Death is “like being made to walk out of a movie you are enjoying”

How do you deal with cancer? What do you say and what do you want to hear when you are the patient and when you are the dear one?

Do you cling on or let go? Do you deny or resign?

During my few years of association with people who provide palliative care, I have been witness to how different people react to the big diagnosis, the gloomy prognosis and the inevitable. I have heard my professional friends talk about a good death. Can we ever accept that death can be good?

What follows is written by Lee Child in his book, The Enemy. I have retained what is relevant to this post and introduced the subheads. The text I have added is in italics or within square brackets.

Thank you, Lee, for permission to use this part of your great work.

♥ ♥ ♥

After hearing from her doctor that she was dying, Jack Reacher and his brother Joe are in Paris to meet their mother.
They know something wrong, they know about an accident.
This description of the time they spent together is in Jack’s words.

We heard slow shuffling steps inside the apartment and a long moment later my mother opened the door.

She was very thin and very grey and very stooped and she looked about a hundred years older than the last time I had seen her. She had a long heavy plaster cast on her left leg and she was leaning on an aluminium walker. Her hands were gripping it hard and I could see bones and veins and tendons standing out. She was trembling. Her skin looked translucent. Only her eyes were the same as I remembered them. They were blue and merry and filled with amusement.

‘My boys,’ she said. ‘Just look at the two of you.’

She spoke slowly and breathlessly but she was smiling a happy smile. We stepped up and hugged her. She felt cold and frail and insubstantial. She felt like she weighed less than her aluminium walker.

She turned the walker around with short clumsy movements and shuffled back through the hallway. She was panting and wheezing. I stepped in after her. Joe closed the door and followed me. My mother made her way to a sofa and backed up to it slowly and dropped herself into it. She seemed to disappear in its depth.

‘What happened?’ I asked again.

She wouldn’t answer. She just waved the enquiry away with an impatient movement of her hand. Joe and I sat down, side by side.

‘You’re going to have to tell us,” I said.

‘We came all this way,’ Joe said.

‘I thought you were just visiting,’ she said.

‘No, you didn’t,’ I said.

Partial face of old woman, mother 

They found out

She stared at a spot on the wall.

‘Well, it was just bad timing.’

‘In what way?’

‘I got unlucky,’ she said.

‘I was hit by a car,’ she said. ‘It broke my leg.’

‘Two weeks ago,’ she said. ‘Right outside my door, here on the Avenue. It was raining. I had an umbrella, it was shading my eyes, I stepped out, and the driver saw me and braked, but the pavé was wet and the car slid right into me, very slowly, like slow motion, but I was transfixed and I couldn’t move. I felt it hit my knee, very gently, like a kiss, but it snapped a bone. It hurt like hell.’

‘Why didn’t you tell us?’ Joe asked.

She didn’t answer.

‘But it’ll mend, right?’ he asked.

‘Of course,’ she said. ‘It’s trivial.’

Joe just looked at me.

‘What else?’ I said.

She kept on looking at the wall. Did the dismissive thing with her hand again.

‘What else?’ Joe asked.

She looked at me, and then she looked at him.

‘They gave me an X-ray,’ she said, ‘I’m an old woman, according to them. According to them, old women who break bones are at risk from pneumonia. Because we’re laid up and immobile and our lungs can fill and get infected.’

‘Have you got pneumonia?’ I said.

‘No.’

‘So what happened?’

‘They found out. With the X-ray.’

‘Found what out?’

‘That I have cancer.’

Partial face of old woman, motherDon’t let’s have a fuss

Nobody spoke for a long time.

‘But you already knew,’ I said.

She smiled at me, like she always did.

‘Yes, darling,’ she said. ‘I already knew.’

‘For how long?’

‘For a year,’ she said.

Nobody spoke.

‘What sort of cancer?’ Joe said.

‘Every sort there is, now.’

‘Is it treatable?’

She just shook her head.

Was it treatable?’

‘I don’t know,’ she said. ‘I didn’t ask.’

‘What were the symptoms?’

‘I had stomach aches. I had no appetite.’

‘Then it spread?’

‘Now I hurt all over. It’s in my bones. And this stupid leg doesn’t help.’

‘Why didn’t you tell us?’

She shrugged. Gallic, feminine, obstinate.

‘What was to tell?’ she said.

‘Why didn’t you go to the doctor?’

She didn’t answer for a time.

‘I’m tired,’ she said.

‘Of what?’ Joe said. ‘Life?’

She smiled. ‘No, Joe. I mean I’m tired. It’s late and I need to go to bed, is what I mean. We’ll talk some more tomorrow. I promise. Don’t let’s have a lot of fuss now.’

