Do Go Gentle into That Good Night

Dying is hard on the living.

Dylan Thomas was 33 when he wrote his famous villanelle, which is worth reading in its entirety:

Do Not Go Gentle into That Good Night

Do not go gentle into that good night,

Old age should burn and rave at close of day;

Rage, rage against the dying of the light.

Though wise men at their end know dark is right,

Because their words had forked no lightning they

Do not go gentle into that good night.

Good men, the last wave by, crying how bright

Their frail deeds might have danced in a green bay,

Rage, rage against the dying of the light.

Wild men who caught and sang the sun in flight,

And learn, too late, they grieved it on its way,

Do not go gentle into that good night.

Grave men, near death, who see with blinding sight

Blind eyes could blaze like meteors and be gay,

Rage, rage against the dying of the light.

And you, my father, there on the sad height,

Curse, bless, me now with your fierce tears, I pray.

Do not go gentle into that good night.

Rage, rage against the dying of the light.

Thomas’ father, D.J., was suffering from throat cancer when he wrote this brilliant poem in 1951. Quite understandably, the younger Thomas did not want the elder Thomas to die without a good fight, raging “against the dying of the light.” D.J. had a profound influence on his son’s love of poetry, and none of us want to lose our muse. But D.J. did die in 1952 and, tragically, his son followed him into “that good night” a year later, undone in many ways by losing his wonderful and kind father.

Dying, as we know it in our modern and postmodern world, is very hard on the living.

And we don’t talk about it enough because most of us are scared shitless of death.

As I write this, my sister Lisa and I are visiting with our sister Lynn for what originally was supposed to be a celebration of their birthdays but what has become a mission trip to support Lynn. In a matter of one short week, her husband, Jon, who has been battling lung cancer for the past few years, has suddenly gone downhill fast and hard. A few weeks ago, he was doing Tai Chi, and today, he’s in home hospice. Now, Lisa and I are committed to helping her see his end with as much love and dignity as possible.

While I am saying “the past few years,” my sister Lynn knows exactly how long it has been: Two years and eight months, during which time, she says, she has “been waiting for the other shoe to kick us in the ass.”

That’s the way it is with a terminal illness — an interminable waiting for everyone, but especially the caretakers. It’s beyond frustrating, maddening, heartbreaking. The terrible diagnosis is just the beginning. Then there are the countless doctor and hospital visits, crazy amounts of medications, in- and out-patient treatments, physical and metaphysical pain, angry conversations with healthcare practitioners, billing departments, down times, sad times, in-between times, depression, talking and, worse, not talking about the end of it all, punctuated by midnight visits to the ER and screaming ambulance sirens.

My own husband, Robert, has one of those interminable terminal illnesses: end-stage liver disease. However, unlike the horror cancer can inflict on the body by metastasizing, liver disease can be contained and, if managed well, allow the patient to survive 10, 20, or more years after diagnosis. Robert’s had a shunt that allows the blood normally cleansed by the liver to be rerouted so the liver doesn’t work so hard, which has improved the quality of his life by a million times or so. But before then, I worried every moment he would die the next moment. I can’t tell you the number of times I woke in a fright mid-sleep just to check to see if he was still breathing. He’s done so well with the shunt that he has been taken off the national liver-transplant list for being too healthy. I no longer awake in the middle of the night afraid that he has died, but that does not mean he and I are not acutely aware of our own mortality.

You often hear people say that we begin dying the moment we are born, that cellular death is a natural part of the life process. So, yes, while we do shed brain cells and sex cells on a regular basis while we are young and healthy, senescence — the body’s breaking down and the inability to create anything new — is a whole different ball game. Add terminal illness to that equation, and what you get is a whole lot of grief for those who have to deal with the messy business of certain death.

My sisters and I are veterans of the death squad. We sat through many tortured hospitalizations with our mother — pancreatitis, heart attack, carotid arteries, stroke, and finally, a seizure, and the thing that finally killed her, aspiration that led to an untreatable lung infection.

Despite the various antibiotics the hospital docs gave her, she did not respond. The cells in the lung wall were breaking down, and there was no coming back from that. I wanted to take her off the ventilator and let her go despite objections from my father. I finally convinced the family this was the most humane choice, but when we visited her one last time, she opened her eyes, bolted straight up, and I swear, said, “Kill me now.”

