A Good Death

Jan 21, 2014 @ 3:22pm

Julie Myerson calls her mother-in-law’s passing “as good as I can imagine a 21st-century death to be.” She urges others to share their positive experiences:

Helen’s death felt oddly like the labor of birth: exhausting and devastating, yes, but natural too and, in some strange way, productive. More crucially, and reassuringly, the nurses understood this far better than we did. As the moment drew near and, inevitably distressed on Helen’s behalf, we requested pain relief, these nurses explained, with real gentleness and compassion, that it would be far better for her if they did not intervene. And they were right. Her final moments were peaceful. And to be allowed to be there with her as they ticked on past – it’s not something I can put into words. … I’ve thought often about whether or not to write about this, especially when I read yet another newspaper account of how the medicalization of death, the obsession with intervention and saving at all costs, is robbing us all of our right to die in peace. But I’ve always hesitated. Partly because death, any death, is such an intensely intimate experience and seeking to describe it may be, for lots of reasons, a step too far. And partly, of course, because this particular death belongs at least as much to the others who were present as it does to me. All you have here is a purely subjective description from someone who loved her children’s grandmother very much.

And yet. It seems to me that what we all experienced on the 11th floor of St Thomas’ Hospital on that April evening was something that ought to be known about, appreciated, celebrated even. We surely can’t be the only family who’ve had such an experience? So I hope that Helen – whose love and friendship I feel moved to have known – would forgive me. Because how can we possibly debate these issues with any honesty if we don’t seek to share our most positive experiences of intensely private moments?


Jan 22, 2014 @ 19:25

Ctd …

Spurred by Julie Myerson’s story, readers share their own:

My mother had a good death. She died in 2006, two days after gall bladder surgery. The surgery was “successful” and she was at home (she lived in a retirement community). I was not there but my sister was. Mother was sitting in her living room chair working a crossword and died very suddenly. Why this was a good death: 1) she wasn’t alone; 2) it was very quick; 3) it was (apparently) painless; 4) her greatest fear – losing her faculties – did not come to pass. Everything about her death was “auspicious”, and this has made my grieving process very easy. She always said, “If I ever get to where I can’t take care of myself, just shoot me.” I wouldn’t have done this but I can certainly understand the sentiment.

America’s handling of death is horribly backward. Everyone from their late 20s on (or even earlier) should have an advanced medical directive made. If you ask doctors what end-of-life treatment regime they want, invariably they select the least intrusive and aggressive option possible – because they have seen the hideous pain wrought by aggressive treatment.

Another reader:

My Dad died of heart disease. As his heart was failing, he considered surgery (even though he was already in his 80s) and the docs would have done it but for the fact he also had COPD and they knew they would never get him off a respirator if they did bypass on his heart. So I watched him come to terms with his own death (the day before he passed, he asked his doc if there wasn’t something to be done, only to be told no). He died in the Intensive Care unit after first refusing to use a bed pan and insisting he could still walk to the bathroom, and he had his last heart attack in that way. So he went out on his own terms, and I’m proud of him for not giving in, even when he had nothing left to give.

My Mom died a couple years later of complications from Alzheimer’s. Her decline was agonizing.

There came a time when my brother and I confronted her doctor about all the various prescriptions she was still taking in the nursing home, and he agreed that some of what she was getting was no longer necessary. To some degree, that might have hastened her departure, but at the same time, she was already so far gone that it made no sense to keep pumping various medicines into her, including the drug she was taking to slow the progression of her underlying disease. She actually passed away from pneumonia, and the doctor and nursing home honored our request not to take extraordinary measures even though they had never signed a medical directive.

I was present when they both passed, and though that didn’t make it any easier (no amount of forewarning can change the pain of losing a loved one), I never regretted anything we did to make their last few months easier. I have friends who think we should have done otherwise with regard to my Mom, but they are wrong.

Another:

My father died last year at this time.  My sisters and I spent his last 3 months taking turns being at his home, taking care of him and just saying good-bye.  We always knew that he wanted a natural death, did not trust doctors and wanted zero intervention. In the last months, he was genuinely frightened that someone would intervene.  It was to the point that we could not even say the word “Hospice” as it sounded too much like the word hospital and it would send him into a panic.

Every person that was allowed to enter the house had to first promise that if he had any type of event or, frankly, looked like he was about to die they would NOT, under any circumstances, call an ambulance.  He had a brain tumor and we were essentially just waiting for the end.  I think it was the greatest show of love that we could spend those last months protecting him from the medical establishment and made sure that the end of his life was as he always believed it should be.