We let her go to bed. We had to. We had no choice. She was the most stubborn woman imaginable.

Partial face of old woman, motherShe’s only sixty

The two brothers found her refrigerator “stocked with the kind of things that wouldn’t interest a woman with no appetite.”
They started talking.

‘What do you think?’ Joe asked me.

‘I think she’s dying,’ I said. ‘That’s why we came, after all.’

‘Can we make her get treatment?’

‘It’s too late. It would be a waste of time. And we can’t make her do anything. When could anyone make her do what she didn’t want to?’

‘Why doesn’t she want to?’

‘I don’t know.’

He just looked at me.

‘She’s a fatalist,’ I said.

‘She’s only sixty years old.’

I nodded.

Partial face of old woman, motherWe’re too late; she made sure

She had made up her guest room with clean fresh sheets and towels and she had put flowers in bone china vases on the night stands. It was a small fragrant room full of two twin beds. I pictured her struggling around with her walker fighting with duvets, folding corners, smoothing things out.

Next morning, their mother was still asleep when Jack went and got breakfast.

‘She’s committing suicide,’ Joe said. ‘We can’t let her.’

I said nothing.

‘What?’ he said. ‘If she picked up a gun and held it to her head, wouldn’t you stop her?’

I shrugged. ‘She already put the gun to her head. She pulled the trigger a year ago. We’re too late. She made sure we would be.’

‘Why?’

‘We have to wait for her to tell us.’

She told us during a conversation that lasted most of the day.

We started over breakfast. She came out of her room, all showered and dressed and looking about as good as a terminal cancer patient with a broken leg and aluminium walker can. The way she took charge spooled us all backwards in time. Joe and I shrank back to skinny kids and she bloomed into the matriarch she had once been. A military wife and mother has a pretty hard time, and some handle it, and some don’t. She always had. Wherever we had lived had been home. She had seen to that.

Partial face of old woman, motherFirst you live, then you die

‘I was ten when the Germans came to Paris. I thought that was the end of the world. I was fourteen when they left. I thought that was the beginning of a new one.’

‘Every day since then has been a bonus,’ she said. ‘I met your father, I had you boys, I travelled the world. I don’t think there’s a country I haven’t been to.’

‘I’m French,’ she said. ‘You’re American. There’s a world of difference. An American gets sick, she’s outraged. How dare that happen to her? She must have the fault corrected immediately, at once. But French people understand that first you live, and then you die. It’s not an outrage. It’s something that’s been happening since the dawn of time. It has to happen, don’t you see? If people didn’t die, the world would be an awfully crowded place by now.’

‘It’s about when you die,’ Joe said.

My mother nodded.

‘Yes, it is,’ she said. ‘You die when it’s your time.’

‘That’s too passive.’

Partial face of old woman, motherSome battles can’t be won

‘No, it’s realistic, Joe. It’s about picking your battles. Sure, of course you cure the little things. If you’re in an accident, you get yourself patched up. But some battles can’t be won. Don’t think I didn’t consider this whole thing very carefully. I read books. I spoke to friends. The success rates after the symptoms have already shown themselves are very poor. Five-year survival, ten per cent, twenty per cent, who needs it? And that’s after truly horrible treatments.’

We talked it through, from one direction, then from another. It was a discussion that should have happened a year ago. It was no longer appropriate.

I waited for Joe to ask the next obvious question.

‘Won’t you miss us, Mom?’ he asked.

‘Wrong question,’ she said. ‘I’ll be dead. I won’t be missing anything. It’s you that will be missing me. Like you miss your father. Like I miss him. Like I miss my father, and my mother, and my grandparents. It’s a part of life, missing the dead.’

We said nothing.

‘You’re really asking me a different question,’ she said. ‘You’re asking, how can I abandon you? You’re asking, aren’t I concerned with your affairs any more? Don’t I want to see what happens with your lives? Have I lost interest in you?’

We said nothing.

‘I understand,’ she said. ‘Truly, I do. I asked myself the same questions. It’s like walking out of a movie. Being made to walk out of a movie that you’re really enjoying. That’s what worried me about it. I would never know how it turned out. I would never know what happened to you boys in the end, with your lives. I hated that part. But then I realized, obviously I’ll walk out of the movie sooner or later. I mean, nobody lives for ever. I’ll never know how it turns out for you. I’ll never know what happens with your lives. Not in the end. Not even under the best of circumstances. I realized that. Then it didn’t seem to matter so much. It will always be an arbitrary date. It will always leave me wanting more.’

We sat quiet for a spell.

‘How long?’ Joe asked.

‘Not long,’ she said.

We said nothing.

