Death Is Not an Emergency

The nurse manager on the oncology unit asked me to look in on Marcelo and his wife. Marcelo was 62 years old and dying of cancer. It had originated in his colon and metastasized to the spine and liver. This was the fourth time he’d been admitted to the unit, and this time he wouldn’t be going home. The next stop was hospice, but his wife would not or could not entertain the idea of her husband dying.

I introduced myself to Mrs. Ruiz as Chodo, the chaplain on the unit. “Hello, Father,” she said, assuming that because I was a chaplain I was a Catholic priest. I told her I was a Buddhist.  “That’s OK, Father,” she said. “The Lord has sent you to us. Please call me Maria, and this is my husband, Marcelo. Can you please tell him he has to fight?” She gestured to her husband emphatically. “He is giving up,” she said. “But I don’t believe God is ready for him yet.

“I want to take him home and make him all his favorite dishes,” she continued. “He’s not eating any of the food they serve him here, and to be honest I wouldn’t either.”

I said hello to Marcelo. “Hello, Father,” he replied. Maria offered me the chair next to his bed, lowering her voice. “Perhaps you can say a prayer, Father,” adding again, “He’s giving up and God is not ready for him yet.”

I asked Marcelo if he would like me to pray for him. “Yes, maybe in a while that will be nice,” he replied.

Marcelo had a gentle voice and a very heavy Puerto Rican accent. He was maybe five foot six, just slightly taller than his wife, with beautiful, deep brown eyes and hair now gray but still thick and wavy. I could tell he had once been a handsome man. He was wearing the standard hospital gown, and I assumed it was Maria who had placed a set of rosary beads around his neck. A Bible and a small statue of the Virgin Mary were on the bedside table. He was listening to his wife and smiling.

“How are you doing today?” I asked, looking directly at Marcelo.

“Oh, he’s doing much better, aren’t you, mi amor?” answered Maria for him.

Marcelo smiled and nodded his head as if to say, “There’s no point arguing with her.”

I asked Maria how long they had been married. “Forty years, three months, two weeks, and three days,” she replied, smiling with tears welling up in her eyes.

Marcelo looked at me and said, “She’s a schoolteacher—very smart and good with numbers.”

Maria continued, “I met Marcelo when I was 19. He was the most handsome man I had ever seen. Of course, I didn’t let him know that, not at first.”

Marcelo added, “We met at my cousin Rosa’s wedding. Maria was the maid of honor. I knew the moment I saw her that I wanted to marry her, but I was too shy even to ask for a dance.”

Maria laughed. “Rosa told me about her cousin Marcelo—how cute he was and how shy. She said, ‘He probably hasn’t kissed a girl yet—a perfect gentleman.’ I wasn’t going to let him get away. I walked straight up to him and said, ‘Ask me for a dance.’ ”

Marcelo chuckled. “And I have not refused her anything since that day.”

Maria began to cry and turned her head away, looking out the window. “Ay dios mio,” she said. “Look at that beautiful sky.”

Marcelo looked at me and winked.

Facing both of them, I asked, “So what brought you to New York?”

“Well,” began Maria, “I wanted to be a schoolteacher ever since I was a little girl, and I wanted to get a good job in a decent school. My older sister was already living here and convinced me this was the place to find good employment and raise a family. We came here shortly after we got married. I will be retiring soon, and I have been teaching for 30 years. Dios mio, how it has changed.” She turned to her husband. “Marcelo, tell Chodo what you have done for all these years.”

Marcelo looked somewhat embarrassed. “I told you she was the smart one. I was never any good in school, but she went to college. I began working for UPS and have been there all this time.”

Maria looked first at me then directly at her husband and said, “Marcelo Ruiz, for all these years you have not only worked at UPS—you have supported me, you have loved me unconditionally, and you have been the best thing that has ever happened to me. I am the luckiest woman in the world. And by the way, you are also one of the smartest hombres in Nuevo York and Puerto Rico.”

It was now Marcelo’s turn to cry.

We sat in silence for a few moments. Then Maria asked, “What do you do here in the hospital, Chodo?”

“Well,” I answered, “I am one of the chaplains here. My job is to visit with patients and simply listen to their stories—to offer counsel and spiritual guidance, and sometimes to be with family members of the patients, much the same as the Catholic priest or the Jewish rabbi. However, chaplains are usually interfaith and serve patients of all religions if needed, as well as patients with no religion.”

