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Sunday
Nov072010

Transition

The word “transition,” to most of us reading this, brings up images of laboring women, typically, seven to ten centimeters dilated (or at least that’s what the textbooks say), each woman working through her transition. Some moms breathe heavily, others moan… and, all too often, many are numbed from nipples to toes, virtually unaware of the mechanical changes going on inside. I find it takes a fairly crunchy woman to push deeper to define the word in a more literal way, acknowledging the obvious; a woman moving from one stage of her life (Madonna/Non-mother) to another (Mother). Transition, as we know it, does not have an absolute demarcation point. There is no stick you can pee on or blood test you can do that says, “I’m in transition.” It is more fluid than the medical world is able/willing to admit. 

Our lives are full of transitions, often celebrated as Rites of Passage. Christenings, birthdays, getting a driver’s license… old enough to vote… are all a part of our culture here in America. But, as we also know, not all Rites of Passage are joyful and pleasant. Divorce, losing a job and, all too often now, going bankrupt are some of the difficult and painful transitions. 

And then there is death. The transition none of us escapes. Death is a measurable, quantifiable end to life’s continual transition that began with birth (maybe earlier?) and ends as someone states the body’s functioning has ceased. But what of a life quickly lost? That person’s final transition might have been imperceptible, similar to some women’s labor transitions. For those that are ill, transition can be slow and painful, requiring the help of those around them to make it through to the other side. 

The parallels between birth and death have long been made in poetry, literature, songs and throughout oral histories. I’ve had the opportunity to experience those parallels first-hand; the experiences are divinely cherished. 

In the 80’s, I was present during the transition period of several men with AIDS, only rarely present for the actual moment of death. I doula’d these men, many of whom had been abandoned by their families, telling them stories, holding their hands and using cool cloths to wipe the fever’d sweat from their foreheads. I know that being with these dying men gave me many lessons I would need later as a doula and a midwife. Of course, I didn’t know that then. 

My children’s grandmother, Abuela, is dying. She has a brain tumor and it is slowly taking over her body, altering functions we generally take for granted. Abuela has been one of those women who were always working –for the pure joy of doing so. The last of sixteen kids, she outlived every other person in her birth family. We knew it was because she loved living! Abuela, also my former mother-in-law, was a chef… an amazing chef, creating dishes from thin air, carving great pieces of art out of fruits and vegetables and, oh. my. god. –made the best peanut butter cookies on the planet. I have never had a peanut butter cookie as luscious as the ones Abuela made. (I’m salivating even remembering… and it’s been 28 years since I’ve had one!) Her hands were magical around food and she was never without a laughing smile on her face. I love(d) her as if she were my own mother. Luckily, she loved me, too. Even after her son and I divorced, her face lit up every time I came to visit; my own face did the same.  

My former husband’s family is from the Dominican Republic, so Spanish is the first language. Abuela, working in America, learned a decent command of the English language. Her husband (Papa), spoke Spanish-only to his dying day. But, Abuela’s thick accent often had people saying, “Excuse me?” so she’d repeat what she was trying to convey. I didn’t learn enough Spanish to communicate easily with her until many years after the divorce, but once I could speak more, I loved being able to talk with her about her life. 

We in the homebirth/natural birth circles are hyper-aware of institutions and how they interact with individuals; there really isn’t a place for individuality. For a variety of reasons, Abuela is in a nursing home, far from my kids and even her son; she is now much too ill to move without it killing her. So, my children and their father are taking turns going down to Miami and spending several days at a time with her. A family member also hired a nanny (of sorts) to keep her company during the day. The nanny’s presence has been a god-send to my mother-in-law. Even still, as my kids make their trek and sit their vigil, they are disturbed by the thoughtless “care” their grandmother is receiving, the nurse’s aids yacking about soap operas, looking over Abuela as they carelessly change her sheets or clothes. My daughter Aimee was especially upset as Abuela cried out when the aid hurt her and didn’t even acknowledge it. (The supervisor was notified and the aid reprimanded, but that doesn’t change the pain Abuela experienced.) 

