Reclining my upgraded first class seat, I sipped my coffee in its white porcelain chalice, giddy inside that we were already half way through the flight that would deliver me to him. The months of separation had been torturous but only moments from ending. Already tasting his lips, I delighted in stretching my legs with the extra room.
The frantic voice that filled the cabin interrupted my delicious imagination. “If there are medical personnel on the plane, please push your flight attendant call button now.”
Instinctually my body responded before my brain had processed the words. Explaining I was an emergency physician, I asked calmly how I could help.
“There is a man who can’t breathe,” was her panicky whispered response.
As she led me to his aisle seat, our eyes met and I recognized him immediately. We had come to know each other intimately over the last seventeen years through our work in the E.R. He had been my nemesis, a curse, my most feared opponent, to be defeated at all costs before he became my wise, respected teacher; a guru of sorts. Acknowledging his grand presence with deep reverence, I took in the frail, gasping shell of a human before me. I was in awe. He never failed to make a grand entrance — always through the eyes. There was no mistaking the look of Death.
Crouching down in the cramped aisle, introductions to the family took seconds as they informed me Mr. Willie had Stage Four lung cancer. “That was my grandfather’s name,” I sighed as I caressed his wrist with respect and also tried to find a pulse that was barely present. My grandfather was the first person I ever saw die. I was twelve. Sitting at the kitchen table, his head flopped into the soup bowl. It was a massive heart attack. I ran next door for help while my mother performed CPR.
With the memory of my precious Grandfather came the most important question I knew to ask, immediately springing from my lips. There was no time for hesitation or sugarcoating the situation.
“Has Mr. Willie ever told you what he would want in regards to CPR and life support, if his life was ending?”
His sister, occupying the middle seat next to him spoke up immediately: “He doesn’t want anything.”
I had to be sure they understood me because Mr. Willie was in no condition to speak for himself. They still both thought he was just having a panic attack, as his son reached from his window position and kept cheering him on, urging him to relax, that all was okay.
“Mr. Willie is not doing well. I can tell from his breathing and his color that his heart may give out before this plane lands. To be clear, he would not want me to try to restart his heart by pushing on his chest or put a breathing tube in if it was the only thing that could potentially save his life?” I asked this of his family as I looked at Mr. Willie, who was continuing to struggle.
Before his son could respond in the affirmative, Mr. Willie managed to also communicate without words. The look on his face turned to one of deep fear and resistance as his jaundiced eyes widened. And this was clearly not resistance to Death approaching, but to the thought that I might attempt to sustain his Life. It was quickly acknowledged between us all that Mr. Willie would not be resuscitated. But I made him a promise. I vowed to stay with him and give him any comfort that he may need.
The stewardess then reappeared and asked me if we needed to make an emergency landing.
“No. There is no emergency. He will die here.”
Her shock at the idea of this man dying in midair as she scampered away in disturbance was replaced with a new face of an angelic goddess. She was one of those gorgeous, bombshell flight attendants that had perfect makeup and nails, whom I couldn’t imagine ever got her hands dirty. She carried their emergency supplies and explained that she would like to be of aid in any way. As she instinctually knelt down at Mr. Willie’s feet, I motioned to her to help set up the oxygen tank with a mask so that I could start to assist his breathing.
Explaining to Mr. Willie and his family that as his breathing became more labored, I would help by giving him extra breaths through the mask only if it made him more comfortable. Mr. Willie nodded and then became completely unconscious as he gasped and drooled, and the family’s horror intensified. Wedging one leg behind his comfort row seat, with the rest of my body at a diagonal in the aisle, I wrapped my arms around him in this awkwardly hampered space, as I cradled his head against my chest. Holding one hand over the mask to his face, I gently squeezed the bag that allowed for more oxygen to flow into his lungs. His entire body softened. He relaxed as his labored breathing slowed against the beating of my heart. He was moments from dying.
Looking over at the relatives as I held their father and brother, I spoke: “He can still hear you and he can still feel you. Express anything.”
The love that was showered upon this man was miraculous to experience. As each loved one rubbed his arms and offered their words of gratitude through their pain, that complete stranger at his feet rubbed his legs as I continued my embrace. And then I felt him take his last breath. It was done. He was dead. He had died in all of our arms.
Letting them all know that I had felt his last breath, I was unable to leave him. I had made a promise to Mr. Willie. I also feared that when we landed, EMS would board the plane and try to resuscitate him, due to legalities that they so often have to follow because of their state protocol. I felt like I was now his protector, who had vowed to uphold his wishes and prevent their assault. Plus, it didn’t seem right to leave his dead body just sitting there next to his shaken family, to go back to my seat in first class and finish my coffee.
The captain’s voice came overhead and asked the flight attendants to prepare the cabin for landing. The angel showed me how to brace myself for impact while standing, also recognizing I could not let him out of my arms, as she secured his body with the seatbelt we had unfastened. It was the first opportunity I took to look around. Things happened so quickly and deeply that I forgot there were others on the plane. My eyes scanned my audience. People were mostly on their tablets, oblivious to the fact that a soul had just passed. One woman stood and bowed in prayer. Another stood to stretch and as soon as she saw the dead man, squealed and sat back down quickly in repulsion. It was a perfect demonstration of how our culture meets death. We mostly look away — some run, and a few bow in honor.
As the wheels hit the runway, Mr. Willie and I were jostled a bit, but continued as one unit while the captain informed everyone to remain seated as EMS would be boarding the plane for an emergency. Now was when I really braced myself for impact. I crouched over Mr. Willie like a wild animal ready to protect her young. Luckily the medic that first entered recognized Death and listened as I slipped into my ER doctor role, explaining that I was sure he had been dead for at least twenty minutes and was an end stage cancer patient who had been clear in his wishes for no resuscitation.
He wasn’t sure what to do, as he introduced himself to the family and then quickly excused himself to go call his medical director. When he returned, I was still holding the oxygen in my hand and next to Mr Willie’s face as I had never let it — or him — go, despite his death. He told me that I needed to release his body. Mr. Willie was now a medical examiner’s case. No one was allowed to touch him until the medical examiner boarded the plane for examination, due to some federal and state regulatory protocol about dying in the air. He could not be removed from the plane.
Everyone would be allowed to exit the plane, except Mr. Willie and his family. I was one of the first to be let off, after exchanging condolences and thanks with the family and flight crew. The depth of this event did not fully take hold until I crossed the threshold off the plane and into the busy Atlanta airport.
Mr. Willie had just given us all such a gift. In our Western culture that mostly refuses to acknowledge death, each passenger on that plane had to walk by his corpse. Would they salute Death, Mr. Willie, and his loved ones? Or would they look away?
I would never know, as I boarded my next flight in deep gratitude. But I did know Mr. Willie gifted us all the opportunity to open to this life through death. And for me specifically, he gave me the courage to own my role as a Death Doula. I was ready to do this work anywhere — not just in the comfort zone of my chaotic E.R., but in the air or in a home. The place no longer mattered. The presence to bear witness did. Love was everywhere, not just in the air.
Image: Pixabay.com
