Waves Through the World

by Joshua Forehand

But the mild night,

That bows with its gentle clouds above me,

Has my mother’s face,

Kisses me, smiling, with inexhaustible love,

Shakes her head dreamily

As she used to do, and her hair

Waves through the world, and within it

The thousand stars, shuddering, turn pale.

from “Holiday Music in the Evening: Adagio” by Hermann Hesse

My mother measured time in cigarettes. She required no clock or any other mechanism to provide a cadence to the monotony of her days. Even the passage of the sun, moon, and stars, on which the very concept of time was created, lacked the precision of nicotine’s timpani drum, which intensified to crescendo as the minutes between cigarettes wore on. They were a long-reliable friend and true. Cigarettes were always there for her when she needed them—her rock and her salvation—a peripheral, yet important element of her long-term treatment for mental illness and, of course, ultimately her demise.

The decline was slow but steady after we moved her into the subsidized apartment complex. Following yet another chaotic manic episode, my father finally threw in the towel after 27 years of marriage. It was a valiant effort; the last years endured to avoid passing the burden of her care to the children. My sister took the lead and moved her to Houston, pushing my mother to work, pay her own bills, and maintain some semblance of independence, but she never held a job for long. My sister called me in frustration, and I reminded her of the time mom was fired from Wal-Mart for stealing candy bars when we were in high school.

Eventually, not having much else to do, she spent the majority of her days and nights smoking in the parking lot. Between cigarettes, she would find menial tasks to occupy herself or sit on the couch “resting her eyes” until the next light up. On my first visit to the apartment complex, I accompanied her to the wrought iron table where she sat shaded by a cloth parasol. She suffered from tardive dyskinesia due to the decades of antipsychotics, causing her mouth to involuntarily cycle through a series of strange configurations.

Once she lit up, though, her mind and body queued up behind one singular purpose. She became wholly unavailable for conversation and entered a trance-like state. Her actions appeared to be governed by muscle memory and she closed her eyes in an attempt to block out everything else around her. She puckered up, brought the cigarette to her lips, deeply and forcefully inhaled, then returned her hand to the armrest of the wrought iron chair. She held the warm smoke in her lungs as long as she could before exhaling. She waited a moment and repeated these steps with eerie, animatronic movements, breathing in with such fervor that the cigarette’s fiery circle would glow intensely. She had to force the smoke through her corroded airways as if through a chimney packed with creosote. She pistol-whipped her protesting alveoli with it. Her lungs tried to fight back with frequent, violent attempts to expel the smoke and tar, but more was taken in than could ever be driven out. At 57 years of age, she had logged more than four decades of this activity that had evolved over time from being glamorous, rebellious, then merely pedestrian; to disgusting, self-injurious, and finally, shunned by the same society that once glorified it. Nowadays, cigarettes are hidden in the homemaker’s cabinet next to the vodka.

As a teenager, I would concoct naive smoking cessation plans to free her from the addiction. We would break cigarettes in half by the carton and high five as they swirled around the toilet and down the drain. But by day’s end, she’d be in the truck on the way to the convenience store. On another occasion, while visiting from college, we spent hours stuffing cigarettes into sandwich bags incrementally decreasing the allotted number for each day of the month ahead. We’d sit on the porch, and I’d sing her “Angel from Montgomery,” allthumbsing my way through the simple chords. She’d giggle at the words while smoking away at the day’s allotment. I’d wake up the next morning to find an additional baggie smoked up overnight and hidden in the garbage. She tried nicotine gum too, to no avail, and was allergic to the patch. Eventually, we both abandoned hope that she would ever be liberated from this curse, besides, how could she abandon her best friend?

Near the end of her life, on a morphine drip, the same automatic, trance-like movements I observed at the wrought iron table would kick in. Lying in the hospital bed, she would search relentlessly for a cigarette, her hand skimming across the fold in the sheets, her oxygen tube, my own fingers; nothing felt quite right, so she’d keep searching, undeterred, until losing consciousness again. Her most well-paved neural pathways were dedicated to the act of smoking.

