At My Father’s Bedside
by Chaplain Bruce Feldstein MD
Ten years ago, when I turned 50, my parents flew in from Michigan. My father told
me a story during that visit that would change my life. We were driving down El Camino
in Palo Alto one afternoon when I mentioned that a friend’s husband died on the Jewish
holiday of Purim. “My mother died on Purim, too.” Dad remarked. “I never knew.” I said.
Dad continued, “When I was 10 she came down with diabetes. I would get up in
the mornings to boil the needles and give her her insulin. They didn’t have disposable
syringes then. She had a stroke when I was 19 and was hospitalized. I was working at
Cunningham’s drugstore and suddenly sensed that something bad happened. I told my boss
I was leaving, took the trolley to the hospital and ran up to her room. Empty. I was too
late.”
As Dad spoke, I felt a punch in the gut and my chest constrict. The car got very
quiet. He continued. “I took the bus home, sat in the back crying. My brother Ben told me
he called the drugstore to tell me that Ma died, but I had already left.” His eyes reddened
with tears as he sat next to me in the car. “I repressed all this. I still can’t walk into Grace
Hospital.”
My father never talked to me that way before or since. I made a promise to myself
that when his time came, he wouldn’t die alone.
_________________________________
Three years later, at the end of March, Dad talked to me by phone from a hospital
bed in Florida where he spent the winter. “My liver and kidneys are failing, multiple organ
failure.”
As a former emergency physician for 19 years and a hospital chaplain for seven, at
the time, I pondered Dad’s history of heart failure, the dismal prognosis, and his long
experience as a physician in general practice. “What do you want the doctors to do?” I
asked. “Put me to sleep,” he said simply.
Dad loved life and cherished the pleasures of living. He also knew well that we all
have to go from something. A time comes when enough is enough. He knew his body
couldn’t keep going, that he was dying. He could accept that.
We transferred Dad by Aerocare air ambulance to St. Joseph’s hospital in Michigan
and I flew in from California. My first stop was to see Mom. I found her in the bedroom,
sitting at her make-up table in front of her mirror, looking small and beaten down. “The
nephrologist says we can give him dialysis,” she said, pleading for hope. “It will help him
with his symptoms. We can stop it after a few days.”
© 2014 by Chaplain Bruce Feldstein MD. All Rights Reserved
1!
I thought about my father’s father. In the old-folks home one day, Zayde’s leg
became very swollen and red with a blood clot. The usual treatment was immediate
hospitalization for blood thinners to dissolve the clot and prevent an embolus from
dangerously breaking off and lodging upstream in the lung. Dad didn’t send him to the
hospital. Days later, Zayde died.
When Dad’s sister Bessie was 90 she was hospitalized with heart disease and put
on a ventilator. She struggled horribly for a month, skin sloughing off her lower legs
before she died. Dad was disgusted. Said if it were up to him, he would’ve let her go way
before. But it wasn’t up to him.
So now it was his turn. Again, it wasn’t up to him. It was up to my mother, Sue, his
wife of 56 years. He would do what she wanted. He wanted to please her. That’s always
how it was.
I knelt down next to Mom and took her hand. “Mom, the loving thing is to let him
be, and let him go.” She sobbed. “This takes courage. I know you can do it. Dad does,
too.” I thought about my sisters and brother. “And Karen, Andy, Lisa and me, we are here
with you.”
We drove to the hospital and entered Dad’s room. My sisters and brother stepped
out to give us time alone. We sat. With barely the strength to speak Dad said, “I need a
new heart…no bullets left…I decided…no more.”
“What do you mean? No more treatments? Keep you comfortable” I asked. “Yes,”
he nodded. His eyes filled with tears. “How is it?” I asked. “Good and bad,” he said.
“What’s bad?” I asked. “Please,” he said, annoyed with my question. I was quiet.
After a while, gently, I offered, “Can I share with you some things I’ve learned about
dying, from different traditions and patients who’ve had a near-death experience?
Dad and Mom are not the reflective or philosophical types. Both looked at me,
nodding yes. I was relieved.
“The moment itself is peaceful, I’m told. No fear. Simply letting go. Smooth, like a
hair being pulled from milk. Floating away. Some say there is a light and what you do is
allow yourself to let go and dissolve into the light.” He listened closely. I continued, “You
know, we human beings have been dying for a long time. Your body has a natural wisdom
built right in for shutting itself down. The body knows just what to do. And there are
medicines along the way to keep you comfortable.”
