I am guessing that "how" her son died has a lot of influence on her request - - - - ?
Anyway - does she want a "frayed" hole"?
I am thinking that - say she wanted an actual hole about 1/2 inch in diameter -
After the quilt is sandwiched, one could line up where one wanted the hole to be - and then cut a hole about 1 inch in fusible interfacing and put that in the area where the hole would be on the top and backing - and then remove the batting from about a two inch area so that it would be "flatter" there -
I am attaching a drawing that might help explain the idea -
Assuming one wants a "frayed" hole instead of a "finished" hole - I think I would do the actual puncturing of the fabric with something like a nail or an ice-pick instead of a punch and then maybe let the lady do her own "wearing away" of the fabric?
The interfacing would minimize fraying the indicated area - and perhaps even do something like Fray Check on the interfacing to be able to "stop" the fraying?