Many people tell me they are sorry for my father’s death.  I am not sorry at all.  He had a wonderful life.  He raised three daughters, got to see all of them married, with children and in fulfilling lives and died with his beloved wife at his side.  Nothing to be sorry about at all.  He had a good death to go with his good life.

One more:

My mother’s death also was as good as I can imagine one to be. When she was diagnosed with lung cancer at age 76, her response was something like “It’s about time.” She’d been a smoker since her college days, and had tried to give it up in her 40s but then decided to stay a smoker. I think she was relieved that she would go quickly from cancer rather than have it take years with something like emphysema – but we never discussed it.

She refused chemotherapy – it might have given her a few more months to live, but she’d have started feeling awful right away. All of her family and all but one of her friends supported that decision.

When discussing what she wanted as a service, she personally shopped around for the cheapest cremation she could find. She didn’t have any directives what to do with her ashes – she said that was our problem. She read about a memorial where people sat around telling stories and eating and drinking. So she and her best friend (who also smoked since they were in college together but had given it up 20 years earlier) went to one of NYC’s swankiest funeral homes to check it out. When they asked who the deceased was, she said “Me!” Turns out New York law forbids food at a funeral home, so her friend agreed to have the memorial at her apartment.

She was given hospice care. A nurse came to visit her in her apartment weekly. She told the nurse that she didn’t believe in god or an afterlife so they discussed books every visit. The nurse gave her a comfort kit that included a low dose of some morphine. She didn’t take any till very close to the end, and was amazed at how good it made her feel. DUH. Not for the pain, but it slowed her body’s need for oxygen and she was short of breath.

She did have her doctor prescribe a presumably lethal dose – it was such a high dose that the pharmacy didn’t stock it. She made arrangement for me to pick it up, but it didn’t arrive till a day after she died.

She was in very little pain (or so she said) till the last few days. The hospice nurse had her admitted to the facility – they thought some radiation might relieve the pain for a little while. I went to see her that day and she was in good spirits. While I was there she actually made calls to her mutual fund company transferring money to an account where it would be easier for me as her executor to retrieve. She smiled and told me what fun it was making those calls. My sister who lived farther away made it up the next day and my mom passed that night. She had been given pain medication – that was her wish – so I’m sure she wasn’t very lucid at the last. I think she got the radiation treatment but I really don’t recall. It obviously didn’t matter, she wasn’t in pain at the end. It was about 4 or 5 months after her diagnosis.

The hospice was a Jewish one, and the next day I got a condolence call from the rabbi who said he’d been able to see her and pray with her the evening before she died. I thanked him and didn’t have the presence of mind to tell him that was probably what pushed her over the edge.

I have no regrets not being there as she breathed her last. We had said all we’d needed to in the weeks and months before she died.


Jan 27, 2014 @ 10:03am

Ctd …

A reader adds to the growing thread:

Several years back, my father passed away from a heart attack at the age of 59. He was at home with my mother having a nice talk and had just poured himself a glass of wine. Then he started complaining about a sharp pain in his chest that wasn’t going away. He proceeded to give my mother a big hug and imitated Redd Foxx’s character on Sanford and Son saying, “I think this might be the big one!,” causing both my mother and him to laugh.

After that, he collapsed and died.

While his death was unexpected at his age and I miss him dearly, I nevertheless feel relief when I think of his circumstances. Not only was his death quick, but I had always known my father to be a particularly grouchy and difficult person when sick and feared that he would’ve handled illness in old age poorly. But in his final moments, he saw what was coming and had the grace and confidence to squeeze in one more act of love and laughter. It can’t get much better than that.


Jan 28, 2014 @ 4:04pm

Ctd …

More stories fill the thread:

In the 1980s, I taught conversational English in Japan. One of my favorite classes had just three students – three middle-aged women who weren’t afraid to say what they felt. Once, one of the ladies missed two weeks. When she returned, she apologized for missing class – her father had died. I hurriedly said how sad I was to hear it, but before I could go on, she stopped me. She told me that I shouldn’t be sad – his death was beautiful. That’s certainly an adjective I had never heard applied to death before.

She explained that her father had caught a cold while he was riding his bike. He was in his late 70s. After a few hours in bed, as the cold turned into pneumonia, he told everyone that he was dying. His children and their families came from where they lived and congregated at his bedside. He was alert and not in pain. He spent a day saying goodbye to everyone. Once he had a chance to talk to his children and grandchildren, he went into a coma. He died an hour later.

By the time the student finished the story, we were all crying and smiling.

Another joins this reader in some gallows humor:

The thread has reminded me of the old joke: I want to die like me grandfather did – peacefully in his sleep – and NOT like the screaming, terrified passengers in that bus he was driving.

