A friend deliberated whether she should visit her father for his 95th birthday. She was swamped with commitments. Since he was unaware of his birthday as well of his surroundings and didn’t even recognize his three daughters, there was no urgency to travel to another state.

However, she cleared her schedule and made the trip, as did another sister and a niece. Both lived out-of-state also.

As it turned out, on his birthday, he had a choking episode with difficulty breathing. He stopped eating and died three days later, surrounded by those he loved who otherwise would not have been there had they not come to commemorate the day he was born.

This story reminded me of a patient I cared for back in the early ‘90’s when I worked as a nurse practitioner in a home care program. I had made a first visit to an elderly man in the western suburbs of Chicago who was referred by his doctor because he had terminal cancer (I don’t remember his diagnosis). But I do remember his sunny apartment. He and his wife sat on the sofa, holding hands, his wife’s face streaked with tears. She had just been informed she had breast cancer. The patient calmly told me he wanted to help his wife through her ordeal. He would call me when he was ready to be admitted.

Sure enough, a couple of months later, he called telling me he was “ready to die.”  In another sunny living room, the patient and his wife held hands as they sat side-by-side on a floral sofa in his daughter’s home where they had relocated. His appearance had changed little since I last saw him. His wife had had successful treatment of her cancer and now his responsibility ended. The serenity of that visit remains vivid in my mind as he, his wife and daughter discussed his impending death.

After he disclosed he was having pain, we agreed I would return the next day bringing morphine with me. When I arrived the following afternoon, he was comatose. His daughter called later that evening to say her father had died.

Was it a coincidence my friend’s father died during the time his family gathered around him? Did my patient let go when he knew his wife no longer needed his support?

Calla lilyMaggie Callanan and Patricia Kelley, both nurses, co-authored Final Gifts, a book that speaks to the dying experience. They use the term “nearing death awareness” which “is a special knowledge about—and sometimes a control over—the process of dying.” In a chapter called “Choosing a time: the time is right, they describe how some dying people “choose the moment of death.”

Vignettes of both sudden and lingering death portrayed in Final Gifts show us “what is needed in order to die peacefully” and how “those close at hand can help bring that person peace and recognition of life’s meaning.”

I read this book years ago. Having read it again, I only appreciate all the more how much of a contribution Callanan and Kelley make toward our knowledge and understanding of the dying process. They do this by telling their nursing stories.

I encourage you to read this book.

What stories can you share about your experience with “nearing death awareness?”

By Marianna Crane

After a long career in nursing--I was one of the first certified gerontological nurse practitioners--I am now a writer. My writings center around patients I have had over the years that continue to haunt my memory unless I record their stories. In addition, I write about growing older, confronting ageism, creativity and food. My memoir, "Stories from the Tenth Floor Clinic: A Nurse Practitioner Remembers" is available where ever books are sold.


  1. Recently, a senior I know at my Fellowship lost her older brother. She was able to be with him near the end, staying with his family out of state. It had been after a long illness so was not unexpected, yet I found her recounting of his death with hospice on the premises very dear and special, a gentle moving on. She also said something I had never heard before and it touched me. She said she had “in his death lost her only WHOLE LIFE WITNESS.” That very expression seemed to raise up the nature of life and death in a new way for me, showing the interconnectedness of it all. I’ve been more mindful of my familial relationships since she said those words – and today is my only sister’s birthday, she’s four years older!


    1. Thank you for reminding me of how important our familial relationships are. I have two relatives alive that are my WHOLE LIFE WITNESSES. And in both cases, I am negligent in contacting them.


  2. This reminds me of a man I worked with (as his social worker) who was inpatient in a VA Hospice Unit. His wife, children and the nursing staff were very attentive and he was rarely left alone, even for a few minutes. His wife usually spent the night in his room. One morning, when she slipped into his bathroom for a few minutes to shower, he died quietly. It was as if he waited until he was alone. I believe that he may have wanted to die alone…perhaps sparing his wife and family the moment of his death.


      1. I think it does happen more often than we think. Earlier this week, a friend’s mother died at the age of 91. She had been living independently in her own home for many years. She fell at home in late December, as one of her children was preparing to leave after a holiday visit. She didn’t think she suffered any injuries but was hospitalized a few days later with an upper respiratory virus and severe back pain. After weeks of inpatient care, back surgery and attempts at physical therapy, she continued to decline and was eventually transferred to an inpatient Hospice Care Center one week before she died. Her children visited often during her weeks of hospitalization and rehab and all five children spent significant time with her during the final week of her life, but it was during a severe snow storm, when her children were unable to be with her, that she finally passed away in the early morning hours…with a nurse by her side. I have to wonder if she chose to slip away quietly at that time to spare her children of the moment of her death.


      2. I think when we are more aware that sometimes the dying want to spare their families, we do recognize this happening. Years ago, my mother told me her mother sent her out to the store–my grandmother was dying of stomach cancer–and when my mother came back, my grandmother was dead.


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