After my 95-year-old mother passed away following a brief two-week illness, my grieving process began with the expected shock. However, what felt unusual to me was that once the shock subsided, I didn’t experience the typical grief stages of denial, anger, bargaining, or depression.

At first, it seemed as though I was in what is often called the bargaining stage—thinking, If I had done something different, then that might not have happened. But what I truly felt was a mounting, sickening weight of guilt. I couldn’t shake the feeling that my decisions as my mom’s medical power-of-attorney were what ultimately caused her death.

Like so many elderly folks who live into their 90s, my mom had proven she was capable of survival. In 1935, Mom was seven years old and hospitalized with double pneumonia. This was before the invention of antibiotics. Her recovery was considered a miracle. Within the last eight years of her life, she recovered from a broken back, had a hip replacement, and was told she would probably never walk again. Yet she did. She also had a bout with COVID-19 that almost took her. And just one year ago, she started to decline. She wasn’t eating, drinking, and didn’t want to get out of bed. The doctor told us she was likely at the end of her life.

Although Mom bounced back after having COVID-19, she was never the same after that. She’d go through periods when she wouldn’t talk, making the hour I spent each night with her feel quite long at times. I knew each day was a gift when I could say, “I’m going to go visit Mom,” yet there were times when I regrettably wished the time away.

The beginning of the end started on Tuesday, September 10^th when the nursing home called and left a message on my answering machine that Mom tested positive for COVID-19 again.

The fact that Mom had just been vaccinated gave me a false sense of security that she wouldn’t get that sick this time. I was most saddened that Mom would need to be grounded in her room, and I wouldn’t be able to take her outside to enjoy the seasonably warm fall weather. A brisk hike outdoors always helped me clear my head of normal daily challenges, and I was sure the fresh air did Mom some good too.

The worst symptom Mom had was a runny nose. I thought it looked like her allergies were acting up. When Mom’s doctor did her rounds, she said that Mom was doing remarkably well. That was until five days later, on a Sunday, when Mom had so much phlegm in her throat that she choked and aspirated on her morning meds.

I was out of town when I got the call from the nursing home. Being Mom’s medical power-of-attorney, I felt confident with my decision that she be seen in the emergency room. I immediately notified my four siblings. When I spoke with the doctor, he said he was glad I called because Mom wasn’t talking. I explained that periods of muteness had become common over the last year. I told him that through various hospitalizations, dehydration and UTIs seemed to be contributing factors to Mom’s inability to speak. The IV fluids and antibiotics had previously worked like a magic potion to get Mom talking. The doctor said he already had the IV running.

I wasn’t surprised that Mom was diagnosed with aspiration pneumonia because a similar incident had happened the year before. I was relieved because the antibiotic the doctor prescribed would not only take care of her pneumonia, it would also help with her chronic UTI.

That first week, recovery was slow. My siblings and I texted, called, and adjusted schedules so there’d usually be someone who could sit with Mom. Depending on which nurse we talked to, we were either lifted with the news that there was a small improvement that day or we were frightened with reports that Mom’s swallowing muscles were too weak to handle food.

We all felt Mom was doing quite well. In fact, she seemed better than she had in months. She had moments most days when she was chatty, laughing, and engaging in conversations.

On Friday, September 20^th, after five days of receiving IV fluids, the doctor made the decision to discontinue the treatment. He said they had to be careful not to overhydrate her body, which could put pressure on the heart, fill the lungs, and create numerous problems. They would keep her overnight and monitor her to see how it goes. He said Mom was struggling with swallowing her own phlegm causing her to cough. On the flip side, she was having productive coughs. The doctor said her lungs and blood work looked better. When he said they were moving her out of the COVID-19 observation unit into a regular room, we all thought that was a great sign.

A few days later, on the following Sunday morning, was the first time since the choking incident that Mom didn’t take her morning pills. I was told she only took a few bites at breakfast. She was very sleepy. That evening when I arrived, Mom laid there mute, staring at me without expression. When the nurse came in I requested they re-start the IV fluids. I explained that Mom was obviously not getting enough nutrition or fluids to fight the COVID-19. I knew my mother better than they did, and I was frustrated that the medical team wasn’t taking all the necessary measures to give her the best chance possible.

I sat close to my mom and forced myself to calm down. Mom remained mute. When the nurse came back with the IV supplies in her hand, I felt a wave of relief. At that point, I just had to wait for the potion to work.

Almost right on schedule, maybe fifteen minutes after the IV was started, Mom spoke: “It’s pretty bad, isn’t it?!”

I was overcome with sorrow. For her, and for me. I responded, “You have to eat, Mom.” I started asking her questions like, is your swallowing out of sync? Are you scared of choking again? Is your throat sore? To each question, she responded in her sweet voice, “I don’t think so?!” I assured her that the therapist at the nursing home, who she knew from years of working with him, would help her get her swallowing patterns working. We started talking about how nice it was going to be for her to get back to the nursing home, her home. She asked me to put up her Halloween decorations and I promised to have her room ready for her return.

