(A lifelong newspaper and magazine writer, End of Life Choices California board member Fran has published fiction, nonfiction, and several books. Her focus on end-of-life issues includes many volunteer years, numerous articles and one book, Dying Unafraid. She holds a BA from Randolph-Macon Woman’s College and an MFA from the University of San Francisco, and currently writes on Medium.com, franjohns.net, and on Substack at franmorelandjohns. This article, used with permission, was originally posted here.)
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This story about one woman’s experience of both best and worst at life’s end is being told for the dual messages it brings.
Mary Ann, a longtime friend in the senior living building which is my home, recently showed us how to die. Her final weeks were filled with love and flowers, friends and family, peace.
But earlier, she had gone through another experience that was everything she did not want: a trip to the emergency room and unwanted treatment that snatched death away.
About a month before her 90th birthday, Mary Ann fainted in her apartment resulting in copious bleeding at the back of her head. This is a no-questions-asked scenario in any senior facility: head injury = call 911. Mary Ann was taken to the Emergency Room. Conscious and clear-headed, she called attention to her POLST (Physician’s Orders for Life-Sustaining Treatment) and other forms specifying that she did not want intubation, resuscitation, or anything that would cause discomfort.
By now, Mary Ann’s daughter, Louise, herself a physician, had arrived at the trauma center and was reinforcing her mother’s clear healthcare decisions. “I’ve had a good, long life,” Mary Ann repeated, a phrase many of her friends had heard, “and I’m not afraid to die.” What she wanted to avoid was prolonged suffering. Given how quickly Mary Ann had changed from better-than-fine to near death, the trauma team, Mary Ann, and Louise all agreed to a single, brief trial of a potentially life-saving medication, for which Mary Ann was transferred to the coronary care unit (CCU.) It worked, and the next day, still in the CCU, Mary Ann sailed through several heart tests. Louise headed home for a few hours of much needed sleep.
What happened a few hours later would leave Mary Ann alive and exhausted, Louise furious, and hospital staff caught with their patient in the middle.
Mary Ann choked on a pill and went into rapid atrial fibrillation; the on-call team sprang into action. Responding to the present emergency, the hospital team began aggressive treatment. It was only when a transfusion was being prepared that daughter Louise was awakened with another phone call – she had to authorize the transfusion. Though she rushed back to the hospital, she was refused admittance to the CCU until three hours of aggressive treatment had brought Mary Ann back to life.
There were logical explanations for all this: The patient’s very clear and explicit wishes had not made it into her records or been transferred from the trauma room to the CCU. That team did what it was so carefully trained to do – and listening to the pleas of a daughter, even a physician daughter, was not anything the on-call resident had time for.
Although the senior members of Mary Ann’s cardiology team came into the hospital in the middle of the night, they couldn’t hear that just because something was possible – keeping Mary Ann alive – didn’t mean it was desirable or right. Everything Mary Ann had not wanted was, in fact, done by the physicians who “saved her life.”
I remember visiting Mary Ann on her 90th birthday, not long after the above episode, at a rehab center where she spent the next several months. She appreciated the cake and balloons (perhaps; perhaps not), but she was in no way happy to be around. Rather than the quick death she had anticipated and prepared for, she had gotten a “new life” and several miserable months.
When she returned home, things were slightly happier. Friends were delighted to have her back. She was able to go on short walks – long walks had always been highlights of her days – and to take up a few social activities she had long enjoyed. But she found it hard to put the anger aside.
“You know how carefully we plan for a quick and peaceful end,” she told me during one of many conversations. “Why can’t we have it?” I hope and believe there were some good days and good times, but she was angry every day about the people who “saved her life” against her wishes.
Not long ago, Mary Ann suffered an intestinal blockage and had to be taken once more to the hospital. The doctors said surgery was the only solution. It would be serious and involve a long recovery, but the prognosis was good. “No, thank you,” she said. “I would like to go home to die.”
Which was exactly what she did. Hospice care was put in place. A hospital bed was positioned by the window where she could look out at the mountains beyond the city. She was surrounded by family and kept comfortable. Friends were welcomed. We would talk about what our friendships had meant, how we loved each other. She slept more and more – eventually slipping into the deep sleep of death.
For Mary Ann, it was the death she wanted. For her friends and everyone else, it was a rare and valuable gift: a model of how to die.
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Final Exit Network (FEN) is a network of dedicated professionals and caring, trained volunteers who support mentally competent adults as they navigate their end-of-life journey. Established in 2004, FEN seeks to educate qualified individuals in practical, peaceful ways to end their lives, offer a compassionate bedside presence and defend a person’s right to choose. For more information, go to www.finalexitnetwork.org.
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Reading this wonderful article made me think of a phrase I would use for “saving a life,“ and that would be “postponing a death.“ It’s the phrase I will use with my physicians when I tell them what I want and what I don’t want.
So agree. Thank you and the author.