Mom reached out and Dad placed his hand on top of hers. His hand was too painful
to have her grasp it.
I stood and took a long breath. “There’s something I’ve come to realize,” I began.
“Death is not a failure of life…but a fulfillment of life…a fulfillment of a promise made
the moment we take our first breath, that some time later—and we don’t know when—
we’ll take our last.” I rounded my hands and brought my thumbs and finger tips together
into an open ball. “This last breath will circumscribe the wholeness of our days. We are
entering those final days.”
© 2014 by Chaplain Bruce Feldstein MD. All Rights Reserved
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I paused for a moment, to gather the courage to continue. I certainly didn’t want to
annoy him.
I looked at my father. “There are special words from our tradition for this time.
With your permission?” He nodded. I looked up. “On behalf of my father, we gather
before you O God, Source of Life, each in our own way. We acknowledge that death, like
life, is in Your hands. My father’s death, whenever it comes, may it be in love.” I looked
back at my parents. “May it be gentle and kind. May he know that he is not alone, that he
is accompanied by those he loves.”
“Any regrets my father may have—with others, with You, with himself—may
they be forgiven.” My father began to cry, shuddering with tears and sobs. I saw him cry
once after Aunt Bessie died—but not like this. I somehow remained focused. “From these
tears to Your ears, hear all the unspoken words of his heart,” I said.
His tears subsided. “That which is incomplete, may it be considered complete.” I
spoke of all the good he brought into the world, and we recited the Shema, the prayer a
Jew says before dying. Then Dad spoke, gave instructions on cemetery plots and his
funeral, and turned to Mom. “Sell the car and buy whatever you want.” “A Jaguar,” she
announced. He smiled then looked at me, “It’s an old story.” They had nothing more to
say. I thought of one more thing. “Dad, if you have any concerns you can’t communicate,
you can trust, they will be taken care of.”
Silence. We were complete. Our focus returned to the room. The door opened. My
sisters and brother came in. We talked with the nurse and proceeded with comfort care.
When the nurse left to get the morphine, my sister Karen reached down to an ice
bag my sister-in law brought for the occasion, pulled out a bottle of Sam Adams beer and
popped it open. Dad had a terrific hankering for a beer but couldn’t have one with his
kidney failure. Karen put a straw down the bottle and held it up to Dad’s lips. Up to now
he was only taking a few sips of water or Vernors soda. But he sipped that beer, and to our
absolute delight, sipped and sipped and sipped some more until he finished off that entire
bottle with a loud slurp. The nurse returned with a syringe of morphine and slipped the
shot into the IV. Dad’s eyes glazed over, his face totally relaxed, so pleasantly intoxicated
after his Sam Adam’s beer with a morphine chaser.
_________________________________
It is 3 o’clock in the morning, a second night of vigil. I am sitting at my father’s
bedside. The rest of the family has been gone for several hours.
Light from the door, cracked open to the quiet hallway, is falling across his barrel
chest and sunken abdomen, illuminating the rhythmic rise and fall of his breathing, a
musical rhythm in four-four time: 1~2~3~4~1~2~3~4… exhale~rest~rest~inhale,
exhale~rest~rest~inhale…his chest rising then seamlessly falling, a series of fourteen
breaths followed by a long pause lasting for a count of seven breaths, then repeating. He’s
been breathing this way for over a day now. I’ve seen this “Cheyne-Stokes” pattern before,
but always thought it came just before the end. I didn’t realize it could last this long. Like
the Energizer Bunny, he keeps on going.
© 2014 by Chaplain Bruce Feldstein MD. All Rights Reserved
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The plastic cannula supplements oxygen to my father’s nose during his quiet
inhalation. I never paid such close attention to someone’s breathing. A two-part exhalation
against pursed lips, Hoo-hoo, an accented first push, followed instantly by a short
remainder, a blowing sound. Not exactly “phew,” as through tightly pursed lips, but a bit
softer and slower, a breathy “hoo,” like when you blow the silver petals off a dandelion, or
when you remove an eyelash with your finger from a lover’s face, make a wish and “hoo”
it away.
