Sitting upright in bed, wearing his blue checked, button-down shirt, his long, spindly legs outstretched, covered by his crisp cotton pajamas, my husband’s eyes were closed. His arms were slightly bent at his sides and reaching forward just a bit. His palms were turned upward toward the sky. The room was silent. Some may have seen it as a moment of confusion. I saw a moment of profound communion. Or a gesture of gratitude. It was a holy moment. I slowed myself, crawled onto our bed and lay beside him. There were so many things I loved about being married to Franny; moments like this was one of them. I silently whispered to myself, Thank you for this man.
We had come to the end of ten months of treatment for an aggressive Stage IV stomach cancer. Franny had weathered an intensive chemotherapy regimen: three months of chemotherapy, two months break, a painful recurrence, three more months of chemotherapy, two months break, and another quick recurrence. As a hospice nurse and his wife, I did my best to keep track of Franny’s appointments, medications, energy, appetite, and pain while also loving him as much as I could. Every moment counted. We did, as Franny said, “Whatever we could to get the cards on our side of the table”: acupuncture, smoothies, nutritional supplements, exercise, long distance healing, candles lit 24/7. Recently he had become too tired to go to the clinic for another round of chemotherapy and had decided to receive hospice care. We were now tucked in at home.
Life for Franny had not been easy, and yet he expressed gratitude and generosity at every opportunity. The Christmas before he died, Franny gave a blue-and-white polka dot silk bow tie he had bought years before in Paris to our nephew because he thought Pito would look handsome in it. On one of our earliest dates, in one of our favorite restaurants, Franny said, “People think my life has been hard.” Franny’s first wife died in a car accident. His second wife died of colon cancer. “But, I feel grateful for all I have been given. I really want to give back in some way.” Franny turned to me each night with the words, “Thank you for today.”
A couple of years before, at lunch, a friend—a Tibetan monk I had known in Santa Fe—walked into the restaurant. Born in a village in the Himalayas, his small stature, round, young face, and quiet, smiling presence surprised me. I jumped from my seat and hugged him.
“What are you doing here?”
“I moved to Pittsburgh to teach meditation,” he responded in his familiar hushed and measured voice.
He told me where he was teaching and living.
“Yes, I know where you are. I have driven past that building and seen the yellow and blue prayer flags on your porch,” I responded. “I didn’t know that was you.”
We talked about Pittsburgh and the Zen meditation center where we had met. As he was leaving, with one hand holding a grocery bag, he gave a slight bow and a prayer gesture with the other hand at his heart. Franny fell in love with this expression. He often repeated it by bringing the tips of his right thumb and first finger together in a circle, his remaining three fingers pointing toward the sky, and the edge of his thumb resting on his heart in a graceful attitude of thanks.
The reverential gesture I saw as I walked into our bedroom, his palms reaching to the sky, different from the monk’s, and although somewhat dreamy, arose, I knew, from the very center of Franny's being.
Several days later, sitting on our bed looking out the French Doors to our garden, my husband turned to me and said, “There is an on-ramp and an off-ramp. I want the on-ramp, right?” He raised his right arm towards the ceiling.
This disorientation was new.
I put my hand on his and gently led it toward the bed. I placed my hand on his bony, warm chest. “Yes, the on-ramp is the right one.”
Later in the darkest hours of the night, I woke to Franny shifting and rustling in bed. By the time I was up and by his side, I found him sitting on the edge of the bed with his feet resting on the floor, ready to go. Standing or walking on his own could be precarious, given his weakness and loss of balance. I sat on the edge of the bed next to Franny and placed my hand on his back.
“Sweetie, there’s no need to get up. Let’s just sit here for a minute,” I said. We looked toward the drawn shades of the French Doors and took some breaths together.
“How about you lie back and get some rest?” I said as I gently pushed his shoulders towards the bed. Franny gave in and rested, only to be up and moving again in an hour.
Franny was delirious. At the end of life, periods of clarity and connection may alternate with confusion, hallucinations, and forgetfulness. Rest and sleepiness alternate with restlessness and agitation. Often these changes are worse at night. He had, maybe one to three weeks, to the end of his life.
I had seen patients at the end of their lives become unrelentingly anxious and unsettled. They could become a danger to themselves as they wrestled with caregivers or tried to get out of bed. One patient called out for days and tried to pull herself over the bed rails where she would have fallen onto a hard floor, possibly breaking a bone or hitting her head causing more pain. No family member could calm her suffering. Eventually, she needed increasing doses of medication to find ease.
I wanted to keep Franny at peace and at home. I worried that his symptoms could progress to an unbearable intensity. I gave him a dose of haloperidol, a mildly sedating antipsychotic medication, the most commonly used for delirium.
