A few nights ago, my sons and husband and I made the annual trip to our favorite ice cream parlor to have chocolate ice cream in honor of my mother-in-law, Martha. We've done this for 2 years now on the anniversary of Martha's death, sitting around the cafe table, laughing as we tell our favorite Martha stories and share her favorite treat. Like many families who've lost loved ones, we feel her with us in big and small ways; we remember her laugh and her stories, her advice and her simple philosophy, and most of all, the constant kindness and respect she gave to everyone she met.
Understanding and honoring a patient's wishes at the end of life is a challenge most people-family members and friends, medical professionals, and volunteers-approach conscientiously, with tender care. Some patients ask that they not be resuscitated or given any treatment that will lengthen their lives. They are ready to go and, after careful thought and the counsel of doctors, clergy, and family members, they may request DNR (Do Not Resuscitate) orders (also known as AND, or Allow Natural Death, in some areas).
I was preparing to enter seminary the fall when my mother-in-law was diagnosed with a terminal illness. She had been having dizzy spells and shortness of breath for the better part of a year; after visiting one doctor after another and having a pacemaker put in, nobody had yet put a name to the illness that had been sapping her vitality and slowing her pace. But Martha was a productive, pragmatic soul; a little dizziness and shortness of breath wouldn't keep her from driving to the grocery, heading off to church, or using the weed eater along the front walk, a task she completed just before heading to the doctor for the visit that changed everything.
That day, the doctor listened to Martha's symptoms and looked over the list of visits to specialists. He called for more blood tests, and the arrangements were made. By the end of the afternoon, we had the answer: advanced leukemia. Finally, an answer, after all these months. Martha seemed more relieved to have a name to her condition than she was concerned about its outcome.
Just a few days later, Martha called the entire family to her hospital room for a family meeting. There were children and grandchildren; great-grandchildren and close friends. We visited quietly with Martha and each other while we waited for the doctor to arrive. When he stepped into the small room filled with 4 generations of anxious people, he looked a bit taken aback, but when Martha smiled and prompted him, he told us what was happening. After explaining the diagnosis and the prognosis, he looked around the room and said, "Martha has told me that she is ready to go and she doesn't want to pursue any treatment options." A surprised ripple went through the room and her granddaughter put a hand on her arm. "Are you sure about this, Gran?"
She nodded and smiled, and we knew. She explained to us all, firmly and kindly, what her wishes were and everyone-from the medical staff to her grandchildren-knew she was truly ready and at peace with her choice.
The next 2 weeks brought wonderful visits, filled with stories, laughter, and memories. Friends and relatives came from all over; Martha was continually surrounded by people who loved her and enjoyed her company. Although she was growing weaker and more tired by the day, it was amazing and healing for us all to see the love that came flowing back to her from the far reaches of her life-from the past and the present, from her community, her church, her friends, and her family.
Early on a Saturday morning, when my husband entered his mother's room, he walked into a crisis. Martha was having a severe nosebleed that couldn't be stopped; the doctor on call made the decision to give her platelets. The bleeding was soon arrested, and Martha gradually regained strength. We later wondered whether the doctor had disregarded Martha's DNR request when he called for the platelets, but truthfully none of us wanted her to go that way. Martha spent another 6 weeks with us, and had time to go home to her own house, see her weeping cherry tree, listen to the birds outside her window, and watch her grandchildren play in the backyard. She met and was cared for by 3 wonderful hospice nurses, and we all had the chance to share Martha's favorite treat-chocolate ice cream-with her at the kitchen table, the afternoon before she died.
In the midst of what feels like a powerless time, being able to honor and protect a loved one's wishes is an important part of doing whatever we can to ensure a peaceful and painless passage. DNR orders and advance directives are handled differently among hospitals and hospice organizations; and families vary greatly in their understanding and ability to make peace with their loved ones' wishes in this way. In our family, Martha's simple, no-nonsense way of telling us what she wanted made everything easier on everyone involved. The kind and direct approach of the doctor and caregivers helped us relax and enjoy our time together. And everyone's graceful acceptance of this natural step in the living process-the beautiful close of a good, loving life-gave all of us a model we can one day follow, lessening our fears of our own passing and lifting up our hope for life beyond.