A Celebration of Life Leads to a Stroke of Insight

family reunion celebration of life

My family had a celebration of life for my great aunt on August 28, 2017. Irene Couto was a 91-year-old proud Portuguese woman who traveled and lived all around the world.  She painted intricate artwork, preferably on porcelain, and dressed to the nines each and every day, always wanting to put her best face forward. She expected to be the center of attention and this day would be no different.

A Celebration of Life

Family and friends gathered in New Bedford, Massachusetts for a celebration of life and weeks later they would gather again on the west coast. While I appreciated the nostalgia, marveling at black and white pictures from her past, and reveling in stories of her heyday, I would remember this day for a completely different reason.

Gathering Together

My maternal grandmother had throat cancer. She failed chemotherapy and was placed on hospice at the time. For those of you who don’t know, hospice care is intended for people who have less than six months to live. Time may be more or less, but the severity of her illness echoes in that short “h” word.

When she arrived at the church for the memorial service, it was easy to see the loss of her sister had taken its toll. She looked pale with ashy skin. She wore a white blouse and dark pants, not the traditional black some would wear to a ceremony like this. This was supposed to be a celebration of life after all, and black would never do.

My grandmother sat in the pew farthest from the altar with her son by her side. The energy it would take to make it to the front of the church would have been far too great. Other family members were scattered throughout the hallows of the church.

Doctor in the House

After mass, family and friends gathered at my great aunt’s home to eat, talk, and reflect. It makes me smile to think of it. Her house had always been so ornate, filled with decorations and fragile tchotchkes, I had always been afraid to breathe too hard for fear of breaking something or leaving a fingerprint on a spotless glass. Now her home would be so full of people, it was inevitable that someone would bump into something and knock it over.

My cousin Mac, Irene’s son, welcomed people at the door and reached forward to help my grandmother over the threshold. While he had her in his arms, she suddenly slumped and a call went up in the crowd. I had just parked outside and hearing the hullabaloo, I pushed my way through the crowd to my grandmother’s side.

She could not speak and her eyes deviated to one side. Mac struggled to hold her up while I tried to bend her at the waist to seat her in a nearby chair, but her body had gone rigid. I nodded yes when a stranger asked if I needed help. Shaken by the events, I asked that he carry her to the bedroom where I could tend to her behind closed doors.

Stroke in Evolution

My sister followed, my uncle too. With the door closed behind us, with the sound of a celebration of life continuing in the other room, I put on my doctor’s hat. I asked my grandmother to look at me. Her eyes remained fixed to the right. Putting my fingers inside her palm, I asked her to squeeze my hand but got no response. I tried the other hand, the same. Her face was asymmetrical, her left lips drooping down compared to the right. Her heart rate was in a normal rhythm but weak, her breathing shallow. Both sides of her body were stiff as boards. I could not bend her arms or her legs.

“Should we call an ambulance?”

The question was not an easy one to answer under the circumstances. By agreeing to hospice care, she had agreed to “comfort measures only” for her cancer, meaning that she had declined heroic measures to save her life.

What I had first thought was a simple fainting episode appeared to be a stroke. There was no way to know what had caused it. The stress of the day? Her cancer? I had never talked to her directly about her wishes, but I knew she was a strong, proud woman who would not want to live her last days with a decreased quality of life, even if she was in hospice. She would resent every moment of it if there were some way to have prevented her from suffering what she would see as an indignity.

“Yes, please call 911.”

Saying Goodbye

My cousin Anita, my grandmother’s niece, came into the room then. She took my grandmother’s hand in her own, interchanging soothing English words with Portuguese as she spoke. My sister and I looked at each other with tears in our eyes. My uncle Ritchie, my grandmother’s son, looked on helpless. Anita may have been doing the talking but this moment belonged to all of us. I felt like my heart was being sliced in two as it roared in my ears.

The fire department arrived and the paramedics shortly thereafter. While we placed oxygen on her, I relayed the necessary information to them. By this time, my grandmother had started to show signs of improvement. Her right side was no longer so stiff though her left side remained immovable. She could look at me when asked. She could mumble and nod yes and no. A tear streamed down her cheek.

“Grandma, I think we should take you to the hospital to see if we can help you. Is that what you want? Is that okay with you?”

She nodded yes.

I watched the paramedics carry her away in a seated chair through a crowd of her sister’s mourners. I watched them raise her into the ambulance, and I watched the ambulance drive away without a siren or flashing lights.

The celebration of life continued inside. Mac sang a song with his guitar in his mother’s memory.

A Reason to Celebrate

Watching a loved one get sick can be overwhelming, but my grandmother pulled through. The hospital team says she did not have a stroke but she did suffer a “mini-stroke”, also called a transient ischemic attack. This means that she had decreased blood flow in the brain, but her signs and symptoms resolved within 24 hours. There would not be permanent changes to her brain. Even more encouraging, her strength improved so much over the first few hours that she stormed into the hospital hallway to demand she be discharged back to her nursing home.

She was always a feisty one!

A week later, I visited with my grandmother again. She smiled a big even smile, facial droop long gone, and thanked me for coming. She pushed herself up from her seat to give me a hug. The rigidity a distant memory. It was amazing to see her this way, and it humbled me all the more.

“Tanya, I plan to live a lot more years yet.”

Go to the Party

You would think I would be accustomed to loss. As a family doctor, I care for people from the beginning to the end of life. It is what I have been trained to do, but I still struggle with it. I always have. I tend to focus on what more I could have done to ease someone’s discomfort. When loss is more personal, those doubts grip even tighter. Did I visit my grandmother enough? Call enough? Do enough? Did I, did I, did I?

My great aunt had a memorable celebration of life, and my grandmother survived it.

We have to remember to celebrate our lives every day. Too often things are taken for granted. My grandmother remains in hospice, and one day she will pass. I do not want to wonder if there was any more I could have done to make her happy. I want to celebrate her life with her NOW, not when she cannot attend the party.