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When Mom Chooses Suicide: A Review of Imperfect Endings: A Daughter’s Tale of Life and Death

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Imperfect Endings: A Daughter's Tale of Life and Death by Zoe FitzGerald Carter (Simon & Schuster, 2010; $25.00)

Experiencing a mother's death is one of the biggest milestones in a woman's life. Whether the relationship is close or distant, loving or corrosive, enmeshed or shallow does not matter; her source, her guardian, her primary model of female identity is leaving forever. Having nursed my mother through terminal cancer when I was only 37, I can testify that the profundity of the experience makes it extremely hard to describe. In the memoir Imperfect Endings, Zoe FitzGerald Carter delivers a moving and darkly funny account of this elusive and often grim topic. (Full disclosure: Carter and I have been members of the same writing group for over 10 years.)

A member of the "sandwich" generation of women called upon to be dual caretakers, Carter is caught between her husband and the two young daughters she's raising on the West Coast and her aging and ill mother, Margaret, on the East Coast. But there's a twist to the usual scenario: Although she is suffering from various debilitating health issues, including Parkinson's disease, Margaret is not actually dying. Instead, she wishes to avoid the further inevitable deterioration of her body by committing assisted suicide. And the assistance she is looking for is her daughter's.

While Margaret has three daughters and wants all of them to be present when she takes her life, it is Carter on whom she most relies and who she ensnares in her morbid planning, which she discusses as nonchalantly as if she were arranging a typical family visit: "Well, gosh, honey, I've been trying to find a good time to end things as you know, and I was hoping that weekend might work for you. I haven't called your sisters yet, but of course I want them here too. And your girls if you can bring them."

As her mother weighs the options for ending her life, Carter recalls with grim humor that as a child she had at one point become obsessed with the question of how people would prefer to die: Would you rather be shot or burned? Drowned or hung? Dropped from an airplane or left in the desert with no water? Now it's her mother's turn to ponder the alternatives: Would you rather inhale helium or take sleeping pills? Die with a plastic bag over your head or while trying not to vomit up Seconal?

Dragging Carter along on her quest for the perfect methodology, Margaret visits a friendly psychiatrist who gives her Seconal, stockpiles liquid morphine that a hospice organization provides, and, in a darkly comedic chapter titled "Mr. Death," even explores the helium option with a Hemlock Society volunteer who cheerfully details how easy it is to kill yourself by inhaling it. (You'll reconsider having the stuff at a child's party ever again.) Deeply conflicted about her mother's wish to commit suicide, Carter allows the reader to consider this charged issue without pushing her own opinion, a rare treat at a time when complex matters are usually discussed in a polemical fashion. Instead, she reveals how easy it can be to selfishly talk about quality of life with your aging parent while ignoring the reality of what that life entails:

I think about the Dalai Lama's book lying on her bedside table covered with chocolates and morphine, the portable commode, the oxygen tank, my mother's frozen, unhappy face. I cover my own face. I've been trying so hard to keep her here, to convince her to accept her fate -- to be happy about it, for God's sake -- that I've missed the bigger truth: My mother has ended up exactly where she didn't want to be.

Alternately determined and uncertain, Margaret sets dates for her "exit" only to continually reschedule, compelling Carter to repeatedly make the exhausting trip cross-country. These journeys parallel Carter's inner journey, as she recalls defining moments of her childhood and examines the fraught dynamics of a family composed of a patrician mother, a charming but philandering father, and a stinging triangle of sisters.

Being one of three sisters myself, I've noticed that women with that family configuration share common experiences, including the phenomenon of the ever-shifting "odd girl out," as alliances change. In flashbacks to her childhood with older sisters Katherine and Hannah, Carter examines the intensity of these relationships with the cool clarity of hindsight. Recounting a silly game in which her merely one-year-older sister Hannah would carry Zoe in her arms as if she were her baby, Carter recalls:

We never discussed this game, but I knew Hannah liked it too. After all, she'd been under Katherine's thumb since the day she was born, an event Katherine had essentially never forgiven her for. (Hannah's third birthday was famously ruined when Katherine snarled, "You may be three today, but you'll be two again tomorrow!") My willing submission to Hannah gave her the strength to stand up to Katherine and she in turn gave me safe harbor from Katherine's free-floating aggression.