That was the last conversation we had.

By morning, the IV fluid that had once worked like magic had made everything worse. Mom was gagging and struggling to breathe. Her body wasn’t processing fluid; it was settling in all the wrong places. My brother called and told me that after the nurse did some deep, painful suctioning, at least she didn’t look so scared anymore. All I could think then was what have I done? Her discharge was delayed another day so the staff could attempt to get Mom stabilized, undoing the damage that was done.

When I went to visit Mom that evening, her breathing seemed normal, but she could barely keep her eyes open. She was mute, and she wasn’t eating. My error in judgement became painfully clear when I noticed the order posted on the wall, stating that only the RN could provide Mom with ice chips and swabs. I was no longer allowed to offer even that small token of comfort.

With clarity on her current status, I sent a message to update the family: We can hope that Mom rallies once she’s in her familiar surroundings with people she knows. If not, I’ve ordered comfort meds, morphine, if she starts showing signs of distress. If you have any concerns or questions about the plan, let me know. I’d like to think we could do more for her. I just don’t know what it could be. I added a heart to end the message as a symbol of hope and love.

On Tuesday morning, it had been only fourteen days since Mom tested positive for COVID-19. I went to the nursing home to get Mom’s room ready for her return. When I started unpacking the ghosts, skeletons, and scary-looking items, I struggled with the thought of plastering her walls with that deco. I thought briefly that maybe I should skip right over to Christmas decorations because that holiday is filled with hope and joy. I looked over at the five-foot skeleton on the wall with its bending joints and had an idea. I bent one arm and put the hand on the hip. I bent the other arm and put the hand over the mouth of the skeleton that hung next to it. I imagined Mom saying, “Stop it! They’re holiday decorations! You kids loved that skeleton!!” The thought made my heart smile, and I happily finished hanging the creepy spider webs and spooky pumpkins just like Mom wanted me to.

Mom got to the nursing home late Tuesday afternoon. When I arrived, she was alert and looked toward me when I spoke. She looked exhausted so I told her to get some rest and that I’d return in a few hours.

I texted my family that the nurse said Mom had fluid overload so it may take some time for that to dissipate. I felt better hearing this news, because to me, it meant she could return to normal. I did some research and found an article about fluid overload and shared it with my siblings. Two of the three elderly patients in the study cited by the article survived. I needed my siblings to believe that I was able to get Mom through this.

At 6:43 p.m., Mom’s eyes were wide open, she focused on the wall, and her breathing was labored. I checked with the nurse to see if Mom could get a nebulizer treatment. The nurse gave her that treatment, plus Lasic drops that would help dry up secretions. When Mom’s breathing didn’t improve, the nurse suggested we give Mom morphine. She explained it would help calm the breathing. She assured me that the treatment would not affect a possible, hopeful, recovery.

At 7:03 p.m., Mom’s breathing calmed. I watched her reach up with ease and scratch her right ear. I was relieved to see her make such a normal movement. Mom was alert, but mute, and her coloring was good. Within 15 minutes, she fell asleep. It seemed like everything truly had returned to normal, so I went home.

At 8:49 p.m., the nursing home called. The nurse said that I may want to get there. She said she thought Mom may be passing.

I called my brother, and we both rushed to the nursing home.

I asked the nurse if she’d check Mom’s vitals.

We learned Mom’s oxygen level was very low, so the nurse cranked the oxygen on high. Within minutes, Mom’s oxygen level and pulse was normal. Once the nurse confirmed Mom’s heart was beating strong, she offered me her stethoscope so I could listen to my mom’s heartbeat. It was the most beautiful sound. My brother said something silly to Mom, and she laughed! I texted my family, It was a tiny laugh, but it was there! I thought maybe everything was going to be okay.

Once Mom seemed comfortable, I went to the nurse’s station and asked her what end-of-life signs she had noticed. She mentioned that Mom’s ears had folded back against the skull, something commonly seen in hospice patients. I asked if Mom could be having an allergic reaction to morphine since she reached up to itch her ear. The nurse said she didn’t think so, but, of course, she didn’t know for sure. She further explained that the signs they look for are hands that may start to feel cold to touch and skin that can become mottled, neither of which applied to Mom at that moment.

I went back to the room and told Mom I’d stay with her until she fell asleep. Her eyelids looked heavy. She seemed to embrace the comfort of effortless breathing. I thought she just needed oxygen. Like so many things that were happening, we’ve seen it before. I turned off the lights, sat close to her bed, and said a prayer. God, please don’t let her die. Not this way. Please make her healthy again… and then let her die in her sleep.

At 9:43 p.m., Mom was sound asleep.