In truth, I actually would like to die as my grandmother did. At age 90 she was in marvelous health, needed no medications, and was quite active in her community and church.  On the eve of one of her many trips to Norway to visit relatives, she visited her doctor for a checkup. After the nurse had checked her vitals my grandmother remained seated on the exam table.  The nurse exited saying the doctor would be in to see her momentarily. My grandmother joked that if it took too long she might just take a nap.

When the nurse and the doctor came back in my grandmother was down on the table, a smile on her face.  She had passed, simply, and one assumes painlessly. Would that we all slipped this mortal coil with such ease.

Another reader:

My mom was diagnosed with Stage IV ovarian cancer in November 2009. She refused any radiation or chemotherapy (she was 84), but in the five months of her final illness, she claimed never to have a minute of pain. (Personally, I think this was due to a benign tumor she had for years above her ear – I think it must have blocked pain receptors in some way.)

At any rate, Easter was April 4 in 2010. Our family celebrated on Saturday so various college students could get back to school on Sunday, and my sisters and all our kids (and their multiple significant others) were there. We had a splendid time, although by then Mom was very frail and occasionally on oxygen. She wasn’t strong enough to sit at the dinner table, but she did spend that time in a chair in the living room, close enough to hear and enjoy the fun. Later that evening we helped her up the stairs to her bedroom. This was the first time she needed help – she was pretty indomitable. We helped her into bed and told her we loved her, and she died in her sleep sometime during the night.

When we went up to see her in the morning, she looked so peaceful. If she had scripted her last 24 hours, I don’t think it would have been any different.

Another:

We lost my brother last year. He was 25, perfectly healthy, almost done with the Navy’s cryptology network technician training, when he started having trouble breathing. After a month or two of struggling with what the base doctor thought might be asthma, he almost blacked out walking to his truck, and checked himself into a hospital. He had rhabdomyosarcoma, a heart tumor. He passed away less than eight months after his original diagnosis.

What was good about that? Nothing – but so many things. He was tired of fighting about three months in, and I worried for him then; so many cancers take years and years to reach a conclusion. The speed of it all was hard – but also merciful, in a way.

His greatest hope was that he wouldn’t lose mental and physical faculties, and for the most part, he didn’t. The stroke and subsequent brain tumor impeded his language faculties, but he could still speak and interact with us, and take care of himself – albeit slowly – almost to the very end.

His treatments were conducted about two hours away from our hometown, which allowed him a strong support system of family and friends. Our mom was able to stay with him at the cancer care center, so from the diagnosis to the end, he was never on his own. In the end, he died in his childhood room, with my mom singing to him and his siblings around him holding his hands and sufficient meds to keep the pain and anxiety at bay, and enough counseling from hospice and the funeral home staff that we knew kind of what to expect.

We all knew this was a traumatic thing, but it didn’t feel traumatic – more like a clock winding down and then just not ticking anymore. There wasn’t a visible wrenching from life to death, just smaller and smaller steps until you pass some invisible line and then … then he looked just like before, only motionless. Whether as the person leaving or as the person being left – I really don’t know what I would change about that. I can’t come up with a much better way to go.


Jan 29, 2014 @ 9:03am

Ctd …

A reader recommends a film for the thread:

For an example of a good death, to my mind there’s no better example than that of Cody Curtis, the “star” of the 2011 HBO documentary How to Die in Oregon. To summarize briefly, Cody was diagnosed with untreatable liver cancer and given only months to live. Using Oregon’s Death With Dignity Act, she prepared to end her own life and set a date. But when that date approached, she realized that she felt pretty good and cancelled her plan. She lived through the summer and fall, relatively pain-free, but then her health began to fail rapidly. Her brave meditations throughout all this were a wonder to behold.

Everything progresses, even our thoughts about death.

Update from a reader:

The reader who references this film fails to note that although Ms. Curtis postponed her plan to end her life by several months, she ultimately did take her own life, as she originally intended.

Another:

This thread may be older than you realize. In Book I, chapters 30–32 of his Histories, Herodotus tells the story of King Croesus, the wealthy king of Sardis, and his meeting with Solon, the great lawgiver of Athens. Croesus, having entertained his guest richly, finally asked him who the famously wise man thought the happiest man in the world to be – assuming, of course, that the answer would be himself. Instead, Solon told him that the happiest man he knew of was one Tellos the Athenian, for he had lived in a well-run city-state, saw his sons grow up and have children of their own, and died well, to the mourning of his peers.

In fact, Solon refuses to call any man happy whose life has not yet ended. Only he who “dies with grace” is reckoned happy, since the most fortunate man is subject to the whims of fate whilst alive.


(Thumbnail image by Flickr user Keebosr)