an envelope.

“Here,” she said, “I want you to have some spending money.”

He opened it carefully. As he counted out fifty dollars, he came alive again, thinking of all he could buy on his way home. “Thanks, Mom… I better go now.” And he gave her a quick parting hug. That was the last time they saw each other.

I visited her as often as I could between shifts at the hospital. We talked quietly and I encouraged her to reminisce, particularly about the gift of the past twenty-one years since her heart attack. Over the next few days, as the toxins built up in her body, she became weaker, grew weary, and slept more, until the day came when she didn’t wake up. Her breathing was slow and calm, and she appeared to be at peace. Trevor chose not to come, saying that he wanted to remember her when she was awake. When I saw him next, it was to join me in burying Tasha’s cremains in their small family plot.


Next Week: Dialysis


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Until next week, ‘Safe Journeys,