The Last Smile

Afternoon, Friday, July 18, 2025, Miami, Florida

“Give sorrow words; the grief that does not speak
knits up the o-er wrought heart and bids it break.”― William Shakespeare, Macbeth

Today isn’t a good day—not because it’s a “sad anniversary” sort of day, though it is that too—but because daily life feels unusually heavy. I’m overwhelmed by stress and uncertainty, and it’s hitting me at a time I wasn’t braced for. Murphy’s Law seems to have made itself a permanent fixture in my life, despite every effort I’ve made to move forward and thrive creatively.

As for the anniversary:
Ten years ago today, I spoke to my mother for the last time. She passed away in the predawn hours of Sunday, July 19, 2015. But she was still—barely—awake and conscious in the late morning hours of that Saturday, July 18.

I remember that day clearly.

The home health aide, “Caridad” (not her real name), had just finished giving Mom what would be her last breakfast and was tending to the usual HHA responsibilities—changing her adult diaper, preparing to leave. I didn’t like Caridad. She was a recent Cuban immigrant, spoke only Spanish, and—thanks to my half-sister Vicky’s acquiescence—only stayed for 90 minutes instead of the scheduled four hours on weekends. Caridad claimed she had to be home to care for her own mother, and Vicky, her champion, was fine with that. Which meant I carried the caregiving burden alone on Saturdays and Sundays from noon to 5 PM, even once Mom entered hospice care.

At noon sharp, Caridad extended her timesheet, falsely claiming a four-hour visit. I signed it perfunctorily, no doubt with an annoyed expression, and she left. I was alone with my dying mother on a long, hot, and gloomy July day.

Despite it being midday, I was already exhausted. Mom had woken me before dawn, calling out over and over for her late brother—my Uncle Octavio, or “Tayo.” He’d died in the spring of 1993, a few weeks before he and Aunt Maria were supposed to visit us from Bogotá. I took her calls for him as a sign. I wasn’t an expert on dementia or dying—not then, not now—but in my heart, I knew: Mom probably wouldn’t make it to Monday.

Caridad hadn’t been gone five minutes when Mom cried out, “Alex… my back hurts a lot. Can you give me something for the pain?”

I was already facing another caregiving moment.

I’d been her primary caregiver for five years. Vicky worked long shifts as a nurse during most of that time, so it fell to me—not because I was trained, but because I lived with Mom and she didn’t. I had no experience with elder care or chronic illness, but life doesn’t wait for credentials.

I considered calling Vicky. She’d lost her job by then, so she was technically available. But she had declared weekends her time to rest and tend to her apartment, showing up only after 4 PM. Besides, I didn’t want to see her. Our relationship had eroded steadily for decades, and the caregiving strain wasn’t helping.

So I didn’t call.

I soldiered on.

“Mom, I’m here,” I said gently. “Do you want something for the pain?”

Good one, Captain Obvious. I winced inwardly. Of course she needed something.

I looked at the cluster of medications on the folding table beside her hospital-style bed—blood pressure pills, Xanax, iron supplements, and a small pillbox with Tramadol, the painkiller prescribed in generic form. There was also a metal thermos filled with cold water, its lid doubling as a cup.

“Alex, mijito, my back hurts,” she whispered again, her voice hoarse with pain and fatigue.

I unscrewed the thermos lid, poured water into the cup, then opened the pillbox and tipped a single Tramadol pill into my palm.

“Okay, Mom. Say ‘Ah’ for me,” I said, masking my nerves behind false calm. My heart pounded, hands trembling as I tried not to drop the pill.

She smiled tiredly—through her pain and confusion—and responded, “Ah!” A quiet reassurance she still recognized me, still held a thread of reality.

I placed the pill gently on her tongue. Gave her the cup. Watched her sip.

Then I asked her to show me her tongue. Almost playfully, she did. Dementia hadn’t robbed her of all humor.

But the pill was still there—clinging to the tip.

I was tired.
I was scared.
I was, above all, sad.

I thought again of calling Vicky. She was a nurse, after all. But even if we’d been close, the ten-minute drive wouldn’t erase the urgency. Mom needed the Tramadol soon.

I poured another cup of water and gave it to her. Watched carefully. She swallowed.

“Mami,” I said gently. “Say ‘Ah’ for me again.”

She did—with effort, and a trace of that motherly smile.

The pill had shifted, now resting mid-tongue. Closer, but not yet gone.

One more try.

I filled the cup again. Her hands shook, but she didn’t spill. She took a sip, gulping it down audibly.

“Okay, Mom,” I said, voice cracking. “Let me check, all right?”

She smiled weakly and showed me her tongue.

Gone. The pill was gone.

I must have smiled—though I don’t remember. That day offered little room for joy. But something must have shown on my face because she asked, “Did I do okay?”

“You did great,” I told her. I may not recall the exact words, but that was the heart of it.

“Thank you,” she said. “Can you stay with me a while longer?”

I had already planned to stay until I was relieved. Mom probably didn’t remember that, but I nodded anyway.

“Sure.”

“You’re a good boy,” she said. Her voice was weary but full of love.

She looked at me for a while—I don’t know how long—then drifted into a Tramadol-induced sleep.

That was the last time my mother was conscious.

She didn’t cross into the “undiscover’d country” until early the next morning.