My mother waited a long time to decide to get old. “Well, I’m about to turn ninety,” I could almost hear her saying to herself. “It’s okay for me to be old now.” Once she decided, she aged quickly. In only three years, she went from living independently to wheelchair-bound and falling almost daily because she didn’t remember that she couldn’t walk.
Mom had in fact been aging throughout her eighties, but she and I were good at denying it. When we talked on the phone, I let her go on about all that she was doing—editing the condominium newsletter, playing bridge, hosting a book club—and never asked about the concessions she was making to her age—limiting her driving to daytime and places she frequented, heating up frozen entrees rather than cooking from scratch, napping more. We were both happy to pretend she would continue her independent life and then, one night, die in her sleep.
A letter from Mom’s best friend burst my bubble. Your mother is slowing down. Soon she will need to move closer to you or your sister. On my next visit with my mother, I watched her more closely. I noticed that it took her longer than usual to get dressed—a full two minutes to pull on the L’eggs knee-hi’s she wore every day—and that she grabbed my hand to steady herself as she stepped off the curb. I could see that she’d lost weight.
As a seasoned hospice care expert, I thought it would be simple for me to navigate the moves I knew would be necessary when my father died twelve years earlier, understanding that my sister and I would have to be there for my mother as she aged. Now, I felt ashamed that I hadn’t picked up the cues sooner, and I was ready to do whatever I could to make the rest of her life the best it could be. I even had a plan.
My mother had always insisted she would not live with either me or my sister, Barbara. Mom said she didn’t want to be a burden. The best option, I thought, would be to find an adult congregate living facility (ACLF) near Barbara’s home in North Carolina, or mine in Miami. Barbara and I would handle all the details of the move, so Mom would feel minimally disrupted.
Mom had other plans. She wanted to stay right where she was. I understood that she felt safe in the condominium where she had lived for thirty-five years, and in her community, even as it shrank to the small radius that included the local grocery store and her hairdresser. Anything unfamiliar was scary, particularly as her physical stamina declined, her reflexes slowed, and her mental acuity slipped. I couldn’t be angry with her—but I was angry about the situation.
When I was growing up, my mother taught me how to make good decisions by weighing the pros and cons, thinking through the consequences. Now, she seemed incapable of making a reasoned choice for herself. I wanted my smart, logical, capable mother back. Barbara and I urged and cajoled, trying to convince Mom to choose what we felt was best for her. Eventually, we wore her down and I helped her fill out the paperwork and send in the deposit for a senior apartment near Barbara.
After a nightmarish few months before and during the move, Mom surprised us by adapting quickly to her new home. Within three weeks of settling in, she said she loved it and wished she had moved sooner. But the reprieve was short-lived. Mom’s physical decline sped up. She began to fall, and Barbara started making regular trips with her to the emergency room. We battled with Mom about every accommodation—about wearing a “panic button” so she could call for help if she fell when at home alone, about hiring an aide to help her shower and dress, about getting a walker.
We always focused on making decisions with her, not for her. When Mom behaved like a willful child, I was tempted to behave like her parent. At the same time, I reminded myself she was an adult who had earned my respect and her autonomy. Barbara and I worried about Mom’s safety, yet we always erred on the side of giving her the independence she craved.
Inevitably, our worst fears were realized. Mom fell while getting ready for bed, and lay on the floor all night, bruised and disoriented. After eight days in the hospital, insertion of a pacemaker, and six weeks of inpatient rehabilitation, Mom made her final move, to the memory unit of an assisted living facility. She lived another six months, playing bingo, competing in the wheelchair pancake race, and singing in the Christmas pageant. She died in her own bed with Barbara and me by her side.
There’s no question that my mother’s evening fall, with no one there to help her, hastened her death. I’ve often wondered if we should have stepped in earlier, more often, and more forcefully; but I knew what that might do to her spirit. I thought about the scene in Laura Hillenbrand’s Seabiscuit: An American Legend, when one of the jockeys says letting a man break his leg might be better than breaking his heart.
It would have been easy to dismiss my mother’s refusal of evening care as the result of cognitive impairment; but I knew her well, and I think that, on some level, she understood she was choosing freedom over security. I struggled with giving her that freedom, and I still wince at the thought of her alone on the floor that night. At the same time, I find a crumb of comfort in the fact that she was doing what she wanted to do, and doing it her way.
Melanie Merriman is author of Holding the Net: Caring for My Mother on the Tightrope of Aging. She is also the co-author of Merriman’s Hawai‘i: The Chef, the Farmers, the Food, the Islands, a cookbook with stories about chef Peter Merriman. Melanie has spent much of her life as a research scientist, hospice consultant, and foundation grant evaluator—driven by a passion to illuminate, understand, and find meaning.