“The End of the War” by Patrick Cook

Image courtesy of USAF Art Program and Victor Juhasz, artist

The last time I had done any nursing had been twenty-five years earlier, in Vietnam.

That was very different from nursing our mother. In Vietnam, we were passionate fighters against death, plunging burned pilots into ice baths to bring their temps down, stuffing gaping exit wounds with gauze four times a day, heroic treatment for heroic men. Now we were presiding over a sure death, the heroics over, surrender our only desire.

The summer sun filtered through shade and curtain, heating the bedroom so it was nearly warm enough for her. Monsignor Ancona anointed her. We had the candles and the crucifix and the holy water laid out, and we lowered the morphine dose enough to let her stay awake for the sacrament.

The morphine. We administered it by eyedropper into her colostomy every four hours and kept her knocked out. It was the only medicine we were giving her, in fact the only substance entering her body. How terrible that our abstemious mother, who smoked two cigarettes a week and had one glass of wine a month, should die in a stupor. It was better than pain, of course. She was prepared for death, and not only by the last sacraments. She’d known she had ovarian cancer for two years. Still, it seemed like a cheat.

She had eight children, and we were all there, with our spouses and the grandchildren. The house was full. We took turns sitting with her, fluffing the pillows and reminiscing. The late watches were especially fruitful of memories—her joy in her grandchildren, her love for teaching, her knack for celebration. There was no one for a party like our mother.

We had the hospice people in. Our nurse, Mary Hollern, expected to help us build a volunteer group of the neighbors, but when she saw all of us, abandoned her plan. We had plenty of nurses right there.

Mom started to develop bedsores. You have to turn a bed patient every two hours, especially an emaciated one, or the skin on the lower back breaks down and ulcerates. I caught hell from a lieutenant commander for neglecting this once—once—during a shift on the intensive care unit. When I wanted to turn my mother, though, Mary looked me in the eye and asked firmly, “Why?”

I thought about it. What was I saving her back for? Turning her was painful, and served no purpose. A lot of nursing designed for the living went out the window when death was a sure thing. We didn’t move her around, or suction her when her breath gurgled in her throat. We talked, we prayed, and we kept putting those drops into her colostomy.

We took turns sitting with her, slept on couches and floors, and tried to cooperate. In a big family like that, it was never possible before. Getting everyone together for a family picture was hard. We never even considered a real project. But here we were, setting up shifts, dividing responsibilities, just as though we knew what we were doing.

I wasn’t running things. It was a cooperative effort. But I was in the middle of it, taking my turn in the long night shifts, holding her hand, swabbing her teeth with an lemon flavored q-tip.

The last thing they had done at the hospital before sending her home was to put a drain into her stomach. The cancer had strangled her bowels, making it impossible for food or water to pass. As her bile built up, she retched once an hour, so the surgeon thought it better that her stomach drain onto gauze pads. Anything we gave her in the way of food or drink also drained through the tube, so it was impossible to nourish her. The only thing getting into her was the IV drip.

She was desperately thirsty. Denying her a drink seemed harsh, but it was necessary too.  I had done that before. We got a big Huey helo full of Vietnamese civilians, mostly women and children, early one day. They were victims of a Viet Cong mortar attack on their village. We had patients lined up on stretchers outside Triage in the morning sun. The mother of a badly wounded boy asked me for water—“Nu’oc, bac si. Nu’oc.”

I couldn’t give her son any water. He may have had abdominal wounds, and we couldn’t risk any leaks into his peritoneum. There was no way to explain that to his mother, of course. I barely knew the Vietnamese word for water, let alone peritoneum. I said firmly, “No can do, mamasan. No can do.” That look in her eye….

It was the right thing for mother, too. That didn’t make it any easier to deny her water. The week wore on, people came to visit—fellow teachers, Monsignor again, her doctor, who was so impressed by the fight that was in her. None of us left, although we took breaks. My sister stayed at my house a few nights, my brothers stayed with old friends. One night a family from the neighborhood stopped by and left two dozen bacon-wrapped filet mignon steaks with us, each about four inches thick. We broiled those in the yard as far away from the sickroom as we could, and practically inhaled them.

