Final Moments

Final Moments

Clif Cleaveland, MD
26 March 2009

The March 16th issue of New Yorker magazine includes three pages of poetry written by John Updike during the final weeks of his life. He died on January 27 this year. The poems capture better than anything I've read the reflections of a person who knows that he will soon die. If you do not subscribe to the New Yorker, track a copy down at your public library and read this remarkable verse. The poems deal with the mystery and the majesty of life. They do not offer easy answers. They point to the critical, sustaining role of the relationships that we build.

On a number of occasions, the nature of my profession placed me at the bedside of conscious people who were aware that death was close at hand. The first such experience occurred more than forty years ago in the Nashville VA Hospital when a man with wide-spread lung cancer eased away in the presence of his wife and me. He spoke in the days leading up to his death of his boyhood, his hard service in Europe during World War II, and his second wife to whom he had been married for a short time. He had no fear of death. His regret was separation from the woman he loved.

Across the hall, a highly decorated hero of World War I lingered for several more weeks, surrounded by three generations of his family who revered him and gathered to talk with him until his final day.

In the early 1970s, a cancer-stricken widow with a 12 year old son prepared him for her death by gradually introducing him into the family she had chosen to raise him. In her final weeks in the St. Barnabas nursing facility she read The Autobiography of Russell Bertrand in the mornings and instructed her son in the afternoons.

Years later, another lady fought to a standstill an overwhelming breast cancer so that she could walk down the aisle at her daughter's wedding. The evening prior to her death she spoke very frankly about the pain she had faced each day. She, too, had no fear of death; it would, in fact, be a release from suffering. She would miss her family and the opportunity to hold unborn grandchildren.

Another veteran, he of the war in Viet Nam, spoke of broken marriages, of a drug-habit that he had finally conquered, of the mother who had never given up on him. He thought of his buddies in his platoon, especially the ones who were killed in action. This unit was his extended family.

I never saw fear in these encounters. Whether the person who was soon to die was devout or casual in a particular religious faith or professed no formal belief at all, her principal concern focused upon the people who would survive her. Regrets centered around loss of that companionship and the shared celebrations of weddings, graduations, promotions, and births. The other common concern of a dying person was the hope of not becoming a burden to loved ones.

On a few occasions, a spouse or family members wanted to keep a dying, loved one ignorant of her impending death. This, in my opinion, is cruel. It denies a dying person the chance to reflect and to put an emotional house in order. It precludes the opportunity to express love or forgiveness that may have been postponed. When the dying person inevitably learns that that she is dying, mistrust of family and care-givers ensues. Relationships are strained at the very time that they are most vital.

I urge you to read John Updike's poetic gift to us.

Contact Clif Cleaveland at