The lady was 88 years old and over the last several years she had broken one hip that was surgically repaired and then broke the other hip again surgically repaired.  During her rehabilitation, her inherent independence and drive to be self-reliant lead her to stand up out of her wheelchair.  She had another fall and fractured her pelvis.  At that point, she was no longer able to get out of the wheelchair.  At one time in her life, she was so sharp and so quick she earned the nickname “Pepper” but now her mind was slower.  All of the blood tests and vitamins and supplements and well intended advice had little impact on the progression of her dementia.  She had vowed that she would never leave her apartment but after the first broken hip even she recognized she was unable to care for herself there so she moved to an Assisted Living facility.  After the second broken hip, she moved into a Nursing facility something she vowed she would never do.  But now, there she was.

     Then there was pneumonia and the associated loss of appetite.  The malnutrition from this followed and her deterioration began to accelerate.  Care and comfort was provided as could be done and mercifully she passed away.  She was unresponsive for two days before her heart stopped.  Family members were called periodically thru her final weeks.  A universal question at that point was, “Should we come now?”

     The death of a parent is something that is long remembered and a very emotional event for most people.  The answer to the question is anything but simple and I am very careful in providing an answer.

     Some friends and relatives come to support the surviving family and the answer is, “Yes, you should come now.”

     Some friends and relatives feel that they should come to say goodbye or see her one last time.  I don’t think that there is a rule or a book that will give you the answer when this is the intent of the question.  My personal thought is no.  Granny was always a proud and proper lady who dressed tastefully.  She would never have wanted to be seen this way.  Pay your respects while she is alive and viable and well and can enjoy a visit.  Remembering a picture of what Granny looked like on her deathbed is not the way she would want to be remembered.  Those images are indelible.  I think no, don’t come now.  It is too late.

     The other event that invariably occurs at these times is the expression of sympathy and grief for surviving family members.  This is well intended but it is misdirected.  The real grief and sympathy should occur during the time of infirmity and decline.  The burden on a family at these times is extreme.  When she finally passes away, it is really a time to rejoice.  This poor soul is released from a life that was miserable for her.  Her suffering is over.  No one likes to lose a loved one.  I feel the loss occurred over the previous several years but not on the day her heart stopped.

     We are now in the 4th year of a new Millenium.  I enjoy reading old textbooks of medicine I have accumulated, some as long ago as 1857.  The strides in medical care and understanding of disease in the last 100 years are awesome.  We have now completed the human genome project thereby having a blueprint of how the human body develops and functions. This next century will very likely result in medical gains that would make a travesty of all that we know now.  But in 100 years from now, there will still be grannys who slowly deteriorate and eventually pass away after a period of misery.  At this time, Dr. Kevorkian continues his sentence in a Michigan state penitentiary.  One of his messages was that granny should not have to suffer when she no longer wanted to be here.  Speaking for myself when my time comes, I agree with him.  I would like a dignified death at a time of my choosing without a prolonged period of misery and suffering.  It would be my hope that in the next 100 years, our society becomes civilized enough to recognize this need.  I have heard it expressed that the real criminals are those who put Dr. Kevorkian in prison.  In my opinion, there are shades of right in that view.