I could see the difference it made to have children and friends around you at the end of a long life, compared to a death surrounded by strangers when it had barely begun. We certainly didn’t try to tell the Marines we loved them in the middle of the night, no matter how far gone they were. We could reassure them—yes, you’ll be able to walk with a artificial leg, no, your face won’t always look like that, yes, your penis will still work. But that was for those who were going to live. Now all we wanted was her release.

Finally, mother gurgled with every breath. Mary Hollern explained to my brothers that her kidneys had failed and that the IV was actually drowning her. It was time to take even that away. I was not there at the time but I came into the sickroom when the nurse was still there. The first thing I noticed was the IV tube wrapped around the pole and pulled away from the bed.

My face must have dropped. I felt myself coloring. I couldn’t speak for a few seconds, and when I did, I sputtered. “What the hell happened? What did you do? Why is the goddamn IV…?” I knew she hadn’t died. I couldn’t believe they had pulled the IV while she was still alive.

Mary Hollern sized things up immediately. She got me out of the house, literally moving me out of the sickroom with her forearm. She said we were going for a walk to discuss this, and it was neither a suggestion nor an invitation. Mary would have made a good lieutenant commander.

My violence left me. I walked with her, up the sidewalk and around the long block.  “Look, Patrick,” she said, “Your mother is dying. Her kidneys have failed. We had to remove that IV or she would have drowned in the fluids.”

I managed to speak. “Yeah. You had to They had to. OK. They had to.”

“You were about to go off. I had to get you out of there. What do you think we’re doing? Trying to kill her?”

“That’s not it, Mary. That’s not it. OK, I lost it back there. You’re right. I lost it. But that’s not what it’s about.  I told you I’d been a corpsman in Vietnam?”

“You told me.”

“We had a tetanus case once. A young woman. Have you ever seen a case of tetanus?”

“No. Not many American nurses have ever seen a case of tetanus.”

“She had a bad case. Very advanced. She was so rigid with it she trembled. Her jaws were clamped shut. Her arm muscles were so contracted you couldn’t even get a blood pressure on her.”

“What did they do?”

“They’d never seen tetanus before either. Three of the doctors went to the medical library and looked it up. The books said to use curare. That’s the poison Brazilian Indians use to tip their arrows. It paralyzes the birds they shoot.”

“No kidding.” She was professionally interested. We were halfway around the block by now, and I wasn’t nearly as flustered.

“They figured out a dose and gave it to her in the IV. You should have seen that stuff work. She relaxed right away, all the stiffness gone, the little tight smile off her face. Only thing was, she couldn’t breathe.”

“Because the curare paralyzed the breathing center too.”

“That’s right. They put a respirator on her and told me to watch her. I was supposed to check vital signs every half hour. If the tetanus came back I was supposed to call them right away. They figured about four hours.”

“Did it come back?” Mary asked.

“That’s the trouble. No, it did not. She lay there, the machine breathing for her, all that evening. It didn’t come back on the next shift, either. Nor the next. Then it was my turn again. All the doctors gathered around the bed, discussed the whole thing, and decided they had given too high a dose. They had paralyzed her permanently.  She would never breathe again on her own, tetanus or no tetanus. So they walked away, and one of them said, over his shoulder, “Pull the plug.”

“Pull the plug?”

“Yeah. On the breathing machine. They killed her but I was supposed to pull the plug. I have a problem with pulling the plug, nurse.”

Mary Hollern took my arm and spun me around. “Look, Patrick. I’m sorry you had to go to Vietnam. I’m sorry you had to see what you saw. But you’re not there now. Your brothers did the right thing. Those doctors did the right thing. That woman wasn’t going to live and neither is your mother. I don’t ask you to accept it, not right now, but you have to sooner or later.”

This was a little tough to take. Mary was right, of course. If I couldn’t accept it, it was my duty to keep my mouth shut until I could. Yelling at my brothers was no answer.

We were back at the front door. I didn’t think any comment was called for. Mary knew that I’d reached a tentative peace, that I wasn’t going to make the situation worse, that the war was over.



Patrick Cook is a retired postal worker who lives in Grand Rapids Michigan with his wife Valorie. They have a daughter, Flannery Crittendon. The name alone tells you how badly he wants to be a writer.

Read our interview with Pat here.