The Final Purl

Death is for the living.

That’s considered a pearl. A key take-away or fact to hold as it is anticipated it will serve you well in the future. At least that is what we are taught in medical school. (Not the death part. We aren’t taught about death. Just pearls. In general. Metaphorically speaking;)

This is the penultimate chapter of Heart Sounds, in case you are curious. Which I hope you are.

At the conclusion, more will follow… as in… another book. Not exactly a prequel or a sequel. Rather, a parallelquel.¹

Now, back to this pearl of purls.²

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Those who bear witness to how we die are the ones who carry memories of our final days…into the future. They are the ones who live through death.

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Ms. Peabody is knitting away. Having just awakened from a deep slumber, she reaches for what must be her skein and begins weaving her arms in the air with graceful gestures, straightening and pulling, gathering the tail of yarn with her pinky and gently nudging the needle into place. All the while her gaze is fixated on the face of another. Someone in the distance. Someone beyond all our sight. And though the wool she caresses in her hands is unmistakable, no thread can actually be seen. 

Ms. Peabody is dying.  

Her children, both with damp hair, the result of taking turns to shower briefly while the other stays attentive, have been at her side for days, tending to her wants, listening to her moans, her periods of gurgled congestion, holding their own breath when hers fails, and sighing with amazement when she regains consciousness only to be startled from their anticipatory grief whenever she yells, “Am I dead yet?”  

Balloons of cardinal and gold (in honor of the upcoming football game) bob in the corner. She is an avid fan, even in her final days. Her room, wanting to smell of naphthalene, doesn’t. Instead, sunlight washes new life into the air, and its beams bounce off the corpulent helium spheres reflecting colors on the walls and adding rainbows of light to the vintage paintings of amber flowers. 

Earlier this morning, Ms. Peabody motioned to one of her daughters to bring a particular painting close to the foot of her bed. It is a tranquil scene of a garden edged by a tall white stone wall with an arched wooden door in the center. A man in flowing white robes and long brown hair blending into his even longer beard is knocking. Ms. Peabody, with surprising strength, proceeds to swing her legs across the picture, verbalizing her intention to “kick the gates of Heaven down” so she can come through.

Suffice it to say, Ms. Peabody is fed up with being alive.  

During my initial assessment as her hospice physician, she is already bedridden and suffering from chronic leg pain and intermittent shortness of breath. She is for all intents and purposes, deaf, so all communication on a visitor’s part has to be written. Her replies are clearly vocalized, sprinkled with laughter and tears.  

“I love you doc, and thank you,” she says to me toward the end of my first visit, “and please don’t misunderstand me when I say, I never want to see ya again, OK?” She laughs and takes another spoonful of the hearty bean soup patiently offered by one of her daughters. “I have lived long enough. And this, well this is no way to live. Can’t we speed things along?” She knows we can’t, at least not in a manner that allows her to continue to enjoy eating. At the time, no law was in place to support an alternative approach. Even still, her intention and frustrations are as palpable as her bounding pulse.

“She has a strong heart,” I share with her daughters as I make my way to the door, “and I don’t just mean how it’s beating.”  

They nod with tears brimming. 

“She has been so clear with us," her daughter, Sharon sighs, "she really is ready to go, and we both understand that. We want her to have her wish granted. But we know it will be her way and in her time.”  

Trying to honor Ms. Peabody’s request to never see me again, my next visit is brief, as I try not to wake her. Instead, I make certain she is free from any signs or symptoms of distress and verify that all medications are in order and go on with my day. I say goodbye as I have learned to do with all my patients given life’s uncertainty, placing my hand gently over her heart and whispering, as much for me as for her, “You are in good hands. You just rest.”

The weekend comes and goes, and Ms. Peabody remains. Despite longer periods of pauses in her breathing and minimal sips of water, Ms. Peabody continues to awaken from her deeper and more restless naps to startle family around her with her incredulous cry, “I’m still here?!”  

