Reflections from an October at Grady: Flowers for the Living

(* Entry written with permission of patient and family, names changed.)

Mrs. L's actual window sill, taken with my phone with her permission

I walked into the room of my patient, Mrs. Lloyd* (names changed) one morning and immediately noticed the same two things that always leap out at me upon entering her room: First, her daughter, Nicole, who had become a permanent fixture at her bedside throughout the hospitalization, and second, the constantly growing shrine of cards, flowers and balloons sitting on the window sill.

"We love you, Mama"
"Get well soon"
"We miss you, Big Mama"
and my favorite one, which read

"Too blessed to be stressed"

Every day there was something new. This particular morning there was a clear plastic container with a little black fish swimming around inside. "That's from her grandson," Nicole said with a hearty chuckle. "He said it would keep her company."

Mrs. L's fish, also photographed with her permission

Although her overall prognosis was poor, the energy in her room was always so rich. The cards, flowers, gifts, balloons, and now fish represented a person whose life was meaningful. This was a woman who was loved and cherished--and that's a blessing.

There are so many people I've cared for during extended hospitalizations whose window sills were a stark contrast to Mrs. Lloyd's. Rooms void of any visitors, cards, or sentimental items despite weeks and weeks in the hospital. There was this one gentleman I cared for a few months ago who was born and raised in Atlanta. He was even a self-proclaimed "Grady Baby," yet in the nearly thirty one days I cared for him, I never saw any signs of doting loved ones on his side of the room. Not a card, not a flower. . . . .not even remnants of half-eaten McDonald's from a hungry visitor. Then one day near the end of the month, I was elated to find a giant bouquet of balloons on his window sill. Eureka!

"These are beautiful, Mr. James!" I recall exclaiming, "I'm so bummed that I didn't get to meet your visitor! Who brought these for you?"

He didn't even make eye contact with me. He just kept staring out of the window with his skeletal back to me when he murmured flatly, "Oh, them was the man's that was in the bed next to me. He had so much flowers and stuff that they couldn't carry it all, so the nurse just left 'em with me. You can have 'em if you like 'em so much." This was his fourth week in the hospital under treatment for complications of AIDS. Sometimes that made me even sadder than his disease. But this wasn't the case with my patient, Mrs. Lloyd--her room was oozing with love.

Aaaah, Mrs. Lloyd. Mrs. Lloyd was a woman in her late sixties who had spent the last several months fighting a cancer that had rapidly spread throughout her body. She was admitted to our team early in the month after she had stopped eating and had become too weak to walk. She was evaluated in the Grady Primary Care Center where she was found to be dehydrated and with signs of an infection. With such advanced cancer, this wasn't unexpected.

Although her daughter, Nicole, had excellent insight on her mother's disease, she preferred to focus on the short-term, concrete details. "The medicine y'all gave her for her bowels really helped. She moved 'em real good, doctor," spoke Nicole while smoothing the cover over her mom. I glanced at Nicole quickly and took a mental picture of her. I'd decided early on in her mother's hospital stay that she was someone that I wanted to remember. At that moment, I promised myself that I would. Remember her. Remember this.

That wouldn't be hard because Nicole was memorable. Her round face was covered with a smattering of freckles, and her wide smile was the first thing to greet anyone who entered the room. Forty something year-old Nicole was what folks in my neighborhood would have called "big-boned-ed" but --like many such women I know--it didn't seem to dampen her confidence one bit. Her head was always held high, and there was always a twinkle in her eye. She smiled and laughed a lot. Each of her front two teeth was rimmed in gold, which perfectly matched her heart and her intentions for her beloved mother. Even during the hard conversations about things like the "Do not resuscitate" order or even hospice discussions. . . .she managed to exude positivity and to eek out a happy facial expression. Remarkable.

Every morning, Nicole was meticulously groomed from head to toe, and this day was no different. Her mane of sandy colored, shoulder-length dreadlocks was neat and purposeful, and perfectly spilling out of one of the many signature, brightly colored fedora hats that she wore daily.

"Wow, you really look so nice every day I see you." I was so impressed by her ability to fix herself up every morning with all that was happening to her mom. Finding her in a tattered t-shirt and wrinkled sweatpants would have been both understandable and acceptable under the circumstances.

"You know, doc, I kinda thank it makes my mom feel a little better when I clean myself up. You know what I'm sayin'? Like, I tell myself, if I look a mess, I think it would scare her. . . I don't want her to be able to look at me and tell how sick she is, you know?" She glanced down at Mrs. Lloyd who remained sound asleep. Yes, I think I do know. Nicole always seemed to know what to say.

"I think that's a great way to make your mom feel better, you know, putting so much time into your appearance," I spoke quietly. Then I added, "I like the way you dress her up, too. I bet that makes her feel good." We both rested our eyes on Mrs. Lloyd, and stood in silence for a few moments. Mrs. Lloyd had lost her wiry mane from a combination of aging, chemo, and chronic illness, but Nicole always decorated her mother with a different turban each morning, and even put a little lip gloss on her lips. And the best part of it? Whatever color fedora that Nicole wore, her mother donned a headcover of the identical shade. It was probably one of the sweetest gestures I have ever seen. Today was fuschia day.

Mrs. L's colorful turbans

I gently peeled back the cover and prepared to examine Mrs. Lloyd. I hated to even awaken her, and did my best not to. Suddenly I saw her lashes batting and her eyes slowly opening.

"Hey, Mrs. Lloyd, it's me Dr. Manning," I greeted in a hushed voice, "I came to see about you and Nicole this morning. Are you in any pain?" She offered me a slightly bewildered look. I knew there was a reason I didn't want to wake her up.

