Seven weeks before he died, my father gathered my mother and us four children for a conversation at his home.
His battle with multiple myeloma was clearly being lost. Compression fractures in his spine had shrunk his 6-foot-1 frame to 5-foot-8. He had lost 40 pounds and the use of one eye. He was diagnosed with dementia and was in constant pain.
Still, the former attorney was sharp as a whip as he held court in his living room. He wasn't ready to die. He didn't want to die. But he knew he was dying – and since he was dying, he wanted to do it on his terms.
I am an obstetrician, devoted to bringing people into this world. Oh, the magic and beauty of birth. Until my father's journey through hospice, I hadn't realized that death can be sacred and spectacular too.
Not everyone has a say in his or her final days, of course. Accidents, murder, heart attacks – these can all claim a person's life in an instant. But many, like my father, die after a long battle with disease. We see ourselves deteriorate and have the time to ask: Do we spend our final weeks in and out of doctors' offices, or do we savor the time we have left?
At our meeting, I printed out some information about hospice care. I got the idea from a patient of mine, a clinical care social worker. She regularly sees families in the ER who have never talked about their wishes and are left bewildered and anxious at the end.
“Hospice,” she told me, “should become a household word.”
So I introduced it to my household, and at first everyone seemed incredibly interested in their shoes. Eventually we began talking: One sibling wondered if we were being fatalistic. Another asked if the pain medication would hasten dad's death rather than support him through it.
In the course of two hours, we asked dad, point by point, about his preferences regarding everything from feeding tubes to resuscitation. Everyone had a chance to hear what he wanted, get clarification and ask questions.
Then we had lunch.
A few of us laughed: “We just had this intense two-hour conversation, and now we're pretending that everything is normal.”
“We're not pretending,” he said. “It is normal.”
Dad was right about that — as he has been about so many things. Planning is normal. All day, I talk to expectant mothers about their plans for the start of life. For my father and for our family, it was meaningful to plan for the end too.
During the next 21 days, as my father became less communicative, we used his plan as our road map, referring to it to determine how to care for him. His hospice caretaker fed him pureed food served on china plates. On nice days, the caretaker would lift him into the car and take him to the harbor. No doctors' offices, no tests.
There were happy times and humor, intense sadness and loneliness. There was exhaustion and fear and a few false alarms. I couldn't help notice how much like a very long labor dad's final days seemed to be.
On his last night, we had a “party” with several of us sitting around him on his bed. At one point, I picked up a sponge we used to keep dad's mouth moist and dipped it into mom's gin and tonic. Reflexively, he began sucking on it the way a baby would.
We said we were toasting dad and began laughing, talking in that shorthand way families do. Later, I looked over at my dad and saw him take a breath that would be his last. It was 8 p.m. on Oct. 20.
We generally have as little say about when we leave this world as when we enter it, but I get some solace knowing that the last sounds dad heard were of his family gathered around him in laughter, honoring his last wishes and seeing him off as he let go. Just as he planned.
DR. ALLYSON BROOKS is the executive medical director of the Women's Health Institute at Hoag Hospital. She lives in Newport Beach.