As their mother moves towards death, the sisters struggle with the history they share with each other and their parents, and Carter reveals the generosity as well as the pettiness that end-of-life situations trigger. But the central relationship in Imperfect Endings is the one between mother and daughter, close and emotionally frank, but also shot through with disappointment on both sides. Carter depicts her mother as a bright, sophisticated and loving woman who is also demanding and elusive. Early on, she mystifies her daughter by claiming she has no one to take care of her, despite having wonderful live-in caregivers:

"It's not enough, Zoe. I need a parent. Not people who are hired to take care of me."

"A parent? What are you talking about?" My mother's parents were glamorous, neglectful people who both died when my mother was young. "Your parents never took care of you. Ever."

"Well, that's true." Oddly, she seems to brighten at this thought and even smiles. "But that's what I need. Parents. No one else can really give me what I need."

No one except your children, of course. Carter astutely portrays the classic turn of life when elderly parents exchange roles with their children, willingly or not. No matter their own age, the children tend to resist this switch, since becoming your parent's parent means that you are finally, irrevocably an adult. It's hard to accept that you can't go home again -- except to be the caretaker, not the one cared for.

Resisting this generational succession, and fearing that she's neglecting her children as well as her increasingly irritated husband, Carter initially rebels, only to be repeatedly drawn back into the primal connection of mother and child, as in a fever dream of a chapter, "Traveling," which reflects the altered state that life and death situations can conjure:

All night I keep waking up, not sure if I'm in bed or down in my mother's room, as if part of me cannot accept that I'm away from her. I wake, startled and disoriented in the dark, and look for her. I bump into Jack next to me in the bed and think it's her.

Ultimately, Carter finds her own way to her mother's deathbed. Bringing her husband and children into her mother's house allows her to practically and symbolically integrate the disparate roles she plays, setting the scene for the last third of the book, which unfolds with an almost trance-like beauty, capturing the often-surreal experience of being with someone who is dying. In the chapter "Singing," she describes spending hours lying on the bed with her unconscious mother, crooning the same traditional tunes that her mother had sung to her in childhood, such as "Shenandoah" and "Shady Grove":

Most of the time I don't feel sad lying here, although sometimes the thought that I'm singing to my dying mother makes me tear up, as if I am watching myself in a movie. Mostly I'm in that surreal, out-of-body state I experienced as a new mother, when the edges of my being disappeared as I endlessly, exhaustedly rocked or nursed my tiny daughter, every cell in my body tuned to her tenuous progress towards sleep.

As her mother moves towards the long sleep that is death, Carter becomes more alive, embracing her life and everyone in it -- a seeming paradox that's one of the great rewards of spending time with the dying. Living up to its title, Imperfect Endings reveals that death is never a neat package, but that if you let it, it will transpire in a way that brings peace and reconciliation.

Nelle Engoron was recently published on and in I Love You magazine (Berlin) and blogs about relationships, sex, movies, Mad Men and other topics at Open Salon. She’s completing a memoir about her quest to find love through any means necessary, from becoming a Christian Fundamentalist to dating hundreds of men through the personal ads. She lives with her partner in the San Francisco Bay Area.

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I just returned home from singing to my dying grandmother in the nursing home and found this wonderful review in my "in box." I, too, am one of three girls and have been struggling with my role in the pending death of my grandmother. She is definitely a woman who wouldn't have wanted to "end this way." I have watched my mother struggle with caring for a mother that she doesn't recognize and had a tentative relationship with at best, all the while questioning my relationships and how I live my life. Perhaps Imperfect Endings is just what the Doctor ordered for me right now. Thank you!
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