I was at a work conference when the call came in from Harris County Adult Protective Services. A female voice I didn’t recognize spoke through the phone, “I have some concerning news about your mother.” I knew a call of this nature would be coming soon. “I need to let you know that we were notified by the manager of Pear Grove Apartments that she’s unable to get out of bed and may need medical attention.” Her voice was soft and compassionate while conveying a sense of urgency, leaving no doubt the situation required immediate attention.

Walking back to the hotel room, the nauseating pattern of the corridor carpet exacerbated the sense of vertigo coming over me. The familiar surge of cortisol flooded into my system, sending a buzzing sensation down my limbs and up the back of my neck. No stranger to the body’s stress response, I took a moment to sit on the edge of the bed and took a couple of deep breaths to pump the brakes a bit. It was one of those moments when urgency prevailed over panic, or at least stuffed it in a lockbox to deal with later.

I flew out to Houston the same day. Though my sister lived just a half-hour’s drive from the Pear Grove apartment complex, she was unable to respond to the crisis. Two months prior, her 3-year old son had been diagnosed with stage 4 neuroblastoma. It was a dire prognosis, every parent’s worst nightmare. In those early days of orchestrating his eventual full and miraculous recovery, every waking minute of her days and nights, every calorie burned and action potential firing between synapses was devoted to keeping her child alive. As much as she may have wanted to respond to my mother’s situation, she could not.

When I arrived, I found her lying diagonally on the bed, uncovered. It struck me as an unnatural way to lay in bed. Her very flesh appeared to be slowly turning into tar and smoke. Her eyes were dark, sunken ovals, like craters on a pewter moon. Even the whites of her eyes were gray. I noticed vomit near her head and feces smeared in multiple areas of the bed. In a corner of the small bedroom lay a pile of adult diapers, wet and soiled, and a pack of new ones just next to the bed.

For an indeterminate number of days, this had been her existence–sit up, drop a soiled diaper and throw it in the corner, slip on a new one, lie back down; another set of automatic movements. She had lost the ability to walk due to years of obesity, arthritic knees, and a childlike obstinance toward anything causing the slightest bit of discomfort. She had come to fear any emotion or even sensation that might disrupt an equilibrium she fought for half a century to establish. She had reduced her world to an area of three or four city blocks in south Houston–the Pear Grove Apartments, the sheltered smoking table in the parking lot, and the convenience store down the street. The only disruption to her daily routine was church on Sundays and holidays at my sister’s house, both of which required a great deal of effort to manage. The appropriate accommodations were made for her best friend to tag along, tucked away and waiting in her purse, nudging her with increased intensity as the sermon wore on.

She sought to walk through life in sensory deprivation, having arrived at a sort of homeostasis that, like an old rope bridge, allowed her to walk across the treacherous abyss of bipolarism; the price to pay, however, was that she must never take her focus off preventing any disruption to the delicate catenary curve on which her life and sanity dangled. Any outward stimuli, especially discomfort and, on the other end of the spectrum, hope, caused the bridge to bounce and sway threateningly, fraying the delicate fibers of the footropes. Behind her, at the edge of the abyss, was darkness and the angry distorted faces that occupied her paranoid delusions, waving serrated knives and garden shears, threatening to cut her wrists and the cables of the bridge to send her plummeting to the darkness below. Ahead of her at the other end of the bridge were her children and grandchildren and the blinding light of hope. But the light was far too bright. She had to look away so as not to lose sight of the ropes that sustained her. In the middle of the bridge she remained, still and motionless, paralyzed from making any movement forward or back. For my mother, there could be no pain and no hope.

She wasn’t as surprised to see me as the circumstances would warrant and greeted me nonchalantly when I entered the bedroom. I could tell she was suffering from dehydration, so I called for an ambulance right away. Upon arrival and a quick assessment of the situation, the paramedics decided she would have to give permission to be taken to the hospital emergency room. She stubbornly rejected the idea at first, then waffled back and forth as I tried to reason with her. She was scared. She would cry out in pain when they stood her up to transfer to a stretcher and demand to be put back down on the bed. I didn’t know what to do with her on my own, she had to go with them. Finally, I persuaded her to go to the hospital by promising to buy her a Coke when we got there.

