Friday, May 11, 2012

Losing Mom

Looking back, it seems I'd waited my whole life for the call. It came late in the night, the Friday after Thanksgiving, my brother Greg telling me our mother had been rushed by ambulance to Brooklyn's Methodist Hospital in terrible pain. The "backache" she'd barely mentioned when I’d called on Thanksgiving Day would turn out to be an enormous tumor mass--squamous cell carcinoma--that had invaded her lungs and swollen her liver three times it normal size.
The call came three days after my 43rd birthday. Like so many other baby boomers, I was living a life vastly different from my parents; living it far from the blue collar enclave in Brooklyn where I'd grown up. Twelve years earlier, my job had carried me to Atlanta, a way station I'd imagined, on the way to the top; like so many others I stayed and stayed. My children, years of friendship and struggle were here. My brothers, my childhood friends, the house I'd grown up in, the streets I'd roamed, were 1000 miles away and fading, becoming stratified under layers of more recent experience. I'd noticed my memories had begun to outnumber my real-life interactions "back home."
Gloria had turned 66 a few weeks earlier. Since adolescence, I'd been telling myself how lucky I was to have young parents, how I wouldn't have to worry about losing them until my own mortality had begun to weigh upon me, until the needs of my children forced me to relinquish any enduring claim to childhood.
Those illusions were shattered in my mid-30s when emphysema debilitated my father, quickly transforming a man whose life had been marked by hard work and self-reliance into a frightened, helpless child. My father's illness set into motion that cycle of dread and responsibility we must all pass through when our parents become too old, too poor, or to sick to care for themselves. In my case, the struggle, though searing, would end early. For tens of millions of my generation with careers and families of their own, it is fully underway--an enduring burden that will affect every aspect of their lives.
There is much irony in the Me Generation having to slow down. Much irony and so little time. The years draw quickly upon us; the oldest among us with grandchildren grown. The parents many of us rebelled so fiercely against have become our dependents, threats to our vaunted freedom only in the demands they make. If they loved and cherished us, we are about to learn that requiting their love, no matter how deep our devotion, can be painful and demanding; a task that can stretch a childhood's length in fact. If our childhood memories are unhappy and escape-driven, we may again find ourselves trapped and bitter. Too many of our parents have nowhere else to turn; the responsibility is ours.
We've held Death at arms' length. We imagine a sterile process occurring in white rooms behind closed doors to other people. Now that it has begun to stalk our parents, we will become intimate with death and dying. And well we should. Death is edging closer to us. As if awakening from childhood's untroubled sleep, we hear the whispers of our friends and peers--whispers only until we are affected--the coworker's father with Alzheimer's disease...another whose father developed and died of cancer in the span of a few weeks...yet another raising the issue old folks so often dread, institutionalization...the realization that strikes a neighbor after her commute back home to Virginia, that roles have somehow been reversed: her parents need more and more support; they are losing their ability to play Mama and Daddy for her. "It's the hardest thing in the world," she says, "and it happened so quickly."
I was the eldest son in what had been a poor family. I was well-educated. Through my 30s, like millions of other baby boomers, I'd steadily climbed the career ladder, started a family of my own, bought into the notion that my generation was unique and special in history. Then divorce, and a series of reversals had abruptly knocked away 15 years of stability. In what is now a familiar pattern, I found myself at least spiritually returning to the nest...turning to Mom and Dad for comfort and support. In varying degrees, my three brothers did the same.  I'd always considered myself responsible for my parents' well-being, still bound by traditions that that in one generation seemed to have gone from being the right thing, the expected thing, the American way if you will, to some impractical folkway practiced only by recently arrived immigrants.
Looking back, I realize I'd taken absolutely no concrete steps to support these notions. Like so many of my generation, I had avoided talking with them about any possibility of planning for their aging. My parents were still young, and I was full of myself. I imagined my life full of drama and tempestuousness. Living it was a full-time job. My parents accepted that. They were of a generation that lived through their children. They'd had four sons to keep them busy. They'd never left the street they were born on and never cared to. The likelihood of either or both of them moving to Atlanta in a crisis was nil. In neither of my unhappy marriages would there have been a place for my folks. Among  Italian-Americans, extended families are still viable; a nursing home would have been out of the question.
When things began to go wrong--for example, my father, in taking early retirement, had neglected to check off a clause that would continue pension payments to my mother in the event of his death--I could offer little more than concern and guilt. My feelings were real, but they wouldn't have put food on the table.
