A Good Death

This isn't really the post I want to put up today. I wrote it a while ago and it introduces you to an essential character is tomorrow's post. So here it is. I just don't want everyone to think that I am sitting here perseverating about death today because I'm not.

Melvin Keiffer was my husband’s grandfather. An extraordinarily petite man with a shiny pate, Mel always wore a nice shirt, dress pants, and a smile. He grew up in Milwaukee, served in the Air Force during World War II, and worked as a accountant at the same bank his entire adult life. He was the husband of Esther, a woman I never really met because she was in the final stages of Alzheimer’s by the time I entered Bill’s life. Mel always said that Esther was the smarter one of their pair and I take him at his word; Mel probably never told a lie in his life. Together Mel and Ester had five children, a stillborn daughter followed by two girls and two boys. Their daughters became nurses; their sons became lawyers. Mel had 15 grandchildren and 5 great grandchildren.

Mel died in 2006 at the age of 89. While he was alive, he loved to bowl and golf. He even hit a hole in one well into his 80s and made it into the local newspaper. Up until the last 5 months of his life, he took only one medication. He still drove and road his exercise bike daily. His mind was as sound as ever and he could still chase after his great-grandchildren, albeit slowly. His appendix ruptured in January beginning a relatively short journey towards his death in May. Melvin Keiffer was a joy to be around and the only thing I ever heard him complain about was his diminishing ability to hear.

Mel never forgot a birthday. Each birthday, a card holding a $50 check arrived in the mail without fail. After Amelia’s first birthday, I misplaced the check and, therefore, failed to deposit it. Mel wrote Amelia a letter claiming that he did not know much in this "www.dotcom world' but that he balanced his checkbook every month. He then asked her to tell her parents to find and deposit the check. That letter still sits in Amelia's baby book as a reminder of this sweet man. Three days before he died, despite his failing heart, he dressed and walked to the mailbox to send my sister-in-law’s 30th birthday card. It arrived containing its predictable $50 check, as usual, on time.

The summer before Mel died he joked with me, “I think God forgot that I am still here.” Only perhaps he wasn’t joking. He had outlived almost everyone he knew. Nearly a decade had passed since his wife’s death. He was a deeply religious man and he was ready to move on to his eternal reward for a life well lived.

His heart began to fail in May and it was clear that his time on earth was drawing to an end. I’m convinced he waited until Bill’s youngest sister got married so as not to dampen the festivities. He spent his final days in his home, surrounded by his children and grandchildren. They looked at old photographs and enjoyed the photos of Jane’s wedding developed hurriedly so that he could see them. His children prayed with him and read from his beloved Bible. He was lucid and aware that he was dying. The day before he died, his eldest son sat on his bed and started to say some kind words. Melvin interrupted him with his usual sweetness, “You are sitting on my foot.” It was only in the last 24 hours that he slipped out of consciousness. He died in the company of his family and in his own bed, beautifully. He had the kind of life and death that we all want: full of joy, peace, and love.

Death is rarely what it could – or should – be. I don’t mean that death is sometimes untimely. What I mean is that it is poorly orchestrated and too often by well-meaning medical professionals who can lose sight of what a dignified passage should be.

I recently learned that the average time that a patient spends on Duke hospice care (including inpatient and outpatient care) is 15 days. Doctors wait until the last moment to refer patients to this service that could help more patients die peaceful and comfortably as Mel did as well as helping families with bereavement. When a friend was dying from scleroderma, it was obvious to everyone that he was in the last months of his life: he was wheelchair dependent, incontinent, and in multi-organ failure. He was being admitted to the hospital every 4 weeks or so. His wife asked his rheumatologist in September, “Should we think about hospice?” The doctor replied that he wasn’t good at talking about that. It was the last time hospice was every mentioned. Two weeks before his death in December, the doctors were scheduling him for a work-up so that he could be placed on a lung transplant list. He complained to me about it on the phone one afternoon. “Do you want a lung transplant?” I asked. “No,” he answered. “Then why are you putting yourself through this? Because they told you to?” I asked frustrated beyond belief, “Cancel the tests.” And he did.

The first doctor to tell my friend’s family that he was dying was Bill. He happened to stop by to visit him in the hospital on the way home from work. When Bill entered the room, he suspected strongly that my friend would not last the night. Bill sat with the family and explained that their husband and father was in his final hours; he made sure they knew what to expect and that they were all in agreement about resuscitation. The only other health care professional to address my friend’s death directly during the hospitalization was one of the nurses. He passed away about nine hours after Bill left the hospital.

It makes me wonder: perhaps an unavoidable death simply should not be managed by people whose self-concept comes from saving lives. Perhaps we should allow patients to self-refer to hospice care rather than relying on doctors to admit that death is approaching in a timely fashion that perhaps should be allowed to flow unhindered.

I cannot think of a worse place to spend my final hours than a hospital -- the glare of bright florescent lights; the sterility of baby blue walls, white sheets, and gray stainless steel and plastic; the care of strangers – is there a more unnatural environment? If it is at all possible I want to die on my own terms. I have asked my husband to do everything in his power to keep me at home where I can see the photos of my children against the aubergine walls of my bedroom. Like Mel, I want my family with me, including Watson, on my own comfy bed surrounded by the memories of life well lived.