Return on Investment: A Nurse’s Mother Makes Her Wishes Clear

By Margaret Gallagher, BSN, RN. Margaret is a cardiovascular nurse currently working in Georgia. This is her first post for this blog.

Shortly after I passed my boards, I planned a trip to visit my parents. I got report for my last shift, then walked in on a shouting match. My patient lay comatose between his two adult sons. Awareness of my presence brought a thick silence, followed by the younger son muttering an “excuse me” as he bulldozed his way out. After a pause, the remaining son searched my face as he began to speak.

“The doctors just told us today that Dad’s never going to get better than this. They asked us how far we wanted them to go.” He bit his lip. “I’m the oldest, so it will fall on me. But I don’t know what to tell them. I never heard him say how he felt. Dad never liked to talk about that sort of thing. I don’t know what to do.”

His eyes drifted to his father’s face, then back to mine. He blinked back the tears, “I only know that, no matter what I decide, I will never know if it was the right choice.”

I knew that this would haunt him for the rest of his life. I don’t remember what I told him. I do remember the voice in my head telling me not to ever have to utter those words.

It’s been a quarter century, but I can still see my parents, sitting at the kitchen table that next afternoon. I told them about my patient’s son. I mentioned that I knew they didn’t like to talk about that sort of thing either. I promised I’d never bring it up again if they would just tell me what they would or wouldn’t want if I ever had to be asked.

And they did. My mother’s response was detailed, drawing on her experiences with her own parents. She made it clear that quality, not quantity, was what was important, and she spent about 15 minutes defining what “quality” meant to her. When she finished, both of our heads turned towards my dad. His succinct reply was, “What your mother said.”

I thanked them both. “If you ever change your mind, let me know. Otherwise, I will live to the assumption that what you just told me is to be my guide. You just might want to be sure Susan knows, too, so we are all on the same page.”

I broke half of my promise 25 years later. When the diagnosis came, and Mom and I were alone, I brought it back up. I needed to be sure. I asked if she’d changed her mind.

“No, I haven’t. If I can get better, I’ll do anything. But if I can’t, then let me go.”

I promised her that every decision made from that point forward would be based on what she’d told me. “And if the point comes when you can’t make the decisions,” I added, “I will be your voice.”

It was a long nine months. Multiple tests multiplied bad news. I left my husband in charge of our middle school–age children and moved in with my parents two states away for weeks at a time. The surgery went well, but a spontaneous pneumothorax extended her stay, and a fever meant readmission with IV antibiotics. Six weeks later, the chemo started. She actually started feeling better, except for her infusion days. In the fifth month, my sister braved the snowstorm to host Mom’s surprise 80th birthday party. In the seventh month, we dared hope she might beat the odds. In the eight month, my dad called just before bedtime.

“Is your offer still good?”

“Of course. When do you want me to come?”

“How early can you leave in the morning?”

I moved in for the final five weeks. It progressed quickly, although not fast enough to spare her the indignity of being dependant longer than she would have liked. When she thanked me for helping her, she commented that she hadn’t expected me to be so strong. She reminisced how much courage she’d needed to tend to her father in his last days. I pointed out that a chemistry major doesn’t prepare you like a nursing degree. “Consider this a return on your investment,” I grinned. She joked back that she wished her stocks were doing that well.

Her mind was clear, and she needed no pain medicine until the final 24 hours. She drew her last breath in her own home—and in her own way. Both as daughter and nurse, I find solace in knowing my mother considered her inheritance well spent.