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Eleventh Hour

K.D. Hayes

Uncle Walt died this morning. Finally.

 I say “finally” because I believed this day would come four months ago, when he had emergency bypass surgery.

At the time, I didn’t believe Walt would live; he was an ailing, seventy-seven-year-old man with severe pulmonary disease. When his heart started to hurt one Friday, his doctors told him, “With bypass surgery, you might live. Without it, you’ll be dead before the weekend is over.”

Walt’s oldest daughter and my parents, who were with him, told me about the doctors’ recommendations.

As a retired paramedic, I’d seen this scenario before–often enough to have a strong opinion, and my own advance directives.

I didn’t think that Walt should have the surgery. I thought it would cost too much suffering and money and ultimately lead to the same predictable outcome. I expressed concern that the medical community was pushing, even coercing, Walt to agree to surgery.

My parents assured me that Walt understood the severity of his condition. He knew that he was a poor surgical candidate, that he might not survive the surgery, that he would suffer.

And Walt said, “I want to live.”

I disagreed with Walt’s choice for another reason: I believed that it would thrust suffering upon his family members, who were also my loved ones.

His four children, who said he’d abused and molested them, would suffer, dragged into advising and decision-making roles. My father would suffer because he loved his older brother deeply–despite my cousins’ assertions and despite Walt’s drinking away the first decades of his life, failing to find a successful career, and heading a family riven by dysfunction.

Walt had made our whole family suffer, and I didn’t want him to cause more suffering. I felt angry with him. Over the years, his declarations of remorse had seemed insincere, his oblique admissions and apologies insufficient to heal his children’s wounds. I felt he’d given them good reason to leave him. And though he had never mistreated me, I’d maintained a cool reserve.

In the end, Walt had the surgery–and lived through it, although sometimes it hardly seemed living.

Essentially, his bypass saved his heart so that his lungs could kill him. He had a breathing tube in his windpipe and a feeding tube in his stomach; he lived through a week of “ICU psychosis,” tormented by hallucinations. After he’d spent nearly a month in surgical intensive care, they moved him to an extended acute-care hospital, then to a skilled-nursing facility.  

He had good days–a few. He taught his tired larynx to form words again. He progressed from sitting in a chair to standing to walking a few steps. Once, he walked all the way from his room to the lobby and back.

He also had many bad days, when he couldn’t even get out of bed. He suffered persistent urinary-tract and C. difficile infections.

Whenever it seemed that Walt’s body might give up the fight for life, the staff would ask Walt whether he wanted to be resuscitated.

He always said, “I want to live.”

It was his decision; I don’t think it would have been mine.

But what came of those days between the time I thought my uncle would die and the time, four months later, when he did die? Those expensive, painful days, dogged by fear and anxiety, when my cousins were spent and my parents exhausted, when Walt could have died but lived instead?

Walt found God. On the night before his surgery, the fear of death opened up a vulnerability in him, and he accepted a priest–and then God. He confessed. That night, with two of his four children by his side, he wept his confession.

My cousin recorded his father’s words in a journal: “Forgive me for the abuse….I abused all of you. I wish I had been a better man.” Walt asked his children for forgiveness, and they gave it.

My cousin emailed this exchange to his brother and sisters, to his mother and aunts and uncles and cousins.

The next morning, huddling with my parents and cousins beside Walt, who lay unconscious after the operation, I did not know how to carry my anger.

But the months that followed gave my father more time to spend with his older brother.

“Such a beautiful gift, this time,” my father says now, even though those days also sucked away my parents’ energy.

I doubt that Walt expected that his family would start healing–that his act of contrition would forge new bonds of obligation, responsibility and caring.

But because the operation gave him those months after his “deathbed” confession, his children were able to tell him that they loved him; and their words resonated with a new truth.

“We thanked him and told him he had given us a gift,” my cousin wrote.

Several days after Walt’s surgery, I stood by his bed and held his hand as he drifted into and out of consciousness.

His oldest daughter stood beside me. Whenever Walt was awake, he’d look at her and mouth the words “I love you.” I felt I was watching them forge a new relationship.

Walt’s fractured, estranged family began reaching out, emailing or calling, traveling, reconnecting with each other–and even with Walt. I heard words of remorse, excruciating admissions, and gradually my anger subsided into awe.

I feel certain that Walt knew of the evolution that began in his family that dark night before his surgery, when he felt sure that he would die.

This morning, when Walt finally did die, he left behind a different life–and a different family. His oldest daughter stood in his hospital room, her boyfriend’s arm through hers. Her two adult children hovered near their grandfather. My aunt stood at the foot of his bed. I knelt by the railing, my parents standing just behind me.

I held Walt’s hand and told him that it was okay to go–and that I loved him.

Four months earlier, I’d thought the most pragmatic, least painful choice he could make would be not to fight for life. I’d thought it would be easier, kinder for everyone.

When is the right time to die?

I used to believe that I knew. Just after Walt’s surgery, I made plans to fine-tune my own advance directives–to forbid intubation or stomach tubes.

But I have yet to call my lawyer. I’m not longer so certain that choosing a quick, efficient death is selfless and honorable.

Now I know that my choice to die won’t be just about me. And that changes everything.

