“Marge died last night, Aunt Dean,” I said when I went in to wake her up. “It was very peaceful, in her sleep. We thought you’d like to know.”
“Lucky girl.” Her wasted hands slid back and forth on the comforter’s edge and she sighed from her pillow. “I thought last night it might be me. But here I still am.”
Doreen is my grandfather’s sister. Half the family calls her Aunt Dor, and the rest call her Aunt Dean. No-one knows why. It doesn’t matter. As I write this, I realize that today or tomorrow might be the last time I ever refer to Aunt Dean in the present tense.
A few weeks ago, while she napped in her green recliner, I read a small lavender booklet which had been tucked into her medical folder next to the caregivers’ diary. It had a butterfly on the front and it was called “Strength for the Journey”.
“It is our hope that this booklet will provide you with all the strength you may need for the journey,” the first page said.
As if all the strength you need to watch a loved die could be found in a small purple book, tucked in among the blood-count and blood-pressure results.
But in caring for Aunt Dean, I’ve learned some things about death. No, not death. What I mean is, I’ve learned some things about dying. And to be fair, the butterfly booklet did help me to understand.
It refers to something that is a new idea to me: the “process of dying”.
At 92 years old, Aunt Dean, comfortable in bed and surrounded by caregivers and family, is about to slip into what seems like death’s best case scenario. Now that I stop to think about it, it’s strange that a very old person’s final decline – the most natural kind of death you could possibly have – has made me completely rethink my concept of death.
I had never seen death as anything but an unexpected tragedy: cancer, car crashes, suicide, heart attacks. All of these have recently happened to people in my community. Death is sudden, shocking, and difficult to bear. I had never realized it before, but my innate concept of death has almost nothing to do with death in its most natural form. I have had to get reacquainted with death not as a dreadful event, but as a natural process. Caring for a hospice patient demands a radical perspective shift – not just the reality of letting go of someone you love, but welcoming death in the place of convalescence.
All my life, I’ve had a recurring nightmare that I’m watching someone in a life-threatening emergency, and I keep misdialing when I try to call 911. The importance of calling 911 when someone is in trouble is one of the first things drummed into us as kids. What will it feel like to override that, if Aunt Dean dies on my watch? The idea of sitting silently by while someone breathes her last is almost as strange to me as imagining life without that person.
“When you realize that your loved one has died, it is not necessary to call someone immediately,” the butterfly booklet explains gently. This still and quiet death is not a call-for-help crisis. Will that make it any easier to handle?
It’s difficult for me to handle this in relation to Aunt Dean, partly because my Aunt Dean is one of the most capable people I know. Even now, it seems a little ridiculous that a person like her has to die. As her short-term memory faded to almost nil, her essential practicality struggled to keep her in the game.
“No notes,” my aunt Jody, Doreen’s niece, said to me at the beginning of my first afternoon as a caretaker.
“No notes?” I asked.
“She always wants to write notes to herself, because she thinks she has to remember things,” Jody explained. “But then what happens is, she sees the note but forgets why it was written, and ends up calling me anyway to ask me what it’s about. It’s just better not to have any notes, because then she doesn’t get worried or confused about them later.”
It was a pretty good rule. Aunt Dean, reading the community newsletter, would contentedly write down on one of her myriad slips of paper – her side-table is a clerical storehouse – that the local orchestra was performing at three o’clock on Sunday. Ten minutes later, she would grasp the note in consternation.
“What day is it?” she’d ask. “Is it Sunday? Did I miss the orchestra?”
With caregivers constantly present who would remember the orchestra, Jody was right: the notes weren’t helping anyone. But I still didn’t have it in me to stop her from writing them – with her independence slipping by the day, I couldn’t squelch this perfectly sensible coping mechanism for the memory which she knew was failing. I would give her pencil and paper to write the notes, and then quietly remove them as soon as she was distracted.
Keeping track of the small things is an indelible part of who she is. Aunt Dean is a dedicated career woman. Born in 1919, she never married or had children, but took a bookkeeping job at the bank right out of high school. She retired as the bank manager, and busied herself with many volunteer pursuits as well as her passion for bird-watching. She also made it her life’s goal never to throw anything away that could possibly be of future use. Right now, she has wax paper in the kitchen from 1964, and when I opened her bedroom drawer, hunting for something else, I counted at least fifteen identical plastic combs, neatly confined with a crumbling rubber band. And even when her memory seemed to have completely deserted her, she could still tell me exactly where most things were in the apartment: which room, cabinet and shelf.
She and her sister Joyce (who also never married) kept a house which was always open to the rest of the family, especially the children. With three married brothers (including my mom’s dad), one married sister, and all the routine crises of a large extended family, Aunt Dean and Aunt Joyce were lifelong fixtures in their nieces and nephews’ lives, as practical as they were joyous. Once she moved into the retirement village, Aunt Dean’s door was notable for never being closed.
“Pull harder, Joyce!” Aunt Dean called good-naturedly from her bed last week, after telling me about a dream she had the night before in which her father walked, smiling, into her room. Joyce died of cancer about fifteen years ago. We’ve been telling Doreen that they’re about to be reunited, and she squeezes our hands, though her eyes stay closed.