No one else heard what I did, and we opted for the terrible choice of giving her a tracheotomy so she could voice her own will, despite the fact that she had a DNR — a do-not-resuscitate order — that we could not find. She did not regain consciousness. A long and awful month after our mother seized, we all agreed to take her off the ventilator. Lisa, Lynn, and I sat with her holding her hands, holding her close to us.

I remember her leaving the earthly realm quickly, within minute, but Lisa and Lynn remember it being longer, close to an hour. We all agree that she left peacefully, giving up one final huff and breath and leaving.

Grief has a particularly sharp way of slicing and slivering memory.

We were wary of telling our other sister, Mary, about Mom because she was in her fourth year of dealing with — actually, not dealing, but in denial of — breast cancer that killed her three months to the day our losing our mother.

Mary was a brilliant artist and musician who rejected anything normative. We did not realize how mentally ill she was until after her death when we learned she thought her cancer was caused by aliens and she had developed a computer chip to communicate with them.

Our lovely sister Mary holding the Beatles’ “Abbey Road: before she got sick.

Because Mary refused to believe she was dying, we could not recruit hospice help, whose premise is based on the patient accepting their imminent death. Therefore, the family provided her hospice. Lisa and I, physically, were the closest, an hour or three away, so we switched out our times of caring for her. And damnit, if she did not die alone despite our best efforts. Lisa had left her Pittsburgh apartment, and Lynn was planning on coming in the next few days.

The apartment manager had found her, dead near the door, on her way to reprimand neighbors for a noisy party. We both loved and hated her for leaving the way she did, but what we have learned since then is that the dying leave on their own terms. We can love them, but we cannot dictate to them.

In 2014, as I was leaving Pennsylvania to pursue a new job opportunity in Florida, a dear friend was battling cancer. One of our dogs had puppies, and I posted dozens of puppy pics to Facebook. My friend wrote that she wanted to hold a puppy. The very last thing I did as we were packed and headed on our journey south was to stop at the nursing home where she was staying with a puppy in tow. As we walked through the home, faces alit, and dozens of hands reached out to pet the puppy. I was humbled by this outpouring of joy and promised to myself that I would volunteer for pet hospice when I was settled in my new job.

This is the puppy who visited my friend in the nursing home.

Once in Florida, my dear older dog, a chocolate lab named Shaman, and I trained for hospice work. He passed all the tests but had a persistent urinary infection that just would not heal. By the time I took him to the veterinary experts at the University of Florida, the poor guy was filled with cancer so bad the vet was surprised his bladder had not burst because of all of the tumors in his urinary tract. My husband and I decided to put him down right then.

Mommy and Shammy. Photo by Bill Cardoni

Like most labs, Shaman loved to fetch. He could play ChuckIt for hours, maybe days. So, we played fetch until he tired then made our way to a private room where the vet gave him a final injection.

Shaman died surrounded by love in our arms, happy to the end. I would like to die that way.

Robert with Shaman right before we said our final goodbyes.

Because Shaman had died, I did not do pet hospice but did agree to be a vigil volunteer for the hospice organization. Those who work in vigil stay with the dying in their final hours, which can be hours, days, or even weeks.

I firmly believe that one of the best things we can do as humans is surround those who are leaving the world with love.

This training has made me a better person. This training has prepared me well for being a better sister for Lynn when she needs it most.

We haven’t used the word “vigil” per se, but we are holding vigil. Jon is no longer conversant and has begun the tell-tale decline: higher pulse, lower oxygen intake, colder extremities as the body is funneling blood to the major organs, which we know are signs of the body breaking down. And we hate it. Really hate it.

This death is not kind, but at least Jon is not hissing and spitting as he had been when he was still conscious. Even though we knew his behavior was the behavior of cancer that went to the brain and was no longer Jon, it was still very, very difficult for my sister and her daughter to comprehend.

When I worked in hospice, I was sensitive to hearing people say they would never put their loved ones in hospice because they just killed them. Families often are unable to accept the inevitable death of those they love, but hospice does not kill people.

Hospice prepares people — both the dying and the living.

I sit with my sister Lynn who lovingly turns Jon every two hours to prevent bed sores, who changes his diaper, who feeds him medicine, who ends each meeting with a kiss.

None of us here desires or welcomes any of this. Lisa wants to have “DNR” tattooed on her wrist. I wish I could die with the dignity my dear Shaman did. How is it that a dog can have a better death than a human?

Do, do, please do go gentle into that good night. Do not rage, do not fight.

Ask the caretakers. We can do better than this.

Poet, writer, teacher, communications professional, soupmaker, animal lover, dog mom, good friend, grateful woman.