The following is an excerpt from the anthology, Exit Laughing: How Humor Takes the Sting Out of Death (on sale May 10, 2012)
“She Laughed Until She Died”
by Victoria Zackheim
Six weeks before she died, my mother and I were together in her apartment, a rare January sunlight streaming across the living room carpet and warming the sofa where she was nested. Aware that her life was coming to an end, Mom was becoming increasingly agitated. An avowed atheist, she was facing the realityâ€”her realityâ€”that there was no God, no life after death, no heavenly place awaiting her where she would be reunited with her husband and all those friends who had died before her. This could only mean that the end, the absolute and inarguable end of her life, was fast approaching.
She had been declaring for months that she was ready, that the quality and value of her life had run their course and that, had she the courage, she would bring closure to this nonsense herself. But she did not have the courage, perhaps not even the inclination, to end her life. So she lived on, her body failing her, her memory slipping, as she continued to be the victim of the cruelest trick of all: death was approaching, and she was poignantly and painfully aware of its proximity.
Mom was eighty-nine, a former art teacher, a painter, Scrabble demon, and political activist. She was a loving friend to her peers, an occasionally difficult and judgmental mother to her daughters. I recall many instances where I felt distrusted and disrespected, despite being a fairly serious girl and woman who followed the rules and rarely wavered from the path I was taught to follow.
When I was a teenager, she harped on the fact that I could get pregnant, like so many classmates, and bring shame to my life. I assured her often that I was innocent to the point of naivete, yet she never wavered from her threats and accusations. When I was a middle-aged woman, she warned me about excessive spending, yet I was never in debt and so fiscally responsible that I too often denied myself the little luxuries I could afford. This difficult side of our relationship was heightened by my motherâ€™s stubborn nature, and compounded even more by a sense of entitlement that resulted in her often saying whatever she wanted, no matter the consequences.
Eighteen months before her death, there were signs of physical problems: general weakness, lack of appetite, blood pressure fluctuations. â€śIâ€™m old,â€ť was her explanation whenever I pressed her to see her doctor. And then the falling, the 911 calls, my phone ringing at all hours to meet her at the hospital. Blood work, guesses, nothing firm. If I took a bath, the phone was perched on the nearby sink. If I ran downstairs to get the mail, the headset was grasped in my hand. I knew the call would come; I just didnâ€™t know when.
For the first time in their three-decade relationship, her doctor called me. â€śSheâ€™s bleeding internally,â€ť said Dr. Candell. â€śIâ€™m sure of it, but she refuses to have a colonoscopy.â€ť He asked me to help convince her, while he continued to plea and cajole. Meanwhile, she was slipping into a state of severe anemia, and a transfusion was given that alleviated her symptoms but did not stop her decline.
After several months and more emergency trips to the hospital, my patience was nearly gone. When next she was shuttled to the ERâ€”I got that call at three oâ€™clock in the morningâ€”I raced across the Bay Bridge, surrounded by the eerie emptiness of a highway normally jammed.
Mom was so pale that she was gray. After the saline bag was empty and the transfusion was complete, I blocked the door of her examination room like some linebacker daring a runner to break through and announced that she was going nowhere until the colonoscopy was performed. With a dramatic scowl and teeth grinding, she begrudgingly agreed.
Instead of the two hours it normally takes to drink the bowel-cleansing solution, Mom drank hers in forty-eight. That was my mother. Heels. Dug. In.
Finally prepped for the procedureâ€”a euphemism for having everything cleaned out and the entire colon visible through an intestine-traveling cameraâ€”she was transferred to a gurney and wheeled into the examination room. I waited outside, concerned that this invasive but rarely dangerous procedure might be too much for her. In less than an hour, the doctor joined me.
Nearly total blockage.
Laparoscopic surgery would do the trick, probably cure it. He doubted there would be a need for radiation or chemotherapy.
I called Dr. Candell and asked him to come and talk to us. We needed his expertise, his calm nature, to guide us through what would be the most important decision of my motherâ€™s life. Most of all, we were desperate to hear the opinion of a medic who truly cared about her well-being and, more importantly, her quality of life.
