"There's nothing more we can do."

I drummed my fingers on the steering wheel as I drove home and replayed the conversation in my head. You can try to couch it in euphemisms or change the wording to soften the blow, but regardless, the message is the same. Despite advances in modern medicine, there always comes a time where our best efforts to stave off the inevitable become futile. I wondered how many times I'd had the same conversation thus far - certainly more than dozens, maybe even a hundred. The same tropes played themselves out on the family's receiving end - the elderly patient's daughter in denial; the wife sorrowfully accepting; the son, guilty as he had avoided the burden of his father's disease for so long, forced to confront the gravity thereof. Like a prism, the same message refracting many different ways.

I remembered the first time I ever participated in such a conversation.

"I went to the hospital - feeling a bit dehydrated. Don't worry. Love you." The house was dark. I read the handwritten note scribbled on the entrance hall table. It was my brother's seventeenth birthday and he was out with friends. I'd returned from an evening shift at the ice cream parlour - at fourteen, a job paying six dollars per hour (in cash!) was my first foray into employment and I took it far more seriously than it was. I called her cell, a now-antiquated flip phone, and she told me she was being admitted. "Don't worry, they just want to make sure it's OK for me to start the radiation. It'll make it easier."

She'd told us a few days prior that her cancer had spread to her brain. She had reassured us that they were going to treat her with radiation and downplayed any concerns. She never wanted us to worry.

The next nine days are a blur in my memory. I remember visiting her in her stark white hospital room and feeling intensely uncomfortable. Who was this sick woman? I could not reconcile her with my mother, the headstrong, larger-than-life woman who I had always known. This woman couldn't be her...this woman was sick. Her voice became more hoarse until she was communicating through a notepad, though that tapered off as well. Her left eye kept tearing and she couldn't quite close it, and in hindsight, I understand that her neurological deficits became more pronounced as the swelling surrounding the tumors in her brain progressed.

"Let's go to the hospital tonight." My aunt took me to see her, and she had been moved to a different room. Something was wrong - she was restless and uncomfortable, shifting in the hospital bed and she wasn't listening to me. At the time, I was ignorant to delirium and changes in levels of consciousness and only viscerally understood that something was wrong, but in my naive optimism figured it would be okay. I vividly remember a brief moment of lucidity where she came to and sat up, briefly focused on my aunt, hugged her tightly, and then lapsed back to her prior state. To this day, I wish that I had stood on that side of the bed. I don't remember the last time she hugged me, or the last words we exchanged.

A physician spoke to us in the hallway using a lot of words that didn't make sense to me - edema, coma, DNR. I remember how startled I was when he explained that meant "do not resuscitate" - what did that have to do with anything? She wasn't going to die. The haze of my ignorance prevented me from fully grasping the situation.

She was in the intensive care unit the next time we visited. Connected to a half-dozen different IV lines, monitors beeping, and hooked up to a respirator - this was something I'd only seen in movies. They encouraged me to talk to her and I did, albeit awkwardly. The ICU had a very serious ambience and I felt like I could speak scarcely louder than a whisper. My memory fails me at recalling how I thought things would evolve from that point. Different family members and friends would rotate visits; my grandmother was there almost all the time and she looked older every day.

It was four thirty in the morning when the phone rang. Disoriented, I picked it up and W told me to wake my brother up and get ready to go - there was a call from the hospital. Bleary-eyed, I dressed myself in a baby blue Ecko sweatshirt and frayed denim skirt. In retrospect, my adolescent fashion choices are quite amusing. Still dark out, W picked us up and we drove to the hospital in relative silence.

The doctor was young, probably a resident or ICU fellow - I remember his face but not his name; he was kind. I wonder how he felt, having this kind of meeting at dawn with the family of a patient far too young to warrant this discussion. There's something that feels inherently wrong when the patient is both a parent and a child. "There's nothing more we can do," he said. "We are going to make sure she's comfortable." The rest of his words were lost on me.

They'd moved her to a smaller room. The myriad of lines and monitors was replaced with a single intravenous line to provide her with morphine for comfort. Her breathing was deep and fast; years later when studying, the section on Kussmaul breathing evoked this moment. She wasn't responsive.

Family and friends filed in and out of the room; relatives were en route and hoping to make it in time. In a haze, I wandered in and out of the room. They told me to talk to her; I didn't know what to say. The entire experience felt surreal. My brother decided to go home. "I don't want to remember her like this," he declared.

