“Generally, by the time you are Real, most of your hair has been loved off, and your eyes drop out and you get loose in the joints and very shabby. But these things don’t matter at all, because once you are Real you can’t be ugly, except to people who don’t understand.”
– Margery Williams
It’s October and my Empress Plums are gorging the tree limbs, bowing to the weather with the egg shaped amethyst fruit. I’m making plum chipotle sauce and canning it for the desert winter ahead when we’ll need the spice and shock of sour and sweet to remind ourselves of the colorful days on the other side of the year.
I get a call from the hospice I volunteer with asking if I’m up for a vigil tonight from midnight until 3 a.m. in a care facility a town over. This is called “11th hour,” when a vigil is called for volunteers to sit at bedside with someone who is actively dying. I agree and write down the following during the call: Patient is Rose M. 99 years old. No family, never married, no children. POA is a former student. Rose was a teacher. Living in facility 17 years. Presbyterian. Requests no meds. Room 11. Diagnosis: failure to thrive. She is actively dying. Facility staff don’t want her to be alone.
It’s not a lot of information, but it’s all I think I’ll need. I pull the last batch of plum sauce from the pot and stand in the kitchen for a while eating the spoonfuls of vinegary autumn that won’t fit into the last jar with a piece of white cheddar. I love hanging around the jars as their lids click down to seal. Pop! I think about Rose and wonder if I should go sooner. But like a woman sent home from the hospital early in her labor, I know to listen to the nurse and wait until later. I sit down with a half read book of Thoreau and let the hours fade.
At 11 o’clock, the alarm on my iPhone goes ding-a-ding-a-ding-a-ding-a-ding-a-ding! like an old rotary. I change into a dress with leggings and clogs. I pack my tote with a sweater, water bottle, my journal, a book of John O’Donohue blessings, and I am pulling out of the garage in 10 minutes. I have done this dozens of times and while each situation is different, I am not nervous.
As part of this routine I’ve established, I drive to the Maverick gas station just before the freeway and get a 32 ounce coffee with half and half. I am finicky about my coffee during the day, but it doesn’t matter at night. I need the caffeine and warmth to occupy the next several hours. It tastes like last time.
At the assisted living facility, I put my hospice volunteer name badge on, pack my coffee and tote with me, and ring the after hours doorbell. Rose is living in the small apartment-like room of the low-level care wing, just as she has for so many years. Well, she’s living and dying here right now. I’m glad that she is here and wasn’t moved.
A very young man lets me in and I tell him I’ll be with Rose for a few hours. He looks confused.
“Like a sitter?” he asks.
“Yeah, sort of. I’m on her hospice team,” I reply and he points me down the hallway in the general direction of her room.
The facility is outdated with overhead florescent lights, white railings down both sides of white walls and not much else. A med cart sits outside of a room and the nurse’s station is empty. I make my way towards the end of the bleak walk and find the door ajar to Room 11. I knock and enter with a soft “hello!” A woman sitting near the bed stands and walks towards me. It’s Camilla, another vigil volunteer. We’ve met before in these midnight alliances.
“She’s pretty good, but she’s getting restless. I just adjusted her pillows.”
Glancing over at the bed, I see two dark canes propped on top of pillows over a quilt puffed up with more pillows under her lower body. A flurry of white at the top of the bed exclaims her hair, with her head to the side. I hug Camilla. She’s warm and smells like Yardley’s lavender. There’s great intimacy between strangers in the presence of dying.
“Thank you so much, Camilla. Get some rest.”
I wash my hands at the sink in the bathroom as Camilla leans over Rose and tells her goodbye. She gathers her things and leaves. Only now do I take my seat in the chair next to the bed. I take a deep breath and take in the focus of all my attention.
Rose is wide-eyed, brow furrowed, mouth open, breathing rapidly but silently, with the top of her chest rising like a small bird is under the covers. The stiff arms over the quilt are mottled with pooling blood, rivers turned to estuaries. I realize that she is in her last hours. Prediction is futile and there have been many vigils that went on for days, a week once, when the dying person held on without any water or intervention for an inexplicable moment of release. But something is different here. I feel more sure this time.
“Rose, my name is Sarah,” I say. “I’m from the hospice. I’m going to be sitting right here next to you. I’m going to pick up your hand. I want you to know that you’re not alone and whatever you need or do is ok. Can you squeeze my hand, Rose?”
The cold fingers in my palm do not respond. Her nails are shaped as almonds, specked with the remains of ivory polish.
I forget my coffee, my journal, my book. I stare at Rose as she is tethering away from me, away from this world. She holds my attention unreservedly and I find myself breathing shallowly with her. I count 26 in one minute and have to gasp to fill my lungs full. I am alert to my own breath and how fragile this space is. I hold it for her.
Holding space is what a vigil is. It does not encourage, interfere, judge or shrink. I may be here, but I don’t do anything but keep the intention of a peaceful death and affirm her life as she goes alone. An hour passes.
I finally look around the room. Framed needlepoint of elaborate flowers hang on two walls. Did she sew these? Were they gifts? A few books are by the television. I look for a photo album but there is none. A slim fabric covered volume stands in the stack and I lift it out. It’s the Velveteen Rabbit by Margery Williams. I flip through the first pages. Rose Meyer is written in the top right hand of the first in cursive, just as I write my own name in mine. The next page shows original publication, 1922.
Rose was 6 when this came out, I think.
