Their Final Days
By Andrew D. Blechman

Hospice offers death with dignity: "If I die, I want the Lord to see that I look good. Wouldn't you want to meet him looking your best?"

First of two parts

Marvel Roberts sits in her hospice bed, eagerly awaiting death.

"I'm curious what heaven is going to be like," says the shriveled 83-year-old dying of lung cancer. "It's like going to a carnival but not knowing what rides will be there. I can hardly wait to find out."

Next door, Martha Layman, also 83, is dying of kidney failure.

"I don't have reason to complain, but I'd give anything to have my other kidney back," she says.

Down the hall, a family is preparing to grieve over the death of a father and grandfather. A man in another room sleeps with his eyes open, his head cranked at an odd, upward angle.

These are the dying voices and glances of the residents of Des Moines' Kavanagh House, one of three hospice facilities in Iowa. They come here to die. In the process, they learn to die and their relatives learn to live with it. And the hospice workers learn from all of them.

"I know more people in heaven than on earth," says Joyce Hutchinson, who helped found Hospice of Central Iowa and spends much of her time at Kavanagh House. "It's an extreme privilege to spend time with dying people. It's a time in their lives when their pretensions are gone. They're honest because they're facing the end of their lives. They're as helpless as newborns.

"Powerful things happen here."

* * *

"I don't know why my parents named me Marvel," she says, taking deep breaths on her oxygen nose inhaler. "I asked them why and they said they didn't know why either. They just liked the name. Everybody says it's a nice name. I just say `thank you.' "

Marvel has been in the hospice for about a week. She is alone. Her husband, Harold - a high-school sweetheart - died of a massive heart attack years ago. And her only child, her son, John, is in a coma in Florida, the result of a car accident. He's been in intensive care for eight weeks.

"I would like to know whether he will live or not before I die," Marvel says, her eyes moistening. "Isn't that horrible?

"He's all I have. We're all that's left. Just the two of us."

Marvel spends her dying days quietly in her room. The lights are low because she's legally blind and can't really tell the difference anyway. She lives in her own world, unable to read anymore or make out familiar faces.

"It's difficult not being able to see," she says. "I'm in a little world by myself. I live in darkness."

Her bed sits beside a large picture window. Outside, sparrows flock to a feeder hanging from the eaves. The woods beyond are bare.

The room is nearly silent. She occasionally listens to books on tape. The player sits beside her on the single bed. Marvel's head rests on several pillows that she appreciates being fluffed from time to time. Every resident is encouraged to bring personal mementos to their rooms. Marvel brought her favorite pillow. Friends have brought her photos, but she can't see them.

Marvel weighs less than 80 pounds. Her emaciated body is covered by a quilt and several crocheted blankets. She looks very much alone.

"I'm new at this," she says of dying. "I don't know a thing about it."

But life in the hospice isn't so bad, she insists.

"I don't have to adhere to any schedule. I just do as I please. I eat when I want. If I need something, I just push a little button and it's done. Isn't that nice? Wouldn't you want that?"

She pauses to slowly place a mint in her mouth. A bag of potato chips sits nearby.

She's thinking about heaven again. She's quietly calculating her odds of making it past the gate.

"I'm going to God," she says. "He's going to take care of me. At least I hope I've been good enough. He says he loves and takes care of everybody and forgives us our sins. . . ."

* * *

In the chapel, several hospice caregivers have congregated. The chapel is a small room in the center of the hospice with soft light filtering down through a stained-glass skylight. It's a subdued room for religious reflection but purposely lacking religious icons.

Gathered are a small group of social workers, nurses, nurses' aides, a chaplain and several volunteers. It takes a staff of about 35 people plus about a dozen volunteers and a $1 million budget to keep the 12-bed facility going. The hospice is witness to about 250 deaths a year, or roughly five a week. The average stay is about 12 days, but some are there four months, others a handful of hours.

Although it may seem odd, the staff prefers to be present when a resident dies.

"We like it when they die on our shift," says Alice Wegner, a nurse's assistant who has worked with the organization for nine years. "We like to be there for them."

"Otherwise you feel like you missed out," adds Ben Shaffer, a nurse's assistant. "It's like you got them that far and then you weren't there when they really needed you."

"Once we give them a bath, they're family," says nurse's assistant Connie McCreery. "Once you've touched them, you want to take care of them, like they're yours."

"We try to make their last days as best as they can be," Wegner says. "This isn't so much a place to die as it is a place to live until you die. We try to make the journey as pleasant as we can.

"It's not a cruel world in here."

The dying come to Kavanagh House when they are unable to care for themselves and there is no one else to care for them. It's a place where patients can finally say no to tubes in their veins and down their throats. The hospice lets people die in peace. The only medication handed out is for pain relief. Patients are spoiled. They can eat whatever they want, whenever they want. If they have a final wish - say to go fishing - it is often granted.

As the dying while away their time, relatives are welcome to visit, spend time in the kitchen or cozy family room, or spend the night on a pull-out sofa. The $200-$465 a night price tag of staying at the hospice is often picked up by insurance companies pleased with saving money on costly hospital care.