Her breathing, laboured as it was, had been consistent and that pattern formed the background noise of all our hushed discussions and procession of visitors. Late in the morning, she inhaled - and it wasn't mirrored by the usual exhalation. In that instant, the metallic tang of panic rose from the back of my throat and it felt like the bottom of my stomach fell out. I learned what an 'out of body' experience feels like. We prayed out loud as she died; W's shoulders trembled with emotion. The moment felt like an eternity. We exchanged unsure glances and I fought the instinct to leave; to bolt down the halls and out and put as much distance between myself and the hospital as I could. The nurse, tears in her eyes, asked for a few minutes to prepare her body and then we could return.

They told me to go back in first. I was hesitant; this had been my first exposure to death. She looked decades younger - the lines of worry and stress, carved into her face by lifelong and recent struggles and hardships, had fallen away. She looked serene; beautiful in her peacefulness. I mumbled a few sentences and left her for the last time. "Are you OK?," they asked me. What was I supposed to say?

W drove me back home and I struggled to make sense of things. My brother knew, at the sound of the door opening, that the inevitable came to pass. W left to attend to logistics - funeral arrangements, burial plot purchases, and the like. My brother and I watched a movie rented a few days prior from the now-obsolete Blockbuster. We followed the plotline of the action-adventure movie set in ancient Egypt. We had to pause the movie frequently as the calls kept coming - family and friends, sometimes people whose names I barely remembered, rang to give their condolences. It was always me who answered the phone; always me who spoke to them. It was nearly mechanical on my end - the same rote recitation of things like "she's in a better place now" and "her suffering is over" and so on. In a bizarre role reversal, it was like I was consoling them. Many encouraged us to "let them know if we needed anything" - genuine, but never followed up on. What could they have done for us at that time, when our lives were going to be turned inside out? It had begun to pour in the early afternoon; I watched the raindrops stream down the windows as I spoke. I didn't cry; I felt numb, and I remember thinking, with a touch of teenage melodrama, that the clouds were crying for me and crying for her.

My father called and gave his hollow condolences. "I had a son a few days ago," he told me. I barely reacted; too much had already transpired that I didn't have anything left in me to be surprised. It wasn't lost on me that the night she went into the hospital, it was three years to the day that he had left.

The funeral was the next morning. When I woke, I was surprised I had been able to sleep at all. Though sleep is after all, the Shakespearean "balm of hurt minds" and my mind and body did me a favour by sparing me from consciousness. I didn't have any attire appropriate for the occasion; I reached into the dryer and pulled out a Nautica t-shirt, originally my brother's, and a cringeworthy pair of light washed jeans with mid-calf slits.

We congregated at my aunt's home where she provided me with clothes for the funeral prayer - a dark brown outfit edged with cream crocheted lace. I was much taller and lighter than she was; the fit was almost comical. I stayed in her bedroom for a long time after I changed as I didn't want to face people with their faces creased with grief and pity. A tentative knock on the door; my mother's cousin stepped in and with a concerned voice asked the ubiquitous question, "Are you OK?" I didn't even turn my head while I studied the ornate pewter curlicues of the dresser drawer handles. "Yes." She didn't seem convinced, and I can't say I blame her considering I was lying flat on the ground.

I was comforted by my cousins' presence at the mosque; I felt like I was floating in an ocean of relative strangers and they were an island of familiarity. People kept approaching myself and my brother; some I knew and others I didn't. I was amazed at the people who came out of the woodwork - an old colleague; friends we hadn't seen in years; distant relatives. A couple whose home we'd been to a barbecue at once handed me a bouquet of white flowers. The funeral prayer was quick, as they usually are, and I watched my mother carried out in a simple pine box.

I hung back at the cemetery. The weather, in contrast to the prior evening, was beautifully warm and sunny with clear blue skies. The coffin was lowered in and covered with earth; I watched my brother spread the white flowers over her grave. After the crowd had dissipated, I approached. I watched insects crawl through the freshly-turned earth. I didn't cry; I felt like I couldn't. There was too much happening and changing and I didn't know how to make sense of it all. I longed for the ability to talk to her as she was the one who, ironically, I would have relied on to guide me through.

The tears did come, eventually. They ebb and flow even now, nearly fourteen years later. This summer marks the halfway point where I'll live without her longer than I lived with her. That brief morning family meeting in the ICU changed so much from that point onward. It's funny how "nothing" then becomes such a "something" in a spiral that persists way past the hospital realm. I miss you, now and always - "sajna tere bina".


From Him we come, and to Him we return. If you read this, please pray for my mother. And for the ones she left behind.