Some people choose the time of their death

“Did you sell the business yet?”

I marvel at my patient Jack: despite his breathlessness, he’s somehow managed to greet his wife Sara with a complete sentence. Given his condition, it’s truly amazing.

Most of his lung function has been devastated by his forty-year, pack-a-day smoking habit; the rest has been demolished by cancer. The easy, automatic breathing he once took for granted is just a memory. He can’t even lie down without feeling like he’s suffocating. Propped up on pillows in his hospital bed, he struggles for every breath–pulling it in, forcing it out–his brow creased in a perpetual frown of concentration.

Sara and Jack have been married for thirty-five years, since before he took over his father’s small shoe concession and turned it into a thriving business.

For the past five years, Sara has been watching Jack deteriorate — first slowly, then more rapidly. He was admitted to the hospital’s critical-care unit a week ago Tuesday. Now it’s Thursday, and Sara and I both know that his decline is accelerating.

I think back to yesterday’s conversation.

“How much longer can he go on like this?” Sara asked.

Feeling that it would be pointless to shield her, I shook my head. “Truthfully? I don’t know how he even made it past Sunday.”

She sighed deeply. “He’s so stubborn. He’s hanging on for all he’s worth … I wish I could do something to help him.”

“We all do,” I replied. “Maybe you could talk him into a morphine drip?” We’ve discussed this every day for the past week.

She shook her head. “God knows I’ve tried. No matter how often I tell him it will relieve the pressure and let him sleep, or even just lie down comfortably, he refuses. I’m at my wit’s end. Even when I leave the hospital, in bed alone at night, I can still hear him trying to breathe.”

I can easily believe this — she looks like she’s not getting any more sleep than Jack is.

Meanwhile, every day Jack has greeted Sara with the same question: “Did you sell the business yet?”

And every day, Sara has given the same answer: “No, not yet.”

Time after time, the prospective buyer has wanted another change in the sales contract. First he wanted a noncompetition clause — as if Jack’s doctor son or lawyer daughter were the least bit interested in running small-town shoe stores. Then he wanted a smaller down payment … guarantees for the leases in the shopping centers … assurances from all the suppliers.

But today, although Jack’s question is the same, Sara’s answer is different.

She nods and smiles. “Yes, we signed the sales agreement this morning. The business is sold.”

She holds up a bottle of Jack’s favorite Italian bubbly wine. “To celebrate.”

Jack pulls in as much air as he can. His face relaxes.

“Asti,” he whispers. “Good.”

It takes a few minutes to find a bottle opener. We end up borrowing one from the obstetrics department — they generally have more to celebrate than we do in critical care.

Jack takes a small sip, savoring it. Then he closes his eyes and settles back against the pillows.

His breath becomes shallower, then slower.

Sara looks at me, tears collecting in the hollows under her eyes. “Could you call Joe and Ann, please?”

I go out to the desk and call the children. With the six grandchildren, they join Sara at Jack’s bedside; they’re all together when he takes his last breath.

Sara and I leave the hospital together, walk down to the parking lot and stand together next to her car.

“It looks like you settled the sale just in time,” I say.

She nods, studying the ground. “Jack built that business almost from the ground up. His father had the shoe concession in Corcoran’s General Store; it was mostly work boots. Jack added more types of shoes, opened his own store, named it after his mother and turned it into a chain of stores up and down the whole valley.” She looks up at me. “Alma’s Shoes will never be the same warm place it was, not after it gets a new owner.”

As I look into her calm blue eyes, I suddenly understand: the store still hasn’t been sold.

Sara sees my dawning comprehension.

“Last night, when I couldn’t sleep, I started thinking about Jack and what he loved,” she says. “Then I realized why he was fighting so hard to stay alive — he had one last task to finish. We’ll get everything settled and sell the business in a few weeks. But Jack won’t have to worry about it.”

She smiles sadly. “My last gift to him.”

Looking at her, I recall a profound and astonishing truth: some people choose the time of their death. I think of patients like Mary, who was so short of breath that she couldn’t walk, yet kept herself alive long enough to dance (in her wheelchair) at her youngest daughter’s wedding. Or Joe, scheduled for surgery and terrified of dying under the knife; he passed away the night before his procedure. Or the multitude of patients whose lab results show oxygen or electrolyte levels seemingly incompatible with life, but who are nonetheless alive, walking and talking.

I marvel at the intuitive wisdom that has taught Sara what it’s taken me so many years to learn: that there’s something within us — call it will, call it the soul — that has the power to fan the life force or extinguish it.

And that sometimes the heart needs permission to let go.

Judith Reishtein is a nurse. This piece was originally published in Pulse — voices from the heart of medicine, and is reprinted with permission. 

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