Content warning: this text contains descriptions of dying.
That’s gonna be boring, my dad says. Can we add this to it?
I look at the salami stick my dad is holding. I had been downstairs, rummaging around in the canned goods, the maple syrup, the paper towel, the extra bars of soap, the bulk shower gel. All purchased by my mom, during her lifetime.
You know Peter, we really should go to Costco one of these evenings. Let’s go at night, so we don’t miss the sunshine during the day.
Behind rows of beans and tomato paste, I found four boxes of Annie’s Mac & Cheese. I had heard about Annie’s! Less toxic and less embarassing than the orange stuff.
So I could make this, and not have to cook, I thought. I stacked my prize in my arms and climbed back upstairs, to fill the pot, heave it over the burner, ignite the light, invert the salt shaker over the water, and cover it. The kitchen is next to the family room, and my dad was watching a dramatic re-enactment of a real-life crash landing.
My dad was an excellent pilot earlier in his life. The youngest class 1 flight instructor in Canadian history, at the time. Chief flight instructor of the largest flying school in Canada, at the time. He flew up North, where pilots fly for hours, and die. He made it out. He flew water bombers over forest fires, where pilots fly for money and die. He made it out. We don’t know why he was so good or why he got so lucky. It’s just what happened.
I look at the salami he’s holding up. That’s all nitrates, I think.
Sure. We might as well add it. Why not.
He cuts up the salami with precision, into wispy pieces, each cut as proximate to the end of the stick as the last.
I add it now?
To this boiling water!? No! Just leave it there, I’ll deal with it.
He goes back to his dramatic re-enactment of the real-life crash landing, teetering on the edge of the couch in sitting’s athletic stance: torso leaning forward, elbows on knees, one hand holding the other for moral support.
So what’s happening? I ask, in an easy valley girl, my wooden pasta spoon loose in my wrist, water dripping onto the tile floor.
They lost an engine. Four engine plane. Commercial turbo prop. The props came off and cut into the fuselage and locked the throttle cables into cruise speed. 100 people on board, they gotta get this thing down, without crashing it.
[NARRATOR]: They cannot control their speed. They must land this aircraft, but without being able to reduce their speed on approach, this will be very difficult. Normal speed on approach for this aircraft is 120 miles per hour. Knotley has just reported their speed to air traffic control at 300 miles per hour. The pilots need to decide how they will secure this approach.
She was able to swallow some Ensure, until last night, but then last night we tried to get her to swallow some water, and she just held the water in her mouth. We couldn’t get her to swallow it or spit it out, and she refused to open her mouth. We were worried she was going to choke on it.
The palliative care nurse holds her shoulder, studying her as I speak. Has she been asking for water?
No, but she hasn’t asked for water in a long time. But until last night she was able to drink some, if we gave it to her.
He looks at me. So, when the body starts to die, it loses its need for food or water. So if she’s not asking for any food or water, then her body doesn’t need any.
They’re going to try to land? I’m watching it unfold from my stove station, one arm twisted behind me stirring the shells, the other on my hip, craning toward the screen.
Well yeah, they have to. But how, is the question. How do you get this thing down, and not crash it. I mean if you make contact and you’re going too fast, the nose will dive and you’ll go right over. This is crazy.
[NARRATOR]: Knotley tells the crew to move to the back of the plane, as he starts the descent for the approach.
God that would be scary, I mutter, a tightness collecting in my chest.
It’s Saturday night, in a rainstorm. We are camped out.
Ok love, so how much Nozinan has yer’mum had? For some reason all the palliative care nurses are English or Scottish. My dad even asked them why once, during a lull. He said he liked it. Liked that their Europeanness felt familiar to him. They didn’t respond. Just took it in, without judgment, as they did everything.
We’ve been giving her 0.2 ml of Nozinan, and her breathing is still up at 42 breaths per minute. She’s also on 1 mg of hydromorphone. And she’s still on her 6 mg of dexa, in the mornings.
As I talk, the nurse is checking the paperwork that they gave us to record our work. I laid out all the forms on the dining room table and made sure to organize them at right angles, and in chronological order. I wanted her to see that we had done as we were told. That we had done everything that we could have, with what we had been given.
I had also laid out all the syringes, in rows, so that she could get right to work when she arrived. I stacked the already filled syringes into differently coloured mugs, so that no one would grab the wrong thing. Even though the nurses already put flag-style stickers on them, showing how much of what is in each vial.
But still - we were told each butterfly needle could only be used for one type of medication. I assumed it would cause her pain, to mix them up. What else could it be . . . ? Because when the far-fetched worst-case scenario of your life has just sprinted up to you and is presenting itself, hands on knees and panting for air, as your new middle distance certainty, you’re left with only the most proximate and inconsequential repercussions to choose from.
The nurse doesn’t look up after I recount my mom’s latest medication round. It’s not doing anything, I state. I try to sound like I know what I want. I try to tone it out the way you would an edict. I’m standing feet hip-width apart over my mom’s body, in the space between the living room wall and the edge of the hospital bed, now set up where our couch used to be, trying to Matilda the nurse to come over to us.
