Shelley wanted me to be with her at her death. Gathered around her hospital bed were her daughter and son-in-law, a friend, the pharmacist with his tray of drugs, the physician who would be providing medical assistance in dying (MAiD, for short), and me, her NP. Shelley had been admitted to our hospital many times with COPD exacerbations. Each time, she passed through the ED and up to the respiratory inpatient unit where I worked.
In her 70s, Shelley was small and quick-witted, a notebook always in hand. I knew she liked me and the way I talked to her. I could tell our conversations put her at ease. With every encounter, her frail body, finally reduced to 81 lbs. from the sheer physical labor of breathing, would spring from stillness to life and she would say the same thing:
"Oh, it's good to see a familiar face!"
I would sit, and she would chat enthusiastically to me about everything and nothing to do with her breathing. I was not surprised when she invited me to her death.
On her death day the sky was true blue, shifting and changing as the few clouds crossed the sun and sent light beams dancing through the room.
I walked through her hospital door, struck as always lately by her shrunken body, and said a meek hello. There was a hush among the silent figures already gathered around her. Before I had the chance to settle into a spot to stand, she held up her salbutamol inhaler for me to see, then drew her arm back and whipped it clear across the room.
"I'm free!" she sang.
I remember how shocked I was at first by this abrupt gesture, so characteristic of Shelley, but even more so, how surprised she seemed for a moment, either by the strength remaining in her hands or by the sheer relief of finally releasing this burden.
"I've been waiting for you all afternoon so I could do that," she said, smiling at me through lips pursed for breath.
I couldn't help but think we had failed her in some way with the limited treatments we had to offer for the unremitting symptoms of end-stage COPD-severe shortness of breath and accompanying anxiety, and functional immobility.
Desperate to respond to this gesture in some way, I met her gaze and shaped my mouth into a sort of smile, as if to say, "I am so sorry."
Almost too suddenly then, as if the event had been orchestrated in advance, she looked to the physician and said, "I am ready."
The rest of us shuffled in place, our eyes on the drugs lying ready in their syringes in order of recommended administration. The physician obtained Shelley's final consent by signature, and then gently prepared the IV site on her arm.
I watched the two of them with rapt attention. With the first syringe partially empty, I followed her gaze to the window. The clouds were shifting slowly, and the sky was changing.
"Oh!" . . . "I see now" . . . "I'm supposed to let go!"
She spoke loudly, and it was as if we were witnessing a conversation only she could hear, or as if she were reading lines from a playbook somewhere out in the blue sky.
The clouds shifted some more.
She settled back and closed her eyes, almost seeming to smile. The physician administered the remaining drugs, and held her hand, and after less than a minute her breath and heart came to a stop.
Every time I am near it-either in intensive care pushing blood into a bleeding body or pressing hard and fast beats upon a heart that just won't restart, or even with my own mother, whose body did not cool even as we wrapped her in the black brittle bag-death surprises me. This time, I saw a different kind of death. Because of her disease, Shelley's struggle for breath as she was dying had limited her ability to talk, eat, or even, at the very end, leave her bed. In choosing her own death, she was able at the end to take a breath past her obstructed lungs and anxious, coiled body. Her death was a sort of liberation.
Being present at her death was an honor I may never fully appreciate. While we have a long way to go to effectively treat and prevent chronic diseases, at least in the end, with no more therapies to offer and the threat of death near, we could help her walk gracefully out of the hospital room one last time, free.