Perspectives on the End Stages of Life

In a way, many of us are searching for the same thing: Who are we, where do we come from and what happens when our life ends? These are questions that become more pronounced as we age, and even more important as we reach the end of our lives. The answers to these questions are somewhat rhetorical, as the true answer to these questions cannot really be ascertained. In the past few years, I have had the opportunity to meet and follow patients during the end stages of their life. The power of the emotional bond created with patients during these moments cannot adequately be captured by words. My patient interactions have been some of the most intimate emotional experiences I’ve had. Interactions with two special patients have shown me that while answers to these questions are certainly important, they pale in comparison the life-lessons learned throughout our lifespan that are not realized by many until nearing the end of life. My time spent with these two patients during their end stages of life was truly a privilege, and an opportunity to be cherished. I was given a chance to be a part of such a sacred process – transcendence of the human form.

The first individual was a pleasant woman in her 80s with a terminal disease. During visits with her I mainly listened to her reflections on life. I remember feeling like I was watching episodes of a TV series. She walked me through her life from her childhood, her career as an actress, to her retirement. She spoke at length about the different cameo roles she had during her acting career, her children and grandchildren, and many different places she had visited around the world. She seemed happiest when she spoke about acting, and how she prepared for the different roles. The time I spent with her felt like a family reunion in her home rather than actually being in a hospital. I often had to remind myself that this was a terminal patient. A few visits before this woman died, she told me that she was “not ready to die”. I struggled to find an appropriate response. She broke down into tears, saying she had “too much to live for” and questioned what life would be like when she was no longer present. Then, she asked me about what I thought happened after death. At first I did not know how to respond to the question, but it seemed unavoidable that the conversation would be directed toward spirituality. I did my best to share my thoughts about the matter, although I myself wonder the same thing. I was not present when she died, but I am thankful for knowing her during these tender moments of her life.

The second patient that I spent time with was a man of Asian descent in his 70s with a terminal diagnosis. I did not know him as long as I knew the first patient, but I can say that his life story was certainly different from hers. While he did not talk very much, it seemed like his views about death were different from the first patient based upon his general demeanor and approach to knowing that he was going to die. During the time I spent with him, he told me about his journey of coming to the United States alone as a teenager at 17. He explained that his dream was to financially support his parents who were farmers in another country. He was confident and decisive in his thinking, a pure realist. He sat alone in the hospital room, unshaven, and seemingly in a meditative state. His demeanor never seemed to change much. He would sit in his hospital bed, seemingly staring into another dimension. From him, I felt a peaceful aura, and it was especially transferrable, as if we communicated without actually saying any words. When I asked him if he had any family/friends he would like for me to contact, he told me that “there’s nobody left”. When I asked him what he meant, he explained that his children were estranged, and that he was divorced from his wife. He said he knew he was dying, and he was okay with it. He planned to stop taking his medication. He knew he couldn’t survive without a transplant and that the odds were slim that he’d receive one. From this experience, I do question the impact of whether him knowing that his condition was terminal altered his mind and body more so than the disease itself. If he had visitors regularly, and was encouraged with optimism of improving his health, would his life have been prolonged?

I was moved by these two patients, and I could not help reflecting on my experiences. What was it that was so different between them? The man was an immigrant, whose parents were laborers. He was alone every time I met with him, and yet he seemed content about his life and knowing that he was going to die. The woman was always cheerful and full of emotion. Her hospital room during my visits was rarely quiet, and felt removed from actually being a hospital. Her social status was glaringly different to me compared to the patient with heart failure. She was an actress, daughter of a physician, and from her stories her life seemed filled with so many adventures. On the other hand, the man shared nothing remotely similar about his life. His hospital room felt sterile, nobody came to visit with him, and he was never very emotional – in my presence at least. From him, I felt calmness, acceptance, and completeness. A completeness that maybe came from his belief that there was nothing left for him to give, and now he was ready for death.

As a future physician, I feel fortunate to gain valuable insight about dying through my patient interactions. I’ve learned that living life without regrets is easier said than done. Discovering the truth of life is a lifelong journey that is unique to each individual. For me, living in the present moment is the most important lesson in life to creating inner peace. I believe that it is too often that individuals fall into the trap of projecting wants and desires causing many to live in the future, or living in the past trying to change things that cannot be undone. I think this attitude leads to internal discontentment and a lack of inner peace. To me, inner peace is attained through acceptance of what is and is not, and can lead to happiness especially in the final moments of life. I believe that such inner peace, allows each individual to achieve superior levels of insight, unlocking truths. Most importantly, for many people, no matter how they lived or what they experienced in their lives, death in its final moments can be as beautiful as birth.