One Last Recipe From Mother, for the Good Death

By LARRY ZAROFF, M.D.

My mother was liberated when she was 80. She and my father had been married some 60 years when he died. Up until then - Eastern European, patriarchal - he controlled her life and everyone else's that he could.

Her space was small, limited. She, a good wife, tolerated, had a capacity for hard work and adversity. Now she was free at last, and she knew it.

As if she had made up a list of what she really wanted to do all her married years, she leapt into a new life. She took over the real estate business, better at the work than he was. The company prospered and so did she. In her 80's, she passed her driver's test.

She picked up the phone, called everyone, soon becoming the mainframe, a communication catalyst and the database for her extensive family and friends of all ages.

Everyone who knew my mother wanted to stay in touch. She had an endless supply of common sense, and sound advice balanced by love. And she traveled from her home near Washington to visit her grandchildren and her great-grandchildren throughout the country.

At 92, still living alone in her house, she flew to California to see her newest great-grandchildren and to teach my son the secrets of her famous Jewish recipes.

I remember the seminar: she at the head of the stove, turning the potato latkes, while Jonathan took notes and videotaped the lesson. She then masterfully went on to explain the nuances of her kreplach, sweet and sour cabbage and, Jon's favorite, chopped liver. The class lasted two hours during which she did not tire, perhaps knowing that the documentation was important, a legacy.

She returned to Washington and two weeks later survived a devastating heart attack, destroying enough of her heart muscle so that she was restricted to bed. My sister had her transferred to a rehabilitation center near her home in Baltimore. She did not do well there.

When I called to suggest that she be readmitted to the hospital for intensive therapy, she refused. When I encouraged her to eat, she remarked, "I have eaten enough."

I said that my wife and I were coming to see her. "Wait a few days, don't make two trips" was her response.

I disagreed, "We are coming now."

Arriving in Baltimore late that night, we immediately went to the rehabilitation center. My mother moved in and out of a coma, but without a doubt she spotted me. Shortly afterward, she died. Quietly without pain.

Now, knowing her well - not as well as she knew me - I am certain she did not want us to make a second trip. For her to cause her family any inconvenience was out of the question. Her plan was to die as soon as she saw us, goodbye and funeral in one package.

We doctors are taught to cure, to heal, when possible to restore patients to a full and active life in society. We are also taught, if we cannot establish health, to allow patients a good death.

But we pay little attention to what dying patients owe their loved ones. Leo Tolstoy understood this. In his novella "The Death of Ivan Ilyich," the protagonist, dying slowly, makes life miserable - complaining, criticizing, screaming - for his family until the last day, when he realizes that they love him. He then understands what he owes his wife and children: a good death.

In the end he dies quietly, blissfully, a good death for him and his family.