I know so many of you who had cesareans talk sadly (or angrily) about the surgeon and the operating room team blithely talking about the latest football game or where to go for dinner as your babies were coming into the world. It’s just sad when a woman has to put on her birth plan “Please do not talk about outside activities. Please stay present with my baby’s birth.” It’s equally sad, even abhorrent, that people responsible for doula-ing the dying can be so callous towards their charges. I wanted to slap that bitch (from 3100 miles away) for hurting my mother-in-law. 

Instead, I taught Aimee a skill that will serve her forever. I told her how to stop someone who’s blabbing in their own world, yanking them back into the here and now and remind them to see the person they are touching as a holy soul. So many of us sit idly by as corporations and institutions man-handle us –or worse, our children, until we have that pivotal experience where we snap and say, “What the hell are you doing to me?! STOP IT!” It’s a toss up which is worse, learning the skill while helping someone else or learning it because of what was being done to you. 

And yes, being in the moment. In my Birth as Yoga post, I write: 

I am her (the laboring mother’s) sentry, quietly “holding the space”… sitting with a clarity I don’t have in the outside/real world. This attuned place keeps me alert, even when I am exhausted; I note time passing, yet it is never anything but right now that exists. 

There is nothing more in the moment than birth and death. Each zeros in at the speed of light, pin-pointing the exact nanosecond of passing from one place into another. Even for witnesses (the stupid OBs notwithstanding), the moment is imprinted in the mind and heart forever. But it is a moment in time that can seem suspended, lingering in the air, waiting for the breath-work to begin/finish what it is going to do. 

(I know the agony of waiting for a baby to breathe, of working to get a baby to breathe… time crawls and flies all at the same time. I have not ever had a baby die in my hands and cannot imagine that pain, but suspect the anticipation/begging the baby to breathe must never end. This sort of time must be in another plane of reality altogether.) 

When I talked to Aimee about Abuela’s need for remaining in the moment, she was already completely understanding the concept and had been holding that space ever since she arrived. It can be so easy to sit with the dying and cry, being sad for the life they are leaving. 

I encouraged Aimee to tell her stories, happy, loving stories, whether they included Abuela or not. Aimee’s concern was that her Spanish wasn’t good enough and she was wishing for someone to translate. I smiled, totally knowing this feeling with birthing women when my Spanish was inadequate for the role. But, it didn’t take long for me to realize when love is the gift, verbal language is no longer necessary… and if words are spoken, they are translated by the heart/soul, creating a complete understanding between the two “speaking.” 

Surpassing even the language barriers, laboring transition, as well as death transition, can include an inability to communicate. The brain tumor has made communicating extremely difficult for Abuela, her speech affected, her hands curled so she is no longer able to write. This is when other modes of communication can move beyond the spoken word; the gentle touch on the arm, loving foot massages, wiping the brow/spittle from the forehead/mouth. We witness bodily functions give way and note that modesty disappears for many women in birth and, as those who attend to the dying know, on the cusp of death as well. It is imperative for birth/death workers to never be grossed out by poop, vomit or blood. Disgust is a mean and useless emotion to the birthing/dying person. None of us wants to be repulsive to someone in charge of our care. 

I’ve seen family members (mothers of the laboring woman most often) and even new doulas feel sorry for the woman in transition. What might better be empathy has twisted into sympathy. Sympathy rarely makes a mom feel better. I’ve seen a mom lose faith in her body’s abilities when those around her are morose and sad for her laboring state. I’ve also seen women buoyed by the positive, affirming words and actions of those around her. It has to be nicer to see people smiling and cheering you on rather than someone sitting, staring and wringing their hands with worry. It’s one reason we discuss who will be at the birth and what their roles will be. If a woman knows someone is going to struggle with the process, it’s good to either work with that person and address their concerns or, as is the case for some women, not have that person at the birth at all. 

