Return to Dust
My father-in-law, Fran, had an Aunt Beryl who was nine years old when he was born. They lived in the same New England-style house growing up—he and his parents in the upper-level apartment and his grandparents and aunt in the lower section of the home. Fran and Beryl were much like brother and sister in those early years. Beryl carried Fran around when he was a baby, then pushed him in the stroller when he was a toddler. She called him her “little doll.” They remained close as adults and lived only about a mile apart for more than fifty years.
Fran was a kind man, and he and my mother-in-law remained welcoming to me after his son and I divorced. During my marriage, they often traveled to New Hampshire to spend weekends with us and usually joined us for a few days on our annual summer vacations to Cape Cod and Lake Sunapee. They were happy and easygoing guests. I have many great memories of the times we shared and the fun my family and I had with them. I am thankful I was able to enjoy a loving relationship with my in-laws until their deaths.
Like Fran, Aunt Beryl was not a churchgoer and did not speak of a connection to any faith. Fran called himself a home Baptist and once told me he believed that all humans go back to dust when they die.
Fran, at eighty-one, was at the end of his life and receiving hospice services at home. Aunt Beryl, at ninety, had experienced no major health issues throughout most of her long life. She was a widow who had been living in an apartment on her own for more than thirty years. She was active and social, often going out with friends for lunch and shopping. Although she developed macular degeneration in her mid-eighties, it didn't seem to slow her down at all. She had remarkable fortitude and rarely complained.
On the weekend that Fran was dying, the family called Aunt Beryl to see if she wanted to say goodbye to Fran in person. She was no longer driving due to her legal blindness and she and Fran were now living about thirty minutes apart. They would offer to drive her to Fran’s home.
They tried calling her on Friday night but there was no answer. Since she was quite active, they assumed she was socializing at a neighbor's apartment. On Saturday they tried her a couple of times, and still no answer. Again, they thought she might be shopping or having dinner with friends, her usual activities. On Sunday morning when she didn’t pick up, they became concerned and drove to her apartment to check on her.
When they arrived, she didn’t answer the door. The apartment manager was able to unlock the door and let them in. Aunt Beryl was found barely conscious, lying on the floor next to the bed with a possible broken neck. She was weak, yet responsive. She had fallen on Friday night while attempting to put on her pajamas. Unfortunately, her med-alert button was on her bedside table and she could not reach it from the floor. She was in too much pain to move and tried yelling for help, but none of the neighbors heard her cries. She had been lying on the cold floor for more than thirty-six hours.
An ambulance transported her to the hospital in Keene, where they explained her injuries to her nephew. The emergency room staff reported to him and Beryl that there was nothing they could do for her broken neck, other than try to manage the pain. They told her nephew privately that she was likely to die within a couple of days. The plan was to transport her to Mary Hitchcock Hospital in Lebanon, New Hampshire, where she would receive comfort measures until she passed away.
Shortly after arriving at the hospital in Keene, Aunt Beryl began asking for me. She and I had remained very close, and of course, she knew I was a hospice nurse. The call came from the hospital to share the sad news and let me know she was requesting my presence. I had just returned from a week-long vacation in Aruba the night before and was propelled back to reality in an instant. My heart sank at the thought of the pain she had endured over those long hours on the floor and how shaken she must be from the whole ordeal.
I quickly decided to spend the final days of Aunt Beryl's life at her bedside in the hospital. My children learned from their dad, of Aunt Beryl’s impending death and all three were saddened by the news. She held a special place in all of their hearts. My eldest son Dan was living in Utah with his young family and said he was so happy to think they had just visited in the fall and spent time with Aunt Beryl. My younger son Adam thought about making the trip, to say goodbye, but decided he wanted to remember her as the lively aunt he had always known. I agreed this was a mature decision. My daughter, Laura, at twenty-seven, chose to travel with me and stay with Aunt Beryl for those final days. Laura had never been with anyone who was dying but had been hearing stories about my patients for more than ten years so had some idea of what she was about to witness.
I worried aloud on our seemingly endless car ride through the mountains of New Hampshire about what condition we would find Aunt Beryl in. My years of pain management training and hands-on experience helped me to consider the worst. I knew we might have to offer sedation as an option to relieve the unrelenting pain of a broken neck. I wondered if she would be delirious from days of lying on the floor and the ensuing dehydration. Would she even recognize us?
We talked of her incredible constitution at her age and laughed about her strong will. She was never one to mince words; my children and I had delighted in her brutal honestly over the years. Though we expected it, she was still able to shock us in conversations.