Come here. Come look at this. Come see what these tumours have wrought.
My dad inches closer to the screen, one hand tucked behind his bad ear. They’re gonna try to land. Wow. How’s this gonna go.
Ambulances, fire engines, and police cars line the runway. It’s a hazy, mid-summer day, based on the grass, and the sky, and the T-shirts on the airplane passengers. The actors playing the real-life passengers fidget and look around at each other.
The screen cuts to one of the real-life passengers: The airplane was shaking. It felt like it was going to split apart at any minute. It felt like we were just hostages on this thing, you know? Like, not really hostages, but just, you know - who could help us?
I pour the shells into a colander, heaving one long exhale through a wave of tears that could come, if I let it.
My mom’s breath sounds mechanical. Possessed, even. Only a machine could breathe at this speed for any sustained period of time. And it’s been hours. Days, even?
The nurse walks over to touch my mom’s chest. I ask if this breathing is normal. She tells me that it can be, yes. I want to say that my mom told me herself, with her own voice, that my mom’s friend died of cancer by just going to sleep peacefully. And that my mom would have told me, if it had been worse than that. And that my mom was, more than anything, a person of truth.
I want to tell this nurse that this can’t be how people die. That people should die as humans, not machines. That we can’t watch her short-circuit, like a collapsed robot. That it would be okay if she sounded like any living or dying creature, in any forest or jungle, or even any sea. But that we just please need to get the intonation of sentience back into her.
Do you think we can get her back down to the 20 breaths per minute range? I venture. I try to sound inquisitive. Curious, even.
The aircraft roars as it approaches the runway.
The show cuts to one of the real life flight attendants recounting her terror: We had no idea what would happen on impact, or if we’d even be able to get the plane down. The screen flips to a depiction of that flight attendant inching her way to the back of the plane as it barrels toward the Earth.
[NARRATOR]: The aircraft has gained speed on approach. Knotley reports to air traffic control a speed of 310 miles per hour.
Her breathing is going up, not down, my dad turns to me, shock in his mouth as it hangs ajar with the realization. It’s at 58 now. He has been perched a foot from her face, counting her breaths while staring at the second hand on his watch, and then calculating the per minute rate in whispered German.
Ok this is her bad side, I proclaim. Let’s turn her. She always breathes better on her right side.
I start to pull the sheet off her, and lift her right leg up from the pillow between her knees.
We have to move her this way first, and then turn her over, I instruct.
The nurse comes over to help.
Ok, on three.
We grab the pee pad on three, lifting and pulling her over the rubber air pockets of her Roho mattress. I always think how they transfer ocean animals from one zoo to another through the air in those massive sheets. When she was conscious, I teased her, You’re like a cute baby beluga whale at the aquarium! as we slid her through space.
No I’m not, she tried to chuckle, her eyes fluttering. She had usually tried to deny us our silly animal analogies, for reasons not obvious, because they always amused her.
Ok let’s turn her to the other side. I push on her right shoulder, rotating her entire torso. I lift her head, to make sure it comes with her shoulders. The skin on her face doesn’t move. She had been on her side, where her lips had been hanging away from her teeth, pulled down by gravity.
We all stop, and as I hold the back of her head, I realize that her lips and cheeks have already started to die.
Her eyes have been open for six days straight, and we haven’t known if she can see. We assume that even if she can see, she can’t process whatever her eyes take in. As I hold her head now, her eyes are locked on mine. Can the eyes still see, when the cheeks are already dead?
We search her face for movement - not just for independent movement, but for the ability to still be moved - but her breath has stopped. She stares, lifeless.
[NARRATOR]: Air traffic control clears the aircraft for landing. The pilots are going to attempt this landing.
Aren’t they going too fast? I ask. A dam of tears is pushing behind my eyes.
Yeah, way too fast, my dad agrees.
I turn to stir in the cheese powder into the shells, and a little tear escapes one eye.
[NARRATOR]: A mere 15 feet from touching down on the runway, Knotley decides to overshoot this landing. The aircraft is traveling at far too high of a speed to land safely. He will go around and attempt it again.
The nurse sees my mom’s face and grabs my arm, and my dad’s. The fingers of her latex gloves stick to my skin.
Oh this could be it love, this could be it. Ok? This could be it . . .
My mom just stares. For 15 seconds, she shows no signs of life. And then she gasps, reaching up with her mouth, like a fish hooked on a dock.
Let’s give her a little bit more then - let’s try another 0.2 ml of Nozinan and 0.2 ml of hydromorphone, the nurse says.
It’s not working though, I insist. We already gave her those dosages, and her breathing is still going up. I think we need something else, or way more medication. Can we call a doctor?
Oh they’re going around again. They’re gonna try it again, my dad calls, over the hood fan.
So what are they going to do differently this time? I ask, around the choke in my throat. I’m stirring the salami into the pasta.
They had the real-life pilot on now: We knew we had to get our speed down, we just didn’t know how. You gain speed when you descend on an approach, and that’s unavoidable, and we weren’t able to stop that process the way we normally would.
