How to Watch Someone Die

By Audrey Singer

His face is pinched, and he is squinting at me today. His left eye is very red and angry. There is a sty in the middle of the lower lid, and I think I can see blood. It is another infection. Just one more thing in a list of things. Last week, he had diarrhea for 3 days straight, and he couldn’t leave the house. He didn’t really sleep either for fear of making a mess. Sometimes I catch him with his head in his hands, or he will just sit and stare off into space. “This is my life now,” he tells me. 

And this? What this is, is cancer. This is three years of chemo and counting. ‘This’ is his body breaking down in bizarre ways. He has diabetes now from the steroids that came with his first chemo. He had a mild stroke some months back. Neuropathy. Increasing heart problems. He drops things because his left hand doesn’t always seem to work. Weight Loss. Fatigue. The list keeps expanding.

What’s strange is that you wouldn’t even necessarily know that he is sick. He still goes to the gym when he has the energy and gets his groceries.  Even some of his doctors say he doesn’t match the person described in his medical records. On paper, he has lung and bowel cancer, heart disease and diabetes, amongst other things. He looks terrible on paper. To me, he is Jack. My good friend Jack.

I met him about 4 years ago because I was looking for an aikido teacher. Jack had taught aikido and Tai chi for decades. I had studied Chinese medicine, and surprisingly, we had a lot to talk about. We would talk about life, and energy, and Qi and the universe. We would talk about music, and he would tell me amazing stories of his adventures. We were always cracking each other up, probably because we both have a similar sense of the ridiculous and slightly inappropriate.

The cancer diagnosis happened about a year after I met him. They gave him 3 years, but now he is “past his expiration date” as he likes to say. It is why I’m here. I had been traveling. I called one day to check on him, and what I heard in his voice made me worry. So,I came for a visit and haven’t left.

So far, there are good days and bad days. He laughs a lot less. When there is a bright moment, it absolutely blazes. Making him laugh is like winning the lottery. Sometimes I make up ridiculous songs on my ukulele trying to make him smile. If I want to annoy him, I play “Leaving on a Jet Plane.” He hates that song. Sometimes, we have conversations of complete silliness. Sometimes, he tells me how he wants to go. He’s not interested in suffering. He doesn’t want to get to the point where he can’t “wipe his own ass.” I get it. 

He tells me stories about his time in the Peace Corp. About his spit fire of a grandmother. He tells me about his years of being an elementary school teacher. I try my best to capture his stories. To bear witness to the life he lived. Somehow, I feel like I always fall short. I can never get it all down.

He tells me it’s legal in Colorado to check out when you want to check out. It’s called MAiD, or Medical Aid in Dying, and that’s how he wants to go.  So, I start researching. I try to understand the process and what needs to happen. The paperwork. What doctors he needs to see. It is overwhelming. I think it’s probably time for hospice to come in, but he’s not ready. ‘Hospice’ means the end to him, and he’s not there. Not yet. I remind him that hospice will just be more angels to help. He’s not particularly religious but has told me of the many angels who have cared for him through his cancer treatments. So, he calls hospice. I am so entirely relieved after the first hospice visit that I go and cry in my room. And I was right. The hospice folks are indeed angels. 

He tells hospice about his wishes, and they help get the things started for the MAID program. He tells them he at least wants this choice, when so many things are now out of his control. He must see two separate doctors, and there has to be 15 days between those two visits. The doctors must assess his health and state of mind. They have to make sure he is competent to make this decision and isn’t depressed. I wonder who wouldn’t be depressed in this situation. To do MAID, a person must have a terminal illness and be expected to pass within the next 6 months. There must also be a pharmacist willing to dispense the medication. There isn’t a pharmacist locally that will do it, but one can be reached by phone in Denver. Even the doctors that come to assess Jack aren’t local.

The first doctor that comes is a woman doctor. We all sit in the living room and talk. She asks him questions. She explains the process. There is a cocktail of drugs first: benzodiazepines, morphine, and also an anti-emetic drug. The anti-emetic one is really important because it keeps the person from throwing up the other medication, and that would obviously complicate everything. Jack has to be able to administer the medication, and swallow it, himself. I learn that the drug they use to stop the heart is a derivative of foxglove, an herb I have studied. Of course, it will be the pharmaceutical version, and a very high dose. They ask me at one point what I think of this whole business. I am surprised to be asked. I suppose they are trying to determine if Jack has the support of the close people in his life. I tell them I think that it is his choice. His decision to make.