When Laura and I arrived at the hospital in Lebanon, we were amazed to find Aunt Beryl lucid and joyful. She had not been told that we were coming, and was surprised and thrilled to see us. She immediately asked about my vacation, which brought laughter from not only the family but the medical staff.
Aunt Beryl was quickly transferred from the emergency room to a private room upstairs. The young nurse conducted her assessment and then a licensed nursing assistant bathed her and dressed her in a clean hospital gown. There was a small recliner in the room for overnight guests, but since both Laura and I planned to stay until she died the nurse brought in a small cot.
Fran was well on his way in his dying process by this time on Sunday evening. Because Aunt Beryl was lucid and since no one had shared the news, I decided to tell her that Fran was in his final days. She knew how poorly he had been doing so she was not surprised by the news. She was, of course, sad to think about him dying.
“Oh, my Frannie. I love him so much,” Aunt Beryl said.
“It seems the two of you will be leaving this world in very close proximity to one another and somehow, that seems fitting, Aunt Beryl,” I said.
“Well, I suppose it does.” She smiled.
She talked a lot that night to Laura and me, reminiscing about family, with no mention of her fall and more than thirty-six hours on the floor. She had never been one to show weakness. I imagine this came from growing up in a large family and living a rugged country life. Early Monday morning she was in tremendous pain and did not speak much, other than moans that were hard for Laura and me to listen to. After several unanswered requests for increased pain medication dosing, the staff finally responded and got her comfortable around eleven —she spoke to us once again. She asked to see the photo on my phone of my eighteen-month-old grandson, Brennan, her great-great-great nephew. She had always adored him and just speaking of him gave her great joy. I had begun sending her photos of Brennan when he was born and continued to send them at each stage of development. Due to her macular degeneration, I had them enlarged to 5x7 or 8x10 so she could make out more details of his cute little face and frame. She always placed them under the glass on her coffee table, and said she enjoyed looking at them daily with her large magnifying glass.
“Oh, I just love this little boy,” she exclaimed, as she looked at the photo of him in the outfit, she had sent for his first birthday. Being so young, Brennan will never remember the joy he brought Aunt Beryl in her final years, but I recount the stories to him often, hoping he will come to know how much she loved and adored him.
Around two in the afternoon, Aunt Beryl finally seemed at peace and began to relax into dying. Laura and I were grateful to see her turn this corner. Laura updated her dad via a text message and told him that she was more comfortable.
After this interaction on Monday afternoon, Aunt Beryl fell into a deep sleep and did not speak to us again, offering only nods in response to our questions about her comfort. By late Monday evening, she hadn’t spoken to us for more than ten hours. Laura and I were sleeping when, at eleven, she called out to Fran.
“Oh, Frannie, you're here? Oh, I love you, I love you,” she said, clear as a bell, waking us from a sound sleep. Then she mumbled as she reached her arms straight up above her chest; we could not make out exactly what she was saying. Still, it was beautiful, and evoked a feeling of awe in both of us. Without speaking, Laura and I both knew what it meant. As quickly as she had begun speaking, Aunt Beryl stopped and returned to her deep sleep, as if her visitor had gone. Our thoughts were confirmed ten minutes later, when Laura received a text message from her father saying: Grandpa Fran died a few minutes ago.
I have goosebumps as I write this. Here were two people who had no religious beliefs. Each had maintained that they did not believe in God, heaven, or anything beyond this life. Yet they were somehow communicating with one another. One lay dying in Hanover, New Hampshire; the other in Bernardston, Massachusetts. If I had been asked to guess beforehand, I would have put money on Aunt Beryl going first to help her “little doll” Fran cross over. At some point, their roles must have switched, and unbeknownst to us, Fran was now caring for her.
Laura and I cried as we consoled each other, thinking of the loneliness of his widow—my mother-in-law, Laura’s grandmother—a woman we both cherished. Finally, around one in the morning, we fell back to sleep. The night remained quiet as our fearless woman worked her way toward Fran.
Aunt Beryl, after speaking to Fran, never spoke again. Time passed slowly Tuesday morning as her breathing became labored and rapid, with intermittent breaks. When her pain spiked her morphine pump settings were increased, with fewer requests than the day before—small blessings. I frequently replaced the cool washcloth on her forehead as she perspired and brought in shallow rapid breaths throughout her marathon. At last her breathing slowed as she crossed the finish line. She died peacefully in the early afternoon as Laura and I watched her gently push out her last breath of life.