The hospice staff has seen it all. The ones who welcome death, the ones who fear it. The family members who can't let go. The resolution of bitter family feuds. The children left behind.

"People kind of die the way they live," says Peggy Gilmore, a nurse. "As many ways as there are to live, there are that many ways to die."

* * *

Madeline Myers doesn't want to die.

"What's wrong with another 10 years?" asks the 76-year-old woman with lung damage. "I want to live and enjoy more."

Madeline is one of three surviving members of a 20-year-old ladies supper club. About twice a month the women get together and cook dinner, play cards and go to movies.

"Four of us have died already," Madeline says. "I don't want to be the next one.

"I still want to have fun . . . to chase men with money," she says with a wink.

She may be dying, but Madeline still fixes her hair and does her nails regularly. Even her toenails.

"If I die, I want the Lord to see that I look good. Wouldn't you want to meet him looking your best?"

She pauses.

"I know there's a new life and I know it's waiting for me, but I don't want it yet. I want to be near my children a little while longer."

* * *

Outside Madeline's room, Wayne Ellis paces the softly lit hallways. His older brother Don is in a room down the hall with a failing heart. Wayne spends each night in a pull-out couch beside his dying brother.

"I stay with him at night because he doesn't like to be alone," says Wayne, 73. "And I want to be with him. I love him. He was my big brother. I admired him."

Wayne spends the evening walking the halls, calling his wife on the phone, and preparing himself for his brother's death.

"I know we're only here for a time and then have to die," he says. "I don't relish the idea by any means, but I know it's coming. Learning to accept that makes it a lot easier.

"But I know that when it comes, I'll have my crying spells. Men aren't supposed to cry, but I do."

Wayne's pager begins to vibrate. He takes it out of his pants pocket. It's his wife.

"She's reminding me to take my heart medication," Wayne says. "We try to look after each other that way. She's not well either."

* * *

Kerrie Brooks, 28, is also passing time in the hallways. She's visiting her grandfather Bill, who is dying of lung cancer.

Bill has been in and out of the hospital with pneumonia several times and recently his cancer has tripled in size.

"He's ready to die," Kerrie says.

Kerrie has always been close to her grandfather. For as long as she can remember he has called her every night at 7.

"My friends would never believe me," Kerrie says. "They were stunned when the phone rang at exactly 7 p.m. and I said it was my granddad and it was. He had a phone list and called everyone every night. He loved to tease me about my boyfriends."

Seeing her grandfather slip down to 90 pounds hasn't been easy, she says.

"But what hurt most was learning that he was scared to die. I don't want him to be scared. He has a lot of questions like whether it's going to hurt or if he will know when it's happening."

Inside her grandfather's room, Kerrie's father, Ron, is reclining on a pull-out sofa. He's been spending nights with his father.

"I'd like him to be a 40-year-old man running around the yard with us again," Ron says. "But by the time you get here, you know what's coming."

Kerrie rubs her grandfather's limp palm. He's unresponsive.

"I love you, Grandpa," she says. "I love you."

* * *

Martha Layman is eating pudding. Outside, two squirrels chase one another up a tree toward the bright sunlight filtering through the frigid, bare branches.

"It's going to happen," she says. "That's why you come here. To die. I'm not afraid.

"I have hopes I'm not going to die. But it's inevitable. I can't live with a kidney like this."

Martha's kidney failure causes her body to bloat with fluid, a discomforting situation, which even the most caring hospice worker can't make go away.

On this day, her face is swollen with liquid. She is wearing a nightgown and sitting in a chair she brought from home.

"It fits me just right," she says of the recliner.

Her hair has that "just back from the beauty parlor" look. Martha alternates between strident independence and humbly asking for help from the staff when, for instance, she doesn't have the energy to clean away a bite of chicken that has fallen onto her lap.

She also vacillates between accepting her death and bitterly denouncing it.

She's comfortable at the hospice, but she misses the independence of living alone, of cooking for herself.

"I saw a recipe in the paper for chicken with mozzarella and tomato sauce the other day. I'd sure like to try it, but I don't think I will ever leave here," she says.

But Martha also enjoys drinking her Chocolate Frosties at the hospice every day. "That should be enough," she says.

Like Marvel, Martha is also looking forward to an afterlife.

"I'm going to have everything in heaven that I ever wanted. I know it's going to be great. I won't be crippled and I won't have kidney problems. I'll be well and I'll be with my friends.

"It's my desire to go to sleep at night and not wake up in the morning. That's the way I want to die."

* * *

It's the day after Thanksgiving and Marvel is deteriorating. Her eyes appear glazed and dried saliva gathers in the corners of her mouth.

"I just want to die," she says. "Isn't that funny?"

She pauses and with great effort takes a sip of water through a straw. She stares off into her world of hazy shadows.

She's thinking of her son John.

"It's my time but not his," she says. "His wife needs him. Nobody needs me like that anymore. He thinks he needs me, but he doesn't. He has his wife. My life's over."s