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“Call me back. Immediately!” 

I deleted the voicemail and lowered myself into the office chair. The walls were blank in my drab office, tucked into a corner of the cancer center. Ceiling tiles intermittently rained down debris.

It wasn’t unusual to receive calls from families after patients passed away. Sometimes they had trouble detaching after the intense months of making wrenching decisions together. Sometimes they needed to rehash the last days or hours or to feel reassured about choices they’d helped to make. 

Sometimes I was all they had left. 

Those were hard phone calls. I had trouble detaching, too. I’d be brought back to the memory of that last visit under the fluorescent lights, my chest heavy as we sat together for the last time, agreeing at last to turn from the final, desperate efforts at recovery towards comfort care for the end. Those meetings ended with long deep hugs and left me with an emptiness in my center.

But why was she calling? The demanding tone wasn’t unusual for Diane, the ex-wife and “designated decision maker” of a patient I’d cared for before he went on hospice care.

Although I never met her in person, we had a fine rapport. She existed as a sharp, disembodied voice across a telephone line. She was clear from the beginning that she resented being named as his Durable Power of Attorney for healthcare. She seemed put out by the task, exasperated by the details she was expected to manage. But there it was, her name in his shaky black script on the crumpled pages of his Advance Directive. By the time she had gotten into town, it was too late to argue. He was skin and bones, disheveled, confused. 

“George is a nice person,” she told me, “but he was an awful husband. And an unreliable father.”

He’d been a heavy drinker, the last one to leave a bar while she was at home raising the children.

“I had to get the girls away from all that. I took them to England to be near my family. We came back to see him when he got sick. He’s the father of my children. I owe it to them to not abandon him completely.” 

My hands shook as I dialed her number, uncertain of her motivation. Her dominance in every conversation made me nervous and oddly submissive.

“It’s Dr. Makoff calling you back.“

“Oh good. Thank you so much,” she said with unfamiliar warmth. She sounded fragile, unsure of herself in a way that was new. Grateful even. But then her tone shifted and became strained.

“I’m really upset about something that happened in his last moments.”

This I hadn’t expected.

“You were there?” I asked, my eyebrows raised.

“No! But the nurse put me on the phone. I told him his children loved him and all that. But before she hung up, I heard her say something else. I need you to tell me. In his condition, did he hear what she said?” 

I felt warmth rising from my chest to my neck. My feet flipped my low-heeled shoes around under the desk. I felt trapped by this question I knew had no answer. I tried to be honest although I wasn’t sure that was what she wanted:

“Well, the last sense to go is hearing. But it’s hard to know. I imagine his mind was pretty fuzzy.”

Silence.

“If you don’t mind my asking, what did the nurse say?”

On the other end, a deep sigh, almost a shudder: “She said: It’s okay, you can go now. God is with you.”

I imagined the moment, the nurse, wearing a cross on a thin gold chain, her soothing voice uttering words she thought would comfort a dying man.

“And that would upset him?” I asked gently.

Her voice rose and tightened. “He was a lifelong atheist. I specifically instructed them: No God talk! And now I have to live with the fact that those were the last words he heard. Please, tell me he couldn’t have heard…”

I thought back to when we’d had the hospice conversation. She’d asked my thoughts about the best options.

“Now I have to live with the fact that those were the last words he heard. Please, tell me he couldn’t have heard…”

“Honestly,” I told her, “my favorite companies are Catholic or Jewish. Their care is spiritually oriented, not specifically religious, unless that’s what you request. Hospice Chaplains are trained to be non-denominational. Their role is to help find meaning—to soothe existential distress.”

I suppose she’d felt reassured after that conversation since they’d signed up with the Catholic hospice.

But had I steered her in the wrong direction that day? Did I bear some blame? I’d had my own issues with this very hospice’s refusal to accept patients who were interested in the “end-of-life option,” the suicide pill that had recently become legal in the state of California. Who were they to judge, I’d thought, if someone with a terminal illness was ready to be done with suffering?

And maybe that’s what really concerned his ex-wife—the judgment.

Perhaps the nurse had decided he needed redemption after seeing his apartment, and the mark of addiction on his jaundiced skin.

Or perhaps Diane blamed herself for not being able to save him from his addictions. Or for leaving him alone without a wife or children.

Or maybe this woman, this voice on the other end of the line, was finding it too hard to process, to accept, the fact of her own grief.

I took a deep breath.

“Diane, I can hear that you’re in a lot of pain. The truth is, we don’t know for sure what happens at the very end. But from what I’ve seen, I can tell you he felt very grateful for all that you did for him the past few months. As hard as it was to stick by him and help make decisions, you were there. And I believe he died in peace.”

I could hear the small sobs on the other end. And we stayed that way, together, until they tapered off and she cleared her throat, ready to speak.

“Thank you, Dr. Makoff.”

Eve Louise Makoff is an internal medicine and palliative care physician. She has published essays and poetry focused on both narrative medicine and personal topics. Dr. Makoff is studying narrative medicine...