Mama ז"ל

May 11, 1930 - December 9, 2025

© Photo by Georgia

My mother, Viviane Bregman, died last month at ninety five years old.

Trying to describe my mother is a fool’s game. Anyone who didn’t know her would suspect me of exaggeration, while anyone who did would accuse me of understatement.

The truth is, she was exceptional in many ways. Here’s an example: one of the most difficult and inevitable trials of aging—I see this with my older patients all the time—is how one’s social circle relentlessly contracts. Old friends die off; new ones are hard to make.

Yet my mother’s social circle kept expanding throughout her life, right up to the end. People loved her, especially young people, sometimes generations younger, who turned to her for companionship and advice. Among the large group of friends she made just in her last decade were some of the closest of her life.

She was born in Paris to a prominent Egyptian Jewish Family. She survived World War II in Occupied and Vichy France with hardships and close calls. Years later she moved to New York to marry my father, whom she met on a blind date, leaving a trail of disappointed boyfriends and two broken engagements in her wake.

She was charming, with a European accent, an elegant style, and a clever, ribald sense of humor. She was strong-willed. She was a great reader of people who knew exactly what she did and did not want. She did not want dementia. She did not want chronic pain. She did not want to live attached to machines or dependent on others. Those were the three things she feared most, and she avoided them all.

She had the usual infirmities of age—macular degeneration, hearing loss, advanced arthritis that made simple movements hard—but she kept going. “Be a doer,” she would always tell us, and she lived that advice by example. Three exercise classes a day. An active social and professional life as an art dealer.

One day she walked through Art Basel in Miami for six hours, stopping at all the booths, viewing the art, chatting with friends, artists, and colleagues, tiring out people much younger than her. The next morning she got out of bed to go to the bathroom and collapsed. Her aides called an ambulance. I got the call early that morning and took the first flight to Florida.

In the hospital, the situation clarified. A large intracranial bleed in the region of the right basal ganglia. She was stuporous, and paralyzed on the left. Her vital signs were “stable,” but her life as she had lived it was gone, with the chance of a neurologically meaningful recovery essentially nil.

The ICU team was skilled and caring. When they learned that I was a doctor, they went out of their way to share results and plans and include me on rounds. If you have ever wondered whether it is good or bad to be a doctor while also the patient’s son, I can put it to rest: it’s good.

My mother had clear advance directives—no heroics, no machines—but she was also adamant that everything be done according to halacha, Jewish law. Sometimes those wishes can come into conflict, but luckily in this case they did not.

After discussions with the ICU team, her rabbis, and my neurosurgeon brother-in-law—and of course with each other: my two brothers, my wife, and my two sisters-in-law—we came up with a plan. We would bring her to New York and arrange for hospice care in her apartment. She would die there, surrounded by family, including her twelve grandchildren. All the complicated transportation arrangements were made.

But then, on the morning she was supposed to be flown out, her breathing pattern changed. I saw it as a son and as a physician. It made me extremely uneasy. The last thing I wanted was for her to die in transit, but I was afraid to cancel everything and end up being wrong. I found myself unable to make a confident decision.

Then it occurred to me that we had never gotten a palliative care consult.

Palliative care, even now, remains a specialty often misunderstood. It isn’t about “giving up”; it is about knowing how to help people die with as much dignity, clarity, and comfort as possible. The consultant came, examined her, and pulled me aside. He said, “Look, we are colleagues, so I’m going to be blunt. If this were my mother, I would not transport her. Everyone always says that you can never know for sure, but I think it looks like hours more than weeks.”

It was the single most helpful thing anyone said during those three days. We canceled the transport.

Another palliative physician came by later who was also a family medicine doctor. She talked us through palliative measures. Morphine for comfort. Glycopyrrolate for secretions. Oxygen to ease breathing. Nothing more. No long list of medications. No procedures, lines or tubes. Just medicine doing what it can to ease the end without hastening or prolonging it.

That night my mother died the way I hope she would have chosen. No pain. No machines. Her three sons at her bedside.

They didn’t want us to take her off the cardiac monitor - it was still the ICU after all - but we silenced the beeping and turned the screen away.

We held her hands. We stroked her head. We sang to her and read aloud the traditional deathbed prayers. We whispered in her ears.

We told her we loved her, and thanked her for everything she had done for us. We said we knew she was a fighter but she had struggled enough. We told her not to worry about us, that we would be okay. We told her she could go.

Shortly after, just as the palliative care doctor said, she exhaled a final breath—and did.