Holding Hands with an Angel
© Copyright 2021 by Christine Marcotte
I retired I volunteered as a guardian for adults who could not make
decisions for themselves, had no family to do so, and thus were
appointed a guardian by the district court. I was Mary's guardian for
about six years ~ until her unexcepted death. It took me
another six years before I felt I could write about my experiences
Friday ~ Saturday
The Pines Nursing Home called as I started supper. Mary had fallen, and the ambulance was taking her to the emergency room. I turned off the stove and drove to the hospital, not knowing what to expect. Two days earlier Mary and I spent a fun six hours together as she had the final adjustments made to her new hearing aids.
Mary came into my life many years ago when a judge appointed me to be her legal guardian. From the moment she put her soft hand in mine, she became another grandmother.
Anyone who took the time to get to know her knew Mary was a gem. Born with an enlarged tongue, Mary was difficult to understand. That, along with profound hearing loss from an illness as a toddler, caused teachers to believe she had a low IQ. Her mother died in 1940, when Mary was six years old. She and her siblings went into foster homes and seldom saw one another.
After the seventh grade, they kept Mary at home, helping her foster mother. A few years later, she became pregnant, the result of a sexual assault. Mary wasn’t allowed to keep her daughter, and the doctors sterilized her without her consent. Then the county sent her two hundred miles away to a sheltered workshop. Mary gradually shared her story with me. I marveled at her resiliency and her ability to keep resentment from impacting her life.
Once in the emergency room, I showed that I was Mary’s guardian and rushed to her side. Mary’s eyes, wild with fear, scared me. She grabbed my hand and wouldn’t let go. I did my best to reassure her, though I had no clear understanding myself. Her speech was more garbled than usual. I answered questions about Mary as best I could. The doctor wanted her to go to a hospital seventy-five miles away. Reluctantly, I freed my hand from Mary’s, hugged her, and assured her I would follow close behind. I called the nursing home to inform them of the transfer and asked that they explain the situation to Jim, her husband.
In some ways, Mary and Jim were such an unlikely pair, and in other ways, they complemented one another. She read letters to Jim from his brother. Jim loved to sing old songs to her. He was the social one which suited Mary just fine. They met in a state-run program, married, and beat the odds by staying together for over forty years. They lived in a small apartment, took the bus to their jobs, and were delighted by small things. Mary washed dishes in the Northwestern Bell lunchroom, and Jim wrapped napkins around utensils at the airport. In the evening they cooked supper together and watched television. When Mary and Jim retired, they moved to northern Minnesota, where they grew up. Mary went to The Pines with Jim when his diabetes and dementia confined him to a wheelchair, rather than live without him. By then, caring for Jim was her world. And now Mary was a part of mine. I was so glad I had decided to go to her at the hospital, and on to Duluth.
It was dark and a bit scary when I was admitted through the only after-hours entrance of St. Mary’s. In the emergency room, they ushered me behind the curtain where Mary lay unconscious. Tears filled my eyes. I stroked her hand and listened to the doctor. Mary’s blood pressure dropped during the ambulance ride and they wanted to admit her into intensive care.
Long after midnight, I curled around cushions on the floor of the ICU waiting room. Exhausted as I was, I couldn’t sleep.
The next thirty-six hours were a blur. They allowed me very brief visits with Mary, though her eyes never opened. Saturday afternoon, they performed emergency surgery to remove an obstruction. I didn't leave the building. I ate in the cafeteria and slept on the floor a second night. I made calls to The Pines so Jim would know of his wife’s condition.
When I first met Mary, it didn’t take long to realize there was more to her than what was on paper. She loved to read, even the same lengthy novels I enjoyed. Mary liked me to attend her care conferences, so I always did. Her health was stable, and her needs were few. When asked by the nurse, “if your heart stops, do you want to be saved?” Mary was adamant that she wanted nothing done to prolong her life. She always resisted the activity staff's goal for her to socialize more. She’d say, “My books,” and then looking to me, “and my angel Chris are enough.” Mary might have thought I was her angel, but she is mine.
In the morning, Mary was still in ICU, though her condition was stable. For the first time since Friday night, I went outside. I walked for an hour, breathing in the smell of Lake Superior and shuffling through the autumn leaves. I called my husband and told him the worst was past.
Not long after I returned to my corner outside of ICU, Mary’s breathing became quite labored. The doctors wanted permission to intubate. I sat beside Mary as I processed this crucial decision. The crisis wasn’t Mary’s heart, but her lungs. How close was it to the same in her mind? What did Mary want?
