Last Thursday morning I stopped by my grandparents’ house before coming into the office. Grandpa was asleep on a bed in the living room, where I woke him when I pulled up a chair. He opened one smiling eye and cracked a joke that he must really be sick now, because I was visiting. (Apparently I’m the family’s Grim Reaper, but hey, everyone has to have a specialty.) Anyway, it’s true. My grandfather is in the process of dying at home, and I was there to bring soup for the family members taking care of him, and to tell him I love him.
If we can bring ourselves to think about end-of-life issues at all (something we discuss in the November issue of Experience Life, both with our marvelous cover subject, Nora McInerny Purmort, and in a feature I edited on new thinking about end-of-life care), we often hope we’ll have an end like the one my grandfather is presently having. He and my grandmother are pillars of their Catholic church. He was a family physician for decades, with patients who adored him; people he often served for no money, because that’s how he liked to roll. He and Grandma had seven children, with multiple friends who spent a lot of time at their house — a place of welcome in their South Minneapolis neighborhood where the backdoor is almost never locked and family dinner is still served every Sunday.
As my grandpa prepares his exit, people from all of these worlds are coming to visit, to pay their respects, but mostly to get a last dose of his humor, or to enjoy a heated analysis of the failures of our current healthcare system, or have him bless them by putting the sign of the cross on their foreheads with his thumb. (I was lucky when I stopped by, and got all three.) In this sense, while he may be dying, he is also having what can only be described as a good life. For example, he told me in detail about the 25-year-old scotch he’d just enjoyed the night before, during a “boys’ night in” organized by my wisecracking uncle. He is having a good life right up to the finish line.
This kind of ending is not something that happens by accident. The other possibility, of course, is that he would still be in the hospital, being poked and prodded and “fixed” at every turn, though his body clearly knows what it’s doing. His blood pressure was 90 over 50 that morning. He kept taking it himself and declaring the cuff was broken, until my aunt — a nurse — took it and said, philosophically, “Well, Dad, maybe that’s just how it is.”
During a hospital death, there is almost no “how it is.” Healthcare providers are required to administer every possible measure to correct a process, like falling blood pressure, that suggests the body has turned onto the exit ramp. And this is precisely what we want them to do — until we don’t. Which is one reason why it’s so important to be able to face the fact of our own inescapable end before it arrives, at least long enough to reflect over how we’d like it to go, and to put those wishes down on paper in an advance directive. That’s if we want to be in some measure of control over where and how we leave this world, since we can’t control the fact that we will. That part is inevitable.
Moving Into Hospice
Being a doctor, and losing a lot of people he loved before it was his turn, may be why my grandpa was comfortable stating in clear terms how he wanted his end to unfold. Hospice nurses are now visiting daily to make sure he has the right drugs, and enough of them, to control his pain. That service was organized through the hospital when he and my grandmother decided that it was time to switch agendas, from curative to palliative care. He’s sleeping in a bed on the ground floor, so he doesn’t have to climb stairs to the bedroom, and his son or son-in-law is sleeping nearby on a couch during the night. They have a system in place that was ready to go, and it’s working beautifully.
“When I was practicing,” he told me last Thursday, “there were three things you did. First, you cured. Then, you healed. And when that was no longer possible, you comforted.”
And that is what he’s still doing, comforting us. Letting us be with him on his victory lap, while showing that he can still dish out a little grief to those of us who didn’t show up sooner. His preparation means that his last days are not only better for him, but for everyone who loves him. He’s teaching me a few things about a graceful exit, and I am thankful.