I become mesmerized as I watch and listen, matching the breathing that is my
father’s song: Hoo-hoo ~ rest ~ rest ~ inhale … Hoo-hoo ~ rest ~ rest ~ inhale … Hoo-hoo
~ rest ~ rest ~ inhale …
Something curious begins to happen. A voice emerges in the exhalation. “Thankyou…Thank-you…” What am I hearing? I wonder to myself. It is my father speaking.
Not his actual voice, but most definitely his words. “Thank-you…Thank-you…Thank you
for my life…Thank you for my parents.” Extraordinary. I’m listening in on a litany of his
gratitudes over the arc of his life. “Thank you for my seven older sisters and brothers…for
football in high school that got me into pharmacy school…for my wife and children…for
becoming a physician after my drugstore burned…for friends along the way, and
grandchildren….and for all those moments of pleasure…the Sam Adams beer with a
morphine chaser—such a mechaiyah!”1
A new voice emerges. “Thank you…thank you….thank you, Herb. Thank you for
choosing to come into this world. Thank you for being there for your mother and father.
Thank you for the care you provided to so many…for getting out in the middle of the night
to deliver new babies into the world…for repairing a working man’s ripped open
hand…for all the unseen moments that live only between you and Me…I remember,
always…and thank you for all the pleasures you took, for we cannot know pleasure except
through you who live in a body, and for that we are grateful.”
Who, Dad, are you talking to? I wonder to myself. Then I realize. Our bodies and
our breath are there even before we are, before our awareness of ourself and our life. If our
body, our breath, belong to life, who is doing the breathing? Who is in the breath that is
listening and responding to you, thanking you? Who?”
And then, I begin to see. Ah, yes. It is “Who.” The One to whom we wonder, to
whom we express our ultimate gratitude. The One who has been there all along, already
always, in the breath that becomes our voice and sounds and words, the breath that
animates our bodies. The Mystery, the One we call “Who.” Or “Who?” Or “Who!”
“Hoo-hoo.” The breath that moves through this body, in and out, until the moment comes
when it returns from where it came, home.
____________________________
The next midnight I return for a third night of vigil, the night of the daylightsavings change. The rhythm of Dad’s breathing continues, more shallow, with longer
periods of rest. His arms and legs are now swollen. There’s a wet, raspy quality in his
breathing. Fluids are going in but none are coming out. I’m scared he’ll go into pulmonary
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
1!Hebrew!for!relief,!great!feeling.!
© 2014 by Chaplain Bruce Feldstein MD. All Rights Reserved
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edema and internal fluids will overflow into his lungs and make him uncomfortable. The
nurse assures me if it gets worse she’ll call the doctor. His breathing remains steady and
shallow.
It is two a.m. – the clock springs ahead. Three o’clock comes and goes. I don’t hear
any “Thank You.” The nurse checks on him, keeping him comfortable with Ativan and
morphine. Tonight he doesn’t reach for the catheter, or try to raise his arms that would
only fall to his side. I close my eyes for a moment and smile, recalling Dad’s face after the
morphine chaser…
… The nurse enters. My eyes open, a pale light through the windows. It is seven
o’clock. “No urine output through the night,” she reports. “Would he want to be
repositioned?” I think of the Jewish teaching of the goses, to not disturb a dying patient
who is like a flickering candle. But, I also want to keep him comfortable. “Sure,” I say, “go
ahead.”
I go into the adjoining bathroom and return moments later. The nurse looks up, “I
think he just took his last breath.” She feels his wrist. No pulse. You did it, good for you! I
instantly think to myself, closely followed by I leave for a matter of seconds and miss it.
Hmm. Just like stories of people who “wait” to let go of their final breath until loved ones
leave.
Bewildered. What should I do? I kiss my father. I look at him. I cry for a brief
while. Not like the prolonged cry after I arranged for the air ambulance, or sobs that would
come, sometimes unannounced, even years later. I call Mom and the others. As I wait, I
sense a quake in my being, a crack deep below the surface of things, like a tremor that will
surface later. He is silent. Completely silent. It is over. His eyes are closed, his mouth stays
open. He is still warm, and still, very still.
At the bedside of patients after they die, I sometimes get the sense that their spirit is
hovering. But not at my father’s bedside. With his breath gone, it feels like his spirit has
gone as well. Quickly and very far. As if there were two teams tugging, pulling him evenly
between here and there. His body let go and he recoiled into the beyond, ever after.
© 2014 by Chaplain Bruce Feldstein MD. All Rights Reserved
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