Fifteen days later, the second doctor comes to the house. A man this time. A similar conversation takes place. Everything is explained again. The drugs. The process. The doctor asks about his life, and Jack tells him stories. A week or so later, the first doctor comes again, and we all talk again. It’s made clear, of course, that Jack can change his mind. He never has to fill the prescription or take the drugs. Thirty percent of people get the medication and never take it. This whole undertaking of getting approved has been a bit more leisurely in Jack’s case; there was no need for urgency. He is not ready. I tell him I think it’s probably better to have the option, and not need it, than to need it and not have it. Finally, he is approved, and just has to decide when he is ready to be prescribed the drugs. 

I don’t really feel like I can tell anyone that I am terrified. That the thought of having the drugs in the house scares me. The medication is sent in a liquid or powder form, but the liquid has to be used within two weeks. The powder can last up to 6 months in the fridge. This freaks me out. I am struggling with it, but I talk to friends. I talk to my therapist. I let go of some of my worry because it’s not time yet.

Though, he is definitely slowing down. He is sleeping more, and certain symptoms are getting more difficult to bear. He decides to talk to the pharmacist and get the medicine. When it comes, I put on gloves and seal it all in a Ziplock bag and put them in the crisper drawer.  We call them the “death drugs” whenever we talk about them. They cost him $1000, and he put them on his credit card.

Each day I wake up, I wonder if today the day will be. He has less energy as time passes. It takes almost all that he has to go from his bedroom to the living room. He hasn’t gone out of the house for a few weeks. The hospice nurse encourages him to take morphine to keep him comfortable, and he tries it, but doesn’t like it. It’s not what he wants. One Monday morning, I find him leaning, hunched over, on the kitchen counter. I can tell he feels awful, and he tells me for the first time ever that he doesn’t want to be alive anymore. I do my best to offer comfort, and later that day, he makes his decision. He wants to go on Friday. He calls the hospice nurse to schedule the time for them to be there. Friday at 1pm.

The next few days are rough. The night before, I go and get him food from his favorite burger place, Five Guys Burgers and Fries. He wants a cheeseburger, with no mayo, and fries. He hates mayo. To my surprise, he eats most of the food. It’s the most I’ve seen him eat in a while, and somehow it feels like a rare achievement. A last meal he really could enjoy. In the morning, I go and get him a ham and cheese croissant from Burger King. He can’t eat anything after a certain time, or it could affect the drugs and slow things down. So, he eats his croissant and watches some episodes of Star Wars on Disney Plus.

I am trying hard to somehow make the day meaningful. I try reading Rumi poetry aloud, because we both love Rumi. We listen to his favorite Pink Floyd song, and I surreptitiously snap a picture of him while he listens. His eyes are closed, and I can’t even begin to describe the look on his face. I realize I am pushing. Trying too hard. Trying to give him a good last day, but everything just feels weird. He is in a strange head space. I am in a strange head space. So, I let go. I let go and just try to be in the moment. It is snowing outside.

Eventually, the time arrives, and the hospice nurse is here with us. The first round of drugs needs an hour to work, and so he takes them, and we just sit and talk about nothing. It is the most meaningless, significant conversation I’ve ever been a part of. The nurse asks him if there is anything he feels he needs to say.  Jack just kind of shrugs and says no. Forty-five minutes go by, and then it’s time for the death drugs. He mixes the powder with water, and he drinks it.

I am holding his hand, and I am crying. I have my fingers on his pulse, and the hospice nurse is right beside me with his stethoscope and morphine, just in case. He asks Jack if he is in any discomfort, but Jack shakes his head no. It isn’t long before Jack seems to go to sleep. I am holding his hand, and watching his breath, and feeling his pulse. I feel it as it slows. I feel it as it stops.

I sit beside him. I hold his hand, and I sing. I sing because I know to the core of my being that he can hear me. I sing because I know that music is a bridge from where we are to wherever we go. I sing because there is no possible way I can make words in this moment. I can only make sound. I wrap all my love, and pain, and grief, and gratitude into my voice, and I sing to him. I sing everything I could never say, and I say goodbye. I hold his hand for as long as I can and wish him well on this next part of his journey. Safe travels, my friend. Shine on, Jack. Shine on.