Marie was a tough matriarch of a family with five children and had lived through the Depression and WWII rationing without complaint. She had buried two babies and one husband and went on keeping her farm and mostly fending for herself.
Here she was admitted to the hospital with advanced COPD and as part of the workup her doctor has told her that she has metastatic lung cancer. She took the news with a stony silence and the oncologist left thinking he couldn’t get through to her. Her children, now in their 60s were upset and worried but determined to honor her wishes, whatever that might be.
I had visited Marie and her sons and daughters several times and it was clear that they wanted to bring her home with hospice support, but Marie seemed withdrawn and they couldn’t get her to say what she wanted.
I stopped by her room mid-afternoon and Marie was alone. “Sit!” she said, indicating a chair next to the bed. She was watching Gunsmoke on TV, and she took my hand without looking away from the TV. We sat in silence for 15 minutes or so, and then I heard a whisper:
“What are you most afraid of?”
“Pain and suffering.”
“We will do everything we can to keep you as pain-free as possible; you have to tell us when you hurt.”
“I know I’m dying.”
“Are you afraid to die?”
“No, I’m afraid of what comes before I die.”
“Are you worried the kids won’t be able to take care of you?”
I then told her about hospice services, particularly that they are experts in managing pain and other types of suffering. I explained that they will bring in expert help to support her kids in her care, be available by phone 24/7, and be there for them when they need it.
“OK. Sounds good.”
When her daughter returned from her lunch, we were again sitting in silence watching Gunsmoke, but Marie was smiling.