“When she goes, I’ll be happy for her, but sad for me,” says Geoffrey, my Grampa, who is Doreen’s only surviving brother. He lives in a different wing of the building, and comes to see her daily. My grandmother died over five years ago, but he has never seemed really lonely til now. Grampa was born with a twin who didn’t survive, and he and Doreen were always especially close. I’ve seen many pictures of them from their younger days, but somehow the strongest image I have of the two of them is one I never saw but heard about over the years: Doreen taking him to the train station to join the service in WWII. Someone in the family once claimed that Doreen named the happiest moment of her life as the time she sat down to breakfast with all three of her brothers, safely home from the war.
Grampa and I played umpteen hours of cards with Aunt Dean over the last several months. About two weeks ago, it was her sudden disinterest in joining us for a game that convinced me more than anything else that she really was dying.
“What’s going to happen in the future?” she asked me and my cousin, her niece Gwen, one night last week.
Gwen gently explained that pretty soon, she was going to leave this world, and that her mother, father, brothers and sisters were waiting for her.
When she asked me the same question an hour later, I told her that Tasha, the friendly night nurse, would be arriving shortly. Practical woman that my aunt is, I figured both answers would be of interest.
Over the last few months, Aunt Dean would stop every once in awhile and, with shrewd impatience, ask, “Do you suppose it’s going to go on like this forever? Or am I going to get better?”
Because she’s a person whom others have relied on their whole lives, a self-sufficient woman born in 1919 whose bookshelves are full of do-it-yourself building and plumbing tips, I wanted to be honest.
“Aunt Dean, we just have to take things a day at a time,” I would say instead.
“Well, here you are,” Doreen said one day to an occasional caretaker who bustled in to replace me for awhile. “I didn’t know that I was still going to be here, though.”
“Now, now, none of that!” the other woman scolded affectionately.
But I reply differently. Aunt Dean has strong religious faith, so I simply tell her that the Lord is going to decide when she goes, that it’s ok to talk about it, and I’ll be here to take care of her til then.
“Did you know that Marge died?” Aunt Dean’s friend Ruth asked Tasha, when she appeared for her evening shift.
“Yes, I did – she died on my shift,” Tasha said with matter-of-fact warmth, settling in for the night. I wanted to ask Tasha what to expect, but kept quiet in front of the old ladies.
When I cleaned Doreen’s little kitchen that weekend, I noticed a strange shortage of dishes. They were all stacked in the fridge, Saran-wrapped with tiny, barely-eaten dinners. My mind immediately went to the purple booklet, with its so-called “normal signs of dying”: loss of appetite, increased sleeping, changes in body temperature – as if dying were routine as pregnancy or a cold.
As Aunt Dean has deteriorated, the butterfly booklet, with its earnest platitudes about “the Journey”, has not supplied us with all the strength we needed. Doreen grew anxious and disoriented, trying to rise from the bed though she was too weak to sit up unaided, and thrashing until bruises bloomed on her legs. A hospice nurse visited and increased her anti-anxiety medication, leaving Doreen to sleep peacefully most of the time.
Last weekend, her eyes popped open at about seven o’clock in the evening, and she uttered her first clear words of the day.
“I have got to get out of this bed,” she announced, as if she was mortified to have been caught oversleeping.
I soothed her as well as I could, explaining that she didn’t need to get up.
“I still think it’s so unfair that people have to leave this world most of the time under great distress or pain. I just can’t figure out why this is necessary,” my mom said in an e-mail to me this week. “What do you think?”
I don’t know what I think – I’ve just learned that sometimes it’s ok to accept that death is coming, and pray that it will be easy.
Perhaps all this sounds a bit banal to people who have lived a bit more than I have. I’m only 28. While I’ve cared for sick or elderly people before, I’ve never sat by a bedside and watched a hitch in breathing grow into a long and quiet pause, and wondered if the chest will rise again.
While there have been bumps along the way – like the conviction that every new pair of socks would bankrupt her – for the most part, Aunt Dean has faced the final stages of her life with grace. Since she is such an independent person, I had feared that she would prove difficult to care for. It’s understandable that some elderly people fight the trappings of aging at every step: the loss of a driver’s license, the installation of grip bars on the bathroom wall, and the use of a walker become minor battles. I worried that Doreen wouldn’t like to rely on others for help.
But she gained an almost childlike quality as she became weaker – I was touched every time she happily donned her bib before eating. You might argue that with her mental state deteriorating, she couldn’t have questioned the changes in her life, or perceived the potential embarrassment. But I prefer to believe that her nature was merely manifesting in a new way: the remaining essence of her lifelong practicality was to genially accept the help that she needed.
My aunt wakes up less and less, and her hands grow chilly. I’m trying to remember that these are nothing to worry about – just signs of dying, that’s all. The impending moment of her passing is a question mark for me – will I cry or sigh with gladness and relief? Probably both. I’m sure it’s all part of the proper process, and that is something Aunt Dean could appreciate.
Update: Aunt Dean died peacefully about five hours after I posted this. Even after all the preparation, there’s a hole in the world. I’m going to go see my grandfather.