Chaplain, Supportive and Palliative Care Services, Bereavement Care Coordinator, Baylor Cancer Hospital, Worth Street Tower, C-328, Dallas, TX 75246, USA
Received date: November 04, 2013; Accepted date: December 24, 2013; Published date: December 31, 2013
Citation: Pounders M (2013) Midwifing Mamacita. J Palliat Care Med 3:167. doi: 10.4172/2165-7386.1000167
Copyright: © 2013 Pounders M. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Birth and death are very similar. Both involve an unknown end result. Both are physically taxing. Both involve anxiety, struggle, worry, fear and emotional upheaval. Both can be chaotic and messy. Both can be holy and beautiful.
As a palliative care chaplain, I am often at the bedside of a patient during their last days. And often, I feel as if I am witnessing a birth. The patient alternates between fighting to push and then letting go to rest. Birthing into death, one ultimately must surrender to fear, embarrassment, guilt, and an utter lack of control. Sometimes, I find myself in the role of a spiritual midwife, comforting and assisting the one who labors in uncertainty. It becomes a very intimate relationship where psycho-social and spiritual pain hold hands with physical pain.
I was privileged to travel this last journey with a patient I’ll call “Mamacita.” Mamacita was an elderly Latina woman who had been a repeat visitor to the hospital on numerous occasions. She had breast cancer, which had spread to her colon, and she suffered from chronic diabetes and kidney failure. Our Supportive and Palliative Services team was consulted and the decision was made to keep Mamacita as comfortable as possible as her life’s journey came to a close.
When I first visited Mamacita, she was very agitated. Her neural transmitters were beginning to break down, causing muscle twitches, pain and confusion. She kept trying to get out of bed until the pain medication sedated her. When she did open her eyes, there was a bewildered stare into nothingness. When she closed her eyes again, she smiled and appeared to be carrying a conversation with someone. Her daughter Janelle whispered, “She’s talking with my dad. He died two years ago. She keeps saying he’s putting on his tux to meet her, but he’s being slow about it, and she’s aggravated he’s late.” Her daughter managed a tired smile. “He was always late, wasn’t he, Mami?” Mamacita was seeing things we could not see. Push, Relax, Push again, Breathe, One more time.
Mamacita became anxious if Janelle was not within her line of sight, so Janelle stayed at the hospital around the clock. “I don’t know what to expect. I’ve never done this before. My dad died of a heart attack, and we didn’t have to vigil like this,” she said. “What will it - death - look like?”
I thought of a classic episode of the old TV show, “The Twilight Zone,” where the Angel of Death comes looking like a very young, very handsome Robert Redford. In the guise of an injured police officer, Redford reaches out to a frail elderly woman who is isolated and paranoid. She is so afraid of dying that she has barricaded herself inside her cold, decrepit apartment for years to keep Death at bay. Her fear of Death has kept her from really living. But she feels sorry for the young man, and takes him in to nurse his wounds. In turn, Death nurses hers. One day, Death gently asks her, “What are you afraid of?” She realizes who the young man is, but she is no longer afraid. He takes the woman by the hand. And she marvels at just how free she feels. He unlocks all of the many locks and chains on her door and persuades her to come out of her dark basement into the light. How paradoxical in this instance, that Death served as a midwife to the living! Push, Relax, Push, Relax.
Death might make interesting television drama. But it can and does involve pain. There may be physical pain, but there is also the pain of guilt, of the impending loss, of grief, of uncertainty. And there is embarrassment. When I was in labor with my daughter, I remember being acutely embarrassed by gross (completely natural, but gross) bodily emissions. “Time for your enema” “Time to break your water” “Push, Relax, Breathe.” My body was no longer my own.
Mamacita’s body was no longer her own. The human instrument was playing an unfamiliar rhythm. She did not want us to leave her sight, even while she was on the bedpan. Honestly, neither Janelle nor I cared. It was simply part of life, this uncontrollable urge, this reversion to babyhood, this helpless birthing. We didn’t want her to be any more agitated or embarrassed than she already was. In spite of the smells and the unpleasantness, we remained close, wiping her face, rubbing her head. Mamacita took my hand. “I’m so sorry. I’m so sorry.” She was lucid enough to know she was losing control. She was sad and weak in her humiliation. She didn’t want to be here. “I love you so much,” said Mamacita. She was asking forgiveness for her helplessness. “I love you, too,” I said, as I patted her hand.
The next day, Mamacita thought the trees waving outside the window were people. She saw her deceased husband, waiting for her. She spoke almost exclusively in Spanish, the language of her birth. I could discern she was praying. Push. Relax. Breathe. Her eyes closed and she gave herself over to her deep exhaustion. One……more…… push. Good. Now, my love, relax. Relax, and breathe, just….breathe.
Mamacita died peacefully that night. The cord of life was cut and her experience in this earthly life was finished. And the reward for her labor and travail? A birth into a new existence where she (with her husband, fully dressed in his formal attire) may dance and feast and love again, a new.
Death is much like birth, and it can be holy and beautiful, especially when you have someone to labor with you.
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