It’s not going down. It’s actually gone up since we gave her the last dose - it’s at 68 breaths per minute now, I relay matter of factly to the palliative care doctor, who is calling me from somewhere in a neighbourhood nearby, in her own house, from her on-call shift. I hear kids in the background.
Ok, your mom needs a lot more medication, she says. This is centrally motivated - this is coming from the brain, not her lungs or heart. The tumours are making her cerebellum send the signal to breathe at this elevated rate. That’s why the medication at these doses isn’t working. We’re going to need to give her much, much more, which will mean that she’s completely unconscious, if she’s not already. Do you have a pen?
[NARRATOR]: On the second approach, Knotley decides to cut the other three engines. This will mean a total loss of control over the aircraft. But this is the only way the pilots can slow the aircraft down enough to manage the landing.
I scrawl down all the medications and dosages she gives me. It’s 8:30 pm. If my mom is going to live until the morning, she will run out of medication by 1 am.
We call every pharmacy on the North Shore, in search of Midazolam, Nozinan, and hydromorphone. It’s Saturday night. Every pharmacy is out.
We find some at a hospital pharmacy across town. A friend gets in the car, to go get it for us.
The nurse talks to the doctor, and then starts to draw up more syringes, to put in the differently coloured mugs. I set alarms on my phone for every half hour, from now until 7 am the next morning. For each alarm, I type the medication and dosage as the name of the alarm. My mom’s breathing marches on, a plundering metronome that taunts our silence, as we work.
It’s still raining.
They’re cutting the engines. Good. That’s what I’d do too. Sideslip it, it’s the only way to get it down.
I want to cry out in shaking wails and sob.
Oh ok, is that a good idea? I ask, my eyes on the shells and the salami.
We give her the Midazolam, which will make her unaware of her surroundings. The doctor increased her medication dosages tenfold, and she now has four butterfly needles, up from three. Two in one leg, and one in each arm.
We take the syringes previously filled to 0.2, and give her five of them. There is no needle to insert. It’s a lock and key port system. So useful, I think, each time I use it. You just take the syringe, push the flat end of it into the recessed portion of the butterfly port, turn to release the medication, and slowly depress the plunger.
[NARRATOR]: All four engines are now off. Cutting the engines worked - Knotley has just reported the speed on approach at 150 miles per hour, down from 310 miles per hour on the first attempted approach. While this is still too fast, it may be slow enough to land the aircraft. However, the pilots have no control over the aircraft, and without any steering control, the landing will be very, very risky.
It sounds slower. Is it slower?
I’m shoving spoonfuls of a three day old salmon cream cheese casserole into my mouth. It’s the first solid thing I’ve eaten all day. I’m dehydrated too, and the pinkish sauce is sticking around my mouth, uncomfortably.
Yeah. It’s down to 45, my dad reports, into the space between his watch and my mom’s face.
The nurse has left to go get more syringes.
I sit down with the casserole, chewing into the beats between my mom’s slowing metronomic pace.
They’re landing. They’re actually gonna put it down. How’s this gonna go. Wow this is fast.
I turn to see the plane descending toward the runway, the pilot rearing back on the control column with all his bodyweight.
[NARRATOR]: The aircraft touches down, but immediately loses control, swinging wildly from side to side on the runway. The pilots are unable to exert any steering force on this machine.
My friend gets back with the medication. The rain is still driving down onto the skylight above us.
It’s down to 24 breaths per minute. Wow. That’s good. It really came down, my dad reports. To us, this time.
Oh that’s so good, my friend reassures us. Yeah, it was pretty obvious that she needed much more, she adds. She knows about these medications.
We need more syringes filled, so my friend and I start to break open the ampoules. I learn on YouTube that something about physics makes the liquid not tip out of an ampoule, even if you hold it upside down. I learn something, while my mom is dying.
The plane continues to flail as momentum kicks it down the runway. I stand at the edge of the counter now, one hand clasped tightly around the other, as we watch the nose swing into the ditch, dragging the rest of the plane with it.
[NARRATOR]: The question looms as air traffic control, emergency services, and bystanders look on in terror: when, and how, will this vessel come to a stop?
You guys, she’s not breathing, my dad says, his voice rising from his bedside post. She took a breath a few seconds ago, and . . .
We jump up from the table, scattering our ampoules.
What was her breathing rate at?
Same thing, 24.
One of the wings digs into the ground, breaking. The plane lurches, and comes to stop.
I put my hand on her head. Nothing.
We stand, waiting for another breath. I smell like smoked salmon casserole and ampoule juice. I managed to mess with physics, apparently.
My mom, did not.
Thank you for sharing this story with us Dominique. It was so well written and brought tears to our eyes. You are a gifted and talented writer and clearly loved your mother and faithfully took care of her until she took her last breath. As sad as it was, what an honour that you were able to spend this time with her. Your mom fought a long and courageous battle with cancer and was always so positive amidst her suffering. We have such fond memories of your beautiful mother which we will cherish. You are in our thoughts and prayers.
Pierre and Heather
Dominique my deepest condolences go out to you and your family. This was so beautifully written.