I am not ready to die. But I am not afraid of death.
I’m waiting for my preceptor in the lobby of a palliative care residence, surrounded by several classmates. We are overheating in our winter gear, making small talk, passing around breath mints. A feeling of anticipation about the impending visit swirls amidst a number of other emotions - anxiety for the upcoming renal exam, annoyance at the erratic nature of Montreal’s winters. I find myself making conversation, but in that disengaged way reflective of a head and heart that are elsewhere. It is the first time I have been in a hospice since she died. My heart patters a nervous thrum, diffusing a light shakiness throughout my body. Dr. P arrives and guides us upstairs, settling us into a comfortable but overly warm room. I like her immediately, as I do with most palliative care doctors. There tends to be a certain kind of presence and wisdom that emanates from any person who has elected to accompany fellow humans on the final leg of their journey. She briefly introduces herself and the aim of the day’s session, and then inquires: have any of you had experiences with hospice or palliative care?
I keep quiet throughout the initial discussion. I still have trouble broaching the subject of my mother’s death amongst new people. Mostly in avoidance of the, at times, clumsy nature of the ensuing discussions. I sometimes trivialize the profundity of its effect on my life in an attempt to outstep uncomfortable silence or to put others at ease. I decide to hold off on disclosing my experience for the moment, and we are brought to meet Will.
In many ways, Will was very different from my mother: no wife or children to speak of, quite a recent diagnosis of cancer with a very limited prognosis, a sports fanatic who appeared to love nothing more than football accompanied by chicken wings and beer with the boys. But the similarities were salient: he was in his early 60s, as my mother had been when she died, with the very same type of cancer. He even had a slightly stoic demeanour and laconic way of speaking that recalled her to my mind quite vividly. I found myself wondering how he would be remembered and by whom. I know very intimately that a person’s influence can extend well beyond their lifetime: in our memories, in our actions, in our ways of understanding the world.
My mother’s death was transformative on a number of levels. Death is not just an event itself, but everything leading up to it and life beyond for all those affected. In the three years since I said goodbye to my mother my life has changed in many ways, both tragically and beautifully. We often said my mother was the glue of our family. This has proven to be quite true: while her sickness and death temporarily drew my family together, as time has passed, her absence has become increasingly apparent in our distance.
The loss of my mother has been staggering. She was my safe place. She was always there, with a cup of tea, her overwhelming love and the reassurance that everything would be ok, which soothed a headache as well as it did heartache. I felt confident in taking risks, knowing the fall would always be softened. Three years later I most recognize her absence in a feeling of stubborn loneliness that no amount of human contact can fully quell.
Death is never easy. Yet, despite everything, I feel very grateful for the way in which my mum died. She accomplished the major goals she had set out for herself (selling our house, moving into a place that would be more manageable for my dad as he aged, celebrating one last Christmas together) and she left this world in a way that was true to her values, in a hospice where she didn’t feel that she would be a burden on anyone. Though my dad and I fought her on this one (we were all too happy to be her care providers), we ultimately realized how important it was for her to do it her way. A stubborn Dutch woman, I should have known she would have never had it any other way. She died on her own terms. When she was ready, she did not linger. After over three years of enormous pain, vomiting, GI difficulties, multiple surgeries and rounds of chemo, my tenaciously unyielding mother had had enough and quickly, gently, slipped away from us.
Her death was deeply hurtful and profoundly humanizing. My entire family, with my mother at the centre, was provided unparalleled support and compassionate palliative care. I remember one afternoon sitting with our palliative care doctor, Dr. C, at my kitchen table over a cup of tea. She clearly explained to me how the disease was killing her, that it was a process that could take days or weeks, and what to expect. She asked me what I needed to find peace - had I said what I wanted to say? Had I asked the questions I wouldn’t have the chance to later on? She made sure I was acutely aware of the reality, and that I had properly reflected on how to make the most of the precious and limited time remaining. She did this with all of my family members, focusing the most time and energy on my mother. Along with the palliative team, she made a deeply difficult process somewhat more bearable. I saw the same process taking place with Dr. P in her interactions with Will and her other patients. Ensuring that their last chapter need not be their most painful. That life need not end in suffering. Helping them remember their lives and cherish their remaining days.
I am different now. I have learned to sit with the most uncomfortable of human emotions. I am able to hold that space for other people. For many, talking frankly about death seems as dangerous as staring directly into the sun. We change the topic. We talk around it. We focus on the future, on hopes that we don’t believe in ourselves. My commitment to my future patients is to give them the opportunity that our palliative care doctor gave my family, regardless of what specialty I’m in. I will have the difficult conversations. I will sit with their pain. I won’t look away.
I still remember how it felt to hold my mother’s hand for the last time, knowing I would never again feel the comforting warmth and familiar texture of her skin. And when it was time, I knew we had both said all there was to say. Goodbye is never a palatable word for the human spirit. The intensity of the pain and fear can be suffocating. But in accepting that she really was dying, we made our final weeks and days together memories that I will treasure until it is my turn to take my final breaths.
I am not ready to die - there are so many things I still want to do, see, feel, experience. But I am not afraid of death.