White Horse Jim became somewhat iconic throughout hospice and our community. He was not shy and wanted people to know “aliveness” was possible, even when you are dying. He hoped his life and his ride would help others. My good fortune was not only in witnessing that ride with the white horse but in being with Jim and his sister, Karen. To be able to appreciate the depths of them both in such a brief amount of time was a gift. In all the messiness of death and family dysfunction, it was clear that they were siblings connected by deep, indestructible bonds.
By the time Jim had started to actively die, we had all formed a much stronger relationship. They both had come to trust me, maybe because I was a doctor, or maybe because I was their doula, or maybe both. Regardless, Jim told me when his time came, he would not fight it or struggle. He would accept it willingly.
That was a big fat farce. He was off-the-chain, screaming and fighting, and had entered a state of terminal delirium requiring heavy duty drugs to keep him safe and calm. It happens often at the end, and I surely wasn’t surprised when I got calls from both Karen and hospice that he was not going to go quietly into the night. Although I had a long shift to work in the emergency department that evening, I agreed to go spend the night with them after work.
As I buckled up for the drive into the emergency department, my gut told me I was in for an intense shift.
My first ‘Last Ride’ came in via EMS as soon as I walked through the ambulance bay. I barely had time to put down my bag before the radio went off with a cardiac arrest alarm. A man in his 70s had collapsed on Alii Drive. He just dropped dead. He had no heartbeat and wasn’t breathing when EMS arrived, even with the CPR performed by nearby tourists. By the time they entered my emergency department, it was over an hour later. There had not been any signs of life despite their best efforts. It was very easy for me to stop the resuscitation as soon as I laid eyes on his ashen, lifeless body. I didn’t have a family to contact. No one knew who he was. I imagined him walking down the street looking at the ocean as his last ride ended. Time of death was called and I moved on.
The next ‘Last Ride’ of the evening had been riding his bike when a car struck him. EMS arrived and found him still talking and breathing, but in a labored way. They called to let us know that they had a seriously-injured trauma patient on the way, and asked us to prep the trauma bay. Five minutes before they arrived at our ER, he stopped breathing in mid-sentence. Trying to revive this young man, I inserted needles, chest tubes, and an endotracheal tube while staff pumped on his chest, all to no avail. The surgeon strode in and asked me to stop. He was gone. His wife collapsed as police explained to her that he had taken his last ride.
The final ‘Last Ride’ of the evening was 52 years old. He was with his ten year-old son when he developed pain in his chest and couldn’t breathe. As he collapsed, the small boy knew to call 911. Again, by the time EMS arrived on the scene, there were no signs of life. Nevertheless, they scooped him up and worked his body with compressions and drugs, trying to revive it. Once again, on arrival at my ER, there was no pulse – yet I could not give up. Three dead patients on my watch that night was unacceptable. So, I refused to stop. I continued beating on his chest and pumping his body full of medications. His heart never flickered. Defeated, I had to call his mother in California to inform her of his death. Her cries and shrieks through the phone as I described his last ride to her will ring in my ears forever.
And so, when I arrived at Jim’s house, I was exhausted and sad. Reflecting on what I had just experienced, I walked into Jim’s room and saw him lying there sedated. Karen, his sister, was beside herself. Her anxiety and agitation would not allow her to be still, so she paced. She needed to move. She needed to do something. He was dying and she didn’t know what to do for him. My instinct told me to lie down, so she gave me her bed right next to Jim. I asked her to also lie down and to take a moment. I held his hand and I held hers. I felt his pulse beating strongly still, even though it was irregular, and I heard her breathing so rapidly, waiting and anticipating his death.
And then, I shared a little with her of what I had just experienced in the ER. Three people had just taken their last rides. Yet none of them had had any idea it would be their last, nor did their families. I didn’t know if they had said their goodbyes. I didn’t know if they had shared their “I love yous.” I didn’t know if they had forgiven or asked for forgiveness. But what I did know was that Karen and Jim had. They did it all and then some. They had done the work. They had shown each other the love throughout and there was no doubt in my mind that Jim’s Last Ride was a brilliant one.
Image: Depositphotos.com
