I don't know if I was humbled, anxious, or both. But there I was—in a darkened room, the lights low enough to make you sleepy, high enough to keep you awake. I had been there for over an hour, but hours and minutes seemed meaningless now. I felt like a traveler in a strange country, existing in a moment which was not my own.
I began that Saturday like any other. At five in the morning, my alarm went off and I woke up. I donned my gladiator's armor—running shorts and a light penny—and stomped through the neighborhood under cover of darkness. In the early California fall, the sun doesn't rise until about seven, so my morning resembled a dream state. The darkness was colored with bursts of life.
Back in the room, however, I quickly realized this was not any other Saturday. I had certainly been in this particular room before—this beautiful room, in a quaint hospice facility—bearing witness to stories, struggles, and suffering people. But I had never felt the weight of this particular moment. I was seated beside a weary and unconscious man, his choppy breaths providing the room's sole soundtrack. There was a pallor to his skin, and his head was covered with sparse wisps of hair. The nurses had leaned him to the left to help him breathe, and his arm on that side was markedly warmer than on the right.
I had never spoken to this man, though the nurses said he was in his eighth decade of life and was, above all, a “sweet and kind” person. The man was suffering from a painful metastatic cancer that had spread to his bones, and had reluctantly entered hospice just weeks before. His pain grew alongside the tumors, and he who had once been so active in old age—taking daily walks, perusing local cafés—was slowly but surely losing his life.
As the tumors grew, meaning and suffering hung on opposite sides of a shifting balance. Walks, activities, even conversations grew increasingly difficult for the man. Where his witty jokes had once been delivered with sharpness, they were now uttered through muffled groans. The medications and round-the-clock nursing helped tremendously, but not completely.
This is not to say that hospice had failed the man. The palliation he received allowed for rich, meaningful moments of joy and independence. But still, as mobility and mirth faded—both replaced by intractable pain—the man reached a difficult conclusion: his life was no longer worth living. Or rather, his life was something else entirely.
I felt a somber humility when I entered that man's room. He had recently chosen palliative sedation, in hopes of finding rest through his final sufferings. In the days before the intervention, his close friends arrived to say goodbye. They came to show their love for him, whose fading life was worthy of love indeed.
When it came time for the intervention, the man's friends returned to their far-off homes. I was summoned to his room a few days later, in the early evening of that singular Saturday. The man was close to death, his physician said, and no one should die alone. I, the hospice volunteer, would bear witness to his journey.
Having lived a dreamlike morning, I now entered a quieter, lucid evening. I was 22 years old, watching a man more than thrice my age enter the rest that I might one day seek. The weight of it all was humbling. I remained in that room for nearly two hours, which seemed an eternity. I felt the man's pulse, placed my hand on his chest. I was trying to understand him—trying to feel his physiology, breathe his sporadic breaths. And as I did so, a human curiosity arose from the corners of my mind. What was he like at my age? I thought, What did he fear? What—Who—did he love?
I wondered about his family: Do they know where he is? and about his body: What is happening in his heart, his brain? But most of all, I wondered about him. With every irregular breath, every fluttered heartbeat, I asked the man: What made your life worth living?
Through it all, I felt the far-reaching implications of that moment. This man had, no doubt, made the most difficult of decisions. He had loved life and cherished it deeply. But with pain and dependence his only constancies, he struggled to feel that he was still, indeed, living. He chose palliative sedation not because he failed to value his existence, but because the existence that he had so valued was gone. For him, the question was not one of years, or consciousness, or philosophy. The question was much simpler than that—one of life and love.
By the time evening had descended, the world outside bore a striking resemblance to the early morning darkness of that day. Yet even in the dimly lit room, I was wide awake. I was wholly aware of the moment as I matched the man's breathing, felt his pulse, imagined his life. I could not help but sit silent, awestruck at the fullness of life that was passing before me. I was humbled, utterly humbled, at the realization that had been running through my mind: that I never would, and never truly could, understand what made this man's life worth living.
That realization was, for all its humbling power, just fine with me. My duty as a hospice volunteer was never to find answers. If I had known the man while he was conscious, I would have asked him about his loves, his fears, his life. I would have explored with him his humanity, striving to know his deepest values. But as things stood, I could only wonder.
And was that not enough? In this complex field of palliative care, where the most important outcomes are often immeasurable, could I perhaps learn to appreciate the idea of not knowing?
I stayed far past the end of my shift that evening, holding the man's hand as his body slowed toward eventual rest. While he still was still breathing, albeit softly, a health aide entered and placed her hand on my shoulder.
“You should head home, honey,” she said, in the gentlest of voices. “I'll take over for you. It's late, and you need some rest.”
I sheepishly nodded, and rose up to stand. My once-warm muscles creaked with stiffness from hours in the chair, like hot magma cooled to raggedy rocks. I turned toward the health aide and asked for one moment with the man who was, just hours before, a total stranger. She closed the door quietly, and I laid my hand on his arm.
“Thank you, sir. Thank you for letting me be here with you. Even though we've never spoken, I can tell you're an incredible man, and I won't forget you. You've taught me more than you know. Good night, and I hope you find the rest you're looking for.”
I thanked the health aide, gave her a hug, and walked out into the settled evening. The night was cool and calm, much like the morning; I barely perceived the layers of the moment. Yet days later, as I ran once more through the silent morning, my mind turned to that same evening. There was odd juxtaposition to the whole scene: the vigor of my morning, the stillness of the night; the potential of youth, the fullness of old age.
All of a sudden, my previous wonderings made sense: they were not the daydreams of a detached young man, but humble inquiries into a future unfolding before me. The man in the room had suffered like so many people had suffered; like I might one day suffer. In asking those questions of life and love, I was trying to answer them for myself.
And there was the crux of the matter. The man had lived a full life and had met those questions in the due course of years. He knew what he loved, what he feared, what he was living for—and he knew this with the assurance of age. I, on the other hand, had lessons to learn. I had years yet to live.
As my legs churned through the new morning air, pounding the pavement with each pulsing step, I understood. I understood that the man in the room was not a stranger, but a version of myself. And I was a version of him. He was mortal like I was mortal; he had suffered like I might suffer. These thoughts saddened me for a moment. But then I remembered his friends, his story, and the wisdom he had taught me. I turned these thoughts over as I ran, and my breaths grew softer.
The evening would come, I knew. But I would be there to meet it.
Author ORCIDs
Aldis H. Petriceks 0000-0001-5136-1023.
Acknowledgments
All identifying features of the patient described in this essay have been removed or deliberately altered. No competing financial interests exist for the author.