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My 90-year-old grandfather has lived a long life, endured a World War, marched for Indian Independence and survived the 2004 Tsunami. After a lengthy career in India’s civil service, he retired to North America to be with family, spending his time mostly reading and occasionally writing the odd article advocating for senior’s dental coverage.
It was one late evening, after I returned home from a long day at work, that he asked me a question. We sat, side by side, him on the armchair, me on the couch. The soft glow of the setting sun lightly illuminated the side of his face. It was then that he abruptly looked up from his newspaper.
“What does it feel like to die?”
I was taken aback. “How should I know Thatha, I’m only 26!”
“Well, you’ve seen it haven’t you. You’ve seen people die. Have they told you what it felt like?”
There was a childlike curiosity to his eyes, once black turned hazy blue, as his cornea degenerated with age. I was stumped by his question and it has clung to me ever since, like dew to a leaf after a rainy day. Although I was only a few months into my medical residency, death was a routine part of my day. Pronouncing a death was a regular task, sandwiched between picking up my coffee order and attending a lecture at lunch.
“I suppose it depends on how someone dies,” I told him.
“I’ve heard it feels like falling asleep to some. I’ve even read that some people get visions before they die. They see and hear things.” He looked at me seriously. It struck me that this had been preoccupying him.
Since that evening, I have tried my best to formulate an answer for him. I’ve watched a little more closely, listened more attentively, hoping to gather enough details to paint an accurate picture for him.
There are physical signs of dying which we learn in medical school. Mottling, where a person’s extremities become patchy owing to poor circulation. Or breathing that follows a crescendo-decrescendo pattern, like a tide rising and falling. Yet, I’ve found as I progress throughout my medical training, that I’ve developed an instinct for recognizing death. Before these physical signs arise, before the blood pressure begins to drop, or the breathing becomes laboured. Before I see it, I can feel it. It’s a heaviness that steals the room, a languidness that settles in the air. Yet, the mystery still stands as to what lies on the other end – what the patient feels.
Recently, I cared for a 90-year-old woman with multiple life-threatening conditions, stabilizing one illness would mean running the risk of worsening another.
“I’m ready to go,” she told me, matter-of-factly, when I explained the gravity of her situation.
“But before I die, I just need to write one more Christmas card.”
That’s the strange part of dying, until its very end stages, it’s always rooted in life itself. It’s the living that agonize over death – the decisions to make, the regrets, the sentences left unsaid. At some point, there’s a switch that flips as someone inches closer to death.
A few days (and a Christmas card) later, my patient made the decision to transition to a comfort care approach. I found her half-awake in bed. She looked like she was dreaming. I said her name a few times and my voice reverberated across the room. She stirred slightly, half smiling. I let her be.
In the last few minutes before her death, I was called to her bedside.
“BP 50/20,” the nurse told me. Together, we watched as her heart slowed, her breathing ceased, her pupils staring fixedly at the ceiling above. The nurse hurried toward the head of the bed and gently closed her eyes.
“She looks at peace,” the nurse turned toward me saying. I thought so, too. Perhaps there was some comfort in feeling that, although we both could not know for sure.
Last week, my grandfather packed up his belongings. He was off to see my aunt in California and was getting ready to catch his flight.
“So, do you have an answer for me?”
How do I tell him that I still have more questions than answers? That dying is almost akin to Heisenberg’s Principle, a concept from quantum chemistry (a course I know he was forced to take but hated). That the closer someone is to death, the less we know about how they feel. The dying and the dead, remain elusive – up close but always at arm’s length.
My grandfather looked hard at my face, which must have betrayed my confusion.
“I guess not. Well, it’s a conversation for later then.” And off he went, his trousers neatly pinned, his spectacles catching the glint of the sun. I waved as the car disappeared past the bend of the road.
Divya Raman Santhanam lives in Toronto.