a good death

Shortly after Sandy died, I described her last days and hours to Sandy's therapist. I was still rattled and a little traumatized by the actual death process: dehydration, milky eyes, the agitation and adrenaline surge that stirred up all my hope again for an hour or so, that horrible barking sound that has been so aptly called a "death rattle," and the seizures we witnessed shortly before her heart stopped. I said the nurses had described it as a peaceful death, but it sure didn't seem peaceful to me. The therapist said that actually, it sounded like Sandy had had a "good death."

Sandy's therapist specializes in working with oncology patients. She knows the details of many death experiences. She knows that death isn't like the scene in a romantic movie, where the dying person kisses loved ones, confesses whatever burden has troubled him, receives forgiveness (or vice versa), and then appears to fall asleep. But going into this whole thing, that's all I'd seen. But real death? Not so much.

I witnessed Sandy's entire dying process, from the onset of the neck pain in April through her heart stopping at about 1:20 a.m. on July 19. But I still have trouble comprehending it. Times we thought the various drug combinations were knocking her out could well have been the strange sleep cycles that come in the last weeks before death, as we didn't know we were so close to the end, especially when she was still at the hospital. Hallucinations might have been from brain swelling, narcotics, tumors, or, again, the end stages of life. I can't make sense of it all. I know that we had conversations, even two nights before she died, in which she was fully present, and fully capable of expressing herself. But I also know that she lost a little bit with each crisis, from the personality changes that came with constant pain and nausea to the inability to read without pain. (And for Sandy, not being able to read was the cruelest torture.)

I'm reading How We Die, by Sherwin B. Nuland, to gain a greater understanding of how these bodies of ours work and what actually happens when they shut down. I've only just begun it, but I've read references to it in several books on grief. I'm sure there are parts that are difficult to stomach, but I figure I've already witnessed the outward expressions of the shutdown, and understanding what caused those symptoms can only help me integrate the whole experience. I'll write more here about the book as I read it, I'm sure.

Just reading the introduction, though, gave me comfort. Nuland says that, essentially, there is no such thing as death with dignity. (Note that the book was written in 1993, before even Oregon had passed their death with dignity laws and allowed terminally ill patients the choice of euthanasia.) As I read his very general descriptions of death, I realized that Sandy really did have a good death.

Though her pain had been almost impossible to manage earlier, she had no apparent pain her last several days and only occasionally expressed any issues with breathing. She'd begun summoning people to her early in her first hospital stay in June, and had continued to say goodbye to many who were important to her until shortly before her death. She had a chance to mend some fences, say some hard things, seek forgiveness and offer it.

She offered a model for dying with grace and dignity. Many of us have spoken of her as a community-builder, and she continued to do that even in her final days. It helps that she has always drawn quality people into her circle, so blending them was a blessing to everyone involved.

I long for things to be different, for us to have found a cure, for the cancer not to have spread to her central nervous system. But if she had to die, I'm grateful that her death was, in fact, a good one. And that, difficult as it was, I was able to be there with her through it all. She had me; she had her Laura; she had her family; and she had many dear friends. She died knowing that she was loved.