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Making sense of a mother's life -- and death

Jerry McCauley with her four eldest children, from left: Kelly, Paula (with her back turned), Jim and Mary Carole.
Jerry McCauley with her four eldest children, from left: Kelly, Paula (with her back turned), Jim and Mary Carole. (McCauley family photo)

I can pinpoint the place where my mother began to die: her tiny apartment in Oak Hill, a supported-living facility in Illinois. My 83-year-old mother was probably in her bathroom, decorated in vivid fuchsia, grass and plum.

I can almost guess the square of beige tile she was standing on when she accidentally poisoned herself with 100 micrograms of fentanyl, a prescription pain medicine. My mother, Jerry McCauley, would have tugged down the elastic waistband of her pants and stuck onto her stomach two patches of a drug said to be 50 times more potent than heroin.

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But the specific time? That's a messier equation.

From left, Jim, Colleen, Kelly, Jerry, Mary Carole and Tom
From left, Jim, Colleen, Kelly, Jerry, Mary Carole and Tom (McCauley family photo / HANDOUT)

It seems to me that Mom's life is contained in her death. If I can solve that one puzzle, identify the moment the dominoes started to wobble, perhaps I will better understand who she was — this fierce, brave, frightened impresario, this conductor of her own six-player orchestra.

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This is the story of one particular daughter's attempt to cope with the loss of one particular mother. But perhaps my experience will resonate with other sons and daughters, those already orphaned, and those who know that day will come.

Friday, March 11, began for Mom with breakfast at a local restaurant with her three kids who lived nearby. Kelly, Paula and Tom bore the brunt of my mother's demands while the trio who'd moved out of state — Jim (Phoenix, Arizona), Colleen (Frederick) and me (Baltimore) — escaped relatively easily.

From left, Colleen, Paula, Tom, Jerry, Jim, Kelly and Mary Carole McCauley.
From left, Colleen, Paula, Tom, Jerry, Jim, Kelly and Mary Carole McCauley. (McCauley family photo)

Breakfast had gone badly, as it often did. A quarrel broke out about a $1,200 vet bill for my nephew's cat.

"You shouldn't spend so much money on a pet," Mom told Tom, her mouth outlined in fire engine-red lipstick. My mother's trademark color reflected not just the 1950s when she came of age, but her approach to life — sirens, flashing lights and racing to the scene of a conflagration.

"Don't get snippy," she continued. "I'm the mother."

The conversation became so heated that Tom muttered something about boycotting future breakfasts.

As I said, it was a typical Friday morning.

After breakfast, Kelly drove Mom to an appointment with her pain doctor. Mom suffered from a plethora of ailments that, like everything about her, weren't always easy to get a handle on.

In 2008, she was diagnosed with Wegener's granulomatosis, a rare immune system disease that nearly killed her. Six years later, she fell while visiting her sister and had emergency brain surgery at Minnesota's Mayo Clinic.

Jerrolyn McCauley, age 24, dressed for an evening out.
Jerrolyn McCauley, age 24, dressed for an evening out. (McCauley family photo)

She retained her considerable smarts and in the most important ways was the mother we'd always known. But over time, we realized Mom's capacity for making sound judgments had been impaired.

Given Mom's history, it would be unjust to describe her as a hypochondriac. Nonetheless, if she'd ever decided to go out for hypochondria as others go out for basketball or track, she'd have been a star.

She believed what ailed her could be cured only by new surgeries or medicines, not by following doctors' orders to diet and exercise. Her favorite word for describing injuries ranging from a bruise to post-surgical wounds was "excruciating."

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Today, when I want to evoke my mother, I open a bottle of BenGay. I inhale the pungent wintergreen odor with its associations of heat. After Mom's visits, I'd find a cache of cough drops beneath her pillow. My mother's preferred brand juxtaposes the bracing astringency of menthol with the insistent sweetness of honey.

Jerrolyn and I loved each other fiercely, and it was expressed through talk. Our discussions after attending classical music concerts, baking Christmas cookies or observing a session of the U.S. Supreme Court became a code language for figuring out our next moves, how best to live.

Jerrolyn and Joseph McCauley in 1957, holding their firstborn child, Mary Carole.
Jerrolyn and Joseph McCauley in 1957, holding their firstborn child, Mary Carole. (McCauley family photo)

We also squabbled: about whether my dining room furniture looked cheap. About whether she should buy expensive gifts she couldn't afford for her children and grandchildren. About whether the dress I wore to my niece's wedding made me look six months' pregnant. About whether she should eat sweet rolls for breakfast, ice cream for lunch and cookies for dinner.