"Momma, are you in pain? Tell Dr. Manning if you in pain," interpreted Nicole to her mother. It worked. Mrs. Lloyd shook her head no. I studied her face carefully, looking for a grimace or any other sign of discomfort. Her face was quiet and peaceful; consistent with her response to Nicole.

I gently touched her cheek with the back of my hand. Her smooth, milk chocolate complexion was free of even so much as a laugh line. "Mrs. Lloyd, Nicole and them must not've worried you too much as kids. You don't have a single wrinkle on your face! Not a one!" I curled my lips playfully, put my one hand on my hip, and gave a "come on" gesture with the other hand. "Give it up, Mrs. Lloyd. You need to come on and tell me your beauty secrets."

"Chile, you know Black don't crack!" Nicole said and rolled her neck in jest. We both immediately laughed out loud, united in our African-American culture, and thus in our knowledge of that age-old saying. Mrs. Lloyd gave a knowing glance in our direction and offered a tired smile. It was her version of a "fist bump."

I then proceeded to quietly examine Mrs. Lloyd. The veins on her neck, her heart and lungs, and her protuberant abdomen. I ran my fingers along her extremities, pausing to check for pulses, and then applying gentle pressure to assess for fluid retention. My eyes traveled back to her face and waited for a moment. She had finally closed her eyes and drifted back into a peaceful slumber. I noticed her eyelashes--someone had applied mascara to them--and even her eyebrows had been shaped. This was what Oprah meant when she said 'The love is in the details.'

After gingerly replacing the covers over Mrs. Lloyd's bony shoulder I returned my attention to Nicole. She stood patiently in her fuschia hat, and as soon as she saw me look in her direction, she gave her same wide smile. What a remarkable woman. I scanned her face once more and vowed to retrieve it from my memory some day. Every freckle, every gesture. Remember her. Remember this.

"Nicole. . ." I cleared my throat and finished, "Nicole?" She raised her eyebrows and tilted her head sideways. I decided that I would tell her exactly what was on my mind. "Thank you for teaching me so much about how to be a better daughter. You are truly a remarkable human being, and . . . .I will never forget you. I mean that." I knew I was at risk of sounding corny, but I didn't care. With all of the flowers that she'd brought to Mrs. Lloyd, I thought she deserved a few flowers of her own. Flowers for the living.

Her face grew serious and determined. She reached down and rubbed her mother's leg slowly. "You know, Dr. Manning. . . .I ain't remarkable. Now my mom? She's remarkable. When you have a mom as good as my Momma been to me, it's easy." She shook her head and then locked eyes with me. "The bible says, 'Honor thy father and thy mother,'" she said with her raspy voice. "I'm just being obedient, Dr. Manning."

I vaguely remembered hearing someone preach a sermon on that at some point. Then I thought about the last time I'd heard someone say that. It was nearly a year ago when my good friend, Crystal C., was caring for her mother during her battle with metastatic lung cancer. Her mom couldn't drive any more, and my friend cheerfully taxi-ed her mom to every appointment, every pharmacy, every errand, and every place she so desired. Like Nicole, she told me that she was honoring her mother and being obedient. What a testament to a parent's life to have a child with such an attitude! Remember them. Remember this.

I do remember. I remembered the many times that I'd seen Nicole carefully doting on her mother over those weeks. Getting her coffee just right and inching it up to her lips to take a sip. "Too hot, Momma?" she would ask, and then put an ice cube in it. Pillows underneath her head with pillowcases from home, paint on her fingernails, and color coordinated head coverings. I also remembered Nicole's two teenage daughters who accompanied her on many of the hospital visits; equally smitten by their grandmother. Plucking her greying eyebrows, fluffing her pillows, rubbing her feet with vaseline. The love is in the details.

"They will remember this," I uttered aloud in context with my thoughts. "Your daughters. They will remember how you honored her." I cleared my throat again and added, "I will remember this." We were both silent again, this time as if someone had pushed a pause button. I glanced out the window into the bustling downtown Atlanta traffic. Nicole released a sigh to break the quiet tension.

"Look, Dr. Manning . . .I know my Momma sick. I know she might be in her last days, too. But taking care of her to me is a joy. I ain't doing nothing she didn't do for me. Nothing. Like I said, Dr. Manning, I'm just being obedient." My eyes moved from the window just in time to see Nicole plant a kiss on her mother's dewy brow. Obedient was an understatement.

"That you are."

I bid her adieu and headed toward the door. I stopped short of the handle and looked over my shoulder toward Nicole and Mrs. Lloyd once more. She had settled down into the bedside reclining chair next to her mother and closed her eyes. Honor thy father and thy mother. Words to live by. Remember her. Remember this.

I looked skyward and thought for a moment. "Exodus?" I asked with my eyes squinted.

She kept her eyes closed and smiled wider than ever. "Exodus 20:12," Nicole corrected me. I snapped my finger and nodded my head slowly as I left the room. I guess I had paid attention to more of that sermon than I thought. I could hear her throaty hum as I exited. . . .humming the old spiritual, "Going up yonder." How fitting.

***

That was the last time I saw Mrs. Lloyd and Nicole. We talked about hospice care, but they weren't quite ready to make that decision when they left that following day. Last Sunday, just two days after she was discharged from the hospital, Mrs. Lloyd passed away. . . . .or, as the church folks say, she "went home." I think I like the idea of Mrs. Lloyd going "home" better than the idea of her dying. . . . . .

"Too blessed to be stressed."

I'm not sure of too many of the details of her death, but there is one thing I know for sure about the moment that she made her transition. . . . Mrs. Lloyd was indeed blessed, and was so surrounded in love that she probably wasn't the least bit stressed. :)

***

"Honor thy father and thy mother:
that thy days may be long upon the land
which the Lord thy God giveth thee."

-Exodus 20:12 KJV

~For Crystal C., a sister and friend who also epitomizes"honoring thy parent"~