Why you should care
Because no child should ever have to do this to their mom.
The author wishes to remain anonymous to protect the identities of his parents.
Everyone has a limit. Mom breached hers well after her cancer diagnosis. Not when she underwent surgery or chemotherapy, or when, between the chemo rounds, she showed up to manage her gift shop — wearing gloves and a surgical mask to defend against germy customers and their dirty money. And certainly not when she drove herself to and from the hospital for exhausting cycles of radiation. But after all of that, perhaps because of all of that, once she had completed her last treatment, my mother decided it was time to shutter her store of more than 20 years. The fiercely independent woman would at last face the dreaded R-word: retirement.
She hasn’t gotten there yet.
In the fall, I flew cross-country to help Mom close her store — a longtime “sanctuary,” she once called it, and where she taught me how to hold my first real job in middle school. A loved one who happens to be a doctor greeted me at the airport — unexpectedly. She recounted a visit with my mother just the night before, noting that Mom’s worries about her store had become full-blown anxiety, leaving her so nervous that she couldn’t sit still. Or eat. Or sleep — she had gone days with just several hours of shut-eye. Mom couldn’t hold a conversation without wringing her hands in distress or pushing her shaky fingers through her choppy, post-chemo hair.
About a quarter of cancer patients experience clinical depression. Even more can suffer from anxiety.
We had been watching for warning signs ever since the cancer struck. For more than a year, my family had shared tidbits of research with one another — like how roughly a quarter of cancer patients experience clinical depression, or how even more can suffer from anxiety. We had sensed trouble and, in the preceding weeks, urged Mom to visit the family doctor. The doctor prescribed antidepressants and sleeping pills, but Mom refused the former (she was proud that she’d “never been a pill girl”), and the latter seemed to have stopped working.
Having flown in to help Mom close the store, I now found myself in a car with the doctor, talking through an emergency plan and contingencies.
Plan A. We persuade Mom to voluntarily accompany us to a hospital emergency room for a psychiatric evaluation.
Plan B. We call in a mobile mental-health crisis team, which would assess Mom and see if she needed to be taken to the hospital, perhaps by force.
I knew Plan B was more likely, given my mom’s headstrong nature on even the best of days. But if she rebuffed the mobile team, they would summon the police for assistance.
Upon seeing Mom, I immediately began ticking off boxes in a mental checklist. She showed every sign and symptom of anxiety that the American Cancer Society warns some cancer patients experience. She had always worried about what I ate before, but now it was uncontrollable. Occasional concern on her face had turned to constant anxiousness. She was restless, unable to focus her thoughts or discuss how we’d even start to close her store. Mom needed help. Desperately.
She swiftly dismissed Plan A with a wave of her trembling hand. On to Plan B, the crisis health care workers. They arrived just hours later, and even though they stalked Mom through her house, they couldn’t get her to stop moving or answer any of their questions about how she was feeling. But they told me she was sick enough that they needed to call for police backup. That’s when I believe Dad hid Mom’s kitchen knives, while the doctor told me to grab Mom’s health care card. I snuck into the home office and yanked it from her wallet. Meanwhile, my mother scurried through the house, eventually locking herself in a bathroom. Were there any shaving blades inside?
I couldn’t bring myself to ask my father, whom I told to hide in a basement bedroom. I wanted to protect him from anything ugly and establish myself as Mom’s bad cop — it would be easier for her to loathe a son who lives out of town than a husband of 39 years. Once Arlene, the police officer, arrived on the scene and coaxed Mom out of the bathroom, they both called for Dad to join them in the squad car to the hospital. Downstairs, he cried. Uncontrollably. “Stay here,” I told him. “I’ll go.”
Arlene took Mom’s left arm. The doctor took the other. And I pressed my hand on Mom’s back as we escorted her to the cruiser, where I slipped into the front passenger seat alongside Arlene. I didn’t dare look back, where for the first time in her life my mother sat between locked police-car doors. She didn’t utter a word during the 15 minutes it took us to drive to the ER.
This is where you wanted to put me? I’m better off dead.