Within a few hours, he was sitting in her hospital room, holding her hand and quietly going over her options. There were two: surgery and hospice. He confirmed what we both suspected, that any surgery performed on a woman nearing ninety had its risks. And not so much the surgery itselfâ€” hers would be less invasive than manyâ€”but the damage that the anesthesia could cause to her organs and her level of strength. What frightened us was the knowledge that anesthesia can cause long-term cognitive disorder, especially in the elderly. Was it worth the chance, subjecting my sharp-minded, opinionated, and creative mother to this risk? What if she came out of the surgery cancer-free, but with short-term, and even long-term anesthesia-induced senile dementia?
â€śHow long will I live if I choose hospice?â€ť she asked.
The doctorâ€™s eyes softened, his fondness for my mother evident. â€śThree to six weeks.â€ť She chose hospice. I phoned my children and then my sister. As the firstborn, Michele had taken the brunt of our motherâ€™s nasty tongue. This was compounded by the fact she is a gifted and recognized artist and writer, and our mother long envied her daughterâ€™s accomplishments. That envy manifested itself as an undercurrent of ill-treatment from a woman who had aspired to similar recognition.
Like so many women of her generationâ€”especially highly intelligent and creative womenâ€”Mom lacked the ability to take risks. While she insisted that her life had been fulfilling, there was a bitterness that ran through her relationships with her children. When learning of our motherâ€™s decision to choose death over surgery, Michele would have been more than justified in distancing herself. Instead, she assured me that she would fly in immediately. With our mother only days from hospice, it was a relief to know that Michele would be there to support herâ€”and in so many ways, meâ€”through this process of dying.
The day of the colonoscopy, shortly after Dr. Candell took his leave, a surgeon showed up in Momâ€™s room. The hospital had contacted him prior to her decision, so he arrived with no knowledge that she had chosen death over surgery. He was young, attractive, and friendly. I assumed that surgeons in his age group would be more supportive of life/death choices, so I was comforted by his presence.
Mom informed him that she was going into hospice. â€śIâ€™m old, Iâ€™m tired, and I prefer a quiet and pain-free death,â€ť she explained.
The surgeon nodded thoughtfully, which allowed me to think: enlightened generation, accepting and respectful of personal choice. He stood at the foot of her bed and leaned against the railing. His face radiated concern and comprehension. And then he spoke. â€śYour death will be anything but quiet and painless,â€ť he said. When I asked him to explain, he looked directly at my mother. â€śYouâ€™ll stop eating, but there will be times when youâ€™ll want a little something. With this blockage, youâ€™ll soon be vomiting your own feces.â€ť
My motherâ€™s eyes widened until they bulged. I had seen fear in her face many timesâ€”going back to when I was a teenager and she suffered from an autoimmune disease that had taken her near death on several occasionsâ€”but I donâ€™t recall ever having seen that look of terror. Had I not been caught off-balance by this manâ€™s insensitive declaration, I would have challenged him. I would have asked, With morphine helping her into a coma, why would she eat? I would have asked, And if she did eat, wouldnâ€™t it be sips of water and juice? Instead, I sat there stunned by the vile picture he had created . . . and then it was too late. My mother had already visualized, with an imagination that comes from sixty years of painting, a tableau that was as inhumane as it was revolting.
The next day, she underwent surgery.
She bounced back physically, but something was amiss.
This woman whose mind had always been sharp and probing was struggling to remember the simplest things. And she knew it.
There were days when she asked me the same question four times . . . in a period of five minutes. There were moments when she stared at me, yet had just enough awareness not to ask who I was or what the hell I was doing in her bedroom.
The delirium of anesthesia, compounded by the extended anemiaâ€”which could have been avoided, had she allowed simple tests to be run early in her illnessâ€”resulted in an increasing dementia that became part of her daily life.
â€śSheâ€™ll come out of it,â€ť said her friends. And it was true, there were hours at a time, often days, when her mind seemed clear and she understood everything going on around her, including the political discussions on C-SPAN. On those days, my heart soared with the possibility that she was coming back.