By the time I got to the emergency room, she was already on IV fluids with an oxygen mask wrapped around her face. At first, the doctor wanted to send her home with a tank and cannula after the fluids had been administered. That was not an option. I hadn’t had the opportunity to clean the apartment, still thick with the stench of my mother’s demise. Already, her coloring had largely been restored from the increased oxygen. I couldn’t take her back into the conditions she was living in. He didn’t understand that she was not capable of making decisions that were in her best interest. He didn’t know her like I did. I appealed to his sense of compassion and ultimately, he decided to admit her. I promised my mom another Coke.

My brother joined me the next day to help clean up the apartment. In the living room was a remnant of the large sectional that had been in my parents’ living room. Its shape was distorted from only supporting weight in one spot. Above the couch was a picture of my grandmother, perhaps the only person my mother ever felt truly safe with, looking happy and elegant at my sister’s wedding. She passed away several years before, herself a victim to that small cylindrical killer. In the bedroom closet, I found mom’s school photo from her senior year of high school. Her skin was glowing and she had black hair that cascaded in waves around her slender shoulders. She could have sat for the Mona Lisa but for her smile; youthful and unambiguous. For much of my childhood, I lived for that smile, however rarely it was made available at times. I owe a great debt to Dana Carvey and Jim Carrey for their mentorship in my relentless endeavor to make her laugh. Her smile was subtle and genuine, never practiced or staged. In fact, if she tried to put on an artificial smile for a photo, it didn’t work. So, you knew—if she was smiling, it was the real thing, warm and warming; it was beautiful.

I think about being held by my mother as an infant. Like all infants, my peripheral vision developed more quickly than my ability to focus on a central object. I imagine looking into her face, toward her voice and laughter, but what is clearest in my underdeveloped vision is the long black wavy hair emanating from that voice like a backlit halo as she “shakes her head dreamily.” With time, my vision and my very consciousness follows these waves out to the world that surrounds. Though as we age, our memory cannot hold on to these moments, this is how our worlds are built. Our mother’s face and hair provide the center point of our conceptualization of the material world.

As my brother and I prepared to clean the kitchen, I opened the refrigerator and freezer. A half-gallon of expired skim milk, a tub of Country Crock, and an open bag of thirty pre-cooked and breaded chicken breasts were all I found. The breading on the chicken was overwhelmed by freezer burn. The only other food in the house included multiple packages of Reese’s peanut butter cups and a can of Maxwell House.

I spent the evenings with her in the hospital, bedside, advocating for her every need. Since entering the hospital, she had become terribly constipated and swollen. Her fingernails and toenails were long and dirty, likely teeming with E. coli. My mother needed to be bathed. It was a shocking reality how hard I needed to push for simple personal hygiene and cleanliness measures to be taken by hospital staff, even while she was subjected to every test and scan they could conjure up. One of these revealed a fractured vertebra and a mass on her spinal cord, which would require surgery. She was fitted for a back brace more out of liability than anything else it seemed. The brace was uncomfortable and made it hard to breathe, so she refused to wear it. She was a tough patient. All she really wanted to do was get out of the hospital and back to the wrought iron table in the parking lot of the Pear Grove Apartments. Back to her BFF.

A nurse entered the room with her supper, the typical institutional tray with dull-colored food and a plastic cup of apple juice. I helped peel the foil cover off the juice and handed it to her. She took a drink, and suddenly erupted into a fit of spewing and coughing. She had aspirated on the juice and could not catch her breath. The nurse began patting her on the back until I reminded her of a broken vertebra. She cursed and became flustered while my mom continued coughing and struggling to breathe until her eyes rolled back into her head. She had gone into respiratory arrest. I held her as she struggled violently to breathe. I wish I could end the story here and tell you she died right there in my arms, cradled by someone who loved her without condition or expectation–the way she once cradled me and loved me. But the story doesn’t end here.

