There are usually one or two pivotal times in a human life which change the way we look at things or/and the way we decide to live. The more or less intense the experience, a corresponding reaction. Patients have told me for example: I'll never touch alcohol because I saw it destroy my father. Sometimes our reactions are flawed: I’ll never have children because I saw my mother burdened with child raising.
When I was 13 years old I began to challenge the awful grip of death. The death contest began after a monumental experience I had on the family farm. I cared for the 1500 pound pregnant black angus heifer for months and watched it’s belly swell with new life, anticipating with excitement the upcoming day of birth.
Running up to the birth scene late, I witnessed the prize cow and calf both tragically die just after birth. Despite the veterinarians heroic efforts, there was nothing more he nor my father could do to resuscitate them. I thought to myself as I scanned the eerie quiet scene: “Are they alive? What? No! They aren't breathing! This can't be!” The baby calf looks so shiny black, so beautiful, so perfect, so still. I stared intently at the mama cow’s last breaths. Moisture droplets glistened about her nose while others’ disintegrated and disappeared ever so quietly. Then utter silence. I looked. No chest wall movement. No sound. No nothing. I looked over to my father’s face for understanding. My dad's cheeks were pink from the chill. His ever kind face was so solemn, so quiet. The only movement was his snow-white hair catching the gentle breeze that crisp April morning.
My young heart fundamentally changed that morning. I was shaken; “cut to the heart.” How could this be? I asked. A perfect mother/calf duo. Dead.
Death became an unnatural thief, a travesty and grave evil I desperately wanted to solve for. As an adolescent, I naïvely put myself in a contest I could never win. I grew older and saw many smaller animal births and deaths, but never one that changed my heart quite like this one.
My fascination with the study of all life never left me. I took every biology and chemistry class available. I received permission to bring my fetal pig home on the school bus daily in an ice cream bucket. I lay on my belly in the den and studied anatomy for hours on end.
I could never quite get enough of the study of anatomy and physiology. I was amazed at how living organisms were perfectly knitted together. When the time came to choose a path of higher education, I considered veterinarian medicine for an hour or so. I quickly decided against that when I imagined how many different size hearts I would need to dissect. I quickly opted for the study of the human medicine and went to MD school. This was much more intriguing to me as I dared to approach the complexity and sublimity of the human person: all heart, mind, soul, and strength.
I had found my passion. Beginning with the human body, I was still enamored with human anatomy and physiology. I delighted in the complexity and intricacy with which every human person is woven in the womb. After one year I was selected chief resident in the county hospital residency program.
Fast-forward 30+ years. As a seasoned (old) physician my practice has now evolved to providing expert level palliative care at the end of life: in other words, hospice. I've cared for patients in Rochester, Minnesota Mayo Clinic, Mpls-St Paul, East to Eau Claire WI and as far north as Brainerd and Pine River, Minnesota.
As Hospice Medical Director, I am tasked with the decision to determine if and when a person has 6 months or less to live. If that is decided affirmatively, a patient has access to a fully supportive hospice team and available potentially high risk medications such as morphine, haloperidol and lorazepam. The decision regarding whether a patient has six months or less to live is critical. It exposes a patient to potentially harmful medications if they are illicitly administered. Correctness in prognostication allows a patient to receive wonderful services and medications when death is close.
I have now cared for thousands and thousands of hospice patients going on 15 years. My goal is to always assist dear patients to a natural death, in other words, not one day late or one day too early. Medications and treatments are extremely skillfully administered to minimize suffering while maximizing alertness and contentment at the end of life.
There's absolutely NO need for a patient to suffer at the end of life. With an exquisitely tuned and highly trained hospice team devoted not only to ameliorating physical pain, but also emotional and spiritual pain, patients can expect to have a beautiful death. A hospice patient and their family should expect to be wholly supported, fully known, ardently loved and honestly seen as they are assisted to say goodbye at the end of life.
As I took care of more and more end of life patients, I saw in them a certain freedom and peacefulness. Approaching the end of their lives, they were assisted to have often delicate conversations with their loved ones and family. Many of these questions and conversations circled around meaning of life, good and bad memories, love given and received, healing started, forgiveness offered and gratitude exchanged.
I soon realized that these personal questions do not need to wait until someone tells me that I have a prognosis of six months or less to live! Maybe I won't be given that opportunity to prepare. Perhaps I will have a sudden accident. Accidents are the cause of death in 10 to 15% of cases.
Jude was one of my patients that had prepared well for death. He had a untimely diagnosis of colon cancer. A young man in his early 40s with four beautiful children. He did everything he could to beat the cancer, but the cancer exerted relentless havoc over his body. Jude already had strong faith before the diagnosis as he battled professional and personal losses. Facing death, his faith was tried severely, and like a great hero, rose to the final contest with exuberance. I was privileged to visit his humble home multiple times. To witness his joy as he approached his final day was riveting.
His only fear was uncertainty over how his death would actually go. Would I have pain? Would I have trouble breathing?? “I'm getting more and more tired and can no longer go upstairs.” He had a great big smile and a joyful laugh. He danced sitting down as his feet tapped telling me how excited he was to meet Jesus. The hospice team grew to love him. He accepted his impending death with joy, oh so beautifully. His children stood by and watched with great sorrow. They watched their dad with a certain tilt of their heads as if to shield their senses from the incomprehensible scene. Seeds of knowing sacrificial love and deep compassion were planted in their young hearts.
With my dear patients to teach and guide me. I too decided to begin living as if I also had six months or less to live. Like Jude. Now. I just celebrated my last Easter, 2024. (Easter 2023 was also my last, somehow I made it another year.) I live one day truly, at a time.
I began my six month or less life looking to reconcile. I got busy making an inventory of experiences with family, friends and acquaintances. If there was anything that I regretted doing or saying, was sorry about, wished to ask forgiveness for, I started with those things. There were plenty!
I made phone calls, sometimes wrote short letters to folks asking for forgiveness. Many hurts in life are due to misunderstandings. I apologized for
these things as well. People received these expressions of sincere sorrow with surprise and great happiness. We talked over events and details. We have been closer, more intimate family and friend relationships since. There is great freedom in practicing forgiveness! I still need to ask forgiveness now as I continue to live— and make mistakes daily.
If my life were taken suddenly in a car accident, fall, explosion or suffer a sudden blood vessel breakage in my brain, I know I would want to be as ready to go before God as possible.
Active reconciliation and gratitude are part of my daily 6 month life. I have never lived in more peace and joy living like I have six months left.
The founder of Apple, Steve Jobs said of his impending death in 2011: Death is very likely the single best invention of life. It is life's change agent.” He also said: ”Remembering that I'll be dead soon is the most important tool I've ever encountered to help me make the big choices in life. Almost everything—all external expectations, all pride, all fear of embarrassment or failure— these things just fall away in the face of death, leaving only what is truly important.”
How would you live today if you were told you had six months or less to live?
-Nancy Miller-Johnson, MD #LiveSMOL
