Is Love Letting Go?

Like many others, COVID kept me from seeing my mother for two and a half years. Before the pandemic, despite having lived in the U.S. for over 25 years, I was able to visit her frequently, thanks to my business trips to India. In her mid-80s, she lived alone in an apartment on the outskirts of New Delhi, not far from my brother’s home. We talked regularly but I could sense her growing loneliness.

I was finally able to plan a trip to see my mother after COVID subsided towards the end of 2022. I was pretty excited when I boarded the flight, thinking about the time we would spend together. However, things had taken a very different turn even before I touched down after the 14-hour non-stop flight. I received messages from both my older brothers informing me that my mother was being taken to the hospital for an orthopedic checkup because she had a fall. I didn’t think much of it. In fact, I felt it was good that she’s getting medical attention which had been ignored for some time. By the time I got home from the airport a few hours later, I learned that she was admitted in the ICU for a host of medical reasons other than orthopedic. I couldn’t even see her right away because the next ICU visitation was a few hours later in the afternoon.

My oldest brother had already flown in from Mumbai and was waiting for me at my mother’s home. We were happy to see each other but were in a grim mood all afternoon given the situation. The ICU hours were between 4pm to 5pm. Jet lagged and laying down in my mother’s bed, I kept looking at the big wall clock. I felt, the minute handle couldn’t have moved slower.??

Finally, it was getting closer to 4 pm. Both my brother and I arrived at the hospital a few minutes early. I was a bit overwhelmed by the chaos outside the ICU hall. There were way too many people clamoring to get inside and meet their loved ones. Some were crying and a couple of them were praying in front of a small temple-like section set up near the entrance door of the ICU. A security guard tried to maintain semblance as he read out the ICU rules loudly and repeatedly in Hindi: “One family member at a given time and for 5 minutes only!”

My brother asked me to go inside the ICU first. As I walked to her bed number 9, which was at the farthest corner of a big open hall, I walked past other patients in dire conditions. I felt my heartbeat go up as I approached her. I couldn’t believe what I saw. She was unconscious, lying in hospital clothes. Her face was almost entirely covered by ventilators and multiple tubes were running through her nose and hands. I tried taking her hand in my hand only to realize that they were tied to the bed. I tried talking to her, but she barely opened her eyes once and was not able to recognize me. Those five minutes could not have gone faster. I lowered myself closer to her ears and told her she will get well soon. I had a quick word with the attending doctor on my way out and found that she had been diagnosed with sepsis and put on a heavy dose of medication.?I took down the names of the medication.

Over dinner, my brother and I talked about the situation and possible scenarios, discussing various options for our mother’s care after she would come back from the hospital. My mind was a whirlwind that first night and I stayed awake, mostly staring at the ceiling and the wall clock, while a bunch of stray dogs on the streets barked nonstop. This time both the minute and hour handles of the clock appeared to be moving even slower than the afternoon. I wished for magic to happen overnight before our next ICU visit at 10 am.

ICU visits at 10 am and 4 pm was starting to become a daily ritual. Both my brothers, my sister-in-law and I would walk together to the hospital, spend a few minutes at the ICU and walk back. In both the visits I would carry a piece of paper and pen to write down her vitals and other details to understand the trajectory and efficacy of the treatment which I discussed with my doctor friends and my wife who gave me a lot of strength and clarity every day.?

A miracle did happen on the morning of Day 4! My mother opened her eyes and recognized me. She was visibly happy to see me and tried to smile a little through her ventilator and nodded her head when I told her again that she will get better. The visit that evening was even better…she had started talking a little, even though her diction was muffled. My oldest brother and I went out for dinner to celebrate and relax a little.

By then, I had made friends with the security guard who offered that I could stay longer in the ICU with my mother. As usual, we walked to the hospital in the morning. Expecting more improvements overnight, I was excited to stay longer with my mother. As I approached bed Number 9, I saw some commotion of doctors and nurses around there. I knew the patient in bed Number 8 was very sick and thought maybe it was for him. I soon realized this was for my mother. Her situation had worsened, she was back on the big ventilator. I was updated on the situation and asked to come back for a meeting at 11 am together with my brothers.

We went back to the hospital. I was getting nervous by the minute but kept trying to put up a brave front. The attending surgeon sat us down in a small room inside the ICU. After introductions and establishing his authority, he said surgery is the only path forward. Even though he was concerned about her age and medical condition, he sounded optimistic. We signed a bunch of papers giving our consent for surgery.???

My mom was taken to the operation room as I waited outside by myself remembering my deceased dad. I sent my eldest brother home to get lunch. My eyes were fixated on the operation room door waiting for the surgeon to come out. All kinds of questions were racing through my mind. What if my mom cannot handle the surgery? What if she dies? Will she be able to lead a normal life if she survives??