When she was genuinely angry, Mom sent what I described as "letter bombs," severing her relationship with the recipient. The banishments weren't permanent. But when I received an unexpected missive addressed in Mom's familiar slant, the envelope seemed in my imagination to be faintly smoking. I was tempted to pick it up with tongs.

"Mom is really hard on you," Colleen once observed. And I was hard on her.

No wonder her favorite phrase was "I'm the mother."

Family portrait at Jerry's parents' 50th wedding celebration in 1979. Top row, from left: Kelly, Jim, Paula, Mary Carole. Seated: Colleen, Jerry and Tom.
Family portrait at Jerry's parents' 50th wedding celebration in 1979. Top row, from left: Kelly, Jim, Paula, Mary Carole. Seated: Colleen, Jerry and Tom. (McCauley family photo)

I think my mother felt awful on the inside every single day of her life, a casualty of a childhood spent on the battlefield of my grandparents' 50-year marriage. My grandmother often was hypercritical; my grandfather domineering and frequently drunk.

Mom's lifelong response to stress was to mutilate her hands. She'd scratch healthy skin until she created an open sore. Once the wound healed, she picked at the scab.

But my mother never gave up hope that if she could change one little thing — if she bought that $35 shower cap or scheduled another medical procedure or even got her kids to show up for breakfast on time — then she'd be happy.

Mom somehow put herself through college, graduating in 1978 at age 45, after divorcing my father while raising six teens. She earned a master's degree in rehabilitation counseling and co-founded a consulting company specializing in workers' compensation cases.

Jerrolyn McCauley's graduation portrait from Chicago's Immaculata High School in 1950.
Jerrolyn McCauley's graduation portrait from Chicago's Immaculata High School in 1950. (McCauley family photo)

And God knows, we tried to make her feel loved. Four times a day, every day, for 19 months, Kelly, Paula or Tom stopped what they were doing and went to my mother's apartment, put a leash on her beloved spaniel, Charlie, and took him outside in all weather. They walked him at 6 in the morning, in the middle of busy workdays and at 11 at night. After Mom's fall, that was the only way she could keep her pet.

In early 2015, Mom obtained a prescription for fentanyl, a drug designed to control the severe pain of late-stage cancer, after complaining that her existing meds weren't working. Tom, who accompanied Mom to that appointment, doesn't recall being warned about the risks associated with fentanyl.

"There was no major discussion of, 'Hey, listen, let's talk about how dangerous this drug is,'" Tom said. "If the doctor brought it up at all, it was casual."

We think she only used the patches briefly before stopping.

America is in the midst of what some experts describe as a fentanyl epidemic. In March 2015, the U.S. Drug Enforcement Administration identified fentanyl as a threat to public health.

About 700 people nationwide died from fentanyl overdoses in 2014, according to the DEA. Maryland's fentanyl fatalities account for a quarter of drug deaths, exceeding those linked to alcohol and cocaine.

A Mayo Clinic advisory on applying fentanyl patches contains as much cautionary language as you might find in a sky-diving manual:

Don't touch the sticky part with your hand. Don't apply the patch over recently shaved skin. After putting on a patch, don't wash your hands with soap.

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And so on.

Jerrolyn McCauley as she looked in her later years.
Jerrolyn McCauley as she looked in her later years. (McCauley family photo)

At the appointment with her pain doctor, Mom complained about discomfort in her back and knees — but, Kelly recalls, not her belly. If she was taking fentanyl, she didn't mention it. Mom also seemed frustrated at the doctor's inability to help.

Mom was fine when Kelly dropped her off at 2:30 p.m. Five hours later, my sister unexpectedly was summoned to Oak Hill.

"Your mother is vomiting," the staff told her. "She wants to go to the emergency room."

My sister found Mom heaving into a bucket. Imperiously, Mom thrust the arm holding the pail out to one side while staring ahead, stone-faced. The message couldn't have been more clear: "Minion, this displeases me. Remove it from my sight."

Kelly, though annoyed, did as she was bid. Mom looked terrible, she thought.

Once at the hospital, the emergency room doctor noticed two small fentanyl patches on her belly totaling 100 micrograms — or four times the amount of an old prescription.

"What's this?" the doctor asked mildly.

"Oh, this?" my mother asked, and immediately pulled off the patches.

That moment haunts Kelly. She can't get the expression on my mother's face out of her mind.

"I think she knew then," Kelly said, "that she'd made a mistake."

During the five days my mother was hospitalized, she drifted in and out of paranoid delusions, a common side effect of the drug.

