Discussing end of the life care with a pilot

An excerpt from Between Life and Death.

Harry’s request to exclude Susan, from this conversation about cancer diagnosis and options of treatment was quite unusual, especially given how close I knew the couple to be. However, since Susan’s gaze remained on the carpet, I had no choice but to respect Harry’s request. As I led the way to my office,

I couldn’t help wondering, “Why exclude Susan?” Susan and Harry were partners, and both had a role to play in the difficult journey ahead.

Inside my office, I gestured towards the guest chair and turned to my seat behind the desk. Outside, the sun topped, the trees, and filtered on to the concrete patio.

Harry seemed to notice the weather and paused to admire the cloudless sky. Did he understand that his time of gliding in the skies was drawing to a close?

He exhaled and settled into the chair. “After evaluating where I stand and how I’ve lived all these years, I feel it would be best for me to start packing my bags for the ultimate and infinite journey.”

He pointed towards the window.

“I’ve been on many flights high up in the sky, quite close to my eventual destination. I have flown and chased hawks, and have even dared to be among the soaring eagles. God blessed me with a life that I have no regrets over, and I don’t want my life ending in any other way than that.”

I was floored. “I agree with your philosophy, but God also gave us treatments for disease. Maybe …”

“Yes, but I think God wants me to look at this milestone of cancer and realize it’s time to seek and explore a different world. I don’t want to defy or interfere with His plan for me. I welcome my destination. It’s time for me to check-in for my final flight, and I’ll gladly await His boarding call. That’s why I don’t want treatment.”

I moistened my lips. “But treatment could buy more time.”

“Treatment with known side effects.”

“We have good drugs to help minimize the side effects.”


“Different people respond differently. There’s no guarantee, but …”

“Let’s face it, doc. From everything you’ve told me, treating my cancer is like trying to save an exploding plane in mid-air. Chances are it’s not going to happen.”

Although I felt like the world had tipped a little, Harry was in perfect control of his emotions. Like a solo pilot experiencing minor turbulence on a plane, he had recovered his composure from our previous meeting.

His voice didn’t waver, and his steady gaze never left my eyes except to periodically glance outside at his world—the cloudless sky.

“I need to prepare Susan and my lovely daughters for this. I’ve always enjoyed flying high. And I’ve been in control all my life. I’d like to go out that way too.”

“That’s understandable,” I said.

He went on, explaining his thoughts. “I think of it like I’ve just received an upgrade on a long flight. I’ve collected so many miles that God has granted me a charter flight to a destination unknown. Now the only issue is the waiting time.”

I hesitated, unsure where Harry was going with the conversation.

“I need to know one thing,” he said.


“Will you help me in making this transition into my new life easier for my family, so memories of my last days aren’t painful for them but something they can cherish?”

I released the breath I hadn’t realized I was holding.

Harry’s request was one I could grant. “Of course. We can consult home hospice. They can give you and Susan the logistical support you’ll need.”

“Not just that. I knew you would be able to help me with hospice. I need more than that.” Harry sounded like he was in complete control. He was the one guiding this conversation.

Fitting, considering he had always been the pilot.

“I’ll do my best not to disappoint you with whatever I can help you with.”

“Help me. I’ve never seen death before. Tell me what you know about it, what you’ve seen. What was it like to witness your patients leaving this world? Tell me how you coped with it. Aren’t you afraid of death yourself?”

Conversation continues.

Harry’s last email he posted before he passed away. Destination unknown.

Hi, friends!

This email is different from my usual. No smiley faces or funny cartoons, for I have moved to another location.

I have often thought that life is rather like a queue at the departure level of a very huge airport. We all have our place in our individual queue, and from the moment we are born, we slowly but surely move towards the head of the line. There we take our turn to get checked out and receive a boarding pass to our next place.

My place in the long line of life has suddenly been jumped up to the head of the queue, and now I have a boarding pass. I want you to know that I am looking forward to adventures beyond this world. And I certainly don’t want to join the many folks towards the head of the other queues, who are in beds, their frail bodies pierced with tubes, or limbs missing, or staring into nowhere with unseeing eyes—all of them waiting patiently for God.

I, on the other hand, have had an exciting and enjoyable life to the end. I have married three times (to my shame), and fathered six wonderful children. Now that I am approaching seventy-eight years of age, it’s time to move on. I just want to let my friends, whether close or far, dear friends or acquaintances, know that I have enjoyed passing on the smiles, which I know most of you have appreciated, and send to all of you my very best wishes for the future.

Live each day to the fullest.


Kashyap Patel is a hematology-oncology physician and the author of Between Life and Death.

Image credit: Shutterstock.com

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