March 27, 2022

Saplings

When immigrant families are uprooted, sometimes the entire tree is transplanted. Both sides of my partner's families crossed the Pacific to escape war and genocide; the ones who escaped alive came together, a sprawl of aunties and uncles and cousins across California and beyond. 

But there are other immigrant families, where the seeds were carried off in the wind, sprouting into saplings a great distance away from the roots. 

When my mother's father died, I didn't feel sadness about his passing. Rather, I felt sad on behalf of my mother. I could count the number of times we had interacted on one hand. I had a vague recollection that A-Gong liked to travel. I remember the scent of cigarettes he used to smoke. When a heart attack eventually took him, I was in ninth grade and had only visited Taiwan twice. I can't recall a single conversation I had with him---not that I could have conveyed much to him with my grade-school Mandarin and non-existent Taiwanese.

My father's mother passed in the autumn of my first year of medical school. I hadn't learned what cirrhosis was yet. I didn't know what it meant when they had to "take out fluid" from Nai-Nai's abdomen. I didn't understand the implications of Nai-Nai going to China for a liver transplant. When she eventually succumbed to pneumonia, I felt somber but it was a more cerebral than visceral reaction. After A-Gong had died, we had visited Taiwan more frequently to make up for lost time. Even still, I wouldn't know what to tell you about Nai-Nai. She liked to watch TV. She had tattooed eyebrows. Everything else I know about her is from second-hand stories of family drama.

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Even if I hadn't lived her for six weeks in 2012, A-Ma had always been different. A-Gong and Nai-Nai were line drawings, sketches in my head. A-Ma was already more vividly painted in my head before that summer, lines and curves shaded in by the stories my mother told.

A-Ma, like my mother and myself, was the eldest child and oldest daughter. She was a child in Taiwan under Japanese occupation during World War II. Food was scarce then. She ate so many yams during that period that as an adult, she never wanted to eat another yam again. 

Her father pulled her out of school after sixth grade. He didn't see the value in a girl getting secondary education. Her first job was at a shop that made and sold jerky. She soon discovered her business acumen and was exceptionally quick at calculating mental math. After she married A-Gong, they opened a business specialized in making fabric for children's clothes. While A-Gong was the face of the business, in reality my grandmother was the one running the show.

Before the late stages of ALS captured her voice, my grandmother was the loudest woman I knew. Her daughters seemed to have inherited this trait. When she and my aunt came to visit our family in California when I was in third grade, my brother and I grumbled about not being able to sleep from the cacophony in the kitchen from the chatter of their excited reunion with my mother.

Before ALS took away her freedom, my grandmother sped off on her moped each morning to the temple and the market. She'd clamber up and down the four-story house, with the ancestral altar on the highest floor, the kitchen on the second floor, the garage on the first floor.

She continued her bustling day-to-day routine after my grandfather died. But my mother noticed that afterwards, A-Ma had seemed prepared to die. She had already planned where her coffin would be displayed on the first floor of the house as part of the funeral rites. She reserved her cremation urn in the temple when she made arrangements for A-Gong. This was even before the disease began to slowly eat away her physical strength. Once she stopped being able to cook, stopped being able to bathe, stopped being able to walk, it was as if her greatest desire was to die. Buddhism does not condone taking one's own life. It's what they would call Passive Ideation in psychiatry. You may wish for it with all your heart, but your hand will not---or cannot---make the move.

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In the summer of 2012, I was a rising college senior riddled with angst about my chances of being accepted to medical school. My mother came up with the idea of going to Taiwan for the summer and shadowing an emergency room physician she knew through mutual acquaintances. She accompanied me for a week to make sure I was all settled in Tainan, and once it came time for her to return to the States, it was just me and A-Ma in the four-story house. 

I quickly learned that around A-Ma, you had to be careful about any food you expressed preference for. After I commented that the pineapples were deliciously sweet, bags of fresh-cut pineapples from the market were stocked in the refrigerator every morning. After I mentioned that I loved the curry udon, she made it for me every single day.