She accused her nurses of conspiring to kill her. She pulled out her IV, said no to a CAT scan, refused her meds. She threatened to check herself out of the hospital and was strapped to her bed.

When I phoned her, I couldn't persuade her to cooperate. But it was she who proposed a solution.

"Call Glenn," she suggested.

"Glenn" is Glenn Forbes, the retired chief executive officer of the Mayo Clinic's Minnesota site, and Mom's brother-in-law. Not even fentanyl could shake Mom's confidence in Glenn.

"Tell him everything that's been going on," she ordered. "I'm putting my trust in you."

Those were my mother's last words to me, and I keep replaying them in my head: the grave cadence, the rising pitch.

That day, I did track Glenn down. After a few minutes on the phone with him, my mother resumed taking her medicine, and her children relaxed.

The following afternoon, a blue-sky, 70-degree March day, I texted my brothers and sisters that they'd be unable to reach me for three hours while I was on assignment. At 3:50 p.m., I walked to my yellow Mini and checked my cell phone.

"Just walked in moms room nurses just left," Paula had texted. "She's in code blue No pulse."

Seconds later, also from Paula: "Mom's gone."

There I was, alone in my little pill-shaped car, and I'd just found out my mother had died — via a text message.

I responded with a string of frantic texts. It was like trying to swallow a whale. I couldn't open up wide enough to fit it in, and was certain I'd die from the effort.

"No," I texted back.

"Can't be."

"Dead? Imp"

"Is she dying, or already dead? Please say."

Scraps of myself were scattered all over the landscape. I knew I'd never be able to retrieve every piece. Nor did I know how to arrange the few remaining fragments into someone who looked like me, talked like me and functioned like me.

A profound shock may have an effect similar to that of a drug like fentanyl entering the blood stream. The old you is paralyzed. A new overseer takes charge and issues orders.

To my heart: "This is how you beat." To my lungs: "This is how you breathe." To my brain?

No, my brain still thought on its own, and it wanted very badly to figure out what had gone so drastically wrong.

When Tom left the hospital at 1:30 p.m., Mom was sleeping peacefully. At 3:30 p.m., she swallowed pills the nurses gave her without fussing. Ten minutes later, Paula walked in. She took one look at Mom and knew instantly something was terribly wrong. At 3:57 p.m., she was dead.

Brian Medley, the physician who rushed to Mom's bedside, thinks those two little patches set off a fatal chain reaction. As he put it: "Fentanyl was the first domino to fall."

After the nurses left Mom's room and before Paula arrived, Medley thinks that Mom accidentally inhaled saliva instead of oxygen, throwing her heart into a rhythm from which the medical team couldn't extricate her.

As for the cause of the crippling abdominal pain my mother rated as an eight on a scale of 10? The X-rays, blood work and CAT scan showed nothing abnormal. Her stomach and kidneys were functioning properly.

"I think she was just constipated," Medley said.

If he's right, Mom applied 100 micrograms of a drug 50 times more powerful than heroin when a few ounces of milk of magnesia might have done the trick.

It's been a little more than a month since my mother died. I know now that grief is more than a feeling. It's also a form of motion, a repeated contraction and expansion, a pattern you memorize until you follow it without thinking.

I'm alone now in a way I wasn't before. No one else will ever care as much as Mom about the mundane details of my life. For whom else will my fender-benders and sprained ankles be of consuming importance? Who will bombard me with panicky phone calls the next time Baltimore makes the national news?

I remind myself that Mom's death was hard on her children, but not on her. For that, I'm grateful. She wasn't in pain for a single second. She never felt a moment of fear. She was triumphantly, defiantly herself until the end.

Her last meal, according to Tom?

A bowl of chocolate ice cream.

I am my mother's daughter. My bones come from her bones, my cells from her cells. Wherever my mother was going, I wanted to send a piece of me with her.

The morning of the funeral, I wrote my mother a note of explanation, spread it flat on the kitchen table, and placed upon it the most intimate things I possessed.

I snipped off a lock from the back of my neck. With my mother's delicate crane-shaped scissors, I cut off the cuticle from my right-hand ring finger. I wet the paper with water from my eyes. Finally, I exhaled three times, folded the note and placed it in the pouch.

At the visitation, I approached the open casket. I ran a finger over the bump on my mother's nose that she'd always hated but I loved. I stroked the scar on the underside of her wrist she'd received at age 12 from a broken milk bottle.

I slipped the pouch into the coffin below her lap robe. On the note, below my name and the date, I'd written:

"My hair. My skin, my breath, my tears."

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