I stumbled into a relationship with Sylvia’s mother. Sometimes the barrier to establishing a therapeutic relationship is as simple as sharing how similar you are. Our role as mothers united us and made a link I had not anticipated. I was focused on my care of Sylvia, but in the process, I had essentially neglected her mother. Sharing my story gave me a place to start a relationship. When I shifted my attention from Sylvia to her mother, it was then that I recognized she was on the verge of losing her only daughter. She needed support too. Even when she failed to make eye contact or seemed to be keeping me at bay she was still losing her daughter. I took her guarded and suspicious interaction to mean disapproval of the care I gave, yet what was missing was a way for her to express herself. I had created a barrier without even realizing it by sticking to “professional” behavior. For her part, Sylvia understood how difficult it was for her mother and allowed her to be protected by a jail of her own making. It was the only way she could manage to stay at the bedside and watch as the cancer took Sylvia from her. Her mom was as much my patient as Sylvia was. The barrier she created was self-protective. It was easier to make the nurses the enemy because the real enemy was cancer and she could not beat it.

Over the course of her hospitalization Sylvia engaged more fully with me. In her own way, so did her mother. She relaxed in her chair when I was talking with Sylvia, an unspoken gesture of welcome. One day as I talked with Sylvia, her mother quietly removed the seeds from a pomegranate and put them on a plate. The deep red seeds bled onto the white plate and Sylvia carefully spooned some into her mouth. She told me, “In my culture, we believe pomegranates are good for your blood. They make you strong.”

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I nodded in understanding. Then her mother lifted the plate to me. Sylvia said, “She wants you to have strong blood, too.” I took a spoonful, the first time I had eaten pomegranate seeds. They were sweet and delicious. When a small dribble of juice ran down my chin, I finally got the acknowledgement I wanted from her mother. She handed me a napkin and smiled.

In all honesty, her mother remained suspicious, what I would call a mama bear. Even with her skepticism it was apparent that Sylvia was dying. When I hear people talk of the stages of grief I wonder how a parent ever gets past anger and denial. Maybe finding a level of acceptance of me and the hospital and western medicine was a greater leap for her mother than I realized. Maybe it was me that changed when I opened myself up to Sylvia and her mother.

We never spoke, not in words we both understood. But finally, in the language of two mothers we made a connection.

Ann Brady is the symptom management care coordinator at the Cancer Center, Huntington Hospital, Pasadena, California.