My Patient Invited Me To Her Home To Watch Her Die. What I Saw When I Arrived Gave Me Goosebumps.

There was a sudden feeling of guilt and shame when I realised I should have brought Mrs MacNeil a farewell gift. Maybe some flowers or a teddy bear. It would have been a thoughtful gesture. After all, this was going to be our final farewell.

I was making a house call to see my favourite 93-year-old patient living in a seniors residence in Toronto. We had bonded over the last few years, and it felt more like a close-knit friendship than a professional relationship.

We enjoyed joking around and talking about the beauty of life and all the wonderful places on our lovely planet, and the beautiful people. We also spent a lot of time talking about Nova Scotia, where we both used to live. 

This was going to be our last visit. She was about to receive medical assistance in dying, which we refer to as MAID in Canada.

When a cherished dog or cat is old, sick and suffering, we “put them down”. The technical term is euthanasia, which comes from the Greek word “euthanatos”, literally meaning “a good death”. We euthanise our beloved pets because we don’t want them to suffer, and we want them to die with dignity.

In 2016, the Parliament of Canada passed federal legislation allowing eligible adults to request medical assistance in dying, essentially legalising euthanasia for human beings to allow for “a good death”.

It was decided that, like our precious animal friends, we should have the right to avoid suffering and die with dignity when there is no chance of reasonable alleviation of a disease or condition, or of sustaining one’s quality of life.

The legislation effectively acknowledged that death is a part of life that should be discussed and even tenderly embraced at the appropriate time. It gives adults of sound mind the option to dismiss the notion of “raging against the dying of the light” as depicted in Dylan Thomas’ famous poem “Do Not Go Gentle into That Good Night”.

Mrs MacNeil was a proud and independent woman who wanted to remain in control of her body, her health and her life. It was her wish to exit this world on her own terms. She was intelligent and competent, and she understood her medical condition precisely.

Her health was deteriorating due to several debilitating and incurable diseases, including cancer. She knew her health would soon worsen dramatically. Sadly, she had been feeling especially unwell for over a year, and it became impossible to sufficiently lessen her suffering.

So, she had had enough. Her health care providers, including myself as her primary physician, her friends and her relatives all supported her carefully measured decision to end her life with comfort and with dignity. After all, it was all about her. 

Mrs MacNeil told me she had lived a long and meaningful life. She travelled all around the world. She made many friends. She lived life to the fullest.

Her husband had passed away years ago and they had no children, but there were nieces and nephews who loved her dearly. She had no regrets whatsoever and was ready to disembark from her fantastic journey on this earth. She clearly demonstrated that she had the capacity to make such a monumental decision. 

The previous time I had seen her, she sat down and paused for a few seconds, and then looked at me earnestly and asked, “Will you be there to hold my hand?”

How could I refuse such a request?

I felt it would be a great honour and privilege, but I wondered if I would need someone to hold my hand as well. I was a little scared. I had never been present at such an occasion, partly because of scheduling issues, and partly because I worried about my own discomfort. Perhaps mainly because of cowardice.

But Mrs MacNeil was a special lady. Above all, I wanted to respect her wish and make her happy.

As I entered the seniors residence and nervously walked into Mrs MacNeil’s suite, I took a deep breath. There she was, standing in the middle of her living room, dressed impeccably and wearing some makeup. She was in her element. Seeing my terminally ill patient looking so majestic gave me goosebumps.

As she noticed me enter, a warm smile spread across her face, and her eyes sparkled. I immediately realised my participation in this momentous event was most appropriate.

Mrs MacNeil looked so happy – triumphant, even. We hugged, and she thanked me for being there. There were already others in the room, including family members and the doctor who would be performing the MAID procedure. I introduced myself to each of them and was relieved that everyone was both composed and compassionate. It certainly helped soothe my apprehension.  

Mrs MacNeil cheerfully stated that she had a gift for me, and she gently handed me a souvenir from Nova Scotia. It was a seagull wearing rubber boots carved out of wood. 

“I’ve had this for many years!” she exclaimed. “I thought about it and decided you’re the one I’d like to give this to.”

I was deeply moved as I embraced the seagull and then gave her another hug. I felt another wave of guilt and shame for not bringing her a farewell gift. Despite feeling blindsided by her thoughtfulness, I accepted the gift with a lump in my throat and told her I would always keep it and always remember her.

As the MAID physician prepared the medications, I wondered how Mrs MacNeil would feel in her final moments of life. She already had an intravenous line in place and I sensed that she was feeling nervous, excited and relieved all at the same time.

Everyone gathered in her bedroom, and she lay down on her bed for the last time. There was a sense of calm. Were we prepared for what was about to transpire? I felt like a wide-eyed child full of wonder about to experience something completely new.

The MAID process was thoroughly explained again for the umpteenth and last time. Then Mrs MacNeil was asked one final question: “Are you certain you want to go through with this? There is no turning back.” 

“Yes,” she responded clearly. 

She was prepared and content with her decision. 

I sat down beside her and held her hand. I looked into her eyes, which were clear and focused. 

I whispered into her ear, “I have a gift for you, but it’s not a physical gift. I think you will recognise this...”

I began singing Farewell To Nova Scotia, a well-known traditional song from our province.

The sun was setting in the west
The birds were singing on every tree
All nature seemed inclined for rest
But still there was no rest for me

So farewell to Nova Scotia, the seabound coast
Let your mountains dark and dreary be
For when I’m far away on the briny ocean tossed
Will you ever heave a sigh or a wish for me?

A radiant smile slowly appeared on Mrs MacNeil’s face, and she kept her eyes on me the entire time I was singing to her. I felt this was quite possibly the most befitting farewell gift I could have given her. 

The medications were slowly introduced into her IV. She closed her eyes, and with that lovely smile still on her lips, she went gently into that good night. 

The room was quiet as everyone processed the sublime event that had just taken place. I had to reach for a tissue to wipe the tears welling up in my eyes. Although it felt odd, it also felt right. 

There are many who feel it is wrong for health care professionals to “play God” – to decide who lives and who dies. But one could argue that such circumstances go beyond “wrong” and “right”.

It’s about acknowledging the individual’s autonomy and their decision about what is appropriate for themselves. What is “right” or “wrong” depends on perspective, and when it comes to the health and body of a human being, the most important perspective is that of the person who is facing their own mortality. It is a sacred perspective.

Mrs MacNeil was in tune with what was happening to her body and what was going to happen to it. She made an autonomous decision of sound mind. She knew what she wanted – and what she didn’t want. Furthermore, she was able to feel the enormous satisfaction of regaining control of her body, which was full of aggressive and unappeasable afflictions. 

It made me wonder about my own eventual exit from this world. Would I rage against the dying of the light? For how long? I would hope to be kept comfortable. If that were not possible, would I decide to take the reins of my departure from life into my own hands? I’m certainly more comfortable with that idea after watching Mrs MacNeil die.

As a result of my first experience witnessing MAID, I received not only a wooden seagull from a special lady, but also another precious gift: a firsthand understanding of a good death. 

Mrs MacNeil had a dignified end to her long life, surrounded by loved ones. It was her decision. And it was a beautiful final farewell.

Note: Some names and details have been changed to protect the privacy of individuals mentioned in this essay.

Dr. Herag Hamboyan grew up in Nova Scotia, Canada, and is the medical director of 20 senior homes in the greater Toronto area. For the past 15 years, his main focus has been caring for medically complex elderly patients, many of whom suffer from dementia. He is also passionate about providing end-of-life comfort care.

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