let go.

I was on call for hospice. At 2am, I heard from a quiet calm adult who asked “Are we doing everything we can?” I asked several detailed questions and satisfied with the answers said “Yes , you are doing everything right.” The caller, hesitated and then thanked me for answering. I took a step further. I could hang up the phone and go back to sleep ; but there was something else. “Do you want me to come out?” She sighed deeply, “Could you?”

After a drive through rural hills and dark 2 lane roads, I arrived at the home. The lights on the porch revealed several younger people playing cards and murmuring quietly. The small house held 12–15 people of all ages . I recognized the husband and the patient. The husband was sitting in “his "recliner surrounded by a few children and their parents. Filling the couch, spilling on to the floor, quiet, comfortable and there for him. I spoke to him and he pointed to his wife. She was lying on their bed. Sleeping. There was a daughter on her left hand , a daughter at her head, smoothing her brow and a daughter holding her right hand. She made a soft moan and all three tensed , gasped and came even closer to her . Gripping her hands and rubbing her brow they looked at me in clear panic.

I asked the daughter who had called me to come outside. She and I reviewed all the symptoms, signs and recent changes. She repeated,” Are we doing everything we can?” I began to analyze her status aloud mentioning what was very evident, she was actively dying. A physical process that is usually a slow barely perceptible slide from living to not living. I guessed that she was aware of the distress of her daughters and was holding on for them. I suggested we move her and make sure she was comfortable ; sometimes lying on a wrinkled sheet can feel like your skin is burning. I checked vital signs and turned her from side to side changing a wet underpad. I reviewed medication and other comfort measures and them suggested that the three daughters come with me outside. They looked at their mother anxiously : slowly walking away from their vigil.

I asked “What is your goal ?”

They were in agreement : no pain, no suffering , peace. I began to describe the likely changes that were coming. Explained that most symptoms and the appropriate response were within their ability ; therefore I expressed complete confidence that they would do all that she needed. I had one question I could not answer.

“Sometimes the hardest thing to do is nothing; can you do nothing? Can you breath even as she stops breathing? Can you allow her to slip away without holding on tightly (literally and spiritually)? Can you hold a space for her- holding back your instinct to save her and just let her be? It is not easy to do nothing.”

We did some role playing and what if ing. Finally they got it. They all agreed they could let her go and be ok . I left written instructions , reminding them I was a phone call away. They hugged me and assured me I could go. They called me at 6:36 . Mom had stopped breathing about an hour earlier. They were ready for the official pronouncement of death and her body leaving the home. They knew they had fulfilled her wish for a quiet death at home. Three generations had loved her and each other through that really hard task — do nothing . They let her go.