The next morning, I waited until 10 o’clock to head to the nursing home. I found it odd to see a CD player set up in Mom’s room, playing soft music from her early life era. I sat close to her bed and tried to wake her gently with my voice. Her breathing was deep, comfortable, and I figured she needed more sleep. I slipped away, whispering a promise that I’d return that afternoon.

When I came back at one o’clock, she was still in a deep sleep, and I thought, She’s had enough sleep. I started rubbing her arms and calling out to her. She was warm, but she wasn’t waking. I began to suspect the morphine might be too much. As I sat there staring at Mom, unsure of what to do, my sister called. She called specifically because she was concerned about the morphine too, mentioning how she got extremely tired whenever she took it. The nurse came back in, holding Mom’s next dose of morphine, and I asked if we could wait on it. I told her I was worried that Mom was getting too much because she wasn’t waking up. I promised to stay with Mom and immediately report any signs of discomfort. I also asked her if she’d check Mom’s vitals. When she left to get her equipment, I held the phone to Mom’s ear so my sister could say hello. Mom didn’t open her eyes during their brief conversation. I told my sister, “I’ll call you with any updates.”

The nurse came back and checked Mom’s vitals. Her pulse was strong. But then I was stunned to see the low oxygen reading at 68. I felt my heart drop and said in earnest, “That’s not good. She can’t live on that level. Can we turn it up?”

The nurse responded that she’d have to put a call into the doctor, which I thought was an odd thing to say. I asked her if she could listen to Mom’s heart and lungs. She said she forgot her stethoscope and would be right back.

I sat there in a daze and thought, What is going on here?!

At 1:19 p.m., I looked down at my phone and saw a text from my daughter telling me to say hi to Grandma for her.

Just then, I heard Mom’s breathing change. My eyes darted towards her. She seemed okay; her breathing was just shallower, so I started typing my response.

Before I could finish typing, Mom’s breathing skipped a beat. I stood up and stroked her arm. It felt warm, so I figured this couldn’t be her end-of-life moment. At 1:26 p.m., I sent the text to my daughter: Grandma is in a deep sleep.

I sat back down, uneasy, staring at my mother’s face, watching her breathing pause…start, pause…start, pause…

And within a blink, I could no longer feel Mom’s soul in the room. It happened that fast.

At 1:28 p.m., I called my sister back and said in disbelief, “I think Mom is gone.” I hit the button for the nurse and felt Mom’s chest to check for a pulse, I didn’t know what I was doing. I felt her arms, hands, and cheek. She was warm! While I was still clutching the phone with my sister on the other end, the nurse came in and confirmed Mom had passed.

The next week I fell into a dark place, from the grief of losing my mom, yes, but also from tortured, guilt-ridden thoughts. Why did I push for that last IV?? I was so sure it was the overhydration that killed her. And why didn’t I opt for a feeding tube when I knew Mom wasn’t eating?! Why didn’t I just turn up the damned oxygen that afternoon? Instead, I just sat there and did nothing. Mom depended on me to be her voice, to ensure she had everything she needed to fight COVID-19. How could I have failed her so terribly?

After a few days, I couldn’t take the guilt anymore. I finally confessed my feelings of negligence to my youngest sister.

Not skipping a beat, my sister responded, “This wasn’t your fault, Doris!” You didn’t hear the part when the doctor explained that if Mom’s body wasn’t processing the fluids, it was because her organs were already starting to shut down…there’s nothing you could have done to save her. The doctor said in cases like these, ‘You’re damned if you do, damned if you don’t.’

“I should have pushed for a feeding tube.”

“Dor, her body was shutting down. She was 95 years old!”

She was right. When I thought back, I could see that there was such a similarity between COVID-19 symptoms and the signs of end-of-life that I didn’t initially recognize the latter. The excess secretions, the loss of appetite, the inability to speak, the last rally, the fluctuating vitals—all of it blurred together. Once I allowed that realization to settle, I was able to understand that her death wasn’t my fault. There’s nothing one can do to stop the normal progression of the end of a life.

With my soul free of guilt, I felt a profound sense of joy wash over me. I wanted to shout out, “It wasn’t my fault!”

At that final juncture, it wasn’t my job to try to save Mom. It was my role to rally the troops for those last goodbyes. The way it happened, Mom was able to share her last days with her children with joy, through conversations and laughter—the way she lived her life.

And as for me, I still struggle some days with the last conversation we had, when Mom said, “It’s pretty bad, isn’t it?” Looking back, she didn’t seem scared when she spoke those words. I couldn’t bring myself to answer her question—I couldn’t bear to imagine my life without her. I needed her to fight for her life. In truth, I was the one who was afraid.

Despite that, I’m mostly doing okay, largely because I opened up to my sister about the destructive guilt that had been holding me back. That darkness was just as quickly replaced with peace and allowed me to recognize the honor my mom bestowed upon me, to be there for her final moments. Being present for my mom’s last breath was indeed a profound privilege, especially as she passed peacefully in her sleep, just as I had prayed to God she would.