Family Farewell: A Lovely Way to Die.
All too often in the practice of medicine, I see patients pass away while lying on a narrow stretcher under glaring lights in the code room of an emergency department or all alone, without family, in an isolated hospital intensive care bed.
In extreme situations, a breathing tube protrudes out of their mouth, defibrillator pads are stuck on their chest, monitor leads are attached all over their bodies and IV lines dangle from both arms. A team of exhausted doctors and nurses surround these forlorn patients with dejected looks on their faces after trying, in vain, to do everything they could to resuscitate a patient’s heart.
In the background of these ghostly scenes, there are opened drawers of a red crash cart with discarded wrappers and packaging from sterile IV bags and emergency medication boxes strewn all over the floor.
When family members finally do have a chance to enter the room, it is heart-rending to see them weep in grief at the bedside of their loved one whose life ended before they were able to properly say their last goodbyes.
This spring, I felt an entirely different emotion when my wife’s Uncle Ralph passed away peacefully and pain-free in the presence of the family he loved.
Ralph always led a vibrant life, full of joy and laughter. As a husband, father, grandfather and uncle, his lively, humorous spirit was truly loved by his entire family. As a high school biology and math teacher, he was known for the vitality he shared with his students in the lessons he taught. Even in his retirement, Ralph would eagerly volunteer to help teach science classes at the local high school.
Unfortunately, at age 92, he developed metastatic cancer and was given only six months to live. When he heard the news, Ralph quickly decided it was not worthwhile to suffer the side effects of multiple chemotherapies or undergo extensive, high-risk surgery. Instead, he chose to devote his last few months spending time with the family he cherished.
Although it was January, he enjoyed his favorite activities of indoor gardening, watercolor painting, and cooking with his family, while displaying his usual joyful energy and enthusiasm. On a weekend in February, twin granddaughters, who were now grown, came to visit and laugh with delight as he taught them how to make cinnamon bread with a perfect swirl.
Always a teacher, he would joke with them, “Now, sweets, don’t put too many raisins in the dough!”
Sadly, Ralph’s cancer relentlessly marched on, riddling his body and zapping his strength. He tried to Facetime with his beloved nieces, Claudia and Donna, but found himself getting weaker and weaker. Then, late on a Friday in early March, he started to fail. All too quickly, it was time for the hospice care facility he had chosen. It was only three months since his diagnosis of cancer was made.
On Saturday morning, my wife, Julia, and I drove up early to Milwaukee to visit with her beloved uncle and to gather with his daughter and two granddaughters, who drove from Madison, to say our final goodbyes. Due to COVID-19 restrictions, the only family members who could visit Ralph were his wife and daughter, Ellen, who drove down from Appleton the night before after hearing he only had days to live.
The rest of us were told we had to wait 24 hours for his COVID-19 test to come back before we could see him. What were we to do? We all had our vaccines, but rules were rules. Should we remain until nighttime in case there was a sudden demise? Should we risk coming back on Sunday after his COVID-19 test was available?
“Well, Dad’s room is on the first floor and there’s a window looking out onto a small garden patio,” said Ellen. “Why don’t you walk along the path behind the building and I can wave to you from his room, to let you know which window is his?” she suggested.
As we walked along a pleasant gravel path with patches of melting snow, the sky was turning a bright royal, spring blue and birds were starting to chirp in the trees. The early morning sun was just beginning to warm the lush hospice grounds. We walked past an idyllic, half-frozen, small pond with a white, Giverny-like, bridge surrounded by browned lily pads and tall dry prairie grasses.
Looking at the hospice windows as we rounded the building, we soon saw Ellen waving to us from Ralph’s window.
“Ellen, can you unlock the window and open it, so the twins can sit on the window sill and speak to Ralph?” I asked. Communication was initially difficult through a window screen, but fortunately it had latches for removal during cleaning which I could release from the outside. Now the twins and my wife were able to recollect memories of their times spent with Ralph.
Even though he was now heavily sedated to prevent him from climbing out of bed and falling on the floor, Ellen could see his attempts to open sunken eyelids and raise his bushy eyebrows while a faint smile appeared on his chapped lips as he listened to the stories from outside.
Looking around the grounds, I noticed a round gazebo just past the pond. It was full of wooden benches stored for the winter under a heavy canvas tarp. By loosening some ropes and maneuvering a stack of benches, I was able to free up one of the benches and carry it over to Ralph’s small patio in the bright morning sun.
Soon the twins were sitting on the bench, with Julia between them, sharing a collage of photos on their computer which chronicled Ralph with the twins as they were growing up. Ellen, the family photographer, had collected and digitalized the photos with care over the years.
At one point in the photo show, there was a video clip that Ellen had recorded of twin four-year-old granddaughters snuggling and giggling with Ralph as they attempted, in their high-pitched voices, to sing along with Ralph’s deep baritone voice the words to We’re Off to See the Wizard and Over the Rainbow from The Wizard of Oz.
Watching the grown twins sitting on the bench, laughing, and clapping their hands to the music was priceless. Inside Ralph’s room, Ellen said afterwards, “I could see Ralph’s eyes start to water as he tried to turn his head towards the singing while he squeezed my hand.”
Later, my wife, Julia, crouched down on her knees by the low-set window and recalled for Ralph the story of him teaching her how to place a worm on a hook to catch fish when she was a little girl. “Ralph, remember how hard we laughed when we discovered that our ‘catch of the day’ had been eaten by turtles when we left the fish hanging in the water from the bow of the boat when we stopped for lunch?”
Soon, Julia’s brother Mike arrived for the family farewell gathering with Ralph. Mike also got into action telling his favorite stories of being with Ralph. “I remember when Ralph would play catch with me for hours after school and teach me how to bat a ball from his soft, lob pitches when I was young. I also remember the times we all gathered to play cards and laugh with Ralph after a Thanksgiving meal.”
Finally, as the sun set in the west and the patio turned cooler on that March afternoon, it was heartwarming for all of us to share the love we felt for Ralph as we gathered outside on the patio while Ellen was inside holding Ralph’s hand as he took his last breath. It was truly a memorable scene.
In comparison to the suffering and shock I have seen when other families see their loved ones lying dead in a cold hospital room, we all felt so good for the warmth we had shared with Ralph during his lifetime. Ralph always let the people he loved know that he loved them. He was truly present for everyone he knew.
All of us were comforted by the peaceful, almost magical, experience we encountered on that beautiful spring morning.
Ralph’s soul is now over that rainbow he sang so joyfully about. It is up in heaven where it belongs. Ralph will always be remembered for what a wonderful life he lived.
Dr. Tim Sanborn is a Professor of Medicine at the Medical College of Wisconsin. He writes on various health issues including smoking prevention, childhood obesity, the importance of daily exercise, reducing sugar-sweetened beverage consumption, senior health and the COVID-19 virus. His short stories and poetry have been published in Pulse—voices from the heart of medicine, Touch: The Journal of Healing, Emergency Medicine, the Chicago Life Magazine, in regional editions of The New York Times and The Wall Street Journal.