The next two days were the toughest days in my life. We kept up our routine of visiting her twice a day, but she wouldn’t open her eyes at all. She was back on a ventilator and heavy medication. By now she had developed a severe form of bed sore which looked bad, but that was a secondary problem. I kept postponing my return flight ticket not knowing what to expect, and when I would be able to go home.

Generally, after the evening ICU visits, my eldest brother and I just sat at home, talked a little, ate something. Mostly they were quiet evenings, but that evening was different. It was the festival of Diwali.?Homes and streets came alive with countless lamps and decorative electric lights. Fireworks illuminated the skies, and the air was filled with the sweet aroma of traditional Indian sweets and the sound of joyous laughter and celebrations. Everyone around us wore colorful clothes and decked their entry doors. Standing outside on the balcony amidst the crackling and booming firecracker sound, I was very quiet within. We had decided not to celebrate the festival, but my brother and I thought it'd be good to light some candles around the house. My brother and I went around the house and lit a few candles. As we finished, we hugged each other and cried on each other’s shoulders. My mom’s neighbor had kindly invited us to join them for dinner that evening, but we were not in the mood. It was very sweet of them to bring us the festive food. I thought of all the amazing food my mom used to prepare for the festival.

The day after Diwali, we glimpsed a glimmer of light. I found my mom wide awake in bed. She looked exhausted but I was overjoyed to see her eyes open. She stared at me for a minute, her eyes searching, like they were in a fog. When she finally recognized me, she gave me the biggest smile. A picture of my daughter as an infant giving me a big smile flashed back at that moment.

The next day was a bit mixed. Her condition vacillated between being stable and unstable. She didn’t look good. The doctors put her back on the ventilators and medications and her bed sore had worsened. I had a harder time sleeping that night. I was back to thinking about potential?scenarios. Seeing her suffer for so long was getting to be unbearable. She had been on the ventilator several times now and I was beginning to be not in favor of making her suffer more. I also had sensed that the hospital didn’t have her best interests in mind. In fact, keeping her “alive” felt like more of a business decision. They billed a hefty one lakh rupees per day to keep her in bed Number 9. I thought about talking to my older brothers and sisters-in-law about the likelihood that we might be faced with the choice we needed to make between keeping her alive in that condition or letting her go.?

My mind was a whirlwind at that time. I was acutely aware of how difficult it is to discuss death with anyone, especially family members. It’s one thing to accept it once a death has occurred but it’s quite another to talk about the death of a person who’s living or has not been medically declared dead. It becomes far more complex and emotionally charged when the person is even somewhat alive and trying hard to survive. And when that person happens to be your mother, and a decision needs to be made that includes siblings or other relatives, it’s even more tricky.?

I thought about three questions that would guide my conversation: First, what's the decision my mom would make if she was in a condition to decide for herself? Second, what kind of life would she have even if she survives her third time on a ventilator in less than two weeks? Third, are we acting in her best interest or are we simply taking care of our emotions while she is suffering?

I had sprinkled my thoughts with my eldest brother on a couple of occasions but nothing in definitive terms. The next morning, I gathered the courage to speak with my brothers about not pursuing another surgery and allowing our mother to come off the ventilator. They listened and were mostly quiet. It felt like there was agreement in their silence.?We reached the hospital a little before 10 am, as usual. My mom was still in an unconscious state, breathing with difficulty despite the oxygen support. I looked at her and spoke with the nurse about her vitals. As we were leaving, we were told that the medical board wanted to meet with all of us at 11 am.

We went back into the hospital. We were seated in a same small room located inside the ICU. A couple of grim-faced doctors and surgeons entered the room. They said the sepsis hadn’t subsided and they could do another surgery. Even though we had not planned it, somehow, I – the youngest of the three siblings – assumed the role of family spokesperson. I looked at every doctor present in the meeting and told them: First, we would like to thank all of you and the staff for taking care of our mother. Second, we’ve had the chance to talk as a family and collectively we think there shouldn’t be any more surgery. Third, we don't want her to continue to be on a ventilator if there’s no chance of our mom breathing on her own. I looked at the head of medicine in the eye and said, “the rest, you know better what to do next doctor.”?

I recall my body shaking after I stopped talking. An awkward pin drop silence had descended in the room. Our eyes were fixated on the doctors. The doctors looked at each other but didn’t talk. The head of medicine began to speak slowly. “We understand what you’re saying. We get it. We’ll give your mom compassionate care.” He told the junior doctor that my family should be allowed to come to the ICU any time we wanted.??

I got out of the meeting room, tears flowing down. I went to my mother’s bed and held her hands. I lowered myself and gazed at her face for a couple of minutes and gave her a kiss on her forehead. I brought myself close to her ears and said, “Mummy you should go, you should go.”