The Long Goodbye: Watching Someone You Love Accept Death

A few weeks ago, I spoke by phone to Holly Prigerson, a clinical researcher on grief at the Dana Farber Cancer institute at Harvard. She told me something that lodged in my brain. Research has shown that when a terminally ill patient "accepts" her death, the bereaved—her family and friends—typically find their grief more manageable than when a terminally ill patient is in "despair" about her death. It is, of course, difficult to study "grief," because the salient feature of grief is that it's not monolithic or singular; it's personal and variable. That said, there are many universal features of grief, I've discovered from talking to and hearing from others who've seen loved ones die. And one seems to be this, the ameliorating influence of watching your loved one accept his or her death.

Needless to say, witnessing the acceptance is painful in its own right. One conversation stands out to me. It took place at the hospital about 10 days before my mother died. We had taken her there because she woke up one morning in a delirious fever, though she had seemed her usual self the night before. We didn't know it at the time, but her liver had begun to fail. She was in the hospital for six days. For two, it seemed as though she'd never be coherent again. But on the third morning, she woke up clear-headed. A mini-resurrection, I thought; the rock rolled back from the cave. My brother had spent the night on the couch and was serving her breakfast when I got to the hospital. "Hi, Meg," she said cheerily; just to hear her tone—her old loving tone—shook me.

Our conversation took place a few days later. I had stayed overnight with her in the hospital, and I was trying to find a local oncologist so the hospital could release her. At this point, my mother wanted deeply to go home, but I couldn't get the nurse to give us permission, because my mother's doctor was in New York. What they wouldn't say, but what we knew, was that we needed a local doctor because time was short and more emergencies were bound to occur. It was a Saturday, and the only oncologist around was a doctor named Malefatto. After a silent double take—his name, traced back to Latin roots, sounded a lot like Dr. "Wrongdoing" or Dr. "Badly Done"—I asked the nurse to send him to our room when he did rounds.

Dr. Badly Done turned out to be kind. And he did well something that is easily done badly: He told my mother she had a few days or weeks left to live, a fact she had not quite taken in. It was his job to tell her that she had to decide whether she wanted to become a "hospice patient"—to receive only pain management rather than medicine that might help slow down, say, her liver failure. He said something about "what remained to be done"; my mother misunderstood him and said she didn't want any chemotherapy. He corrected her: "There's really no more chemotherapy we can do," he said. In that moment, I saw my mother realize, anew, what she had realized earlier that fall when her primary doctor told her there were no remaining treatments. "So," she said slowly, "there is nothing left to do?" "No," said Dr. Malefatto. Her face grew still. I could see how strange this was to her, as it was to me. Five days earlier, she'd been walking around, even going to work for an hour. Now she couldn't stand without one of us lifting her. How had we gotten here so fast? Then she looked at me. "I have to call your father and tell him," she said.