About the author:

A writer and retired paramedic, K.D. Hayes has an MA in interdisciplinary studies and an MFA in creative writing and is college editor at Hiram College. Her work has appeared or is forthcoming in JAMA, Bartleby Snopes, The Saturday Evening Post and other publications and has been anthologized in Chicken Soup for the Soul: My Cat’s Life and elsewhere. Her website is “While I enjoy writing light, fun things, stories such as ‘Eleventh Hour’ are very difficult but seem to demand that I write them. And they always teach me something; in that regard they are most rewarding.”

Story editor:

Diane Guernsey



16 thoughts on “Eleventh Hour”

  1. A moving, well-written narrative of growth at the end of life, something we rarely think about as a possibility. Yet families who experience this growth often find it to be a transcendent experience, one they are very grateful not to have missed. Well done, KD!

  2. It’s interesting to read about decisions and reasons for them. My mother had severe blockage at age 85 and would die without bypass. The surgeon was very reluctant but her internist said that she was one of his two healthiest patients in that age group. The other one rode his bike to appointments. The surgery was difficult for her but she lived four more quality years and only died after she fell, had a hip joint replacement, and congestive heart disease was kicked off by the anesthesia. She went through rehab and was walking just fine so the hip surgery was a success. Had that not happened I believe she would have lived well into her nineties. In her case she had a loving family of me, as only child and a multitude of nieces and nephews who saw her as a second mother. We all wanted that extra time with her.

  3. Thanks for sharing-been in a situation like this before. Bitterness in family due to several people not being on the same page. 77+ Father in law not well, had massive MI dies after 3 weeks of intensive care, had aggressive treatments as son was a MD, family came together for about 5 days after his death then all fell apart. Now mother in law not well- family bitterness continues, decisions being made for her even though she can do so on her own: medical, financial etc…life is a cycle: what goes up comes down.

  4. The decision about when the ‘right time’ to die is a very personal one. And there is no right or wrong answer as each person must make that choice for him- or herself. This article helped me to understand, like the author, that it is also about more than medical prognosis, quality of life, or longevity, or even financial cost. The possibility of emotional and spiritual healing at the end of life is truly a gift not to be ignored.

  5. Wonderfully written article! As an RN, I too struggle with what I think people should do at their end of life experience. I have found that while I believe I know “best” what should happen, that it is ultimately a personal decision that involves a complex number of issues, including values, beliefs, relationships, etc. I learned as a hospice nurse to not invest too much of myself into those end of life decisions and just support what the individual wanted, which was sometimes hard to do.

  6. Thank you K.D. for your brutal honesty that makes us all stop dead in our tracks when faced with the horror of abuse and the actual possibility of a genuine forgiveness. That must be wonderfully freeing. You express the dilemma so many of us face regarding the “way” to die and how it splays out the ripple effect to so many family members and friends. It is never easy.
    I am a health care provider and have grappled with what to do or say or just keep my damn mouth shut when such horrendous decisions need to be made. We cannot tell others what to do and how do we know what is best for another? Your openness confirms that God is in control and His plans may not be ours! All we can do is share our knowledge and then let it all unfold.
    Thank you for giving us hope in even the most dire circumstances.

    1. Thank you Marge, and everyone, for your thoughts on this essay. If my uncle had opted not to have the surgery – or had died that day anyway – much of what was so remarkable about the last four months of his life never would have transpired. Regardless of my own thoughts at the time about how much fight was enough or too much, in hindsight, I may have thought he should fight with everything he had if I’d known how transformational the next months would be. That, of course, is just the flip side of the same coin – and reinforces the notion for me personally that all I can (or should) do is respect and support an individual’s decision. I still haven’t changed my own advanced directives to forbid intubation, PEG, etc.

  7. Hey K.D. you have hit the proverbial nail on the head which few realize is the truth in healthcare. Every person is different and every person is an individual and has different wants, and dreams. Who am I to decide for that person. That being said I can provide a lot of information to help them get through the transition fronm life to death. We all will face it and I have no idea when death knocks on my door how I will feel at the moment and I am a physician or better said I am in the business of healthcare because I am no different nurses, paramedics, respiratory techs etc to have a different perspective. Folks when the reaper knocks we are all the same. The sad truth is that we go through life and we don’t realize that is true from the day we are born. We are truly all the same. K.D. I understand I have been wehere you are and where you were. It is not a happy place but somewhere we alll must face. Thank you for listening and God bless you and your family. Best, AD

  8. Thank you, K.D., for bringing forth such a personally challenging story. In doing so, you challenge some of our self rightiousness. Life is so much bigger that we can grasp. I am deeply grateful to you and changed as a result of reading this piece.

    1. Thank you for your words, Marita. You’re right about challenging some of our self-righteousness. I tend to have very strong opinions, and it’s a slow, difficult process learning to set those aside, especially where other people’s lives are concerned.

  9. This story takes my breath away. So much to reflect upon. I will share this in my work with nurses and nursing students as we consider forgiveness. Thank you for your ongoing work to use humanities to help us come fully present to healthcaring.

    1. Thank you, Julia, and I hope your nurses and nursing students benefit from hearing some of the lessons I’ve learned. It’s a delicate balancing act for those in health care, figuring out how to balance technical/medical with spiritual/intangible issues.

  10. A fine example of what Pulse does best. This is a beautfiully written piece about the world of caregivers, patients and doctors that has substance and food for thought. I’m in the process of re-doing my advance directives and this tale is one to think about as I do.

    1. Bravo KD….well wrought– and very moving–and especially meaningful for me. Thanks for sharing this remembrance with us.

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