Seeing her this afternoon, she appears to be dreaming in her sleep. Her eyes roll about under her lids, and her lips flutter with unintelligible words as her feet seem to pitter-patter on pavement miles away. Occasionally, her hands shoot out from under her covers and begin to fiercely scratch the top of her head. And just as quickly, they dive back under the patchwork quilt, eyes never opening, contact with this world far from reach.

During my exam, her dreams maintain possession of her attention. It isn’t until several minutes later, after watching her darting eyes and restless hands, that her furrowed brow makes me increasingly concerned she is uncomfortable.  

“Whether it is physical or spiritual I cannot say, but she looks tense, and her breathing is more forced.” I suggest an additional dose of medication to ease her symptoms, and the family agrees.  

Immediately after the first drops are administered, her eyes open, and her face begins to glow as she takes in the scene around her. At first, she focuses back and forth between her daughters flanking each side of the bed. Her smile broadens, but she says nothing. She then begins to focus on my face. A faint squint flashes as she struggles to discern my identity. Then, she begins to giggle. Her gaze leaves me and moves to a space past the foot of the bed. No visible person occupies the area. No photo or image hangs in its path. But Ms. Peabody sees something … or someone. And it is then, without moving her eyes, without a sound, she begins reaching.

The room falls silent. Even the constant groan of the oxygen compressor seems to disappear. Several minutes pass before anyone dares speak. None of us can believe what we are witnessing.  

“Is she … knitting?” I utter softly not quite believing my own eyes.  

Sharon cups her hand to her mouth and stifles a sob.   

“It is her most favorite thing in the world to do,” Sharon's sister Maggie says. “Knitting, purling, tabbing, crocheting, she loves all these things … her mother taught her how.” That final statement is spoken with her head facing in the direction of Ms. Peabody’s gaze.  

“No question, she is happiest when she is knitting,” Sharon concludes between tears.  

“I have never seen anything like this,” I whisper, mesmerized by her choreographed arm tugs and pulls and swings in the air. Tears graze my own cheeks as I speak not realizing it is aloud, “It’s so beautiful … what a gift to know that which makes you most happy.”  

With Ms. Peabody’s demeanor now relaxed and all our breathing eased, I make my way to leave. As Sharon walks me to the door, we pass by dozens of bags spilling over with yarn and thread sorted into different colors and textures.  

“She is definitely going to heaven,” Sharon says with a smile, noting my curiosity over the skeins. “She has knit over a thousand caps specifically to give away to children and shelters. Doing what you love for others, now that is a gift.” 

It’s not until I am home that night that I can reconcile my startling wish for Ms. Peabody to die. All the while watching her knit, I had been secretly hoping for her to take her final breath. What could be more meaningful, more beautiful than to die while surrounded by those you love watching you be happy?   

I inarticulately try to share this urgent thought with my husband. 

“What is your most favorite thing to do? Mountain bike? Kayak? Should we bring you a paddle when you are dying?” 

He doesn’t smile and quickly changes the subject. 

But I cannot leave this thought. It is too important. Maybe, I think, it is the most important legacy I can leave my family.  

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Death is for the living. Those who bear witness to how we die are the ones who carry memories of our final days, our final kiss, our final breath into the future. They are the ones who live through death.     

I realize I am jealous of Ms. Peabody and her family’s clarity. They know precisely what makes her happiest. I decide then that I want to die like that. I want my family to know, with certainty, what makes me happiest. 

Actually, I want to live like that, too.

1. Not to be mistaken with the Hunger Games Quarter Quell. Obviously, that is two words and this is one. One which I just made up. Kind of tickles my tongue in parallel with my fancy. Which the Quarter Quell does not… tickle my fancy, though kinda does tickle my tongue.

2. In case you do not knit, the term purl (which is pronounced identical to the medical school and, interstingly, the oyster’s pearl) is a type of stitch one makes with knitting needles and yarn. I suppose you could also make it with other things. Of course, that is not the point, though some needles can be quite sharp.