I start to flip through the tender pages and there is the same cursive hand up and down the margins on page after page, all showing a close reading and great care for the story inside. Oh, Rose! Without doubt, I am sure these are her annotations.
I sit back down with Rose and begin to read, “There was once a velveteen rabbit, and in the beginning he was really splendid. He was fat and bunchy, as a rabbit should be; his coat was spotted brown and white, he had real thread whiskers, and his ears were lined with pink sateen…”
Around 1 a.m., Rose begins to moan and her eyes shut and open, open and shut. She shifts around in her bed, visibly aching.
“Rose, are you alright? Rose?” I feel her hot forehead and she doesn’t react. She arches her back a bit and tries to pull her chest up.
“Rose, are you in pain?”
My heart beats in my throat. I scan up and down her body for any sign. Her feet move. She moans again and I freeze. I remember that she hasn’t had any medication. Usually, people are sedated with morphine or a Fentanyl patch. Sometimes medication isn’t needed if the patient is in a natural coma and seems comfortable. This is not normal. Or is it?
I step into the hall while dialing the on-call nurse on my phone. Jan answers.
“Jan, this is Sarah. I’m with Rose M. She is in pain, moaning, and moving around. Her forehead is scrunched. She’s not responsive though. What can we do?”
Jan pulls up her chart. “Well, she was clear that she doesn’t want any meds. We can give Tylenol, but that’s it. Do you want me to come out?”
“What could you do?”
“I can be there with her if you want to go home.”
I pause and take a good ten seconds before answering, “No, I’m ok.”
“Ride the waves, hun. Sometimes it’s like a birth. Remember she’s wants it like this and we have to respect those decisions. Hold the space. Call me back if she’s in any danger or you want me to come over.”
I end the call and walk back in to Rose’s room. She is hurting and I start to cry. I wipe away the tears and take a deep breath. Many, in fact. I sit back down and take her hand as gently as a dried flower.
What had I been doing at each vigil before now? Had I been a sitter? That’s not completely true, right? Was I really competent and comfortable only with sedated patients? So many questions disrupt everything – my sense of place, my role, my reason for being here.
Suddenly, I am the patient. I quit my mind, accepting that I can learn from Rose’s realness. God, I think, like the Velveteen Rabbit. I start to read again.
Rose draws up in bed, this time, her shoulders raise off the bed. Her eyes are open, but she can not see. But I believe everyone can hear until their last breath, or beyond. When I was in training to become an End of Life Doula, our teacher told us that the body shuts down fragmentally. Just because the breath is gone, or the heart stops beating, doesn’t necessarily mean brain activity is done and it can take several minutes after. Or sometimes brain activity ceases before the breath does. Once I was with a man as he died. As I sang to him, he passed away. It’s a good way to describe it, “passing away.” I stayed still by him and a couple minutes later, he breathed one last time, but I knew he was already gone. It did give me a fright though and I’m glad I knew to stay.
Rose is showing me another way. Maybe I am not here to help her die peacefully. I’m here to learn to live more fully, the way she wants. I’m here to hold this space and breathe with her. She’s choosing to embrace this experience its fullness and pain and mystery and I’ll be damned if I’m so arrogant to think it should be done otherwise.
Looking at my watch, I start counting Rose’s breaths. She’s down to 11 or 12 per minute and she’s calm again, motionless with her eyes closed. I return to an underlined section of The Velveteen Rabbit.
“Real isn’t how you are made,” said the Skin Horse. “It’s a thing that happens to you. When a child loves you for a long, long time, not just to play with, but REALLY loves you, then you become Real.”
“Does it hurt?” asked the Rabbit.
“Sometimes,” said the Skin Horse, for he was always truthful. “When you are Real you don’t mind being hurt.”
“Does it happen all at once, like being wound up,” he asked, “or bit by bit?”
“It doesn’t happen all at once,” said the Skin Horse. “You become. It takes a long time. That’s why it doesn’t happen often to people who break easily, or have sharp edges, or who have to be carefully kept. Generally, by the time you are Real, most of your hair has been loved off, and your eyes drop out and you get loose in the joints and very shabby. But these things don’t matter at all, because once you are Real you can’t be ugly, except to people who don’t understand.”
At nearly 100 years old, here is Rose, body broken and dying with a stranger. But I know she was well loved through her life. I know this in my soul. I love her now, truly. What could be more authentic than this? Two people who don’t shy from suffering, who go their own way, who love to read. This is Rose’s final gift, her last lesson, to her last student: When we expect others to mask their distress to make us feel included and outgoing, we’re not genuinely connecting. If we are holding a space that’s been covered by a coping mechanism, a lie, a crutch, an addiction, a shadow of our fullness, we’re missing the aesthetics of life, the part worth living and loving. I think of the ways we numb and cover our grief, our disappointment, our sense of shame. Are we real when we’re anesthetized?
This is the first vigil during which I don’t write in my journal. Instead, I keep by Rose’s side, telling her that she is brave and loved. After an uncomfortable hour, she does relax and her breaths slow to 6 per minute and then 4, gasping between long stretches of nothing. Rose dies at 3:10, give or take some minutes, in the morning. Her body is instantly a husk and it is over. I call Jan and sit next to this body who is not the real Rose, incredibly grateful for this lesson, and my tears start to flow.
 Due to HIPPA, names and other identifying information has been changed.
 Power of Attorney, legal guardian in this case.