Seven weeks before he died, my father gathered my mother and us four children
for a conversation at his home.
His battle with multiple myeloma was clearly being lost. Compression fractures
in his spine had shrunk his 6-foot-1 frame to 5-foot-8. He had lost 40
pounds and the use of one eye. He was diagnosed with dementia and was
in constant pain.
Still, the former attorney was sharp as a whip as he held court in his
living room. He wasn't ready to die. He didn't want to die. But
he knew he was dying – and since he was dying, he wanted to do it
on his terms.
I am an obstetrician, devoted to bringing people into this world. Oh, the
magic and beauty of birth. Until my father's journey through hospice,
I hadn't realized that death can be sacred and spectacular too.
Not everyone has a say in his or her final days, of course. Accidents,
murder, heart attacks – these can all claim a person's life
in an instant. But many, like my father, die after a long battle with
disease. We see ourselves deteriorate and have the time to ask: Do we
spend our final weeks in and out of doctors' offices, or do we savor
the time we have left?
At our meeting, I printed out some information about hospice care. I got
the idea from a patient of mine, a clinical care social worker. She regularly
sees families in the ER who have never talked about their wishes and are
left bewildered and anxious at the end.
"Hospice," she told me, "should become a household word."
So I introduced it to my household, and at first everyone seemed incredibly
interested in their shoes. Eventually we began talking: One sibling wondered
if we were being fatalistic. Another asked if the pain medication would
hasten dad's death rather than support him through it.
In the course of two hours, we asked dad, point by point, about his preferences
regarding everything from feeding tubes to resuscitation. Everyone had
a chance to hear what he wanted, get clarification and ask questions.
Then we had lunch.
A few of us laughed: "We just had this intense two-hour conversation,
and now we're pretending that everything is normal."
"We're not pretending," he said. "It is normal."
Dad was right about that — as he has been about so many things. Planning
is normal. All day, I talk to expectant mothers about their plans for
the start of life. For my father and for our family, it was meaningful
to plan for the end too.
During the next 21 days, as my father became less communicative, we used
his plan as our road map, referring to it to determine how to care for
him. His hospice caretaker fed him pureed food served on china plates.
On nice days, the caretaker would lift him into the car and take him to
the harbor. No doctors' offices, no tests.
There were happy times and humor, intense sadness and loneliness. There
was exhaustion and fear and a few false alarms. I couldn't help notice
how much like a very long labor dad's final days seemed to be.
On his last night, we had a "party" with several of us sitting
around him on his bed. At one point, I picked up a sponge we used to keep
dad's mouth moist and dipped it into mom's gin and tonic. Reflexively,
he began sucking on it the way a baby would.
We said we were toasting dad and began laughing, talking in that shorthand
way families do. Later, I looked over at my dad and saw him take a breath
that would be his last. It was 8 p.m. on Oct. 20.
We generally have as little say about when we leave this world as when
we enter it, but I get some solace knowing that the last sounds dad heard
were of his family gathered around him in laughter, honoring his last
wishes and seeing him off as he let go. Just as he planned.
DR. ALLYSON BROOKS is the executive medical director of the Women's
Health Institute at Hoag Hospital. She lives in Newport Beach.