Death had come early in our extended family. Aunt Dolly, my mother's elder sister, died of breast cancer in her early forties. Aunt Marguerite, a younger sister, succumbed to cancer in her 50s. "Not three," I'd told myself.  "Three sisters couldn't get cancer." I was younger then. Later, shadowed by the ironies and disappointments that mark our passage into adulthood, I knew the clock was ticking for Gloria.
Death came closer in 1982. My 28-year-old brother, Thomas, a struggling actor living in Greenwich Village, developed Kaposi's sarcoma, a skin cancer that signaled the onset of a disease that would become all too common, AIDS. Thomas returned home to die with his family. Gloria tried to save him with home cooking, prayer and a mother's love. Every day for a year, my father, Joe, bucked Manhattan traffic in his old Cadillac, a raging bull on a mercy mission: getting his son to Sloan Kettering Memorial Hospital for treatment. They barely spoke, the issues were way too complicated, but one morning I found my father in the backyard shaking his fists at the heavens.
"Why him?” he demanded. Why him!"
Thomas died in the spring of 1985. I remember cherry blossoms and dogwood petals floating in the bright sunlight as we passed into Brooklyn's Green-Wood Cemetery. I was forced to purchase his grave while he still lived.
That year, my father's chronic shortness of breath--the result of his smoking unfiltered cigarettes for 40 years--developed into full-blown emphysema. He grew afraid, a man who had seemed to thrive on shouting and turmoil, who as a foreman "down the piers" had terrorized deckhands and longshoremen with his furious temper and work ethic. At his funeral, half-a-dozen, gruff, gnarled men, old beyond their years, came up to me and said, "Your father worked like an animal!" It was the highest compliment they knew.
My father died over the telephone. My part played out in a series of long distance calls. It took five years and as many hospitalizations. I was in Atlanta those years, trying to put Thomas's death, the ruins of my first marriage, and a financially devastating career change behind me. I called often, trying to get him to let go of the oxygen bottles, the cigarettes and the sofa that defined his world.
At the time, I was married with two children, a demanding job, mounting bills. I lived far away. He had two other sons nearby. I constantly reminded myself of these things; it kept the guilt for the nightmare I knew was unfolding in Brooklyn at bay.
At age 64, my father couldn't walk 10 feet to the bathroom. He'd urinate into a milk carton. Gasping for air, he kept the windows wide open on January nights while my mother shivered upstairs. At the same age, his father, my grandfather, had sat proudly at the head of a long table, surrounded by doting children and grandchildren. My great grandfather had lived at home well into his 90s.
Too many nights I knew my father had only the white noise of the television for company. Too many nights, his needs left my mother and brothers angry and exhausted. When I called, he would whimper, "I'm scared." He was a wonderful cook; sometimes, to distract him, I'd ask for one of his recipes, always endlessly complicated and detailed. He'd hand the phone to my mother. Once when I'd gone too far, he moaned a desperate, "Please!" After that, it became easier when he didn't feel like talking.
March 6 was a special day. My wife, an actress, had landed a television commercial. She seemed happy. (A month later, she would pack up and leave; our marriage over.) We picked up the kids and headed home to make dinner. The answering machine's red light was flashing angrily, five...six messages.
"Vincent, this is your brother Joseph. Daddy just died."
Again and again, each time the voice choked with panic.
"Vincent, Daddy just died. Please call! Vincent, please! Vincent, Daddy's dead. He's lying on the floor!"
Thanksgiving marked the third time my mother's cancer had recurred in three years, despite all assurances that the massive neck surgeries and larynx reconstruction she'd endured had been successful. "No evidence of tumor," the lab reports had read, but each time renegade clusters of epithelial cells had escaped detection. The four months she'd spent recuperating in the crowded wards of Mount Sinai Hospital and her permanent inability to drink liquids or swallow most solid foods (we'd sit silent and helpless at the dinner table watching her gasp and choke as fluid flowed into her lungs) were a terrible price, but--we told ourselves--she could speak and she would live.
Twice before, my response had been optimistic and aggressive--read the literature, roust the experts, get second and third opinions, find the best hospital, the latest treatment, listen to the anecdotes of miraculous turnabouts everyone seems to volunteer. This time, the machinery of hope shut down. I could neither think nor act. I made one call, to Dr. Sanford Matthews, my kids' pediatrician. I wanted medical advice; Sandy tried to comfort me. Then came a telephone conversation with my mother.
"I can't understand what's happening," her voice a morphine haze. "I went shopping last Wednesday. I was fine. I walked all over the Avenue."
"I love you Mom. I love you so much."