Mandarin was neither of our first languages; she preferred Taiwanese, while I spoke English. Her Mandarin far surpassed mine, but we were able to cobble together conversations. I would return from the hospital and tell her about the funny observations I had made. The language muscle I exercised each day bulked up in tone, and by the end of summer, my Mandarin was the most fluent it had ever been. 

There was one particular evening, where A-Ma and I sat in front of the TV after dinner. The kitchen/dining room was on the second story of the house. If you walked into the room, the first thing that would catch your eye is Keanu Reeves' brooding visage on an enormous movie poster of Speed directly above the kitchen table. The explanation I was given was that my youngest aunt had a celebrity crush on Keanu, but that didn't explain why his face was still hovering in the kitchen nearly a decade after my aunt had married and moved out of the house. As much as we were bonding, I wasn't about to ask A-Ma in bungled Mandarin if she found Keanu pleasing to the eye.

A-Ma used to watch dramas on the 'Big Love Channel' produced by a Buddhist charity foundation. Something in the show must have inspired a conversation about relationships. How we got to this point eludes me, but what I remember clearly is the story A-Ma told me about my mother, from a time before she met my father. I hesitate to use the word secret. There was nothing scandalous about it. But it was a piece of my mother's life that she never would have told me. There is a point in your life when the kaleidoscope turns, the pieces shift into new shapes and colors, and suddenly you view your parents as full-formed people who had their own life, hopes, and dreams before you ever existed. My grandmother told me not to tell anyone what she had told me. I carried that piece she gave me close to my chest. 

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I realize I haven't mentioned Ye-Ye yet.

The yin-yang symmetry is evidence of a higher power with a sick sense of humor. My mother's mother, her brain as sharp as ever, her body whittling away as her muscles failed her. My father's father, physical health as pristine as could be, his mind wringing dry from the cruel squeeze of Alzheimer's.

What would you rather? The question has crossed all of our minds. Maybe there is something merciful in not knowing. Could you bear to live with the full knowledge that your disease has trapped you in a body that refuses to cooperate? But then I think of Ye-Ye. He was a former ship-builder who once took pride in the fact that he could speak a little German, Japanese, and English. He was already growing more forgetful when I saw him in 2012. By the time I was in medical school, he would ask me the same question every ten minutes. When I saw him the spring before I started residency, he asked me if my brother was a doctor yet. By the time my brother went to visit seven months later, he had no memory of him left.

Alzheimer's is not a blissful slide into unknowing. In reaction to his eroding ability to remember, he compensated with increasing stubbornness. In the early stages, like a toddler unable to express himself, Ye-Ye would lash out. In some ways, I find that aspect even more frightening. That sliver of consciousness, the awareness that your sense of self is disintegrating and that there is nothing you can do to stop it from slipping through your fingers.

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A-Ma seemed to think she would die quickly. But months coalesced into years. When she began having trouble breathing in January, the family in Tainan worried about the logistical nightmare of arranging funeral arrangements around Lunar New Year. But then, February 1st came and went. A-Ma rented an oxygen tank and seemed to be sleeping better. Because Taiwan continued to require a fourteen-day quarantine for all international visitors, my mother relinquished the idea of going back to see her mother. Instead, she video-called her mother every day. 

Perhaps because there had been numerous false alarms over the years, I was caught me off guard when I received a text while at work that her wish had finally come true. But my mother later told me that this time had felt different. My grandmother, who had eaten nothing but dietary supplements for years, suddenly asked her caregiver to make her pumpkin and water spinach soup. Maybe she knew this time, the end was truly near. 

On her last day, my uncle's family had come to visit her. Four generations were under one household: my grandmother, my uncle, my cousins, and my cousin's daughter. Palliative nurses have told me that the dying often seem to wait for permission to let go. I imagine her lying in the bed, listening to the four-story house reverberate once more with noise and life. I wonder if she thought of the rest of us. Picture a forest in Tainan, a cluster in California, a lone sapling in Connecticut. The roots stretch below the ground for miles. The rain falls, but tomorrow, the leaves will stretch towards the nurturing sunlight, the flowers will bloom, and the seeds will sail aloft once more.