Disclaimer!! the topic of death and reading details of what occurs at death is not for everyone. Please skip this blog and/or be mindful of those around you when reading this. This is not content may be too sensitive for children to read.

As I continue to mature, I often reflect on the many lives that I’ve been involved with in the those last months, weeks and days leading up to one’s death. I still spend much of my time reviewing hospice cases for my work and I feel this intuitive sense that I am somehow connected to these people that are dying.
We’re all dying, some of us are just on different trajectories than others. Often, people have a terminal illness and know what their disease path will likely be and how they will die.
As I drift between working in sick care and learning about wellness, I thought I’d share my observances or common threads across some of the amazing individuals I’ve had the privilege to support as a hospice nurse. I have never met anyone who wanted to have a terminal diagnosis. Some individuals made choices and the results of those choices were cancer, for example.
I was assigned to a case for this middle aged woman some years ago, let’s call her Anna. She was this vibrant, strong, outgoing personality and she was brilliant. Anna was a PHD professor at a local university until she was forced to take any early retirement due to being diagnosed with stage 4 lung cancer. She smoked since the 1960’s, she began a career as a model and was still a stunningly beautiful human in her early 60’s. She shared that she knew smoking was horrible, but she never really thought it’d affect her, until she heard the diagnosis. Staring at such a grim diagnosis, she decided to just live as best she could at home. Her grown children would visit several evenings a week and she would happily sit on her outdoor patio, part of this adorable 1950’s bungalow just outside of Denver, CO. She’d sit on the patio and wave to people as they walked their dogs, get some sun on her face, and smoke a cigarette or two. I know what you’re thinking, she STILL smoking? WTH?! Yes! she did not give up smoking. She would say ” Why would I put myself through hell trying to quit when I know I’m going to die!” and she’d let out a cynical laugh.
Things went ok for Anna until they didn’t. I recall it being late summer when I began her case and within just a few months she had unrelenting pain as the cancer progressed. She was no longer able to walk too far, so her time on her patio became less and less. She was indoors more often and even smoking, something she found great joy in, was often just too much to manage. I managed her pain through conventional methods which often causes more complications with the human body. Her body was revolting as the cancer continued to slowly choke out her life.
I showed up on a Tuesday morning, she was already awake and sitting in her kitchen having a cup of coffee. She offered me a cup. I gently dove into my assessment of her. How she’s feeling, her pain level, is it manageable with the regimen she’s on, is she sleeping, how is her appetite, and as she walked me through her last few days I would infer how she was doing physically and emotionally. On this particular day, she shared that she had not had a bowel movement for 6 days. As a nurse, this is not something I could ignore. Especially since Anna was on opiods, it’s imperative that I keep her bowel regimen working. So, it was time to institute an enema. You should have seen her face! you want to do what? why? I’m sure I’ll go tomorrow! I insisted though since she told me she was uncomfortable, that we at least try this intervention and assuredly things will hopefully move in a positive direction.
So, I grabbed my nursing bag and we decided to start in the bedroom. I’ll spare you the details but the intervention was quite successful and we were able to get Anna to have an amazing bowel movement. Life felt good again.
Over the next few weeks, Anna declined. She was no longer safe to be home alone and unable to walk independently in her little bungalow. The days sitting on the patio were now gone and her son spent his nights on her couch. I do want to assure you that I implemented all the interventions to ensure her comfort, increased pain medication, oxygen therapy, a walker, bedside commode, but there’s nothing easy about watching someone die from advanced lung cancer. As the days crept on, a diagnostic test was not necessary to know the cancer had spread to her liver, as even with her beautiful olive complexion, her skin tone was now somewhat yellow.
It was nearly the holidays, and Anna was rather completely bedbound. There’s never a good time to leave this world, leave our loved ones, our children, pets, our home, but the holidays add another layer of angst when watching someone’s demise. She died just before Christmas. This beautiful, vibrant woman, reduced to a nearly lifeless body, with God’s grace, was able to slip away relatively quietly and not have too hard of an impending death in those last days and hours.
So what are the common themes as we all face our demise? we go from independently thinking and moving bodies to the inability to care for ourselves. We lose mobility, complex thought, we cannot prepare food for ourselves or bath on our own. Much support goes into helping someone who is dying. We will all face this someday. For Anna, 61 years old was too young to leave this world. She had never experienced grand children and left her love of teaching too soon.
The choices we make for ourselves today impact how we will leave this world. Will we live a long and healthy life or will it be burdened with chronic or worse, terminal illness. Learn and institute practice’s to put you on a path of health of longevity, your life depends on it.
be well,
Alli
resources for you or your loved one;
https://www.nhpco.org/
https://www.capc.org/