I spent Thanksgiving weekend lost on familiar streets, alone though surrounded by friends who cared for me, beyond of the reach of arms that would comfort me. "We all have to go through this," someone whispered. "It's part of life." Even so, in my car, I howled the injustice, the unfairness of it into the night. I raged. I cried and hated myself for crying; each tear was an acknowledgement that she was dying.
By Monday, I'd come to a decision. I was going to New York and I would stay however long it took...two weeks, a month...a year. This was my personal choice and I attach no moral certitude to it. Everyone makes his or her own. This woman had given me life; she made my well being her life's work. She'd sung to me as a child. In our toughest times, seeing me shamed by cardboard stuffed inside my worn-out sneakers, she'd risked my father's wrath to buy me new ones. She still cooked my favorite dishes, still pressed money on me when I was broke. She loved her sons and grandchildren more than herself.
The bond between us was fierce. I'd never, as I'd promised, taken her to Florida, Los Angeles or the Vatican. Never become rich or famous... never danced with her at my wedding. She never cared. Last autumn, swept by some strange prescience, I'd taken six weeks off from work and traveled to New York to write, sleep in my old room, be her son again.
This would be my time to comfort her and stand with her at the fading of the light. If pain and tragedy were my mother's lot, I wanted my share. Something else was at work. The dying can give precious gifts to the living clarity... perspective... priority. This would be my last opportunity to give back something; the last time in this life I would ever be a son, the child of a living person.
In some ways, my position was special.  My children were young, and, after the breakup of my second marriage, they were living most of the time with their mothers; my expenses modest. A support system of family and friends was in place in Brooklyn. I was not bound by corporate dicta that typically make no provision for extended leave or other support in times of family crisis...that make it simpler for employees who are substance abusers to get help than for caregivers to provide it. Journalism for all its prickly edge is a sympathetic business. My boss told me to do what I had to do. We'd worry about it later. (After eight weeks, he fired me.)
"If God wants me, then I'm not afraid," Gloria always told us. Whatever God wants..." was a phrase I grew up with. I'd never seen her without her rosary beads. She supported an endless stream of church-related charities with $5 donations, yet could curse a blue streak, held grudges and always wanted the latest gossip. She attended services three times a week at Our Lady of Peace Church, one of the last devoted churchgoers in what had once been a thriving parish. As a child, it had been my job to stir the tomato sauce on Sunday mornings during the hour she was at mass. She always sat in the same pew, "Gloria's row," her friends called it. Over the last few years, I'd begun attending mass with her whenever I was in town.
She always wore high heels to church. Young women had always marveled at my mother's figure. In the three years, since her first operation, she'd lost 40 pounds, suffered disfiguring scars and complained she "looked like a skeleton." Greg, always loyal, still called her "Tubsy."She still wore those high heels. Awash in memories in the nearly empty old church I'd look at her and tears would flow.
She pretended not to notice.
Returning to New York had always been a joy for me. This time it was a rite of passage. I had come as a son seeking his mother; instead, I found myself in an empty, memory-haunted house, the head of a family heading for disaster. Once again, I found myself emotionally, but not practically prepared for crisis. Gregory, who had been supporting Mom since my father's death, was unemployed. Another brother was in rehab. Bills were piled up; the mortgage and property taxes hadn't been paid. My parents had managed family finances out of an old shoe box in which they kept payment books, canceled checks, etc. Mom's hospital costs were already in the tens of thousands of dollars and surging daily. Though well-insured, she still owed thousands from her previous surgeries. Our resources essentially consisted of her small savings account, a $2,000 life insurance policy and the modest row house we'd grown up in. Determined to keep the house and our family intact, I found myself worrying about losing both every day.
At the hospital, Mom was being maintained on heavy doses of morphine and little else. We asked that the dosage be cut back and discovered the pain had diminished. Other problems had developed: her feet and ankles had begun to swell with fluid; she couldn't swallow without choking. Her only sustenance was the intravenous solution that dripped slowly into her arms. Every day, untouched containers of soup, pasta, fruit, toast, eggs, Jell-O, tea, lined her window sill.
After ten days, she was finally transferred to Methodist Hospital's third floor cancer ward for chemotherapy. Each day, I'd imagine the runaway cells inexorably growing, approaching some critical mass.
"Do you think this can really help me?" she asked.
"Please Mom,” I said, "there's nothing else we can do."
I'd half-convinced myself the harmless-looking liquids in the clear plastic bags above her bed could work some miracle. They were powerful cytotoxins that would kill any fast-growing cells in her body: she would lose her hair, develop sores in her mouth and the lining of her stomach, experience nausea or worse. On Friday night, she was given a cocktail of painkillers and anti-nausea drugs to prepare her for her first treatment.
