Chicago, Illinois, United States
The subject of death is by its very nature a personal thing. Woody Allen said he didn’t mind dying; he just didn’t want to be there when it happened. Most of us feel the same way.
Death frightens us in proportion to our systems of belief formed through societal and scholastic training. But our basic fear of death is innate. It helps to keep us alive; it prompts us to run from danger, to look before crossing the street.
Many Americans view death as an option, believing modern medicine can cure anything. Medical universities compound the situation by selecting students with sharp and pragmatic minds, then through years of training, teach them that death connotes failure. When medical miracles fail to save Mr. X, many doctors feel defeated.
But death is not a failure. It is an intricate part of life. Everything that comes into being eventually goes out of existence. Mountain ranges, rivers, stars, even galaxies die. Life and death are natural processes, inherent in our universe.
To extend life is a wondrous thing, but to turn away when death approaches does a great disservice to the patient who faces it. More than at any other time, a patient needs to know his doctor still cares and stands ready to help when he awaits the inevitable.
So it happened, one spring morning, my father refused to go to dialysis. My mother was frantic and called the doctor, who came to the house. The two men talked: “Carl, if I could make you just a bit better, I would sit here all day until I got you to resume dialysis, but I can’t. You’ve lasted longer than most, and I know you want to die at home. Death from kidney failure is easier than most. When my time comes, I hope I have your courage.”
Four days later the phone rang, and I answered it. “Hello, this is Dr. David. I was wondering if I could come to visit. This wouldn’t be a medical visit, I’d just like to have one last conversation.”
“He’ll be thrilled to see you,” I answered.
I walked Dr. David to the bedroom. The men shook hands as I provided a chair for the doctor. Over the next hour, I walked down the hall several times, but never entered the room. The two were recalling wonderful meals they had shared, things they had done over the course of their lives. It was a time of sharing and gathering memories. There were no questions or comments about my father’s condition. They both knew and accepted the situation. As an observer, I know that both men were enriched by the visit. My father died as he had wished.
Dr. David followed his heart on that spring day. As he entered my father’s bedroom, he left his medical training behind. All that mattered on that day was to be with a man who had become a dear friend, to talk and laugh and remember fine times, to be with his friend as he walked his last mile.
Three years later, on the night of my daughter’s death, a doctor I had known for several years walked with me through the winter night snows of Wyoming. My true grief hadn’t yet arrived; I spoke philosophically. As we approached the side door to re-enter the hospital, the doctor leaned his forehead on the glass door and said, “I hate death so much I didn’t even attend my own brother’s funeral.” I went home alone in both body and spirit.
I have found that in most cases it is the nurse, not the doctor, who attends to the dying. When I was 21, I was thrown over a cliff by a horse. My left pelvic bone was cracked, and every connecting tissue had been stretched and wounded. Two months later I realized I was pregnant. However, I kept telling my husband and my doctor that things weren’t right. At six months of pregnancy I went into labor. My doctor said I wouldn’t deliver until morning, and he went home to get some sleep. An hour later the pains increased; a night nurse came in and examined me, gathered everything she would need, and gently helped me deliver a deformed fetus that had been dead for weeks. As I started to sit up to see, she gently pushed me back down. “There is no reason to carry the visual memory of this around with you for the rest of your life. It never had a chance.”
In the morning the rested doctor performed a dilation and curettage. Later I woke up and padded out to the night desk. There stood my angel. We held each other’s hands. “Thank you,” I said, over and over again. Somehow I never got that nurse’s name; I never sent her a card, but every time her memory enters my mind, I mentally send her roses.
There are also doctors who have made a difference in my life. They never got roses either, but they too sit solid in my mind. I am particularly thankful to Dr. Jose Velasco, who read my book Passings: Death, Dying and Unexplained Phenomena when still in manuscript form. At the time, I offered him a piece I had written about a family member whose father had signed a “do not resuscitate” form after battling cancer for five years. Threats of lawsuits against the doctors and the hospital ended up stripping the father of his dignity and his wishes; he was intubated despite his adamant opposition. The man died in agony.
Jose replied, “Everything you say in this story is correct, but people who do these things think they are doing the right thing; you’ll never change their minds.” “I know,” I said, “but many others will read the words, and years later when a loved one is dying, they will remember the story and listen to his wishes rather than follow their guilt and ego.”
Jose thought it over. I watched him. In the end, he cooked up something wonderful, a story I shared in my book Passings:
One of Jose’s patients was in end-stage cancer. Then another complication arose that could be relieved through an extensive operation but wouldn’t save or extend the man’s life. In private, the man let Jose know that he didn’t want a useless surgery under the circumstances, but that his children were having a hard time and wanted him to have the operation. In looking over the situation of this particular case Jose had a stroke of genius. He stayed at the hospital and waited for the man’s family to arrive for their nightly visit. He approached the family and invited them into his office. He then explained that children are frequently placed in a difficult situation when a parent is near death. He told them how children often feel that it is imperative that they make final decisions on behalf of the parent, but that what is most important is that they listen to the desires of their loved one. He then walked with them to their father’s room. After the greetings, Jose took the patient’s hand and spoke to him of his condition, saying that he wanted to explain everything with his family there as such situations are usually difficult for loved ones to understand and accept. Then he told the man what he already knew. First, he spoke about the operation, how extensive it would be and the painful recovery period. Then he addressed the man’s current condition and what could be expected, ending his discussion with, ‘Knowing all that, as your physician, I feel that the decision must be yours. I wanted your family here so they could become aware of all aspects concerning your situation and hear what it is that you want under the circumstances. I will do anything and everything I can for you. Be it all or nothing. It’s your body and your life. You have full mental and emotional faculties; it’s your decision. I will follow your wishes.’
The man squeezed Jose’s hand, then he thanked him and said that he didn’t want the surgery, that he had suffered long enough and that the trauma of surgery, on top of his cancer, would be too much. He said he wished to be made as comfortable as possible, have his family about him and die in peace.
Jose promised to fulfill his wishes, shook the man’s hand, gave hugs to the man’s children, then left as the family crowded around their father with love and understanding.
Death comes in many forms; each case demands a personal touch if it is to be successful; and those who have managed to accept death can turn it into a time of love and sharing. Even my husband, the epitome of the angry cancer patient, eventually found a peace of mind. During my father’s last week, my husband went to see him to say goodbye. After shaking hands he looked down at my father and said, “Hey Carl, save me a seat.” In a heartbeat my father replied, “What the hell makes you think we’re going to the same place?”
CAROLE A. TRAVIS-HENIKOFF is the author of Dinner with a Cannibal, honored by Choice magazine as one of its "Outstanding Academic Titles" of 2008. She sits on the board of directors for the Stone Age Institute, and has given lectures on paleo-anthropology at Loyola University (Chicago) and lectures on death and dying at Rush University Medical Center (Chicago). Passings: Death, Dying and Unexplained Phenomena was a twenty-three year project that began between the spring of 1983 and the fall of 1986 when Carole lost her father, husband, maternal grandmother, mother and grown daughter to renal failure, cancer, entropy, suicide, and a horse-riding accident. Seven years later, her youngest son's wife died of a rare blood disease following the birth of their second child. Passings can be previewed at www.passingsbook.com. Carole shares her time between Chicago and Wyoming.