One-way ticket into faith

The room was still. Eerie.

In our silence, there was understanding.

Centre stage: our nonagenarian. At 99 years old, mostly bones—osteoporotic ones at that—she took up virtually no space at all. A smile ever so faint as she lay in bed. Peaceful.

Stage left: 3 of her children, local. Stage right: another 2 children, both having flown in from out of town that morning.

A palliative care physician in training, I had found myself in dozens of rooms where death was inevitable. Such was not the case in this room.

Only weeks prior, 1 wrong turn had unforgivingly left our brittle-boned lady immobile, unable to bear weight. Physically broken, yet still sharp of mind. Grounded in the knowledge that despite any manner of physiotherapy, her baseline mobility would not likely be restored. This reality was the prologue from which I set foot in her final act.

“Do you remember what we talked about the other day, ma’am?” my staff attending asked kindly, a hand placed gently on our nonagenarian’s shoulder. I attempted to look occupied as timekeeper. Oddly, as an observer, I had not the faintest idea where to look or which expressions were appropriate to make. Do I smile? Should I try to appear affirming or apologetic?

“We talked about life,” she replied in kind. “I’m almost 100 years old. I want to stop breathing.”

Medical assistance in dying was the rising action at play. And I, simply a background character.

I had made it a habit with patients and their families to reflexively distinguish between good-quality palliative care and medical assistance in dying. Not that the 2 should exist in opposition, but rather that the former does not aim to hasten death, whereas the latter necessarily does.

I will likely never perform this procedure. For me, there is too much power in such a role, and an abundance of subjectivity. What if 2 subsequent assessments, though in agreement, came out to the wrong conclusion?

Despite these ongoing reckonings, I still believe there to be a role for such a provision—that in certain cases, perhaps it is what is needed.

But it certainly is bizarre.

One minute, our nonagenarian lay smiling, responsive. Alive.

She gave a small chuckle as she shook the performing physician’s hand and agreed that today was her last day. Confident that along with nearly 3 digits earned to her name, she would leave behind a sufficient legacy.

I admired her certainty. I was also frightened by it.

In the next minute, the climax.

She was gone.

The finality. Her certainty. Where did she think she was heading when all was said and done, and the curtains closed? Did she really think this was her final performance? And, if so, where had she found the courage, the faith, to willingly take her final bow with no reservations?

As a person of faith in medicine, I have never felt particularly fearful or distressed at the thought of death, or at least not of my own. Or maybe this is just the story I tell myself. I suppose what I feel is comfort in the notion of an afterlife, provided that it was my time. When there would be no choice but to transition from one plane to the next. A life everlasting having grounded my decision to pursue this work.

Our nonagenarian was not dying, but now she is dead.

In one moment, she was able to find out for herself if a transition from one plane to another exists. If her time on stage had truly ended, or whether there would be an encore. In one moment, our nonagenarian had found out if my belief in an afterlife is, in fact, true.

A one-way ticket into faith.

• Copyright © 2024 the College of Family Physicians of Canada