I arrived early Saturday morning carrying coffee and a newspaper, eager for some hopeful sign. A nurse stopped me outside the room to ask whether Mrs. Coppola should be revived if she went into cardiac arrest. I rushed past her to find Mom semi-conscious, gasping for breath. A nurse was suctioning her throat with a vacuum device. The anti-nausea drugs had suppressed the gag reflex that allowed her to clear phlegm: she was drowning in front of my eyes. We stared silently at each other. Half-a-dozen other patients were in distress; the nurse passed the vacuum tube and saline solution to me and left.
Mom revived, survived the first round of treatment. By then, she'd seen herself in a mirror and asked for Father Louis DeTommaso, her pastor. We all took communion together around her bed. Another lifelong image was seared into my consciousness. My relatives had begun placing religious pictures by her bed, alongside those of her grandchildren, Justin, Gabrielle Pia, and Thomas. Her brother Sonny and his wife Madeleine, postponed their annual winter trip to Florida.
In the cancer ward, some patients slept constantly; others never. One woman, suffering from both lymphoma and Alzheimer's disease shrieked through the night. Many of the patients smoked constantly. One of Mom's roommates, a woman apparently without family or friends to support her, endured three days of chemotherapy and then was preparing to make her way home alone. Gloria ordered me to drive her home. She had Greg give $10 to another, indigent patient.
Despite the high tech medicines and the decency of the caregivers, the ward was not a place to inspire hope. Half-a-block away on Seventh Avenue, the shops were ablaze with lights and Christmas decorations; men hawked Christmas trees on the sidewalks while carols played over tinny speakers. Our house, always bright and filled with people at Christmas time, was dark and empty.
Greg and I stayed in shifts. Our relatives visited regularly but we kept the haunted hours. Other families kept similar vigils; many of the "children" were my age. Two brothers, both in their 40s, had flown in from Florida at Thanksgiving to care for their mother. A month later, they were still there "trying to get Mom home for Christmas." At the other end of the scale was the daughter who publicly berated her dying mother for all the "trouble and expense" she was causing. The woman's last months would be spent shuttling between cancer ward and nursing home.
Three days before Christmas, I asked Mom's permission to return to Atlanta to spend time with my children. She insisted I go.
"I'm okay, I've got plenty of company."
Holidays were important in our family, heralded by huge dinners my parents would spend days preparing. I sensed she was passing on the tradition to me. As I was leaving for the airport, torn between my responsibilities as both father and son, she handed me money for gifts and Christmas cards for Gaby and Thomas. Inside, she'd written,
"Grandma will love you always."
A patient died Christmas Eve. Three days after Christmas, a surgeon had cut into my mother's abdomen attempting to install a feeding tube directly into her stomach. He failed. He told us her liver was so enlarged with tumor, he couldn't find her stomach. A tiny tube he attached to her small intestine pulled free and Mom refused to have it reinstalled.
On New Year's Day, a 43-year-old woman whose husband and daughters had kept a lonely vigil in the room across from us died of brain cancer. Their wails echoed through the ward. At noon on Saturday Jan. 5th, Gloria was discharged from Methodist Hospital. The plan was to get her out of the grim ward environment for a week, after which she'd return for three days of chemotherapy. Visiting nurses and home healthcare workers would help us manage.
I spent that morning at home scrubbing the floors and putting everything in order. Over the last year, Gregory had renovated the ground floor of our dilapidated, 100-year-old row house, ripped out walls, exposed brick, installed new appliances, windows, even parquet floors.
While Mom was hospitalized, he had her dingy bedroom redone all sunshine and bright colors. I'd dumped the worn-out bedroom and living room suites, bought new sofas and a bed--charged it all--framed and hung pictures of my brother Thomas and the grandchildren alongside her photograph of Pope Paul VI. My mother had spent her entire adult life living in that rundown house. The renovation was a final gift to her.
On the sidewalk outside the hospital, she couldn't walk four steps to the car without gasping. The painful swelling that had begun in her feet by now had bloated her legs. When I'd massaged them, imprints of my fingers remained in her flesh. She couldn't have weighed more than 90 lbs. Her face was grey, her lips pulling back from her teeth.
"It's so beautiful," she whispered as Greg carried her into the house. "So beautiful."
A neighbor had prepared lentil soup and run it through a blender for her. She couldn't eat. (At the hospital, she'd ordered her cousin Millie to eat the food I'd leave "...so Vincent wouldn't worry.") She spent the day exhausted on a Barca-Lounger we'd borrowed from a neighbor. On Sunday, a visiting nurse noted Mom's systolic blood pressure had dropped below 90; she looked at me oddly when I announced I had gotten Gloria to eat two full tablespoons of oatmeal. A medical reporter, I refused to acknowledge any medical information. It had come down to "...what God wants."