But more than the occasional rallies were the signs that she needed increased care. The cancer was goneâ€”and with it, the blockageâ€”but she had little appetite and she was severely depressed. I suspected that she wasnâ€™t taking her medications, so I kept a tally of how many there were on a given day and compared those numbers to what remained in the bottles three days later. She was missing six pills for blood pressure, when only three should have been taken. The thyroid pill count had not changed. As for the vitamins, minerals, antidepressants, pain pills, and sleeping pills, the numbers were all over the place.
Several years before her illness, Mom had sold her town house and moved into a retirement community for seniors who enjoyed independent living. Despite the number of elderly residents pushing walkers and an average age hovering near eighty, Iâ€™d never seen such comings and goings! There were poker games, movies in the leather-seated theater, Democratic club meetings and residentsâ€™ committees that, urged on by my leftie mother, might have threatened to build barricades and storm the management offices if demands were not met. There were lectures and concerts, van rides into San Francisco for museum and gallery tours, dances, and mahjong games.
Fortunately for my mother, Cardinal Point was also a haven, an elegant and comfortable place that rivaled many four-star hotels, and was staffed by the kind of people anyone would choose to watch over their aging parents. One of their services was to provide daily care for residents recovering from illness. If able, they could remain in their apartments and be visited several times a day by aides. For Mom, this was a blessing. Morning and night, someone was there to be sure she was comfortable, that the correct medications were being taken, and that I had everything I needed to care for her. I continued my morning-to-night visits, but I also welcomed and appreciated the support. As someone who occasionally is tripped up by her own hubris, I found it difficult to let go of control. But as incontinence became an issue, I soon learned to ask for help.
One afternoon, we were together in her living room, Mom nested on the sofa as she attempted to concentrate on her crossword puzzle. Quietly, she put down the paper and turned to me.
â€śI believe in the Eskimo tradition,â€ť she said. â€śIâ€™m going to die soon. Why canâ€™t you just take me to Alaska and put me on a block of ice and float me out to sea?â€ť
At first, I wasnâ€™t sure how to react, but then something struck me. Taking this as one of those moments when levity might be appreciated, I said, â€śWell, with global warming, Iâ€™m not sure thereâ€™s much ice left.â€ť
She stared at me for a moment. â€śIf thereâ€™s no damned ice,â€ť she responded, â€śjust hold my head underwater!â€ť
And then we laughed. It was one of those wonderful, belly shaking laughs that makes you feel joyful and reminds you that life is worth living. It was also the perfectÂ entrĂ©e into a discussion about how she wanted to die, and what she wanted after death, in terms of burial or cremation, funeral or memorial service. One little laugh together became an important segue: now I knew her final wishes.
Within a few months, the aides were checking in every hour. Several times a day, I had to call them to help clean Mom and change her bedding. There was a commode next to her bed, which she hated. Looking back, I realize how quickly she went from expressing her distaste of that commode to an unawareness of its presence. I wonder if placing the commode nearbyâ€”an object she found undignified and distastefulâ€”in some way hastened her desire to die.
I walked in one morning and found Mom chatting with one of her friends, a neighbor who had dropped by to bring her some breakfast. She had stopped eating several days earlier and we were all working togetherâ€”friends, family, aides, anyoneâ€”to urge her to eat. I was delighted to see that Mom was nibbling on toast and that there was color in her cheeks. â€śYouâ€™re looking better today,â€ť I declared.
â€śYou know, Iâ€™m feeling better,â€ť she responded, with a lilt in her voice I hadnâ€™t heard for months.
I looked at her and smiled. â€śThatâ€™s too bad,â€ť I told her, â€śbecause I need a new car.â€ť
Her friend was shocked, perhaps even offended.
Mom and I shared a laugh. She had mentioned on many occasions how her estate would provide a little financial cushion for me. A few times, after she offered to buy me a new car, which I didnâ€™t need, I told her Iâ€™d wait until she died and splurge on something totally outrageous: low, fast, expensive.
