The House Always Wins

How does one care for someone that is dying? How does one care for his mother?

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My mom lives in Laughlin, Nevada with cancer.

She had lung cancer that went into remission years ago. Then a few months ago, she was told the cancer was back. I asked her to come live with me in Pennsylvania, but she liked her apartment, her doctors, her cats. I sent money every month and called every two or three days.

It got worse. Last week she went to the hospital saying she didn’t feel good. She had pneumonia. Doctors admitted her and started treating her, but the next day she had a seizure. They tried to sedate her but then her heart was having problems, so they had to put her on a breathing machine. My mom doesn’t like being out of control and fought the doctors. Trying to intubate her to save her life they accidentally knocked out two of her teeth. She fought more, and they had to sedate her and restrain her before succeeding with the intubation.

They did a body scan and found a tumor in her brain, in addition to the tumors in her lung. They are inoperable.

When I got to Laughlin, she was still on the breathing machine but conscious enough to shake and nod her head yes and no. She cried constantly. I spoke with her and told her everything was okay. She looked very upset and weak and ill.

I talked to her more, and she kept herself calm enough to come down from the sedation and be extubated. Now three days later she is on a liquid diet and taking massive amounts of pain medication but looks a little better. There are many questions. I’m still in Laughlin, and I have a hard time knowing what to do.

I spend most of my time in the ICU ward but sleep in a hotel casino. It was the cheapest room in town. Going from one place to the other in the morning and at night, I follow a circular route that crosses the Colorado River.

There are a lot of similarities between hospitals and casinos. Both are mostly filled with elderly, sick-looking people. Both have a lot of machines with blinking lights — the monitors in patients’ rooms and the slot machines. They both have a lot of young women walking around with trays, carrying palliatives to people who didn’t ask for them. Both doctors and Blackjack dealers speak in the coded language of odds-making. The food in both places is equally bad, though it’s more expensive in hospitals.

Another similarity is the occasional spark of life one sees cutting through the haze of confusion and noise and false hope.

When my mom needed to be bathed by a nurse — a young Vietnamese woman named Gerlie, who for all I know might be some kind of a saint — she had to lay on her side in the hospital bed. I held her hand and tried to avert my eyes from the tubes but could not miss the mastectomy scar where her left breast had been removed.

When my mom was getting restless, Gerlie said, “I need you to stay still just a little longer, Pam.”

“My name is Pamela.” My mom has always hated being called by the shortened version of her name, and that didn’t change even lying naked and shivering in a hospital bed.

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I saw something of this stubborn vitality in a much more casual, familiar form in a flirtatious exchange between a middle-aged married couple at the casino, as I rode the elevator up to my room one day.

I call my wife a lot. Like the nurses who care for my mom, she has an otherworldy stability and calm. Her ability, even from our home in Pennsylvania, to take care of matters which to me seem incomprehensible at the moment — insurance, social security, medical power of attorney — approaches a sort of heroic wherewithal that very much reflects our everyday life together. But it still somehow surprises me. I’m very thankful for her.

Another thing I’m thankful for is Netflix. I use my laptop to let my mom watch her favorite show, Star Trek: The Next Generation. Watching this show during its original syndication in the ’90s when I was a kid had been part of our household’s daily schedule. I am thankful beyond any kind of logic for the existence of the internet and Netflix and the people who wrote and produced this show, and also for my job, which has given me time off without any question or even a real request — after I told my bosses what was happening, they both quickly said, “Just go, and don’t worry about anything” — and which as well as allowed me to have my laptop, so that my mom could enjoy this show at this time. That my mom gets to watch episode after episode of her favorite show while her son sits with her in her hospital room seems like a small miracle.

Even in the best-case scenario, my mom’s prognosis is grim. I am glad that she’s responding to treatment for pneumonia and getting stronger by the hour. But her cancer can’t be cured. She is in the position of having to decide whether to receive radiation treatment to prolong her life or enter hospice.