Mom’s small holding cell was as cold as I feared, barely furnished and with a heavy metallic door that could be unlocked only from the outside. The room’s harsh fluorescent lights felt overexposing, constantly illuminating the ever-present security camera tucked into a top corner of the room. A hospital security guard kept barging in, once to supervise a forced injection that sedated Mom. He seemed so smug; I wanted to punch him on my mother’s behalf. But as I sat next to her, trying to provide silent comfort, I learned that it was my presence — not his — that felt … infuriating, confusing, like betrayal to her. “I never imagined one of my kids would do this to their own mother,” she told me.
For hours, Mom drifted in and out of sleep, sometimes looking at me, sometimes closing her eyes to avoid looking at me. She also underwent a psychiatric assessment. Through it all I stared at her. Or her toilet. Or her sink. Or her “bed” — a metal box, I think, that seemed bolted to the ground. Nothing here could be picked up or moved, except for a thin pillow and a blanket, or my chair. Were even those items safe? I believed Mom’s admitting health workers had noted something about suicide risk in her file. And why else would she have been left with nothing but a hospital gown and her undergarments? All of her personal belongings, including a wedding ring that marked a marriage just one year and a month shy of a ruby anniversary, had been confiscated and given to me or placed into a white plastic bag. It looked like the kind I used in my kitchen trash can back home.
For most of the day, Mom begged me to get her out, usually through a certain look in her eyes. Once in a while she’d punch me, verbally: “This is prison,” she deadpanned. “This is where you wanted to put me? I’m better off dead.”
* * *
Seated and sedated in a wheelchair accompanied by the security guard, Mom was transferred to the hospital’s psych ward. There, she was shown to a shared room and formally diagnosed with what her psychiatrist later told us was “textbook” major depressive disorder, defined in her case by:
- Feelings of worthlessness and hopelessness
- Fixating on past failures
- Angry outbursts, irritability or frustration
- Loss of interest or pleasure in all normal activities
- Reduced appetite and weight loss
- Trouble thinking, concentrating, making decisions and remembering things
- Anxiety, agitation or restlessness
We had lots of questions. Why had this happened following, and not during, Mom’s cancer treatments? Could her post-cancer medication have triggered all of this, perhaps like how this Stage III melanoma survivor had written about a certain med that spun him into a suicidal spiral? Psychiatrists couldn’t definitively answer my family’s first question, though they had ruled out our second concern. Looking ahead to solutions, they told us talk therapy wouldn’t do any good right now — that might come later, once the depression wasn’t so deep that it rendered some sleeping pills useless.
Only aggressive treatments could make a meaningful difference now — like, maybe, electroconvulsive (see: “shock”) therapy, or ECT. That option was abruptly dismissed by both my parents, who had seen it depicted by Hollywood but had missed its more recent advancements. Instead, Mom opted for an alphabet soup of prescriptions, some with side effects that included dry mouth, nausea, headaches, weight gain and so on. Initially, she swallowed antidepressants called citalopram and escitalopram. Then quetiapine got introduced to help with the depression, anxiety and sleeplessness. Duloxetine, also used to ease major depression, was later added to the mix. All of that was on top of a post-cancer med, sleeping pills and laxatives.
Mental illness complicates compliance, though, and as the weeks dragged on, Mom would tell Dad and I that she’d sometimes slip her pill under her tongue and later spit it out when a nurse wasn’t looking, because she knew certain ones were “harmful” or “dangerous” given their side effects. If we tattled to the nurses and Mom found out, she’d stop trusting us with these kinds of secrets in the future. We risked telling them anyway, and in doing so, each of us in Mom’s support network became more and more vilified. Her depression dug deeper — unearthing symptoms of psychoses.
Soon I was listening to Mom’s stories about how the nurses and doctors were giving her “poison” in the form of pills. “Please believe me,” she’d beg. “I’m not crazy.” Then she started suspecting the food and tap water at the hospital, complaining that both were making her even sicker. All of this, she argued with straight-faced conviction, was to build a case to keep her in the hospital against her will — or, worse, to prove she needed to go to jail.