‘You don’t need me any more,’ she said. ‘You’re all grown up. My job is done. That’s natural, and that’s good. That’s life. So let me go.’

Partial face of old woman, motherWe owe it to her

As she wanted, they went out to dinner.

[We rode a cab part of the way and then walked.] My mother wanted to. She was bundled up in a coat and she was hanging on our arms and moving slow and awkward. But I think she enjoyed the air.

We all ordered the same three courses. We ordered a fine red wine. But my mother ate nothing and drank nothing. She just watched us. There was pain showing on her face. Joe and I ate, self-consciously. She talked, exclusively about the past. But there was no sadness. She relived good times. She laughed.

‘Why didn’t you tell us a year ago?’ Joe asked.

‘You know why,’ she said.

‘Because we would have argued,’ I said.

She nodded.

‘It was a decision that belonged to me,’ she said.

Next morning when Jack woke up he heard Joe talking to the nurse.

She told me she was my mother’s private nurse, provided under the terms of an old insurance policy. She told me she normally came in seven days a week, but had missed the day before at my mother’s request. She told me my mother had wanted a day alone with her sons.

Later, Joe found Jack getting ready to leave.

‘You leaving?’ he said.

‘We both are. You know that.’

‘We should stay.’

‘We came. That’s what she wanted. Now she wants us to go.’

‘You think?’

I nodded. ‘Last night [at dinner]. It was about saying goodbye. She wants to be left in peace now.’

‘You can do that?’

‘It’s what she wants. We owe it to her.’

[At breakfast] my mother had dressed in her best and was acting like a fit young woman temporarily inconvenienced by a broken leg. It must have taken a lot of will, but I guessed that was how she wanted to be remembered. We poured coffee and passed things to each other, politely. It was a civilized meal. Like we used to have, long ago. Like an old family ritual.

We left thirty minutes later. We hugged long and hard at the door and we told her we loved her, and she told us she loved us too and she always had. We left her standing there and went down in the tiny elevator and set out on the long walk back to get the airport bus. Our eyes were full of tears and we didn’t talk at all.

♥ ♥ ♥

Of late, I have been devouring one Lee Child book after another and getting lost in the world of Jack Reacher. This part, in The Enemy, was a surprise.  I just had to reproduce it for my friends, especially those in palliative care, who deal with death every day and try to make every end, always abrupt, as good as the movie.

Once again, thanks Lee.

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8 thoughts on “Death is “like being made to walk out of a movie you are enjoying””

  1. Excellent article. It clearly states few palliative care principles. Principle of autonomy i.e. ethical right to make her own decision and carry it through. By doing this, she has taken a call what she feels is best for her in given situation. It also very clearly states the emotional dilemma both the children go through, and finally they decide to respect her wishes.

    As a palliative care physician, i feel things are little different here, in India. We always make sure that someone from family accompanies elderly, frail, patients at home. Mostly, women in villages are not given a choice to decided what is good for them as male ( either husband or elder son) takes the decision.

    But i think, with increasing palliative care awareness, people will stand out and say what they need to do with their life.

    It also beautifully writes the concept of death. Heading of “Walking…..” says it correctly. only probably difference is when you say you are enjoying the movie, the patient is not, as he / she is not in frame of mind as you are. Probably, she is not enjoying the movie at that moment as she has no interest in the story.

    Generally people know that they are going to die one day. They are always afraid of ” process” or way in which it will happen. who will be with them, when it actually happens etc. With giving realistic hope and telling truth in a human way, and giving assurance that they will be comfortable till the end, many people can still face it boldly. We see that happening daily with palliative Care

    1. Thanks for your comments, Dr Priya. You are steeped in palliative care and your observations are very important. You are right about the patient not enjoying the movie. I suppose the “mood” may keep changing. My only worry is about “giving realistic hope” because the patient and the caregivers tend to have extreme hopes. But I am sure communication is an important part of palliative care and you will know best how to put it across.

  2. Thank you. I do have a similer thoughts regarding death. Changes are there in the surrounding considering our life style at India.I feel like I have experienced it on subtle level. The same will happen with me.
    Thank you for the reminder. It has to be like a continuous journey for life and death, hand in hand. After each [sad and happy] incident, I experience my rebirth. Now I have less ups and downs considering the feelings in life. One way it is good. Am I missing something? Let it be.
    Anyway, thanks a lot.
    Vaijayanti

  3. What can I say……? Thank you! Simply beautiful! Inspires me to live well, so that (may be) I can have a “good” death…..”First you live, then you die”……… Let me ensure that I enjoy every bit of the movie as I am watching it, before I am asked to walk out………..Wish I can have as much strength to face death as gracefully as in the article….Thanks again.

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