I grapple with many questions, not least of which having to do with the death of someone I love dearly. But since my mom seems to be out of danger for the moment, the more immediate question is how should I advise her about how she wants to live the last chapter of her life. If she opts for more cancer treatment, she will need constant care, and even the most optimistic timeline is not very encouraging. The other option, to go into hospice, is of course merely a waiting game with death.

One night after a long day in the ICU ward, I decide to walk half a block from the casino parking lot to a burger joint to get some food. While waiting for my order, a drunk man stumbles in and walks up to me where I’m waiting by the counter. He asks me if I can “do him a favor.” I ask what he wants. He says he needs the cup I’m holding, which I’m drinking lemonade from. I tell him I’m using it at the moment, and he says to me, “You look like a nice guy, but I’m not sure if you actually are a nice guy.”

The man is a great drunk. His appearance feels like a scene of comic relief in a very serious movie, which in a way it sort of is. He makes a perfect jackass of himself but manages to speak an oddly eloquent sentence. I do look like a nice guy, but like him I’m not ever really sure if I am one. And the distinction has been weighing heavily as I consider the possibility of having to care for my mom — bathing, feeding, carrying her.

The drunk man walks over to the soda fountain and puts his whole head under it, taking deep drafts from the flowing liquid. He straightens up with a bleary look in his eye, his face dripping. He walks over to two guys eating at a table and tries to strike up a conversation. He gets nowhere with them and leans through the door.

Walking back to my hotel room, I wonder if this drunk had wandered out of the casino where I am staying, or even if he believed that the interior of the burger joint was still in it. Maybe he thinks that the whole world is a casino. Judging from the example of Laughlin, Nevada, it would be an honest mistake.

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Throughout all this — on the plane ride, sitting in the hospital, in my hotel room — I have been reading The Seven Storey Mountain by Thomas Merton, a book about the author’s early life, being raised by artist parents and travelling throughout Europe, his education at Columbia, his experience as a poet and scholar, and his decision to enter a Cistercian monastery.

Merton’s transition from the intellectual life to one of sacrifice and silent contemplation resonates deeply with me. At Columbia, Merton became a communist and protested WWI and involved himself in the intellectual conversations of his age. But he found all these pursuits inadequate to address real modern problems. He tirelessly strove after meaning and happiness and the fulfillment of self but felt fulfilled only by turning away from the world. He experienced a sort of revelation at a retreat in a Harlem orphanage where he met a woman who gave up all concern for worldly recognition to care for impoverished and abused children. Only after years as a monk did he very unwillingly go back to writing poems and personal essays about his experience, at the prompting of his superior in the monastery where he lived. His books went on to become classics.

One passage in particular seems to address casino logic, and striving for personal gain.

Merton discusses the flaw in the democratic concept of personal rights, where a justice system makes no consideration for the weak and destitute. According to Merton, in such a system, only those who loudly demand the highest threshold of personal rights actually receive just treatment, and if everyone were to demand that threshold all at once, the system would collapse. Without advocacy from the strong, the weak get nothing. Thus, a system based in fairness often relies on people willingly forgoing fair treatment.

Said Merton:

Indeed, the truth that many people never understand, until it is too late, is that the more you try to avoid suffering, the more you suffer, because smaller and more insignificant things begin to torture you, in proportion to your fear of being hurt. The one who does most to avoid suffering is, in the end, the one who suffers the most: and his suffering comes to him from things so little and so trivial that one can say that it is no longer objective at all. It is his own existence, his own being, that is at once the subject and the source of his pain, and his very existence and consciousness is his greatest torture.

I think a lot about the elderly people in the casinos and everything that might have led them to spend their golden years rolling the dice on the promise of some future happiness. I think a lot about my mom and how she has been banished to this netherworld of chance against her will.

I decide that I want to get my mom out of this casino town, however that might happen.

Photos courtesy of the U.S. National Archives

Nathan Pensky is a writer and editor living in rural Pennsylvania. Follow him on Twitter.