The nurse hit the button on the wall above the bed to signal a Code Blue. I saw a group of people in scrubs scramble past the door–wrong room assholes. When they came in, I was ushered out by a man with kind eyes who asked me what I wanted them to do. I wasn’t ready for the question. I wanted to call my sister. Before I could answer, another doctor moved in, smiling at the camera on the wall over the bed, and set about saving my mother’s life as if it were her next half-marathon. It felt more narcissistic than Hippocratic. Had she saved her or merely prolonged her suffering?

From that point forward, she would require assistance breathing. At first, she was fitted with a bipap that forced oxygen, as she once had done with cigarette smoke, through the black, slackened mess of a trachea that threatened to cave in like the coal shaft it had become. Eventually, she was intubated for the surgery to remove the mass from her spinal cord and never again regained the ability to breathe on her own. As the pre-op crew prepared to wheel her out, she looked at me and said, “Thank you for bringing me here.” These were the last words that passed along my mother’s vocal cords and into my ears. Though altered by years of abuse, it was the same voice, the same vocal apparatus, that produced the first mother’s coos my ears would perceive.

My mother spent the last day of her life intubated in the back of an ambulance, traversing the expansive Texas countryside from Houston to Lubbock, where she would be moved into a nursing home, twenty miles from where her life began. We didn’t know what else to do with her. Our Aunt Kathy, my mother’s only sister, would visit her every day and take the lead in caring for her from that point forward. Aunt Kathy made plans to read to her, reconnect with her, and prove to her that she had always been loved.

But my mother had a different idea.

Shortly after she arrived at the nursing home, she reached up, grabbed the contraption in her mouth, and began pulling. She pulled and pulled, hand over hand, until the tube pumping oxygen into her lungs emerged in strings of blood, saliva, and residual tar. The degree of premeditation or even lucidity with which she approached this moment will always be a mystery. I like to think she was fully in control and the decision was a conscious one. She would wait until no one was around to intervene and she would end her life on her own terms.

Perhaps, with nine hours in the back of the ambulance, she contemplated how infinitely grateful she was that her previous attempts at suicide thirty years earlier had been unsuccessful. Maybe she felt a sense of contentment that she battled through such a debilitating condition, as best she could, for so many years, to see her children play football and marching band, and graduate from college, and have successful careers and marry and bring their own children into the world.

Perhaps she thought, “This is the right time. I’m ready. I’ve set my waves in motion.”

Or maybe it was far less romantic and more of an adverse response to being subjected to the humiliation of a five-hundred-mile ambulance ride only to arrive at a strange and unknown nursing home where she was meant to spend the rest of her days hooked up to life support. Perhaps it was more in the style of, “Fuck this, I’m out of here” as she extubated herself on a gurney. Knowing my mother, I think this is the more probable scenario; a final exertion of her will, a final act of obstinance. Soon thereafter, and just a few days past her 58th birthday, my mother burst forth from a crematorium chimney into the west Texas sky, finally completing her transmogrification into a cloud of pure gray smoke.

Now, all that remains is her legacy–my brother, my sister, our trauma and our healing. We were child soldiers, recruited against our will in the war against human suffering. In one hand we were given a sword of compassion and in the other a scatter gun of dread. We were the newest cogs in the machine of addiction, abuse, and mental illness that has plagued our family for generations. But each in our own way has attempted to metabolize the trauma. We chew it up and swallow it down, dry and chalky. We overeat, we work without ceasing, we run, we do not say no, we medicate and self-medicate. We walk through the world with a near pathological compulsion for self-sacrifice. We do what it takes to keep ourselves off the frightful sway of my mother’s rope bridge. On the other hand, as a result of our experiences, we give back generously. We possess an abundance of empathy for the suffering of others, and we make attempts to inspire those around us with our words and actions. In the end, we become more than the sum of these complexities and copings, as we glide and tumble along the crests and troughs of the waves my mother left behind.

Joshua Forehand is an educator of 23 years, having worked in Honduras, Texas, and Wisconsin. Writing has been a constant in his life since childhood–an escape, a travel companion, an emotional pocket-translator. His work has been published in the online journals Half and One, Beyond Queer Words, and Gramercy Review.