With death, even if someone is uncomfortable, it can be a time to face the discomfort, suck it up, so they can pay homage to their friend or relative leaving the earth; in birth, they can be excused from the event. But, sitting with a dying person, we face our own mortality and that can be unbelievably difficult for some (most?) people in our culture where death, like birth, is hidden behind institutionalized walls and attended to by people in white scrubs. When we keep the dying company, we have seconds, minutes, hours and even days (if we’re lucky) where we hear nothing more than the breathing in and out of our ill or old loved one. Yet, inside our heads, we are far from alone… it is anything but silent. Our inner dialogue works with our situation, making sense of things, organizing thoughts into “What I need to do/What I want to do/What I will do” for the rest or our lives’ unfolding. Being in those last moments, being supremely present, we learn/realize what the crucially important parts of our lives are and figure out where to go from here. 

I want to die at home. I do not want to die amongst sterile (HAHA) machines and even more sterile attendants. I want to lie in my bed… my loving, soft, cooing family around me. I want to die in the same manner as I love to give birth -supported and believed. I want to smell my own pillows, feel my dogs licking my hands, feel Sarah kissing my face. I want to melt into tomorrow, leaving no regrets for what I did today. 

As George Strait gently sings: 

Just like it took my breath when she was born
Just like it took my breath away when dad took his last that morn

Life’s not the breaths you take
The breathing in and out
That gets you through the day
Life’s not the breaths you take
But the moments that take your breath away

Abuela & Aimee - November 4, 2010

 

Reader Comments (12)

Wow. This was a very powerful post for me. Death, like birth, the two most important events in our lives, is now relegated to the hospital for too many of us, segregated from the rest of our lives, from our loved ones.

In 1995, my grandparents took their son, my uncle, home from the hospital so he could die (of AIDS) in the room he grew up in. My mother and my grandparents all were in the room when he transitioned. He had been asleep/in a coma for two days or so. They ended up all sitting together on the other bed in the room, just quiet and present, one night. He sat bolt up right and cried out - said something, though none of them heard quite the same thing - and then fell back in the bed, gone. It was the first time my mother had ever see someone die - she was in her 40s at the time, so that's one thing - but it also was the first time either of my grandparents had ever seen someone die. It's become a hidden process, kept in the confines of institutions.

My husband's grandfather, to whom he was very close, was dying in another state as my due date with my first pregnancy came and went. We were on our way out the door for my 41-week NST when we got the call that he had died. He was being buried as I was being induced four days later. He had been so excited about the pending arrival of his first great-grandchild. I'm not a very spiritual person, but sometimes I think that maybe, knowing they would never meet, they someone managed to pass each other on the way out/the way in. My son is named after him.

November 7, 2010 | Unregistered Commenterchingona

This was wonderful, tear-jerking, thought-provoking. Thank you!

November 7, 2010 | Unregistered Commentermamavee

Chingona - so beautiful. Thank you for telling us the love you share for your family. And yes, they surely hugged and kissed as they passed each other in the "hall".

November 7, 2010 | Registered CommenterNavelgazing Midwife

That was beautiful to read. I'm so lucky to have your words of wisdom said to me first hand. You are so much of my strength. <3 I love you.

November 7, 2010 | Unregistered CommenterAimee

I hated to see my grandpa try to cover his pain when he was dying of lung cancer. He had to be someone else for me, he wanted to protect me. When his sister, my great aunt Dot apologized for not making good conversation when she was in intense pain and dying, I told her it didn't matter to me if we talked at all. I just wanted to be with her period. When I had to stay half a country away with my pregnancy at it's end as my great aunt was within a few weeks of death and listen to her loose her telephone calling out, "Dawn" and know no one was there to help her find it again, I was in agony. I wanted to be with her, hold her hand, and not let her die alone. And I hated how people spoke over her like she wasn't human anymore, was just a dog or a piece of the furniture. You are right that birth and death can be similar. A woman doesn't want people to control her, or worse yet, talk above her like she's a "case" or a mindless child. Doctors come in and say to the nurse, "have her squat" without looking me in the eye and talking to me. How much more frightening to experience the social death at the end of life. It's as if a person is already dead in the room. The letting go happens too early, and a person has to live in that hell just like a mom might in labor or during a c-section, with all above her treating her as if she's no longer there. That is, until she has a baby in her arms, then the nurses chat again with her.

