The business of death and life is tough stuff.

Apparently when my mother was admitted to the hospital a week ago today through the emergency room, she had neither an advanced directive nor a health care power of attorney.

 In the absence of both, they've assumed she was a full code status; that is, that she'd want to be fully resuscitated in the event that she had either cardiac or respiratory arrest.

The respiratory status is now a moot point.  I was in Portland in the early morning hours yesterday preparing to fly back to Florida when a younger sister called to tell me Mom had taken a turn for the worse and I should return the hour south to the hospital.

When I did, I learned they'd put Mom on a respirator in the night, 2 o'clock in the morning. . .the same time that I awoke and sat bolt upright in my hotel bed surrounded by fluffy pillows, wondering why I was awake.

This was something Mom told me earlier in the week that she absolutely didn't want.  "I'll rip it out if you do," she threatened.   She called to mind the legend of a great-aunt who'd apparently caused her own death in the hospital by disconnecting herself from a ventilator.  "I don't know if it's a true story or not," she said, "but I'd do the same thing."

Of course, breathing for someone can be a useful therapeutic measure in the short or long term in hospital settings, so it's not always so simple.   In the middle of the night, when a decision needed to be made, my sister made the most informed and responsible choice she thought she could based on different experiences with Mom, different facts.

I was just surprised to see it, not prepared for it.

In hindsight, we should have gotten Mom to express her wishes a couple of days ago when she actually had some ability, albeit limited, to speak and sign a paper--not particularly easily done, but she was writing on a piece of paper attached to a clipboard two days ago, little scrawls, and wasn't sedated then, wasn't totally out of commission in spite of the fact that she was on a BiPap machine and it was complicated to understand her.

So yesterday morning, the nurse in charge of her care for the day informed us we needed to decide as a family what Mom's code status would be.

Tough stuff.

*******

When my husband was in the hospital, it was easier.  He was a full resuscitate, and we had discussed it earlier, had all the appropriate paperwork in place before his surgery.  

When he arrested on the second day, he was intubated and given very aggressive medical treatment.

Eight months later we took him home.

*******

My siblings all gathered in Oregon earlier this week, on Tuesday, on the day Mom thought she wasn't going to make it and insisted I get them all there.  A brother drove down from Seattle.  Two sisters flew in late that night together from Utah.  I was there already from Florida several days earlier, and two sisters live here in Oregon.  

We all got here, one way or the other.

My brother had left already to celebrate a twenty-fifth wedding anniversary in Las Vegas for the weekend when the nurse said we needed to have a family meeting yesterday.

As oldest in the family, I assumed responsibility and began calling each of my siblings individually to inform them.  My brother agreed to join us by telephone when we met.

Tough stuff. 

*******

We sequestered ourselves into a small conference room, with my brother joining us on speakerphone.  As firstborn, I began speaking first and explained how we would proceed--in birth order, with my brother (next-oldest) first, then each of my sisters in turn, then I would speak last.

There were lots of tears, some hugs, the occasional laugh, mostly tears, appreciation for a mother's life, and a prayer.

*******

My mother is still on a respirator in an ICU somewhere in Oregon this morning, holding her own, trying to get better.

*******

I need to put my affairs in order.