Let It Not Be a Secret


THERE ARE TIMES WHEN DYING GOES AS SMOOTHLY AS ONE COULD HOPE. It was this way for my friend, Margie. She would be delighted to know that her story was being told.

I met Margie late in her life through a family friendship. She had the good fortune to afford living in an exclusive continuing care community on the Mainline outside Philadelphia. Margie and her husband had joined the community many years earlier and lived there independently.

As they aged and downsized, they moved into a comfortable apartment in the community’s personal care wing. They were surrounded by engaging neighbors and enjoyed sharing their meals in a lovely community dining room. There was a complete health clinic on the premises with 24-hour nursing care available as needed—as eventually it was—for each resident aging in place.

During one of our lunchtime visits, Margie asked me to reach an old book from atop her library shelf. Her modest collection reflected a lifelong love of reading, both fiction and non-fiction. You can tell a lot about a person by the books he or she keeps. Margie loved history, art, music, and travel.

But this book’s importance was that it held a faded article she wanted me to see, clipped long ago and tucked away for later reference. The writer conveyed a quiet “secret” she’d discovered, a long-practiced custom that had been entrusted to her by word of mouth.

The writer’s pearl: that we could choose the time of our death by giving up eating and drinking.

With an inquisitive lift of her eyebrows, Margie asked me, “Have you ever heard of such a thing?”

I smiled in reply. “Yes, it’s how my mother chose to go.”

Margie’s face softened, reflecting calm reassurance. Her gaze was down and forward, and she nodded slowly to herself. These pivotal conversations need not be long. The mission is to convey what’s most important to a person. A simple understanding between us was sealed.

Now into her early 90s, with her husband long passed, Margie’s bus trips with her fellow residents to hear the Philadelphia Orchestra had dwindled. As with many seniors, incontinence can be a determining factor in how far afield one travels. Her beloved children continued to visit and give her cause to soldier on, but it was plain to see that she was in decline.

Although the staff helped her with activities of daily living (ADLs) in the apartment, Margie’s instinct was to downsize and simplify by transitioning to the assisted living wing. Accompanied by favorite family photographs, a comfortable chair for visitors, and an African Violet or two, Margie moved into a single room with a picture window. Her medical team was now at her beck and call, just steps away.

What made all the difference was neither her good fortune nor her manageable decline, but her graceful acceptance combined with clear, direct communication. Having an exit strategy that matched her values brought peace of mind. Margie confided in her doctors her intent to die on her own terms and in her own time. They, in turn, entrusted her with an honest prognosis and pledged their support.

She and her family spoke comfortably about important choices that lay ahead while embracing the present. There were no secrets, and little was left unspoken. It was an honor to be included as her chaplain.

Family and friends came and went from her small room. Her son installed a bird feeder outside the picture window that became a flutter of activity. Margie continued to read and to ready herself. When one daughter was reluctant to offer her blessing, Margie was gently resolute.

As often happens, her body was requiring less food, and her appetite conspired to support her plan, until one day she stopped eating. A few days later, her need to use the toilet diminished, and she let us know that “the day” had arrived. She toasted to our health, thanked us one and all for our loving support, and had her last glass of water.

Margie was alert and expectant for the next few days. When her mouth became dry, her nurse would gently moisten Margie’s lips and mouth. The hospice team was fully on board, and they prescribed Ativan for Margie’s low-level anxiety, as well as maintenance doses of morphine to quell her under- lying pain and relax her breathing. She was resting when I visited to say goodbye, but she woke easily and opened her eyes.

Clearing her throat, with a wry smile, she managed to say: “I’m still here,” evidently a bit perplexed as to why.

I read in her eyes the question How much longer? and attempted to reassure her with a gentle touch, saying, “All in good time.”

The next day, her eyes closed, and she dropped beneath the surface, not to return. Her loved ones began a bedside vigil, as old as time. A day later, in the dead of night, our beloved Margie slipped away.

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Is there a chance that our end-of-life decisions are made years in advance? Do we come to them alone or in concert with others? Will my goals of care be determined by speaking up, or by happenstance and by factors seemingly beyond my control?

I think we each have a significant say in how our end-of-life care unfolds, blending foresight with a willingness to bow and to bend.

Margie’s clear-eyed vision, seeded by an Ann Lander’s column years earlier, set a direction for her family and care team to follow. Though Margie was of the silent generation, her self-determination and confident communication with her family and clinicians models the themes that baby boomers are beginning to emulate.

What’s alive and growing within you that could well blossom in the final chapters?

Next Week’s Post: The Voluntary Suspension of Eating and Drinking (VSED)


A Medical Advice Disclaimer 

The content of this blog is for informational and educational purposes only. No aspect of its contents is intended to substitute for professional medical advice, consultation, diagnosis, or treatment. The author is a spiritual care provider, not a doctor. Always seek the advice of your physician or other qualified health care provider with questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen. Never disregard professional medical advice or delay in seeking it based on something you have read here.

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Until next week, ‘Safe Journeys,