Ira Byock, M.D., a nationally recognized authority in end-of-life care, says there are only four things left to say that matter most at life’s end (indeed, while living as well):
Please forgive me.
I forgive you.
I love you.
These words have the power to transform relationships, whether to heal connections at the end of life, or during day-to-day living.
As you know from several of my earlier posts (Dancing with Chopin, You are My Sunshine), my past work in Hospice was a profoundly moving part of my life journey, a vocation to which I hope to return.
I was called to a nursing home to be with with Mary and her family as she entered the final stage of life known as “active dying.” It was only a matter of a few days. Cancer had ravaged her middle-aged body to the point that she looked much older than her years. Mary was kept sedated most of the time because of the constant pain, only occasionally coming out of it to become partially aware of her surroundings.
Mary was a widow with two children, both in their mid-thirties – a daughter who lived in North Carolina and a son who lived at home to care for his surviving parent. Mother and daughter had a falling out some years ago, and their relationship was strained at best. Mother and son were close, and Tom was always at his mother’s bedside. The most time away was perhaps 5 minutes for a bathroom and coffee break. Without a family of his own, Tom was devoted to his mother. The staff told me that for the past 6 weeks, he had never missed an 18 hour day at his mother’s bedside; they often had to force him to go home for some rest.
As hours stretched into days, Mary’s coma deepened and her body temperature rose, her moments of lucidity few and far between. The attending physician noted that Mary’s core temperature was 108 degrees; he had never seen a person live with a temperature that high. For days, I watched Tom talk to his mother, telling her how much he loved her and how he knew she could beat this cancer. Mary’s doctors had explained to Tom that her organs were shutting down – her death was imminent; his head understood the facts, but his heart could not – would not – accept them. She was suffering and I found myself wondering why she was hanging on to life when she was in so much pain.
I gestured for Tom to join me in the hall.
“You need to tell your mother that it is alright for her to go,” I counseled gently. “That you’ll be okay here without her…”
He pulled back, shocked and a little angry. I was asking him to give his mother permission to die; the person he loved more than anyone in the world, the person he needed more than anyone in the world. It went against every feeling of normalcy, safety and love that coursed through him. He couldn’t find words.
“Your mother is suffering. I know you want her to be with you forever, but her body just can’t do it anymore. She needs to hear that you’ll be okay after she’s gone.” I paused. “Does your sister know just how sick your mother is?”
Tom explained that he had called her 2 weeks ago, but heard nothing since. She wasn’t even planning to come to see their mother one last time.
So that was the reason Mary struggled to stay; she needed to hear from her children – both of them – that they would be okay. Only then could she drift away, finally at peace.
“Tom – please give me your sister’s phone number. It’s essential that your mother hear her daughter’s voice. Would you like me to call her?”
He nodded his head, eyes filled with tears, then turned to go back into his mother’s room. Changing his mind, he instead went through the door marked “exit” and ran out of the building.
While I stood looking at the door, hoping to see Tom, one of Mary’s nurses came by. I told her what happened. She was as surprised as I; Tom was never absent from his mother’s side, let alone in her last few hours. She left to get the daughter’s phone number.
Anna, Mary’s daughter in North Carolina, answered on the second ring. I introduced myself, told her I was at the nursing home with Mary and advised her of the doctor’s prognosis. If Anna wanted to say good-bye, it had to be now. Her answer was crying on the other end of the line, and in her tears, I could hear regret, shock, fear. And love…I could hear love.
I explained that Anna didn’t have time to get here from North Carolina, but that I would hold the phone to Mary’s ear so that her mother could hear her voice. Even in a coma, hearing is the last sense to leave, so I felt certain that whatever Anna wanted to say to her mother, it would be heard and accepted. I told her Mary was suffering and needed Anna’s permission to die.
As I held the phone to Mary’s ear, I could hear Anna’s voice cloaked in tears. As Anna continued, Mary’s eyes remained closed, but her body visibly relaxed. At one point, I saw her lips turn up the tiniest bit, and I knew Anna had been understood. After a few minutes, I softly told Mary that I was taking away the phone. Then I spoke to Anna and described what I had seen, telling her that she had given her mother a wonderful gift and blessing. I thanked her and promised that Tom would call her in a while.
Out in the hallway, there was no sign of Tom. I went to the nurse’s station for his phone number. No answer, so I left a voice mail. Fifteen minutes later, another voice mail, asking that he please return to the nursing home. I went to sit with Mary and noticed that her right hand kept grasping the sheet into a tight knot. As I held her other hand, I explained that Tom had to leave but that he would be back.
Please, I prayed silently, please bring Tom back. In my heart, I begged Tom to return because this time, his mother needed him.
After a half hour passed, I looked up to see Tom in the doorway. He looked exhausted but determined as he entered the room. He leaned over Mary and whispered in her ear, tears streaming down his face as he clutched her hands to his heart. Her agitation disappeared as he continued, his words known only to mother and son. Finally, totally spent, Tom laid his head on their joined hands and closed his eyes.
I leaned against the wall in a shadowed corner of the room, listening to Mary’s breathing grow more labored. The intervals between breaths grew longer, until after one long exhalation, the room stilled, the only sound Tom’s choking sobs. It was over.
As the physician pronounced Mary’s time of death, I reached out to touch Tom’s shoulder in communion with his grief.
An ending and a beginning. Sacred Ground. Holy Words.
Please forgive me.
I forgive you.
I love you.
I offer these words up to my friends and relatives; indeed, to humankind.
But most especially to Mom and Dad, to whom I should have said all of these things while they were alive.
Please do the same, today.
Honor the Circles of Grace all around us.