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I used to always walk in the woods

      before I became crippled.

            — from a dying woman 

I respond to a ranch house at twilight. An old woman is dying from metastatic lung cancer, vomiting blood. In between episodes of dry heaving and spitting dark clots, she reaches her hand out, sometimes grabbing my arm, other times involuntarily seeking the sky. We both know what her family refuses to see: she will be dead in a few hours. 

While she's being transported to the hospital, she points out the back window at a mule deer crossing her country road, loping gracefully behind our departing ambulance. The doe has long white socks on its legs and a matching underbelly. It pauses on the concrete, observing us. An omen.

My patient's smile is beatific as she gazes on her animal spirit--part bliss, part peace, part morphine. Hospice, magic pill, bullet--it ends the same way. I am supposed to facilitate life, save it. But there are situations where I nod quietly and compassionately shepherd the end of it.

Joe Amaral
Arroyo Grande, California