Thank God for people who acknowledge the dying as people who still are living, still have value, still deserve love from those in their presence.

November 7, 2010 | Unregistered CommenterDawn

This is a timely post for me. My grandmother died recently - she was active and at home, so while we knew she was ill her death was still a shock. She died at home, holding my grandfather's hand, in the early morning. It's comforting for us to know she was somewhere she knew with someone who loved her. However my grandfather insisted on calling an ambulance, which took her to hospital, and we spent most of the following day with her body in a room just off Accident & Emergency, waiting for 'them' to release her as legally she might have needed an autopsy. Unnecessary, and made me realise how glad I was that she'd been at home rather than hospital. I'd rather be at home, too.

November 8, 2010 | Unregistered CommenterQoB

And, my sweet Aimeebel... *I* am the lucky one to have you in my life. Many, many moms wring their hands that their children will have nothing to do with them. Thank you for being in my life and choosing me to be your mom. It is a role I cherish.

November 8, 2010 | Registered CommenterNavelgazing Midwife

both Abuela and your daughter are so beautiful!
great thoughts.

November 8, 2010 | Unregistered CommenterEmily Weaver Brown

This was so beautiful. My grandfather passed away recently and was blessed to be able to do so in his own home (after an illness-- he and we knew it was coming). I know now I don't want to "transition" in a hospital if it can at all be avoided. Whether bringing a new life into the world or passing from it.

November 9, 2010 | Unregistered CommenterDreamy

I am so happy this piece moved others besides me. Thank you all for sharing your stories... they move me just as much.

Thank you.

November 9, 2010 | Registered CommenterNavelgazing Midwife

Barbara,

Thank you for the wonderful words. I'm a practical person as you know. I don't get hung up on a lot of things and I realize that this "transition" is necessary for all of us. A few weeks ago my mother told me: "I don't understand why dying takes such a long time, I never thought it would take so long."

This made me think of something as she now refuses to eat and is slowly decaying and degrading. I can't tell you how many people have called me and asked if there isn't anything we can do for her. People call and pray with her saying that God will make her strong again and she will recover. Some can't understand why she doesn't have a feeding tube! Some can't understand why we can't prolong her... life? No.. I would say death!

It seems that we as a society are so adverse to the death "transition" that we are willing to delay it as long as we can. Even if it means dying longer. But why I ask about a feeding tube? What would a feeding tube do for my mom right now? As you pointed out, an active woman who never stopped. We used to call her the energizer bunny. At 75 she would put any of us into shame by running circles around us. She doesn't want to prolong her death. How else would you refuse to eat for more than a month? It is a testament of her strength and will. If I don't eat for a day, I get VERY UGLY!

In this process I had long hard thoughts about my ultimate transition. Where will I be? What will my kids think and do? I've thought about the next step for my mom and the aftermath. When she passes, what will people expect? I know she hated funerals. I don't want to mourn as much as I want to celebrate her beautiful life. I don't want to wear black, I want color, because she brought so much color into our lives. She has touched so many people. So many people who I don't even know call me to say that she was like mother to them.

So right now, life for her seems to be just the breaths she is taking... but those breath taking moments are still there when in her frail condition, she still manages to work a smile or open her eyes.

November 25, 2010 | Unregistered CommenterBo Lora

My mom is a doula to the dying. She works in an alzheimers unit and has been there for deaths, has cleaned and nurtured the dying and the dead. She does not fear death, and is loving and kind to those passing on.

She talks about those who are callous, for whom it is just a job, and it saddens her.

But everywhere she has worked, there have been other kind souls. I am sure that there are kind souls there for your children's grandma, too.

November 25, 2010 | Unregistered CommenterSarah

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