Sunday night, Greg carried Mom upstairs to her bedroom, the stairway as insurmountable to her as Mount Everest. It took six pillows to put her at ease and still she couldn't sleep. She called to me in the middle of the night. I lay awake next door in the narrow room that had been mine as a teenager.
"Vincent, my back...I can't get comfortable any more."
I adjusted her pillows for the 10th time.,
"I'm sorry," she said. "I'm not letting you sleep. I'm sorry I made you come up here so far from the kids."
I clung to the iron rail of her new bed. An enormous chasm stretches between the living and the dying, a gap love cannot bridge. I wanted to hurl myself across it. "Mom," I said, "There's nowhere else in the world I want to be." I realize now that I had been granted a precious moment. A chance to say those special things we feel for those we love but so rarely do. A chance to say goodbye.
"Mom, I want you to know that you've been the best mother any son could have. I want you to know that whatever is good and special in me has come from you."
She lay there staring.
I was blinded by tears. "Mom, You know that I can't change this. I can't change what's happening to you. You know if would if I could."
"I know that," she whispered. "I know."
Monday morning, her blood pressure continued to drop.
"Vincent," she said, "I don't feel good Maybe I should go back to the hospital."
I didn't want her to die surrounded by gaping strangers in a crowded emergency room or wind up lifeless on an respirator. "Okay, Mom. Let's wait a little bit." I knew what choice I was making. The hospital had an arrangement for bypassing admitting procedures on the cancer ward. After a while, it became too much Greg drove to the hospital to find the head nurse. I was upstairs when our cousin Millie shrieked, "Vinny, come down! Something's happening!"
Mom had pitched forward in the chair. She'd grabbed Millie’s hand She wasn't breathing. I pinched her nostrils and began breathing into her mouth. It was the first time I'd ever kissed my mother on the lips.
"Breathe Mom. Please, Mom breathe! Don't die!"
Somehow she heard me and delayed her passing. She came back, but only for a moment. Her last breath passed into my mouth. Later, Josie Stuto, our octogenarian Italian neighbor across the street would tell me this was a special gift.
I was aware of Greg kneeling beside me sobbing. I won't cry," he'd said, "until there's no hope." There were no open beds at the hospital. Angela dialed 911. Half-a-dozen police officers and EMTs piled through our front door, pushing us aside. Mom lay on her back, her pajama top open as a team worked to defibrillate her. Her ribs and collar bones protruded It was the only time I'd ever seen her undressed.
At that moment, our brother Joseph walked in. He never got his chance to say a last goodbye, make amends, and tell her he loved her. Of course, Gloria knew that. Her last thoughts were of him.
When I wrote this, the tulips and irises I'd planted in the yard that last fall were beginning to blossom. I was going to surprise Gloria with them. Her favorite outfits and a few pieces of jewelry were given to family and friends, the rest donated to the poor. I would have kept everything exactly as it was. But life goes on. Her passing left a hole in my life into which I hoped would flow all the kindness she represented...
Sometimes, I wonder what might have happened if Alzheimer's had been the diagnosis instead of cancer...if those intense and devastating 10 weeks had stretched into 10 years. And I wonder about the road ahead.
Remember how I'd assured myself that the cancer that killed Gloria's sisters had somehow inoculated my mother against the disease. In fact, my Aunt Mary, another of her sisters, and two of her brothers, Sonny and Tony, would all die of cancer. They grew up in a house on the corner of Carroll and Nevins streets, since demolished, a few hundred feet from the Gowanus Canal. As a boy, I remember the poisonous green tides flooding the cellar, my uncles wading into the noisome water to clear the drains.
Ours is just one story of a hundred families in a forgotten neighborhood. My hope is that neighborhood and its people will live again on these pages.
I remember wise guys dumping medical and other wastes into the canal. It was cheaper for their corporate customers than loading the toxic material on a barge and ferrying it out to sea, the deals no doubt done in Monte's Venetian Room, a restaurant across from our house. Most neighborhood people couldn’t afford to eat there. As a boy, I played pirate on half-sunken barges, climbed a mountain of metal barrels filled with industrial chemicals. A king, I held "magic" turquoise crystals and golden powders in my hands when the containers spilled open. I remember raw sewage from our toilets passing straight into the water through a stone conduit alongside the Carroll Street Bridge.
Last year, the EPA declared the canal--now eagerly eyed by a new generation of developers and self-styled urban pioneers--a Superfund site.

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