I find myself constantly ruminating over this question and am regularly fascinated and surprised by the variations in responses that I see.
It is easy for me to say what a “good death” looks like from the comfort of the nurse’s station. The patient is peaceful and comfortable with family and loved ones by their side. Their final wishes have been honoured. They die quick enough that their loved ones don’t have to sit vigil for more than 48 hours but slowly enough that everyone has had a chance to say their goodbyes. Perhaps the only way my ideal scenario has evolved over time is the additional clause that “there are no COVID restrictions.”
But, that is my own bias. When you are sitting on the other side of the bed, all the above may seem like irrelevant platitudes, only visible as an outsider, as the family grieves through the worst days of their life. If I have learned anything in my musings around “a good death,” it is that I must constantly be open-minded to each family’s unique expectation and not point out anyone else’s silver linings.
Despite my attempts to shelve my own beliefs around this, I will confidently profess that yesterday I was given the gift of bearing witness to a TRULY
This lady was not my patient, but due to COVID restrictions, I had been asked to care for her while staying with us at hospice. I never saw any visitors; her age was such that most of her family and close friends were already deceased. Dementia that had ravaged her brain for the previous five years shrunk her social circle
When I first met her, I was struck by how dignified and put together she seemed even amid a hospice setting. She was unable to swallow, unable to control her bowel and bladder, and unable even to turn herself in bed, yet she sat upright, beautifully coiffed and groomed in her own nightgown, and welcomed me into her room.
It took me a while to realize that the slew of words that welcomed me made absolutely no sense. It is incredible how the right tone, inflection, and sequence of words and sounds can make it seem like you are having a coherent conversation. She duped me for the first few minutes as I tried hard to put the jumble of words together into something to which I could respond.
We call this a “word salad” in medicine, and she had perfected the art.
I learned later that she had been a university Professor. She had lived her life a dignified and intelligent academic. And, despite her advanced dementia, she was going to live out her final days in much the same way.
I enjoyed my daily visits with her and looked forward to the adventures her words took me on. Sometimes I could catch enough phrases that I would know, to her, we were girlfriends out for a night on the town or waiting impatiently for the bus. Sometimes we were disgusted by protocols and bureaucracy. Other days I had only her animated facial expressions to go on. Either way, it was always an exciting story or adventure. Her life, to the end, was filled with wonder and enthusiasm.
On her final day, the nurses warned me before I went in that she had taken a turn. She was no longer sitting up in bed. Although still sporting her elegant floral dressing gown, her hair still lovingly tended to, her open-mouthed breathing and blank stare gave her grim status away.
I walked over to her quietly and held her hand, just as I had done every day previously. This time I spoke first; “It’s a beautiful morning today,” I started.
Her eyes suddenly brightened, and I was shocked to see that my words had awoken her.
As she tightened her grip on my hand, she smiled and said her final words to me, “I love you. I love you. I love you! I love you. I love ALL of you.”
I didn’t feel worthy of receiving these words, having only been a part of her life for her final week. But, I promised her that I would pass her message along to “everyone.”
Society romanticizes death with the pressure of having the perfect “final words” spoken on one’s deathbed. It doesn’t happen often, and I am not often privileged enough to bear witness to them, but I couldn’t help but feel the elation of this moment for her. It may have happened in an isolated room without familiar friends and family by her side, but this dignified lady, for the first time in years, was able to string together a perfect final sentence for the world to hear.
I am honoured to be the one chosen to share them for her.
Dr. Alyssa Boyd, CCFP. FCFPP (PC) | Medical Director, Hospice Georgian Triangle