After this one dose, I stopped. I remembered that dying and death is most often a natural, sure, and steady process of unwinding, weakening and allowing that one last breath. I often reminded families to listen carefully to what their loved ones were saying.
“Perhaps your loved one is speaking of people or images that are meaningful to them. Perhaps what seems confusing makes sense somehow.”
Families listened and often moved closer to their loved one’s bedside when I shared this thought. One family listened differently to an elderly mother who kept calling out, “I gotta go. I gotta go.” They had been struggling to get her fragile body to the bathroom. Instead, after we talked they sat with her, listened, and reassured her that they were close and she was safe.
I lay beside Franny, giving my attention. I yearned to assure him that he was not alone. I wanted him to know he was loved, that someone was watching over him.
Two afternoons later, as I rested in bed next to Franny, he whispered, “I was just talking to the boatbuilders. We don’t have a lot of time.”
With the new spring air filling our room, I gently stroked his hand and thought of the many sailing trips he had taken long before we met.
“I loved long-distance sailing, especially at night. It was peaceful and quiet and gave me time to think and be with myself,” Franny had told me.
Despite never learning to swim, Franny sailed to St. Martin, Antigua, and Honduras and earned his captain’s license for fifty-foot boats. On the first day of our sailing honeymoon in the Virgin Islands, Franny wanted to be sure I knew what to do if he fell overboard. He lowered the sails and we had an emergency drill. I thought of Franny’s wish to ride in the Tango, a 1912 mahogany and black-lacquered freshwater boat he and my older brother talked about repairing. I imagined his beloved boats offering him comfort and showing him a way across the threshold from this world to the next.
The next morning, Franny asked, “Who was in the house last night? Who were all those people?”
I rolled over and kissed him on his broad forehead and rested my hand on his heart.
“I don’t think anybody was here, my love,” I said.
“There were people here,” Franny insisted. “Please close the door,” he said.
I got out of bed, closed the bedroom door, crawled back into bed, and curled up close to Franny.
Who in the starry realm were reaching toward Franny to welcome him to the other side? His beloved mother, father, his dear friend Donny, his older brothers?
“Nothing to be afraid of,” I said.
Franny fell asleep.
Later that day, the French Doors were open in the bedroom. Crisp, sweet air filled the room.
Weak as he was, Franny said he wanted to be outside in the garden.
“OK.” I was a little hesitant. He hadn’t been out of bed for the past week.
Kate, Franny’s twenty-five-year-old red-headed daughter, brought the wheelchair close to the hospital bed. Franny put his arms around my shoulders. I put my arms around his back and pulled him upright. I wrapped his terry cloth bathrobe around him and put my arms under his to help him stand and sit in the wheelchair. The oxygen tubing trailed behind him as Kate wheeled the chair to the top of the stairs. Bear, our twenty-pound black poodle-mix, followed close behind.
After putting the brakes on the wheelchair, Franny slowly and deliberately pushed himself out of the wheelchair into a standing position. With his left hand holding the wooden railing, he took one step and then another step down our stairs. Six steps down, then a landing, where Franny paused and turned to the next set of steps and took two more and then turned to me. He was breathless.
“I can’t do this,” he said. “I can’t breathe.”
“OK. Let’s just stop here and take a break,” I said.
Franny considered the step.
“I have to get back up,” he said.
He faced his body up toward the stairs, put his right hand on the banister, and took the two steps to the landing. He stopped for a moment and then took three more steps, turned around, and sat down. His breath came and went with effort. He lowered his head. I moved toward him. Franny pressed his head into my sternum. I leaned into him and placed my hands on his shoulders. Moments, minutes, five minutes went by with his head burrowed into my chest, me giving him the rhythm of my breath and willing over and over: You will get your breath back. You will get your breath back.
In time, Franny lifted his head from my chest, reached for the bannister, pulled himself up, and turned to climb the stairs. Slowly, steadily, three more steps. He sat in the wheelchair at the top of the stairs. Kate wheeled him across the bedroom, and I helped him back into bed. Franny fell asleep.
I took a long walk, breathing in the far-reaching light-blue sky.
I already missed our conversations. Franny’s delirium had brought communication that was spirit-filled and important, but otherworldly—ramps, boats, night visitors. We were no longer discussing our day-to-day or planning our futures.
When I returned from the walk, I sat on the bed next to Franny. He opened his eyes and reached toward me. He wrapped his hands and arms around my head and pulled me toward his chest and held me there.
Later that night, I sat on our bed next to Franny, shoulder to shoulder. Bear walked to the end of the bed and curled in on himself at my feet.
“Rach, it’s spectacular. It’s so colorful,” Franny said as he gazed far into the distance.