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facts & arguments

Weeks before her move to a granny suite in our new home, my 86-year-old mother got out of bed to fetch her morning paper, bent down at her door, fell and broke her shoulder against the floor. That was to be her last independent act.Neal Cresswell/The Globe and Mail

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Weeks before her move to a granny suite in our new home, my 86-year-old mother got out of bed to fetch her morning paper, bent down at her door, fell and broke her shoulder against the floor. That was to be her last independent act.

It's not that there weren't warning signs. Weeks before, while waiting for her to finish dressing so we could head to the doctor's, I heard her fall against the bedroom wall. She landed on plush carpet, luckily. Her first words were, "It's vital that I get up." She didn't want her Lifeline button to trigger a 911 response. Ironically, she felt too faint that day for us to make the appointment about her dizzy spells.

So, my mother had fallen again. Racing there, I mulled over the usual dilemmas. Should I have called 911 right away? What if they arrived before me and carted her off to a hospital far from her specialists? But what if I arrived to find her passed out, or worse?

I was all too familiar with emergency-ward routines. This time, Mom's broken bone meant quicker admission, but I'd spent long hours waiting in hallways while she dozed on a gurney. Paramedics would wait, too, until a bed was freed. Sometimes, a shift change would occur, and new paramedics would come. Sometimes, they grumbled: It was the lack of staff; it was too many elderly patients; or it was the rehab hospitals that wouldn't rehydrate their own aged patients, shipping them back to hospitals instead.

I feared the hospital might patch Mom up and release her without getting at the cause of her falls. If elderly people don't have an advocate – a pesky son – or someone to provide a baseline on their health, they can end up warehoused. In fact, a year before, Mom had been hospitalized with stroke symptoms, no longer able to use a phone, eating with her hands and scoring abysmally on cognitive tests. They said she needed 24-hour care. I asked my brother to fly in. I gave away her cat.

But I also stalled, unsatisfied that no one had found a cause. The next week? My mother told it best: "The doctor's jaw dropped this morning – 'You're reading?!'" Mom had begun a novel. Treatable epilepsy was the diagnosis, and she would enjoy living in her condo, albeit catless, for another year.

The months in rehab for her broken shoulder were happier, with pleasant grounds, relaxed staff and bright facilities. Specialists were helping her with balance and strength. But she didn't get better; if anything, the time spent off her feet was contributing to her decline. Her kidney function worsened, dehydration set in. And rehabs don't rehydrate their patients.

Suddenly, I was in a room with a doctor and a ward manager talking about palliative care. How did we get here, I wondered, when a week ago Mom's discharge was in the works?

I wanted a diagnosis, so we returned to the hospital we'd left four months earlier. Answers came. Her symptoms were the result of her body's inability to process her anti-epileptic drug. Then more bad news: congestive heart failure, and her kidneys couldn't handle the meds for that. Also, she had trouble swallowing. A kind resident was left to deliver the news.

What followed was an eye-opening view of the ethics of living when dying is at hand. I asked for a feeding tube so Mom could survive. I hoped she'd bounce back. Indeed, she returned to herself, wry and witty, if weak of limb and still unable to eat.

The hospital wanted a do-not-resuscitate note in her file, and doctors were graphic about the trauma if she were revived: Her ribs would break; she would be burned by the electroshock paddles. Another said she must be terribly uncomfortable with the feeding tube. She said it was just fine. But it was only weeks before doctors recommended it be removed.

"That would be death," my mother said. The doctors said that being without food would neither hasten nor prolong her death. I had a hard time believing that.

The lowest point came when I found her fallen over in bed, her head wedged, more upside down than not, against the bed rail. "I've been like this all day," she said. "You got me into this; you get me out."

I hired 24-hour private care. Mom did make it home, lasting 10 days. She rallied a little, and one day even began to drink tea and eat toast. The morning of her last day, her breathing had changed, rasping and thin. Time for the meds I'd been given, including morphine. I don't know if she heard me at all in those last hours.

In the weeks after, I puzzled over the strange arc of her journey. Why had no one caught the heart condition in all those months of hospital and rehab? I can't say Mom was a victim of neglect; many tried to be helpful. But the sense was of a collective throwing-up of hands.

Over the years attending to Mom's health, I was always being persuaded to go in one direction – toward discharge, toward the nursing home, toward palliative care, toward an end that freed up a hospital bed. I worry about what's in store for those without pesky sons; in store for me. Maybe for you, too.

Brian Wickers lives in Ajax, Ont.