Four Horsemen

Pneumonia rode a white horse on the sea breeze from the harbor, across the terrace into the bedroom; it reared its head and threw off its bridle, which my mother Mary now wears connected to an oxygen tank; she is a respiratory cripple.

My mother Mary is 86 and has been living by herself, since dad died three years ago. She has been lonely and would "look for him in his bedroom in the middle of the night." In spite of my shopping for groceries for her every week, she was not eating very much (except when I had lunch with her) and lost weight. She preferred to live alone. My family and I live in New Jersey, while she lives in Connecticut. She wanted to live in her apartment in Greenwich, Connecticut, which has a beautiful view of the harbor leading out into Long Island sound.

This was a woman who had a basketball scholarship to Rider College; she had good endurance. When she was 22 her first job was in Washington, DC as an assistant to a Congressman from Rhode Island. All her friends smoked; it was fashionable. She drank coffee while having a cigarette and smoked 2-3 packs per day for 60 years.

When I was called that she had fallen and could not get up I called 911. She was smoking a cigarette when the paramedics arrived-they couldn't believe it, because her oxygen saturation on room air was 45 (half what it should have been).She spent two weeks in ICU recovering from pneumonia. She was nearly intubated twice; I told the resident I wanted everything done. Miraculously, she survived, started eating, was forced to stop smoking and was sent to a rehabilitation facility on the nicotine patch and oxygen. She was very weak and could barely lift 2.5 pound weights. When she was stable enough to be in the step down unit she said to me "what is the bottom line of all this?" I replied: "You're still alive."

Osteoporosis rode a red horse, which looking askance with its oval eyes, shied as she tried to get out of bed, causing her to fall-breaking her hip. She had a successful partial hip replacement done under spinal anesthesia.

When she was 20 (1942) she was 5' 4" and looked like Barbara Stanwyck in modeling pictures in her portfolio. I remember her perfect posture as she sat by the Christmas tree covered with pink angel hair (every year the tree was a different color) and my dad taking 8 mm pictures of her. Inexorably, her vertebrae were fractured into a Dowager's hump.

Her silver hair is neatly pulled into a ponytail by June, a Jamaican caretaker. She is lying in a hospital bed in her apartment; she wears Depends. When asked "how do you feel"? Mary always replies "fair." No complaints, she says she has no pain, although the tell tale grimace and "can you take off my boot" gives her away.

These uninvited guests came to my mother's apartment in the past nine months. They were allowed in by smoking. She always said "smoking is good for you." Twenty years ago when I brought her the nicotine patch she said "everyone knows those cause heart attacks." She never opened the box. Ironically, after she was weaned off the patch and can no longer smoke she "doesn't miss them." A bonus- her personality is much nicer now that she is no longer anaerobic.

I arranged hospice care for pain control; She is on Oxycontin® every 4 hours as needed. I made an appointment with a vascular surgeon, who confirmed what I already knew.

Gangrene rode a black horse that relentlessly invaded her heel after she developed a pressure ulcer the size of a quarter. A grim reminder was its hoofprint of exposed calcaneus and dead, rotting tissue on the sides of her toes. I had a heart-to-heart talk with her Christmas day and told her my family and I all want her to live and surgery is the only option; she told me she wants to live, too. I brought her into the hospital for intravenous antibiotics and a blood transfusion pre-operatively. She nearly changed her mind, but I (and the infectious diseases consultant) told her "this is life, or death." She had the operation on 12/29 and is doing well.

Over the years, there have been other visitors-severe periodontitis. She called on a Saturday, in the summer, after I had finished mowing the lawn and said "you'll never guess what happened." She told me one of her front teeth fell out as she was getting dressed to go to a banquet where Frank Sinatra was performing. A quick fix by a nearby dentist got her through the night; while an oral surgeon and seven titanium implants drilled in her upper jaw got her through the last ten years of her life. Also, cataracts- requiring a bigger incision, the one hour "old operation," instead of the "new, 15 minute operation" and a longer recovery time, since the vitreous humor had been stirred up. She was so upset with me many years age when I quoted a Medical Letter that said smoking is linked to wrinkles that she got up and left the dinner table. "Man plans und Gott lacht,"-i.e., when man makes plans God laughs.

I heard her neighbor tell another neighbor "you know, some people you just can't kill," but Death is slowly riding a pale green horse towards her.