“So it’s okay that you are a Buddhist and we are Catholic?” she asked.

“Yes,” I said. “Absolutely. In fact, I would love to hear about your faith and what you think you are being called to do right now.”

Looking at Marcelo, she said, “Oh, that’s an easy one. We are being tested right now by the Lord. We are being asked to put all our faith in him and to understand his will for Marcelo.”

I thought carefully before asking my next question.

“You said earlier that you don’t think God is ready for Marcelo. Is it possible that he is?”

“No,” she replied. “He is not ready for my husband. Marcelo is going to get through this.”

This was not the time to be talking about moving Marcelo to the hospice floor.

Maria was a smart woman. She understood what the doctor, the oncologist, and the nurse manager had said to her. She had been witness to her husband’s slow and now rapid deterioration, but she was not yet ready to go through that door. After forty years, three months, two weeks, and three days, she wasn’t ready to say good-bye. She wanted more time.

I turned to Marcelo and asked him if he was ready for that prayer. He said that he was getting tired and would love a prayer. The three of us held hands, and I prayed for the relief of Marcelo’s suffering. I asked the Lord to watch over Maria and to be with her and to show his love for her and Marcelo in the difficult days ahead.

The next morning I went to visit Marcelo. Maria was there, and she looked exhausted. She told me she hadn’t been home now for three days and hadn’t slept for more than two or three hours each night. She had been sleeping in a chair next to Marcelo’s bed, holding his hand and praying. Marcelo was visibly weaker, but his voice was still clear and strong.

“Good morning, Chodo. I’m glad you came by,” he said.

“I wanted to see how you are today. What’s new with you, Marcelo?” I said. “How’s Maria treating you?”

He smiled. I think he was relieved by my lighthearted inquiry.

Then Marcelo told me his story. “I keep telling Maria I want to go home and be with my father in his garden.”

Maria sighed.”Chodo, he is talking crazy from all the medicine. His father died 30 years ago,” she said.

As a chaplain, I am always listening for the story beneath the story when visiting with patients. There is often much more being said than what is being verbalized in the moment. In my early days of training, my supervisor would say, “Remember, you cannot not tell your story.”

Here was Marcelo speaking of his father in the garden. I wondered if this was the “heavenly father” he was referring to. I asked him, “What’s it like in your father’s garden?”

He replied, “I won’t be sick when I am there. I will be happy, and I will be waiting for my darling Maria, but she does not have to rush.”

“You see, Chodo?” Maria said. “He is talking like a crazy person. He needs to come home to our apartment and eat some good food, and he will get better this time.”

We sat in silence for a minute or two. Then I ventured into delicate territory: “Marcelo, are you talking about your heavenly father?”

Marcelo took a deep breath and with a clear voice said, “Yes, Chodo.” Then looking at Maria he said, “That’s who I am talking about, mi amor.”

Maria began to sob. She walked over to Marcelo and lay next to him on the bed. I left them to be with each other. The door was now open—perhaps Maria and Marcelo would be ready to walk toward it together.

The following morning Marcelo looked much worse. He seemed weaker and could barely speak above a whisper. Maria had again slept in the room overnight. There was something different about her this morning. She looked not only exhausted but incredibly lonely.

“It is not getting better,” she said. “They want me to make a decision about hospice. What do you think I should do, Chodo?” We were sitting next to each other at the side of the bed. She was holding my hand and Marcelo’s.

I told her, “I think you should do what your heart tells you is best for your darling husband. I know that if he goes to hospice in this hospital he will be very comfortable and will get great care.”

She took a deep breath. “Then will he get better and come home?” she asked.

“I don’t think so,” I replied.

We sat in silence for a moment that seemed like eternity, until I squeezed her hand gently and asked, “Are you ready?”

“Yes,” she replied.

I asked Marcelo, “Are you ready?”

“Yes,” he replied.

Maria made the sign of the cross and kissed her husband’s hand. We prayed together for a smooth transition from the oncology unit to hospice, for continued relief from pain, and for God to watch over Marcelo.

I excused myself to let the nurse manager know that Mr. Ruiz and his wife were now ready for hospice.

