I’ve known that my mother is dying for several months. She has end stage heart failure and has been deteriorating slowly since early spring. This week, though, she’s taken a sudden turn for the worse and now it’s only a matter of days until she’s gone. Mom lives in a nursing home and most of her caregivers are kind and good at their jobs, but they’re busy. Very busy. Many days they work short-staffed and the dozens of patients they care for need a lot of care. Nursing homes in Ontario admit only patients who need full-time care and most of the people on my mother’s ward need help with everything from getting dressed to toileting. Staff does the best they can, but it isn’t the standard of care that I would give to a palliative patient so I’m visiting several times a day to help her be comfortable. This is my comfort zone. It’s when my clinical brain clicks in and I can push the emotional shit to the edges and be a nurse. Being a nurse is easier than being a daughter about to lose her mom.

There’s a phenomenon in palliative care known as anticipatory grief. It sometimes happens when a loved when takes a long time to die. The bereaved starts to let go of the relationship while the person is still alive. It comes near the end when caregivers are tired and it dulls the emotions. It’s one method of coping and I’ve often heard caregivers say that they’re ready for their person to die. In some ways they are. They’ve started the process, but they’re tired and dull and anxious for the struggle to be over. The thing is, though, that even if it takes a person a long time to die the moment when death happens feels sudden and no-one is ever really ready for the vacuum that appears where care and concern and love lived only a moment ago.

I’m an only child and we have no other family here. My mother’s relatives are all far away in Germany and there’s only the two of us left here. We’ve had a complicated relationship, mom and I, and I’ve worked through a lot of issues over the course of my life. I’ve let go of a shit ton of anger and in these past months I’ve made sure to say all the things I wanted to and to listen to all the things she wanted to say. I’ve been surprised by how much love managed to survive underneath all those other complicated emotions and I’ve let that guide me in these past few months. I have no regrets, there’s nothing left unsaid and I’ve been telling myself that I’m ready. It’s my coping mechanism, too, it seems, but in these last few days I’ve been surprised by how tender I feel and the facade of being ready is fading fast. I’ve nursed so many dying patients and their families that I thought I had an edge, but not even a palliative care nurse is ever really ready.