I held her hand and described what the doctors intended to do. I told her Jim couldn’t come to her, but she could return to him if the procedure was done. If it weren't for the soft squeeze in response to my questions, I would have honored Mary’s request to have nothing done to sustain her life. I believed she wanted to see Jim.
While they did the procedure, I tried to read a magazine but couldn’t concentrate. An idyllic print of an angel caught my eye, and I smiled. It reminded me that Mary had a book she wanted me to read, something with angel in the title.
Mary's color returned, and she seemed more at peace. So was I. By late afternoon I decided to go home for the night. My mom, in town for a high school reunion, hoped to see me. I realized time with my mom would be a welcome break. I stopped at home for a shower and my backpack. I included a couple books with my clothes as I expected I'd return to the hospital.
Only a month ago, Mary and I had gone to the library book sale. Her eyes were as bright as a child’s on their first trip to the library by the endless tables of books. On the last afternoon, the price dropped to three dollars a bag, and Mary filled hers to the top. Although we sometimes read the same books, she leaned toward romances where the girl and guy always found each other. I preferred more complicated plot twists.
The first Christmas I shared with Mary, it was clear she and Jim didn’t have many family members who kept in contact. The couple received only five Christmas cards. Jim enjoyed the activities offered at The Pines, but it was difficult for Mary to make friends. I decided I would step outside my role as an advocate. My grandmother no longer lived nearby, and I loved the companionship of taking Mary on outings. Both my grandmother and Mary liked to hold my hand, which always made me smile. Sometimes Mary and I would walk to a bench near the river. Other times we'd go to a greenhouse or Walgreens. She liked the small stores where she didn’t need to make many choices. Most adventures included a meal out at Dairy Queen, her restaurant of choice. A cheap date, I'd tell her.
After the hospital food, dinner with my mom was lovely. I drifted in and out of the conversation. Thoughts of Mary never left my mind. I already felt like I should be back in the ICU. Mom understood the challenges I faced in the last couple of days and was proud of me for ensuring Mary was getting excellent care. I had a good cry and was glad I had Mom to comfort me.
My phone rang after 11 p.m. A different doctor attending to Mary wanted to remove the intubation tube. He said it wasn’t working right because of her enlarged tongue. Another monumental decision. Once he removed the tube, Mary might quit breathing and die.
The doctor gave me ten minutes to decide.
If Mary quit breathing, I didn’t want her to be alone. I was exhausted and one hundred miles away.
I wanted to delay the procedure until morning when I would be there. The doctor wasn’t pleased with my decision.
Restless as my sleep was, it allowed my mind to consider options. If Mary were able to tolerate oxygen but the prognosis was not favorable, I wondered about getting her back to The Pines. I left a message for Becky, her social worker, glad that it was finally a workday.
The ICU team was ready when I arrived. I wrapped my fingers around Mary’s and explained that I wanted to take her back to Jim, and by removing the tube, she could leave the hospital. I felt she understood it was now up to her.
I asked about hospice and learned of the Palliative Care Wing in the hospital. Mary was on oxygen, but the prognosis was that she would not regain consciousness. For Mary’s comfort, I requested a referral for palliative care. Between Becky, me, and a diligent palliative care nurse, Mary was transferred by the end of the day. She looked so small and was ghostly pale when they wheeled her away.
Mary liked to wear bright colors. Twice a year, I'd take her to a thrift shop in a nearby town. We'd start the day with breakfast and finish with a chocolate malt. Mary had short legs, and fall was the best time to buy pants. The summer capris on clearance fit like they were tailor made for her. In the spring, Mary looked for colorful sweatshirts to wear in the gloomy winter months. A pink fuzzy angora sweater was a prize she cherished and wore for an annual Christmas photo I took of her and Jim.
If Mary could, she would have sighed in relief that we were in the Palliative Care wing. It was quiet and much slower paced than the hectic ICU. Mary had a room with a pull-out couch for me. The cafeteria provided meals, and there were plenty of pillows and blankets. Some heaviness in my shoulders dissipated. I spoke with Becky for the third or fourth time that day. She appreciated my diligence and arranged for Mary’s transport back to The Pines the following afternoon. I hoped for Jim’s sake Mary would live through the night. As darkness fell, I lay on the couch listening for any lengthy pause in Mary’s erratic breathing. I thought of what I needed to do before she died. Through an earlier guardianship, I learned that any money in a resident’s nursing home account was unattainable upon their death. If I made a request on Mary’s behalf, I would have a little money to use for a memorial service.