As we became more comfortable with the subject of her death, I asked about her childhood in Manhattan, the acting classes with Lee Strasberg, the camp her father ran where only Yiddish was spoken and where she met my father, and memories of her marriage, motherhood, and her career as a teacher and artist. During these conversations, and often supported by anecdotes that included humor (forced or otherwise), we were able to slide quietly into discussions about our relationship, including the difficult times and wounded feelings; the pain I carried from a childhood passed with little motheringâ€”at least, the affectionate, kisses-smothering kindâ€”and her regrets at not having been a loving, supportive mother throughout my childhood and a good part of my adulthood.
I thought it odd at the time, but I now realize that it was because of the inherent power of humor that we were able not only to laugh together but to use that levity as a way to reveal to each other where our relationship had gone wrong.
Humor softened the anger, opening a door that allowed us to step through and repair some of the damage.
While we could laugh about some things, other areas tested our patience. Mom thought I was bossy and too quick to make decisions for her. I became annoyed with her unwillingness to allow little if any wiggle room for beliefs that diverged from her own. Art, books, philosophyâ€”you name it. But nothing brought out the claws faster than religion.
She was not a wavering atheist whose beliefs might be jarred with one good miracle, but one of those â€śthere is no God, no heaven and no hellâ€ť atheists. In truth, she fit very nicely into that group of â€śdonâ€™t give me that religion crapâ€ť atheists who denigrate anyone who dares to question the existence of a divine presence. As she moved closer to death, an interesting thing began to happen. No, my mother did not discover God. What she did discover, however, was that her belief that she would die and that would be thatâ€”forget heaven, hooking up with old friends, running into your deceased husbandâ€”unsettled her. No second chances to come back and do it right; no reincarnations to be the woman she perhaps wanted to be, which was a risk-taker and adventurer. I saw it in her face when she talked about death. Fear. Finality. Period.
It may have been my recognition of her fear of death that led me to humor, as well as my sometimes inept attempts at jollying her out of the doldrums of dying, but humor became a means to fix our damaged relationship. And then it became an energy that ran between us and allowed us to breach a wall built on more than sixty years of distrust. Humor was our shared gift. For meâ€”and I believe for my mother as wellâ€”humor not only provided a measure of respite from the sheer pain of her illness, but eased the emotional and physical tension that comes with illness and dying.
The day I arrived and found my mother snuggled on her sofa and watching not C-SPAN but a childrenâ€™s cartoon, I knew that she was near the end of her life. â€śWhat are you watching?â€ť I asked, and she responded, her speech labored and her voice low, â€śI have no idea.â€ť
The following week, my sister arrived. Six days after that, Mom died.
Exit Laughing is more than a collection of twenty-four personal stories, written by some of our country’s finest authors, on the subject of death and humor. It’s a reminder that all of us approach death in very different ways. Whether we face our death or the death of a loved one with fear, sorrow, joy, or confusion, and whether or not we believe in an afterlife, we cannot deny that death happens.
Ellen Sussman writes of flying home her mother’s body and watching her mother’s burial wardrobe spill out on the baggage carousel. Kathi Kamen Goldmark regales us with memories of playing the kazoo at Jessica Mitford’s funeral. Broadway and television actor Richard McKenzie shares the riotous story of a funeral procession led by a lost hearse. Bonnie Garvin writes about her parents’ double suicide attempt (and yes, it’s funny!). Joshua Braff recalls a death in an upstairs bedroom during his childhood, Roadrunner cartoons included. L.A. Law star and author Michael Tucker describes his last visit with his dying friend, Cleavon Little, and how they said goodbye. International bestselling novelist Jacquelyn Mitchard writes about her husband’s untimely death, and how his three best friends ended up held in a psychiatric hospital after the wake. These stories, along with seventeen other memorable essays, constitute a book whose purpose is to remind readers that when dealing with illness, dying, and death, there is an important place for laugh-out-loud humor.
Catch Victoria Zackheim and the Exit Laughing contributors on tour! See the full schedule at VictoriaZackheim.com.