In the past 30 years, I have had countless end-of-life conversations both in state-of-the-art hospitals in the United States and in more nascent clinics in Rwanda. They are always soul-wrenching. Typically, you can feel a heavy mixture of fear, disbelief, sorrow and regret in the air. Sometimes, the only measure of comfort comes from a fierce embrace or a whispered prayer.
So, it came as a shock when one of my patients exhibited quiet strength in the face of death—a patient whose room was festooned with flowers and children’s drawings. This was a well-loved woman who would be deeply grieved by the steady stream of loved ones who came to visit her.
When she called for me, her room was empty. I sat on the edge of her bed and reached for her. Her hand was frail in mine, and yet her grip was tight as she asked a series of questions. She asked straightforward and thoughtful questions, each one requiring her to gasp for air.
- “So, how much time do I have left?”
- “When I am short of breath like this, I feel terrible. Will my suffering worsen?”
- “You’ve witnessed the final moments of many others. What will it be like?”
- “My family understands what is coming, but what exactly will they see?”
I began to share with her the painful truth: she was dying. Her disease had ravaged her lungs to the point that it was time to make some critical decisions.
My Dying Patient Comforted Me
I answered her questions as clearly, honestly and gently as possible. However, something about this particular moment – perhaps her quiet strength in the face of death, or maybe the fact that she would be missed terribly by her family as well as by myself – moved me unexpectedly. When I finally said, “I’m so sorry to have to tell you these things,” I began to weep.
To my surprise, my patient grabbed my other hand and squeezed even tighter.
“It’s okay,” she said as she comforted me. “I am going to have a good death. Please prepare my family. I am ready.”
Her eyes closed as she was wearing the oxygen mask again covering her nose and mouth. I had witnessed her decline with each hospital visit, and it was obvious that the end was approaching. I stood up and left.
As I shut her door behind me, I paused to catch my breath and gather my thoughts. What did she mean by a “good death”?
Here is something I know as a doctor: persistent pain is always a signal that deeper investigation is warranted. Maybe a question that will not go away is meant to serve the same purpose. It was time to investigate this patient further.
What is a Good Death?
In the days and weeks that followed this beloved woman’s death, I continued to wonder, “What does it mean to have a good death?”
I thought about how so many people struggle against our common destiny, seeing nothing about it as good. Meanwhile, others face death willingly, almost eagerly, as though they are arriving at a long-sought destination or getting a chance at last to become the self they knew they were meant to be.
Most people have heard the old quip that “the only certainties in life are death and taxes.” However, until that heart-stopping moment when death raps loudly on the door, barges into one’s hospital room, or whispers softly from the other end of a dreaded phone call, taxes seem like the surer reality.
We indulge in fallacies like “If I don’t think about death, maybe it’ll forget all about me.” Or we entertain fantasies like “I don’t have to worry about that now. I’ve got at least 30, maybe even 40 years left.”
Then reality hits.
For those facing the ultimate loss (either their own life or the life of a loved one), this giant, uninvited and unwelcome visitor has a way of hovering in the imagination, haunting one’s every step and invading one’s nightly dreams. Realizing that we cannot escape it forever, we wonder, “Is there any way to lessen death’s sting?”
I have friends who have lost children and spouses. I have seen diseases such as dementia, Alzheimer’s and ALS slowly and cruelly take away moms and dads, sisters and brothers. I have watched many enter the unfamiliar world of hospice so their loved ones might live their final weeks and days in familiar surroundings.
Persistent Questions Get Answers
In many brushes with mortality, sorrowful moments, painful experiences and sudden calamities, I have continued to ponder that provocative phrase “a good death.”
I have become convinced that goodness and death are not mutually exclusive. Even when death comes via violence, tragedy or unspeakable evil, I have seen how, in time and in wholly unexpected ways, death can be a catalyst for good things, like those that happened at the bedside of that cherished woman—lessons learned, love expressed, nobility seen, courage revealed and families united.
I have also discovered that doing good and being wise now, in life, actually prepares us for a good death.
Dr. Pamela Prince Pyle is a board-certified internal medicine physician, who was one of three physicians selected in 1992 by Carolina Health Specialists to begin the first hospital-based internal medicine practice outside of a university setting in the United States. In 2009, Dr. Pyle began traveling to Rwanda for medical work with Africa New Life Ministries and was instrumental in the founding and growth of the Dream Medical Center in Kigali. She is the author of "A Good Death: Learning to Live Like You Were Dying," coming in 2022.