Cases in the Betwixt: No Family

What Becomes of Them?

I can’t seem to stop thinking about the article in the Washington Post last week on people with cognitive impairment or dementia who live alone in America. It’s in the millions.

Sad and somewhat horrifying. It took me back to when I worked on an inpatient hospice unit and there were people dying that had no visitors. I remember we sat at the nursing station and whispered about how does that happen?

And then I had a close encounter with that.

I had found my biological mother when I was 55 years old. Earlier in my life, I had no interest, but when my daughter started having kids, she asked me about family history. One thing led to another, and I ended up meeting my biological mother in Durham, North Carolina, when she was in her mid-seventies. She lived by herself in a low-income apartment building. Never married and no children. No siblings and both her parents were dead.

She professed to have good friends and even though I never met or saw anyone on the several visits I made cross-country to see her, I assumed she had those friends. I flew her out to Seattle to meet her grandchildren once, and all seemed well until I broached the subject that she could move out to the west coast, we could help her find a place, and she could be close to family.

My biological mother and I

That was too much. She had lived in Durham all her life and she would never leave there. She was adamant. I sort of understood that. But it also felt like rejection. Complicated.

And life got busy, but we continued to communicate, by email mostly, but several years went by and the contact became less and less.

Then I got a call from Duke University Hospital. She was in the ICU and they had me listed as emergency contact. What?!?  Yes, they said, next of kin.

Whoa. I explained the situation, emphasizing that despite our biological connection, we lacked a legal relationship. The social worker relayed they had no other contacts listed, and the doctors were looking for someone to discuss end-of-life issues with.

She had fallen and not clear how long she was down. She was not able to make decisions for herself because her brain wasn’t working, and she was in heart failure. They were giving her drugs to support her blood pressure, but it wasn’t looking good. What should they do?

The social worker asked if I would talk to the doctor. What was I going to do, say no? I reiterated to him I had only known her a few years, and I lived in Seattle. I told him she had no family.

Awkward barely covers it. I shared I worked in Palliative Care, which seemed to help because he explained the situation and what his thoughts were, and I told him that withdrawing support is what I would do if she were my patient, again stating I was not her power of attorney.

I ended up flying back east with my daughter to take care of her burial costs. We also cleaned out her apartment, where outside the door a crowd of her “friends” waited to see what would be left for them to scavenge. I remember looking at her in the coffin and having the same thoughts I had about those patients on the hospice unit.

Sad. So very sad. How could this happen to someone?

Apparently it is happening more and more.