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Witnessing Two Deaths

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Sometimes dying is full of confusion, fear, regret, denial, secrets, and chaos. But sometimes, if we’re lucky, letting go of life is more easeful and feels complete.

Sometimes dying is full of confusion, fear, regret, denial, secrets, and chaos. Grief and conflict swirl through the person dying as well as through their family and friends. Decades of emotional and social dynamics intensify and sometimes remain unresolved at the end of life. This is especially true when someone is facing what we think of as an “early” death — the death of someone not yet in old age, someone who’s busy with children and career, has relationships in process, and still has so much left to do. Death can feel entirely wrong, cruel even, and like it comes far too soon.

But sometimes, if we’re lucky, letting go of life is more easeful and feels complete, which seems to happen most after a long and happily lived life. It can seem like the right time for someone very old. Sometimes, even for those who haven’t lived long lives, death can seem timely, peaceful and organic. In my job as a certified nursing assistant at Zen Hospice Project’s Guest House in San Francisco, I recently witnessed two deaths that epitomized these two extremes.

I had been helping care for “Evelyn” during the last weeks of her life at the Guest House. Only in her early 40s with school-age children, Evelyn’s dying process was complex and distressing. Her enormous grieving and confused community of loving friends and family filled the Guest House every day. Her children, bright, earnest and sweet, massaged their dying mother's hands as the adults wept with anguish and prayed fervently for a miracle. Friends showed me photos of Evelyn when she was well, beautiful and vibrant, nothing at all like the silent, skeletal figure in the bed.

There was a lot of chaos and conflict with Evelyn and her community around communication, religious beliefs and practices, and Evelyn’s emotional and medical reality and needs. Her wishes could change hourly as she struggled to find a balance between her own desires and those of her devoted family and friends. We, the nursing and caregiving staff, dedicated ourselves to following her wishes even when they were challenging for her loved ones. This was very stressful at times, and watching her wrestle with these issues in her dying process was painful.

One day, with unflinching candor, she stared directly into my eyes and whispered to me: “I want to be free. But I don’t want to die. I want to be here for my kids.” I was hunkered down on the floor in front of her, holding both of her delicate hands in mine, feeling the full impact of her words enter me.

I had just helped her off the commode at her bedside, fully embracing her weak and dying body in the transfer, feeling her humanity still completely present. Her humanity was like mine, and yet it was clearly very close to its end. Being that physically and emotionally intimate and present with her illness, pain, regret and sorrow was raw and intense. My heart quivered and expanded in empathy and care. I felt her suffering, her loved one’s suffering, and my own suffering dissolve into the universality of all human suffering and loss. I sat with her in that intimate reality with nothing resolved, nothing easy — right on the edge of life and death. Evelyn died three days later.

In the midst of Evelyn’s process was “Lillian,” another resident at the Guest House. She was a truly adorable 98-year-old woman who loved to cuddle. I only had three shifts with her, but each of those times was rich with sweetness and meaning. A tiny, bird-like, but extremely strong woman, Lillian had lived independently a few weeks before her death. Whoever was at her bedside at the Guest House would receive Lillian’s effusive, affectionate petting and hugging. Stroking my arms, face, and neck, she would reach up and wrap her wiry arms around my neck and pull me in for an embrace, completely nestling into me like a sweet child. “You are such a cuddle bug! You feel good Lillian,” I told her, truly enjoying her hug. She giggled softly.  She even smelled of sweet goodness.

The first day I met her, Lillian was becoming silent, although still enthusiastic in her caresses and cuddling. Days before, she’d told others stories of her early life, remembering exciting dates with romantic boys. Looking through photo albums of her from decades earlier, I saw her wholesome, movie star beauty with a big, joyous smile. It seemed she was quite popular with men, yet she chose to remain independent and support herself financially. She never married or had children. There were many photos of her and her sister traveling all over the world together, smiling and adventurous in Argentina and on various cruise ships, obviously having a blast. Her nephew told me she had always been a sweet and wonderful lady who loved to give and receive affection. I was lucky enough to hold her for about an hour that day.

On my second day with Lillian, she lapsed into unconsciousness. I helped give her a bed bath as she slept; this was probably her very last time to be bathed. The home health aide and I tenderly cleaned her body and brushed her soft cloud of white hair, noting the signs of approaching death in the purple mottling on her feet and legs. We dressed her in a pretty flowered gown and spoke lovingly to her, gently rubbing lotion onto her sinewy arms.

The next morning when I arrived for my shift, Lillian was actively dying (the medical term for when death is very near). I sat alone with her, holding her hand as I watched her body shut down slowly and peacefully. I stroked her forehead and murmured reassuring words to her occasionally. I watched her breath become softer and shallower. While holding her hand, I also kept a finger on her pulse, feeling her heart go through its final stages. I clearly felt a last strong burst of beats and then gently her pulse quieted to nothing. Such sweet intimacy, such an honor to share her final moments of life, just the two of us, me feeling her good heart finish its work after 98 years of living and loving.

Embracing people, literally and figuratively, as they are in the endless varieties of living and dying is a profound honor. I am grateful to share these intimate human moments at the threshold of life and death. We will all make that transition some day, somewhere on the complex spectrum between peace and suffering. My wish is that we all are lovingly supported in however our last days turn out to be.

Learn more about how Zen Hospice Project is helping to change the experience of dying.


Read more from This is Terminal:

Born to be Wild at the End of Life

Dying Surrounded by Laughter and Song

A Hospice Social Worker on Grief and Empathy