Saying Goodbye

There is a time for everything and a season for every activity under the heavens…a time to be born and a time to die.

Ecclesiastes 3:1-2

 

Worse than anything is the wish to die and yet not be able to do so.

Roman poet, Cornelius Gallus.

By Dr. Jim Ferguson

I lost one of my ardent fans last week, but our family lost its matriarch. Joanna was approaching her 104th birthday, but her attention in recent years had not been on birthdays. And in the last few weeks she was focused on “Crossing the Bar” as poet Alfred Lord Tennyson poetically penned.

Over the twelve years of this column Joanna has read every one of my weekly essays and frequently offered commentary. Since The Focus does not do obituaries (perhaps it should), this essay will not only be an homage to my mother-in-law, but also informational, because that’s what Joanna would have wanted.

It’s too bad we don’t get to hear our own eulogies. I once imagined the semblance of a eulogy when I was honored by those attending the book signing for my novel “Epiphany,” even though science fiction is not the preference of some. Perhaps like coffee, science fiction is an acquired taste. I’ll readily admit romance novels and mysteries are not genres of my choice.

As a doctor I’ve seen death and I’ve been near the dying. In times past death was more a part of the life cycle than it is now. People lived and died at home, usually among their families. Unfortunately, in our post-modern society many people have become separated from the realities of death and dying.

Perhaps science and medicine have contributed to the hope that a correct diagnosis or the right combination of medications or treatments will prevent or at least forestall the inevitability of death. Sometimes this is the case, but I’ve participated in many discussions of the futility of more tests and false hopes of cure.

As I approach seventy years old, my youthful notions of immortality have disappeared. Joanna had the same thoughts because, true to form, she planned her end of days well in advance.

Dying people often begin saying goodbye to loved ones. Friends tend to accept that the dying have a dwindling horizon of their existence. Unfortunately, family members sometimes find this distancing more troubling, as the dying start bidding them farewell as well.

Joanna courageously struggled with the infirmities of aging. Ben Franklin once quipped that “Those who have drunk deeply from the draught of life should expect to find some dregs at the bottom.” Since Joanna was not a beer drinker, I never shared Franklin’s perspective with her.

Joanna stopped going to church after 102 years. She welcomed fewer visitors in her last months. She continued some phone chats, the daily crossword puzzle and even had a hair permanent the week before her death. I suspect this was also a part of her travel plans.

Joanna and her doctors finally concluded that medications to control pain would be more helpful than additional tests. The cocktails had mixed results. And with increasing pain and debility she courageously told her family she was “done” and decided to stop medications, food and water.

People are sometimes flummoxed when sick people don’t want to eat or drink. Without getting into arcane medical explanations of physiology, people who are sick are not hungry and often not thirsty. And forcing the dying to do things against their will is problematic. Joanna retained her capacity to understand and make choices right up until the end.

We have a large and supportive family, but the care Joanna needed to stay at home was challenging, so we engaged hospice for help. The hospice movement originated in Malta in the 11th century as places of rest for travelers, Crusaders and the sick. Over the centuries there have been various iterations of the hospice philosophy, but the modern concept of palliative care arose in the 1960s in England. Psychologist Elisabeth Kubler-Ross’ 1969 sentinel book “Death and Dying” came out of the care of hospice patients. The focus of hospice encompasses opioids for pain, psychological, spiritual and compassionate care of the patient, and support of the patient’s family. One of the first hospice care organizations in Tennessee was developed in Knoxville by Nancy Kerr, RN in 1979.

Like most people Joanna did not want to be sent to the hospital, cared for by strangers or isolated from family, so prevalent in the Covid era. Hospice provided a better option than hospitalization or inadequate home care.

Over the years I have had many patients in hospice and it has been a uniformly good experience. This time it was personal, and, similarly, we had a good experience with prompt and compassionate hospice care.

As I helped the family with Joanna, I thought of the wonderful Southern coming of age novel, “Cold Sassy Tree” which opens with the family’s matriarch dying at home surrounded by family. Joanna spent her last days saying goodbye to daughters, grandchildren and spouses. Though dying is often tough, Joanna’s suffering was minimized with morphine and she passed peacefully three days after she told us she was tired and ready to go home to her Master.

The living find it hard to imagine that someone could be so miserable that they prefer death to continued suffering. In fact, suicide is considered taboo and a sign of mental imbalance. But what if you have an incurable illness like Lou Gehrig’s disease and want to avoid the agony of a ventilator and progressive debility and pain? Our neighbor’s father, a physician, was in this situation, and near his end he chose euthanasia, which is legal in Oregon where he lived. The family described his death as tragic but uplifting. There are now nine states with euthanasia laws. I’m convinced Joanna would have chosen this route even over hospice and morphine. The fear is that when people are involved there will be abuses of euthanasia. I can’t deny that possibility, but professionally, and now personally, I believe we should consider this option in Tennessee.

I’ve read that Jewish people believe you’re not gone as long as you are remembered. If that be the case, our “Greaty Cuckoo” will remain our guardian angel for a long time. And I think I just heard a bell jingle. Way to go, Greaty!

 

 

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