I visited Marcelo every day for the next week. He actually began looking better now that he was no longer hooked up to all the tubes from the oncology unit.

On his last morning he was sitting in a chair at the side of his bed. He was in a private room. Jazz was playing softly on his cassette recorder. I pulled up a chair and sat facing him knee to knee, and we held hands.

“Where’s Maria?” I asked.

“I sent her home last night to get a good night’s sleep. I told her not to come back until this afternoon.” His voice was soft, clear, and strong. “I want her to take care of herself,” he said.

We sat there facing each other while he talked about his life as a young man in Puerto Rico. He told me again how he had met Maria, the most beautiful girl in the world. How perfect they had been together all these years. “You know, I never thought she would marry me. She was from a very good family, aristocrats from Spain many generations ago. Her father was not very happy, but as you have seen, what Maria wants, Maria gets.” He laughed softly. “El amor de mi corazon.”

He told me he was ready and began to cry at the thought of leaving Maria, but he wasn’t worried for her. “She has her sister. They have lots of friends and other family members who will take care of her.”

Quite suddenly he looked directly into my eyes and said, “Chodo, I’m dying.”

“Yes, I know,” I responded. “I’m dying now,” he said.

In the next moment he began to spit blood. Still holding onto his hand, I stood and reached for the emergency buzzer at the side of his bed. Within a minute the nurse was in the room with the attending physician. The doctor saw what was happening and said, “Let’s get him into bed. There’s nothing we can do now.” He added something about platelets and that he had thought this might happen.

Marcelo was lifted onto the bed, and I took his hand and held it until his last breath. The doctor recorded the time and was about to leave the room. I asked him and the nurse to stay in the room with me while I prayed for Marcelo, followed by a minute of silence to honor this wonderful, gentle man’s passing.

It was the first time I had ever seen a doctor cry. When I bowed my head to end the silence the doctor said, “Thank you, Chodo, for asking me to stay. He was indeed a gentle man and much loved by the staff on the unit. He will be missed.”

I called Maria and said she should come to the hospital. She asked if Marcelo was OK. Sensing the alarm in her voice, I said that he was fine and asked when she planned to get there.

She said she had to get dressed and run some errands. “I am so behind in everything,” she said.

I told her not to worry about the errands today. There would be plenty of time for that.

“You’re right,” she said. “I’ll be there in an hour.”

I did not want to tell her over the phone of Marcelo’s passing. I knew she would be distraught and wasn’t sure if her support team, her sister and friends, were around. Death is not an emergency.

I let the nurses know that Maria was on her way. They cleaned Marcelo, and I combed his hair and placed his rosary beads in his hands, which I had folded across his chest.

If you have ever been in the room at the moment of someone’s death, you have probably experienced the shift in energy that occurs and sometimes remains for minutes or hours afterward. I call it the silence of the leaving.

At 10:00 a.m. on our busy inpatient hospice unit, the sounds of the staff on the phone at the front desk and the occasional muffled cries from a family member in a nearby room were not loud enough to break into the mysterious silence of death. I sat with Marcelo’s body for an hour wrapped in this soundlessness.

As a Zen monk I have sat many, many hours in silent meditation in the hope of quieting the mind. There are often a multitude of sounds to contend with, not the least of which is the noise in my own head, the chatter that never stops.

On extended retreats in the still of the countryside, one can hear the crickets trilling in late afternoon and the cicadas at night. We awaken long before the songbirds in the morning and hear them singing as the sun rises. At our center on 23rd Street in Manhattan, the noise of the traffic outside is constant: buses crawling along, the whoosh of air­brakes every few yards, ambulances en route to the nearest hospital on the East Side, all against the never-ending cacophony of hammers and pneumatic drills heralding yet another skyscraper.

Within the silence that follows the final breath of a dying person is the certainty that something is occurring. In the nonmoving movement of air in the room one senses a deep, deep loneliness and at the same time the connectedness of everything.

Like dew drops
on a lotus leaf
I vanish.
–Senryu (d. June 2, 1827)

♦

From Awake at the Bedside: Contemplative Teachings on Palliative and End-of-Life Care, edited by Koshin Paley Ellison and Matt Weingast. Reprinted with permission of Wisdom Publications, www.wisdompubs.org.