As I sat at the bedside talking with my 90 year old lady who was struggling with cough and chest congestion from pneumonia, I was struck by the realization that this was it for her.  She and her family had already previously decided that there would be no further aggressive care because of her severely debilitated state, constant pain from arthritis and post herpetic neuralgia, and overall poor quality of life.  She had stopped eating several weeks ago and had been stubbornly refusing to take most of her medicine.  Hospice consultation had been requested but not available yet.

     "What do you think about my condition?", she asked.

     "I think you've got a pretty bad pneumonia.", I said, hoping to avoid the conversation that was probably coming next.

     "Do you think I'm dying?"

     Not wanting to lie, I said, "Well, it does look like you may have reached the end of the line, although I've thought that before and you've made it through somehow."  I thought about her several prior hospitalizations over the past 2 years for things like endocarditis, pneumonia, pulmonary embolism, etc.

     "You think I'm at the end of the line?", she repeated, trying to comprehend.

     "It kind-of looks that way.  It looks like you're pretty miserable.  I think we should give you some medicine to make you more comfortable."

     She was quiet for a moment and then I forged into something that I had never done before.  "Do you believe there's an afterlife?", I said.

     "An afterlife?  I don't know."

     "I'm sure there's a much better place we go to after this."  Having read a number of books about near-death experiences and combining that with my own faith, I felt fairly confident about this statement, although I must say that I have never been an overly religious person.  I generally don't go out of my way to pray with people, although I know there are many physicians who feel comfortable with this.

     " How can you be so sure?"

     " I've researched it a lot and the evidence is overwhelming.  I'm sure of it."  After a pause, I said,  "Don't be afraid.  There is nothing to fear."

     "I am afraid."

     "That's only natural, but really you don't need to be afraid.  Everything will be all right in the end - You'll see."

     I could see she was contemplating this and seemed more comfortable thinking about it.  After a time, I said my goodbye and got up to leave while trying to reassure her not to worry.

     I thought about her all during the evening, hoping I had said the right things.  I'm not really sure if I did or not.  I got a phone call early the next morning from the nurses telling me she had been calm during the night and then died peacefully in the morning.

The family was grateful for all I had done for her over the last 25 years or so.  I think they were mostly grateful, as was I, that she was at peace now, no longer suffering and almost certainly in a better place.

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