Cause of Death: It’s Complicated

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“How did your mom die?”

It’s a simple question…. If only I had a simple answer.

What I wish I could say: “Well, first she stopped breathing I guess, then her heart stopped, then she was dead.”

But I know that’s not the type of information people are seeking, when they ask how my mom died. They are inquiring about the cause of death, which is a natural curiosity I suppose. The question still makes me a bit uneasy.

For eight years after my mom passed away, I had tried to answer that question diplomatically. It usually ends up sounding something like this:

“She had diabetes, and she didn’t take care of herself. The doctor said she had many ‘co-morbidities’ in addition to the diabetes, such as obesity, high blood pressure, and other various issues…she didn’t watch her diet, or blood sugar, or exercise… and finally her body just couldn’t function anymore.”

The above is true, but as my mother herself would have said, it is technically a “lie of omission”, not the whole truth.

And here I’ve continued, for eight years and counting, to tell various versions of the truth, in hopes of avoiding judgment, the awkwardness, and the humiliation of stating a simple fact, as basic as how my mother died.

How much am I required to tell about her manner of death, to be considered truthful? Is it really anyone else’s business, after all? Probably not. However, it’s almost more uncomfortable to try to avoid the question, than to just answer it. How long should I try to protect my mom’s legacy, when she wouldn’t even protect her own legacy, or even her own life?

I don’t blame people for asking how my mom died. I know, that when people ask, most are just trying to help, to empathize, relate, commiserate, even offer support. I know, because I ask the same question of others too, not meaning any harm or hurt by inquiring.

When people ask, they expect me to reply by naming a clear-cut, unavoidable condition that claimed my mom as its victim, after which the inquirer can sympathize, or empathize, and then relate a personal story about a loved one whose life was also tragically extinguished by cancer, Alzheimer’s, stroke, or, like my dad, a sudden heart attack. But Mom was not a victim of any of those things.

In revealing to others how my mom died, I’m also revealing how she lived — or existed — in her final years.

She, of course, is no longer here to feel the humiliation, the shame, or the guilt about her condition. She left us behind, to feel all of those things, on her behalf.

My mom did, in fact, die of an actual, clinical disease. It says so on her death certificate, and an M.D. signed off on it.

But it feels as though my mom died of bad habits and poor choices. Choices she made over her own spouse, her son, three daughters, seven grandchildren, and countless friends and relatives.

I’m sure there are people who saw Mom in her final years, who figured out what was happening, even though no one discussed it openly.

For those who only saw our mom periodically, her problem may have initially been well hidden by her twinkling blue eyes, her broad, dimpled smile, her infectious, boisterous laugh, sparkling jewelry, and bright dresses.

Later, as the twinkle in her eyes gave way to a watery haze, her distinctive laugh became a gravelly grumble, and her brisk pace was replaced by a wobbly stagger, people could surely see the truth with their own eyes.

A few weeks before Mom died, we were sitting in the neighborhood restaurant where she was a “regular”. She was trying to eat dinner, but really couldn’t stomach much food anymore. Her weight had plummeted. All the parts of her body that used to be plump and puffy, were now gaunt, bony, and sunken, except for her stomach. Her abdomen was greatly distended and bloated. Like some grotesque freak of nature, my once beautiful mother now resembled how one might imagine a very frail, elderly, pregnant woman would look, if there were such a person.

A family friend passed by our table on her way out the door of the restaurant, and gasped at the sight of Mom, as she was clearly very ill. The friend, “Joan”, didn’t try to hide her shock or curiosity. In her demonstrative, Southern way, she draped her arms dramatically around mom’s shoulders as she tried to make sense of mom’s appearance. Joan leaned over and put her face right up to mom’s and asked her: what “on Earth” is wrong?

Mom said “I’m sick….it’s not good. And I’m not getting better.”

Joan, the wife of a physician, said “Well, I mean, Sue, what is it? Is it cancer? Good heavens! Can’t the doctors do ANYTHING?”

“No, it’s not cancer…”, mom said. And I don’t really remember what Mom said after that. I think she said the doctors weren’t sure what it was. And then she changed the subject. Joan graciously went along with the new topic of conversation.

Sometimes, I too have tried to change the subject when asked how Mom died. But changing the subject can never change what is printed on her death certificate.

“The truth will set you free, but first it will make you miserable.”  James A. Garfield

I will never forget the first time I saw those words, the cause of death, typed so matter-of-factly in seemingly huge bold letters. There was no more denying it. It was as if, from the grave, Mom was finally owning up to her illness, like a defiant child, caught red-handed, and forced to own up to her behavior. I could almost hear her angrily shouting the words out loud to me as my eyes scanned them on the paper:

“Cause of Death: ALCOHOLIC LIVER DISEASE.”

It hurt my eyes to read those words, and it hurt my heart to reflect on the past few months, and years. The very thing that my mom had tried desperately to conceal, was now emblazoned on an official and public government document for all posterity.

By refusing to say those three words, “alcoholic liver disease”, out loud to anyone else for all these years, I thought I could pretend they didn’t exist on that paper, and perhaps even spare myself some embarrassment. But keeping the secret doesn’t make it go away. In fact, I think I gave it more power. I’ve been weighed down, nearly paralyzed at times by its gravity.

With the truth, and hopefully acceptance, maybe I can free myself from the grip of secrecy and shame.

Yesterday, a friend asked me how my mom died. Once again, I started into my standard spiel about co-morbidities, diabetes, high blood pressure, and obesity. My friend looked at me, confused by my ramblings. So I took a deep breath, and then said,  “…the bottom line is, her death certificate says ‘alcoholic liver disease’.”

And with that, the conversation ended. Not surprisingly, my friend picks a new topic. Instead of confusion, my truthful answer prompts that awkwardness I’ve been trying to avoid, but it’s fleeting. And the brief moment of awkwardness was actually not as bad as it has felt to deceptively dance around the truth all these years.

Suddenly, I feel lighter.

One burden lifted, even as my heart still breaks. The denial is gone, but guilt remains. Now I’m just left to wonder: what could I have done differently? How could I have created a less ugly outcome to a beautiful life of an admittedly flawed, but very gifted and loved woman? If only somehow we could have helped her realize, and appreciate, that she had so many reasons not to die of Alcoholic Liver Disease.

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For part 2, please see Sober Truth, Secret Salvation, for the continuation.

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Alcohol abuse destroys lives, kills dreams, and crushes souls. And it’s not just the drinker’s life that is impacted, but friends and family are brought down too. Alcoholism is a disease, not just a choice or a bad habit that can be easily broken. One choice that can be made, is to get medical treatment. If you or someone you know abuses alcohol, you can get professional help from specialists in addiction medicine.

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