Sometimes my mom’s on-call nurse called to tell me she’d refused to take any of her meds or to eat or drink anything all day. Dad and the nurses hoped I could convince Mom to comply; otherwise the hospital would eventually have to administer an IV to prevent dehydration. So I’d grab some soda and water, and whip up a few of the home-cooked dishes she would still eat, like rice and veggies or lentil soup. I’d pass by the nurses station, where they’d hold onto my metal cutlery (only plastic was allowed) and wish me luck.
Hours could go by coaxing Mom. I started with niceties, then shifted to guilting her and then, sometimes, threatened that she might get an IV if she refused to eat or drink anything. Don’t skip the laxative, I’d say, keeping that prompt for the end of my visit. It’s been several days since your last bowel movement, which is partly why you don’t feel hungry in the first place. Talk of constipation, at this point, had become more regular than discussions about the weather. “Pro tip,” I started in an exasperated text to my friend, a nurse whose sister has suffered from depression. “It is easier negotiating with toddlers, and probably terrorists, than those with certain mental illnesses.” Her response: “That’s awful that you know that.”
* * *
Mom always wished her store would be packed with customers one day, with a line stretching out the door and down the block. Her dream came true just days after I admitted her to the psych ward, when my siblings and I blanketed Facebook groups with notices that Mom’s beloved shop would be having a brief closing sale for unspecified health-related reasons. I relearned how to use my mother’s sales terminal, helping customers whom I hadn’t seen in more than 15 years, and who gave me “get well” cards or flowers to pass on — everyone just assumed her cancer had come back. A couple regulars returned on multiple days during the sale, sharing with me stories of how Mom had helped them through terrible times of their own over the years. One even moved merchandise to assist me during a busy rush and threw out the store’s trash at the end of a day. Mom missed these moments, and discussing them just triggered anxious questions, so I’m saving them for happier times.
Once my father and I closed the store each night, we’d visit Mom to ensure she ate dinner before pleading with her to take her pills. Then I’d try to visit my own wife and kid before completing work from my normal day job until, as I finally admitted to some friends, I felt broken and burned out. I took temporary leave from work, started sleeping more than I normally do and found my favorite meals didn’t taste all that special. Numb is how I felt, when asked, and I lacked the empathy to deal with the tears of loved ones if they started to cry while talking about my mother. I was too spent to shed tears. Following a visit with my father to a therapist, which I set up to help him avoid falling into depression himself, I asked Google: “Is depression contagious?” (Sort of. See caregiver depression.)
“I love you,” she said without facing me, “but I hate you.”
It’s been just over seven weeks now since Mom went in, and she’s unable to leave without a temporary day pass. We’re hopeful that one day, maybe for Christmas, she’ll be able to transition back home, something we frankly thought would have happened around Thanksgiving. On one of the few days she was given a day pass and actually came home, she and I doodled in adult coloring books, went through her wardrobe to find new outfits for the hospital and cooked a couple of basic dishes. She derived no pleasure from coloring, found nothing that would look good on her from the closet and seemed only mildly satisfied that cooking didn’t overwhelm her — but the day was a huge success. I figured it would be a fleeting moment. It was.
Mom was showing little improvement and continued to skip treatments, including ECT, to which she had consented and underwent one round but then fled the room just before the second course. Concerned about her lack of progress, a couple of psychiatrists and a nurse filled out a form that called for a third party to make decisions about Mom’s best course of treatment until she showed significant gains; it allowed the hospital to use force, if necessary, to administer care. Once again, I imagined Dad helping Mom through a transition back home and decided it was best if I volunteered. I signed my name on the form.
Some doctor friends tell me Mom won’t remember “the early days” of all this — that the mix of meds, ECT or some other mind-bending miracle, maybe, will wipe her memory clean of my guilt. But I know my mother better than that. During my last visit with her, we barely spoke. She lay on her bed, with her back against me, teaching me that these visits were more about my penance than actually being any help to her. “I love you,” she said without facing me, “but I hate you.”
I couldn’t stay in the room anymore; I felt too … angry? Anxious? I don’t know. Yet I did know that I couldn’t promise her when I’d return for my next visit, as I normally did at this point. “I love you,” I said. “I’ll see you next time.” Then I walked out of the room without giving her a hug, for the first time since I put her there. Everyone has a limit.