‘It’s enough now’

My mother died quietly on 29 March. She was 91. On the morning that she died, my husband and I sat with her in her bedroom. Unconscious, she already seemed far away but occasionally her eyebrows flickered and I wondered if she would open her eyes. We talked about this and that and talked to her, told her we were here, that we loved her, and held her hand. A sunny day. Spring coming. I opened the window a little and a breeze ruffled through. I held her hand and kissed her. The bruise on her forehead from a recent fall had almost healed but not the stubborn wound on her leg. I spoke to the dog who lay curled up, downcast, on the sofa, knowing something was different. Time passed. We waited. Her breathing, which had been light and quick, began to slow and labour, then picked up, then slowed. There was a moment when she cleared her throat, in the way she always would when she was about to speak after a silence. I was sure she was going to say something, but she didn’t.

Her death certificate gives the cause of death as ‘frailty of old age’. There was no obvious terminal diagnosis. She had suffered from arthritis for a long time which had eroded her mobility. A year earlier she had slipped and cracked her femur, which meant a hip replacement, a month in hospital, recuperative physio, returning home at last to a hospital bed, carers four times a day, and the indignity, as she felt it, of a commode. Over the next few months there was a temporary triumph over much of this. She made it back to the loo, to the kitchen, to one carer twice a day. She read and re-read a pile of novels. We had DVD film seasons: Hitchcock, Powell and Pressburger. My husband and I lived with her, partly together, partly alternately, as we juggled work, exhaustion and the dog. Friends visited. Her grandson went to see her. We were lucky: lucky that she had a nice flat and a large bedroom, lucky that she had enough money for it not to be a (constant) anxiety.

But over this period, she would say, simply and unmelodramatically, to anyone she knew well, that she wanted to die: ‘I’ve had enough’; ‘I’ve had a good life’; ‘It’s enough now.’ We watched the first Commons debate on the Assisted Dying Bill introduced by Kim Leadbeater last October. It was a strange experience. And even though the bill in its current form didn’t apply to my mother and she knew it, it allowed me to say uncomplicatedly that I knew what she wanted, that I thought she should have the right to die, and that I would probably want the same thing in the same circumstances.

Years ago, when my father was in hospital for the last time, I snapped at the consultant who spoke to me about treatment plans, ignoring the man in the bed. Realising his mistake (but not without making another one, ‘oh does he speak English?’), he bounced up the bedside to pat my dad on the shoulder. ‘Don’t worry, we’ll soon have you home,’ he said in his most reassuring manner. My dad shook him off.

My mum became weaker, moving became ever more painful, her limited horizon contracted, everything became more difficult. Then came a chest infection, which was cured with antibiotics but left her more fragile. And then another fall, knocking her head, blood everywhere (she was on blood thinners), another trip to the hospital where she spent an agonising night in A&E being scanned for breaks and a day waiting for an ambulance to bring her home, with a wound on her leg that would never heal. She became frighteningly thin, despite the avocados and cheese she loved. I watched her late life pleasures further eroded. I watched her life reduced to waiting for carers, waiting while I waited to hear back from the doctor or the palliative care team. Waiting for the nurses who came to dress and bandage her leg, waiting to die.

I say that that she died quietly, but she suffered the most terrible pain in her final weeks, screaming when the carers moved her or when I adjusted the pillows ever so slightly. She suffered dreadfully and we suffered too. So now I am dealing with the ordinary matter of grief, discovering that it’s many things and messy. The other day I nearly broke down when I nearly reached for the rice pudding she liked in the supermarket. I am racked by the fact that I didn’t reorder her favourite lavender scent in time. I have wrapped her favourite shawl, the shawl I wrapped around her just after she died, on my pillow.

Earlier this week I listened to a member of the Royal College of Psychiatrists on the Today programme, outlining their reasons for not backing the End of Life Bill:

When someone has a terminal illness, they may well develop a depression, a mental disorder, and that may lead to feeling suicidal. But actually, if you treat the depression, that suicidality might lift.

‘A’ depression, ‘a’ mental disorder, ‘suicidality’: a language of objects and concepts, almost as if the person who should be at the centre of it all has been forgotten.

My 91-year-old mother did not have a terminal diagnosis, though she was in a great deal of pain. She wasn’t suicidal. She just wanted to die. And to her and to me, her position was both reasoned and reasonable. It didn’t represent anyone’s failure, certainly not her own.

The registrar on the radio raised the very real issue of resources: not enough psychiatrists, not enough anything. True, of course. But the right to die and proper resourcing should not be alternatives.

In acute pain, her horizons terribly narrowed, dependent on others for nearly everything, all independence lost and unrestorable: this was what my mother didn’t want. But this was what she got. I will never forget that clearing of her throat, as if she was about to say something.