A family, even one as small as mine, is an intricate web of individual and group dynamics. The complexities are bound up in family history, personal sensibilities, secrets and memories which can be both faulty and true. A family cannot be understood by friends, certainly not by strangers and is often a mystery to family members themselves, though they know in their bones their roles. It is well for outsiders to keep this in mind.

By the time my mother was diagnosed with inoperable liver cancer in early 1992, our immediate family consisted of her, my brother who lives in Portland, Oregon, and me. Neither my brother nor I have children and we were both unmarried at the time.

My mother had an attachment to a family in Sacramento for which she was a substitute grandmother to the two boys, and her strongest tie was to her oldest, best friend Barbara. They loved each other like sisters.

Mom had been widowed by her third husband, Jim, a decade earlier. Because we were all adults when our parents married, my brother and I and Jim’s three sons felt no sense of kinship to one another and we had, in fact, met on only a few occasions. But something special had happened between Mom and Jim’s oldest son, Joe. Even after his father died, Joe visited Mom in Sacramento several times a year and kept in touch from around the world whenever his duty to the U.S. Navy allowed.

Joe was about 43 years old and recently retired from the Navy when Mom got sick. When I telephoned him soon after my arrival in Sacramento, he drove up from his home in San Francisco immediately.

From that day forward, Joe stayed with Mom and me four, sometimes five days a week. He helped cook, clean, take care of Mom’s needs during the hours I was working and hallelujah – the man thought folding is the least tedious part of doing laundry. I questioned his sanity and gratefully handed over the chore.

Joe was a capable housemate who is the only man I've ever known who noticed, without being told, that the trash needed taking out, and as we worked and lived together week by week, I came to love him as though he were a brother by blood. But even with Joe’s help, my time was stretched thin, particularly when Joe needed to be in San Francisco, so I contacted a local hospice Mom’s doctor had said could supply a home health aide, someone familiar with the sensibilities connected to caring for a dying person.

After introductory pleasantries at the kitchen table, the hospice worker pulled a six-page form from her briefcase and asked to see Mom alone “to conduct the psycho-social family evaluation."

My guard shot up to code red as I grabbed the form. The questions, there were about 100, would probe Mom’s childhood, her marriages, relationships with family members, her sexual attitudes, medical history, religious beliefs and much more. I was shocked, then outraged. When I'd telephoned the hospice, they had offered help with no mention of preliminary interviews. There was no possible need for such information for an aide to bring a bedridden person a glass of water and a pill while I was out shopping, and it was out of the question to inflict a this intrusion on Mom. My mother was a woman who would give anyone an earful of her political opinions, but personal matters were her own, rarely mentioned en famille, and never to outsiders.

The interviews, with Mom and with me to be conducted separately, were a requirement, the woman said, no exceptions. As I led her to the door, she protested that the questions were needed to “prepare for the counseling that both the dying person and the caregiver would need.” She was quite persistent until I closed the door in her face.

Other hospice people telephoned several times warning me of the “dire consequences,” without their counseling, to my mother’s peaceful death and to my grieving process. Shameful scare tactics that some people, in our over-analyzed era, might even believe. By the time the hospice and I finished our final conversation a couple of days later, they were in no doubt at all as to my opinion of their deathbed psychobabble.

Dying is a natural process. There is nothing wrong with it. Humans have been dying on their own since mankind climbed down from the trees and survivors have devised uncounted ways, depending on heritage and belief, to honor their dead and console themselves. To believe that a stranger's probing into the most intimate particulars of a dying person’s life is either suitable or valuable to that person is arrogance run amok by the death and psychology industries.

There were no “dire consequences” as Mom and Joe and my brother and Barbara and I lived Mom’s final months together sans counseling. We were a patchwork little family whose main dynamic was simple: to give Mom all the love and care we had in our hearts for her.

I have no idea how other hospices operate and I am undoubtedly being unfair, but I am nonetheless suspicious now every time I hear or read of one.

…to be continued…

A mother's final, best lesson: Part 1
A mother's final, best lesson: Part 2
A mother's final, best lesson: Part 3
A mother's final, best lesson: Part 5
A mother's final, best lesson: Part 6
A mother's final, best lesson: Part 7
A mother's final, best lesson: Part 8
A mother's final, best lesson: Part 9
A mother's final, best lesson: Part 10
A mother's final, best lesson: Part 11
A mother's final, best lesson: Postscript