Mary was still alive, and I had slept. Hot coffee and breakfast delivered from the cafeteria were a welcome sight. I made a few lists and a lot of phone calls. Our local hospice would provide Mary with end-of-life care. The chaplain, I knew, would also help me provide a funeral service. Becky and I discussed Mary’s desire for a burial, and the county’s policy of cremation for indigent individuals. Mary fell into the latter category, but a call to the mortuary revealed that she and Jim had a limited pre-paid arrangement. With funds Becky had access to, a discount from the mortician, and a reduced fee from the cemetery, we had enough to cover a burial—as long as we withdrew the money while Mary was alive.
I paced the floor, eager for the call that the medical transport had arrived. Mary seemed comfortable. I talked to her and thought a lot about my grandmother who had died two years earlier. They both loved You are my Sunshine, so I sang in my off-key voice. The late afternoon sun highlighted the crimson and russet leaves, which tumbled from the trees outside Mary’s room. If she could, she’d want to walk to a park and watch them fall.
Mary loved the holidays and put out decorations for the next as soon as one was over. Halloween was the season kick-off. One year my nieces helped. They were both taller than Mary and hung a few scary posters for her. Another year we had a birthday party for Mary. She relished the chance to be with children and loved that I shared my family with her.
Finally, the call came. Palliative Care transferred Mary from her bed to a gurney in the van. I left the building where I spent the better part of four long days. I expected I would get to the nursing home ahead of Mary until I saw a van marked as medical transport pass me. The driver appeared aware of the urgency because he soon was well out of my sight. I tried not to get concerned about his speeding and instead watched my own.
The nursing home staff agreed it was better for Jim that Mary was in a room other than the one they shared. Becky met me at the door, concerned for my state of mind. I assured her I was fine now that Mary was home. I was thankful Becky and others would also be with us. Mary had a room at the end of a quiet hall. When they got her back on oxygen, and she looked comfortable, Jim came in. We got him close enough to take her hand. “My Mary, my Mary,” he repeated. He asked me if she was going to be all right. I shook my head and explained that she was not. I told him there was nothing the doctors could do, and that she was going to die. The big man whispered, “I love you, Mary,” with tears rolling down his cheeks. Jim had several brief visits with Mary that day and the next. His message to her never changed, his words were from his heart. Bringing Mary home was the best decision I had made on her behalf.
Towards the end of the day, the hospice nurse arrived to finish the paperwork and review Mary’s status. She adjusted the oxygen levels and medication to be administered for comfort and provided the nurse on duty with directions for continued dosage. I spent the night in Mary’s room, though I’m not sure if I slept at all. The events of the last six days whirled with thoughts of how to honor Mary’s life.
I awoke to the footfalls of the hospice nurse. She gave me a hug and a cup of coffee. Mary’s breaths were shallow, and the nurse’s assessment was that Mary would die before nightfall. After breakfast, Jim came for a quick visit. We encouraged him to say he loved Mary, which he did between sobs. I worried about how he would cope with her death. Becky and I sat on either side of her bed. I stroked Mary’s hand until her breaths stopped. I stayed beside her while waiting for the funeral director to arrive. It was hard for me to focus on much of anything for the rest of the day. When I fell asleep, it was for twelve uninterrupted hours.
Mary’s memorial service, attended by residents, staff and some distant family, was held in The Pines’ chapel. Jim helped me choose photographs, which we arranged on two large displays. I wrapped Mary’s romance novels in pink tissue paper and affixed a label saying something about “on a difficult day, escape in a book,” in memory of Mary. We chose silk flowers so that Jim could keep a large bouquet beside her photograph, and I could keep a small one.
It has taken me six years to feel that I could look back on the challenges of that exhausting week with a critical eye. Since the day I allowed intubation, I have wondered if it was what Mary wanted. I couldn't find an answer by looking into her eyes, they were closed. And I wasn't sure if Mary had squeezed my hand in agreement, or if it was my pulse.
Now I believe that Mary would say I made the right choice, the one she conveyed to me. Mary returned to the place she called home. She was there so Jim could hold her hand. She was there, so her husband of four decades could say he loved her one last time. Being able to bring Mary home was one of the best decisions I have made in my life. Another was becoming Mary’s guardian. It gave me the chance to hold hands with an angel.