A Parting Gift

I have come to believe that when you die, the world changes.

I believe that we each inhabit a space that forms a delicate balance in the universe. Birth and death disrupt this balance. Sometimes the shift is imperceptible to those who aren’t there. Occasionally, however, the aftershocks are felt at a distance by others.

My mother described it as a severe pain that developed suddenly in her hand. It was strong and swift. Minutes later the hospital called to say my father had collapsed. One of my patients told of severe chest pain that occurred just as his wife was dying from a heart attack. He didn’t know that she was dead yet. He had never felt this type of pain before and never would again.

I hear of these occurrences frequently and have come to believe they are real. It gives me hope that, alongside the medical knowledge and science we practice daily, there is an energy or force that connects us as human beings. This force is especially strong between those that love each other. And when a person dies, he sometimes sends a parting message to those who care.

But what is the nature of these “messages”? Are they unspoken utterances between parting lovers or a last goodbye to family and friends? And what if there are no family and friends? Is the message still sent? Does it fall on deaf ears?

Mr. Walters had been coming to my office for years. He was in his eighties and in poor health. The decline was a slow progression. It started when he was diagnosed with a lymphoma that grew rapidly in his pelvis. Surgery, radiation, and chemotherapy had eradicated the tumor but left him with severely obstructive kidney disease. By the time I met him, the stents placed to open his urinary system had begun to malfunction. No matter how many procedures the urologists performed, his kidneys were failing.

His physical condition was also deteriorating. He maneuvered gingerly around his apartment. There were no family or friends to take care of him. He lived a solitary life. His only connection was a distant niece he saw infrequently.

I tried to have many conversations about the end of life. As his primary care physician and only advocate, I needed to make sure that I knew his wishes. Unfortunately, he didn’t like to talk about such things. His usual response was similar to other men in his age group: “Doc, do whatever you think is best!”

Eventually I convinced him to move to a nursing home. He sustained a number of falls and was no longer able to cook or clean for himself. He was placed on dialysis when his kidneys failed.

Every few months he would get admitted to the hospital for a kidney infection. Each time I walked into the room, his face would light up and he would thank me for coming. We both knew that his time on this earth was limited.

I saw him one last time before he died. He was admitted to the hospital with low blood pressure and another urinary infection. He was on a ventilator.
I knew through our brief conversations that short term life support was okay, but he did not want to be kept alive for a prolonged period. As the days passed it became clear he was dying. I called his niece. She would come to visit him and then life support would be withdrawn.

As I drove home that day, Mr. Walters was the farthest thing from my mind. His niece was arriving soon and then he would be extubated. The ICU staff could manage everything. I had just picked up dinner for my wife and son and music was playing loudly in the car. It was a beautiful day and the windows were open. I felt invigorated.

Then all the sudden it happened.

It came over me like a thunderstorm. One minute I was happily bouncing to the music, and the next I wanted to cry. I pulled the car over, closed the windows, and wept.

I couldn’t stop thinking about Mr. Walters and how much he must have seen in his eighty years. He lived through world wars and depressions. He experienced the sadness of the holocaust and the fear of nuclear annihilation. He likely loved and lost many times. He had eighty years of constant motion and now he lay quietly in a hospital bed, gone.

As quickly as the burst of emotion came, it left. I wiped my eyes and turned on the car. Moments later, it was no surprise that my cell phone rang. It was the ICU; Mr. Walters had just passed away.

As the years go by, I often think of Mr. Walters. In his dying moments he sent a message to the world and I was lucky enough to receive it.