His eyebrows have grown long in the last three weeks. The tight pajama tops fit looser. We didn’t expect him to live much beyond the first weekend here. The hospice nurse mentioned yesterday she didn’t expect him to be here this long either. My father, bless his heart, has never done anything quickly in his life. He is deliberate and thoughtful even in dying. Of course he is. 

We’ve told him it’s ok to go. We’ve told him everything is taken care of, that he’s taught us what we need to know. He's beginning to change now.

Jasmine came to give a bath. “He smells different.”  I've worked with dying patients and smelled the smells. This particular parfume de Noble is unfamiliar to me. 

I asked Jasmine, “Is the smell a kidney failure smell to you?” 

“Could be.” 

Toxins build up and come out the skin or the breath. It's not terrible. It is distinctive.

Noble is itching a lot, something we attributed solely to medication until Linda pointed out that building toxins in the bloodstream cause itching, too. So much to learn.

When Dad offered a detached "Hi, Sweetie" several days ago, I realized he didn’t recognize me. This morning he smiled. Ever the polite gentleman, he nodded and said, “Hello, Ma’am.” 

He has been eager to be out of bed. “Can we go now?” “Can I get up now?” One leg has regularly been over the side of the bed.

When he’s awake, his hands tremble. When the pace of tremors quickens, we know it’s time for the magic trifecta of calming balm: Benedryl, Ativan, Haldol. A nurse encouraged us not to put it on his arm without wearing a glove or we’d be napping right along with him. 

I kissed his forehead and touched his arm when I arrived this morning. I could feel the heat rising from him and teared up. 

The heat, the away-ness of his eyes, droop of his mouth, and open mouth breathing are all signs I recognize. Until today, I’ve seen him come back to present time when he opens his eyes. He's slowly, slowly inhabiting a different place now. 

His language has changed, too.

Monday night he said, “Unlock the door”, a common metaphor of the dying. Once the door is unlocked, more exploration happens.

Tuesday night, “Dot, Dot, would you bring me…? I couldn’t understand the last part. I did understand the Dot part. My mom is Dorothy. She died in 2006. Dad called her Dot. This was the first comment he’d made about someone he loved who has died. I’ve been listening for more and have asked several times who is around. He watches and reaches. This afternoon he talked to someone beside the bed.

"Papa, who is here?"

"I don't know but he came by to us."

"Is he someone friendly?"

"Yes. Yes."

Then he was back asleep.

He wants up. Out of bed. To go. 

"Can we go now?"

“Where do you want to go, Papa?”

“Springfield, Missouri."

"Why Springfield, Missouri?"

"To see Jimmy.” (A deceased friend of his.)

“Ah, Papa. Jimmy will be along to see you soon.”


He’s been checking his watch regularly and asking for the time.

Dad: “I have a meeting.”

Me: “When’s your meeting?”

Dad: “9:30.”

Me: “You’re late. You better get moving.”

Earlier he asked, “What time do we leave?” John said, “We can leave whenever you want to.”

As I left for the motel last night, Dad was working to relieve himself of his pajama top and sheet.  He wanted his pants off, too, though he wasn’t wearing any. Finally, he took off a prized necklace with a Huguenot cross. I'd never seen him wear it until three weeks ago, the night we discovered his kidneys were failing. He'd put it on the day before and wore it until last night. When he took it off, I knew things were changing. 

I got a text from John:

Early this morning there were questions in rapid succession:

"The doors are open?"

"Is the door open, open, open?"

“Can you raise the floors?” 

“How can we get out?”

“How do we pop it out?”

Much of the day he’s been reaching towards things the rest of us can’t see. Sometimes his eyes are open. Sometimes he smiles as he does it, pulling himself up off the bed. Sometimes his brow is furrowed as though he’s concentrating deeply. 

He's resting now. No pain meds have been needed for more than a week. He’s peaceful. He’s making his way.

He asked John tonight, “Can we undo this connection?”

Yes, Papa. As soon as you’re ready.



Martha Jo Atkins, Ph.D., LPC-S is the Executive Director of Abode Contemplative Care for the Dying in San Antonio, Texas. Dr. Atkins is a professional counselor, coach, and researches and teaches about the trajectory of dying. You can learn more about Abode Contemplative Care for the dying at www.abodehome.orgYou can learn more about Dr. Atkins at www.marthaatkins.com.

Martha Atkins