Dying Well on Thanksgiving Day

            Mrs. Esther Wholesum¹ died on a Thanksgiving afternoon in the mid-to-late 1990’s, surrounded by her family and full of years. I remember it well.
            Three weeks before she died, I, TAT, was the medical resident on call, working the long shift in “FMIS,” the Family Medicine Inpatient Service. That rotation was a major part of the three-year training program for all of us Family Medicine residents at In His Image, in Tulsa, Oklahoma. FMIS was a busy service, so busy in fact it was the last year we residents took call alone without a partner and an attending physician continuously present through the night.
            As usual, I was answering back-to-back phone calls through the dark and lonely hours, monitoring patients in the intensive care unit, delivering babies (sometimes several per night), talking down suicidal patients by phone, and admitting sick people from the emergency room for heart attacks, pneumonias, and ketoacidosis.
            As a doctor in training, I wore a long white lab coat with heavy-laden pockets over my blue-green scrubs. Hooked to the string tie at my waist was a black pager, the kind that beeped a high-pitched tattoo. By pressing a side button, I could retrieve a few hard-to-read phone numbers and short alphanumeric messages.
            The pager mattered. Twice I dropped this precious beeping tool, this link to all my medical duties, straight into a toilet, with predictable results. I kept spare batteries on me, but the technology was spotty, regardless. Whenever my pager ceased to work, I had to call the answering service every few minutes to see what new messages might have just arrived. I was supposed to respond to all messages within five minutes.
            Morning hospital notes were written in black ink—never blue—on white lined paper, collated into three-ring binders. These thick binders were stored in slotted pigeonholes on spinning Lazy Susans. Doctors and nurses had to wait for each other to get access to the paper charts and make their daily documentation.
            Those of us with terrible handwriting got reprimanded formally by the hospital administration. In my case, the rebuke didn’t help: my printing in all caps was no better than my cursive scrawl.
            Call was no time for rest. There was a mantra among us residents, to help us through our 36-hour shifts: “A shower is worth four hours.” But most nights after a long call, we were disheveled, sweaty, and stinky. There had been no time for a “power shower.”
            At 3:00 A.M. I received a page to 4-South. I called the number and the nurse answered immediately. “Mrs. Wholesum says she’s seeing angels, she’s talking to people who aren’t there, and she’s gasping for air. I think you should come quickly.”
            Mrs. Wholesum was in heart failure. Her aortic valve was moderately leaky, but her mitral valve problem was much worse. The left side of her heart was dilating and losing function. She was not a candidate for valve surgery, due to the severity of her problem, the two-valve disease, and the enlargement of her heart. I performed my routine for heart failure: started her on oxygen, elevated the head of her bed, and gave her IV diuretics to reduce the excess fluid in her lungs.
            Her breathing improved. Then she told me details about the angels she had been seeing and the presence of several of her loved ones, long deceased. Her face was radiant. It was one of those “lightbulb” moments we see sometimes when people are close to death. It’s as if they are given one last chance to speak clearly with their loved ones, to make amends if needed, to offer their blessings, and to say their final goodbyes.
            I listened closely to Mrs. Wholesum. What a privilege to be so near to someone actively crossing to the other side, to the place most of us have never been.
            The following day I transferred her to a different hospital floor, a hospice environment, where I gave her a morphine drip for comfort so she wouldn’t feel like she was drowning from the fluid in her lungs.
            She survived considerably longer than I expected. Three weeks after Mrs. Wholesum’s angel-filled near-death encounter—on a Thanksgiving Day—I was on call once more. The holiday shift seemed particularly heavy, and I was sullen as I labored away in the belly of the hospital, knowing my family and friends were celebrating with turkey and stuffing.
            Dr. Ed Rylander was leading us residents through our morning rounds. In the long-term care facility, we came upon Mrs. Wholesum, surrounded by her loved ones, breathing only twice a minute. The morphine had slowed her respirations.
            “Mom, wake up,’’ said her daughter, rubbing her chest and shaking her. “You need to breathe more.”
            “I was with the LORD!” said Mrs. Wholesum.
            “Well, you’re with us now,” said her daughter.
            “I see that!” she huffed.
            We prayed with the patient and her family in a circle around her bed and then said our goodbyes.
            Later that afternoon, Dr. Rylander brought all of us residents, save one, out of the dark hospital, and into the sunshine. He took us to a restaurant, where he bought us all a Thanksgiving meal. Then he said, “I’ll finish the discharges myself. You may all go home. Be with your families.”
            I had no words. It was a lightbulb moment in a dark hour.
            My pager beeped one last time, just before I left the restaurant. Mrs. Esther Wholesum had passed away. Her family members had been with her, gathered by her bedside.
            It was a Thanksgiving Day.

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¹ Not her real name

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