A good man eschews modern medicine in his last days and dies peacefully; not in an ICU, but in his town, in his own bed.
GENE was a politician, first to last. After 40 yr as the postmaster in a small town and two heart attacks, he retired to cut the grass and take care of Mama, as he called his wife of more than 50 yr.
Gene had always been a doer: president of civic clubs, deacon in the local Baptist Church, member of the school board while his children were going to the local public schools and Mama was teaching. He organized the local rescue squad that his oldest son joined as a high school junior. In later years, his son would recount how this experience fed his desire to become a physician. Yeah, Gene was a doer.
After years of chest pain and his first myocardial infarction, he retired from the Postal Service. After a few months of rehabilitation, he ran for the town board and took up the cause of serving the little town that had raised his parents, his siblings, and his family over a span of more than 100 yr. As he had done all of his life, he immersed himself in every aspect of governing. He became a maven of sewers and a connoisseur of traffic. He talked to the Chief of Public Safety daily; he was always on the phone to one of his constituents. With these seemingly endless phone calls, with discussions at church, and with real “curbside” consults on his three mile morning walks around town, “Mr. Gene” learned about the problems of the citizens, his constituents. Every morning, day in, day out, no matter the weather, he was out there at 5:00 AM. Five and a half times around the courthouse, regular as a Swiss watch; nearly everyone knew “Mr. Gene.”
The next 15 yr were kind to Gene. He was a good patient and his physicians were always impressed with his positive outlook and his continued level of energy, despite the profound and progressive failure of his heart.
Nevertheless, after his youngest son died, a victim of severe diabetes, renal failure, and depression, he began to show the inevitable signs of his 84 yr and his heart failure. During the next 2 yr, he became progressively short of breath. Despite many medication changes, his energy level waned. He began to lose weight; he had no appetite. His morning walks at 5:00 AM ceased. In the face of his physical ills, he continued to respond to the needs of the community and his family. He tried to talk to many of the townspeople daily and was a source of inspiration even as his disease progressed. Stooped and sometimes breathless, he listened as the citizens of the small town begged him to continue on, and to the amazement of his family, he did. In the last months of his life, despite not being able to campaign, he was elected to another term on the board.
By this time, his condition was deteriorating rapidly. His cardiologist suggested that a few days of infusion of cardiotonic agents and further diuresis in the hospital might alleviate some of his symptoms. He acquiesced to this begrudgingly, not wanting to leave Mama or his home. For the next 3 days, despite progressive increases in the doses of multiple intravenous agents, his symptoms did not improve. His children, sitting with him at night, listened as he worked for every breath with the knowledge that each might be his last. While he was awake and lucid, his son and daughter had a chance to talk to him about the future. Over the next 24 h, they asked him about turning off his defibrillator and whether he wanted to be intubated, about dialysis, about code status. Despite the illness that was rapidly overtaking him, his thoughts were remarkably clear when he responded that, he really did not see the point of being shocked back to life when his heart was failing his body so miserably. He talked about the wonderful family that he and Mama had raised, and how proud he was of each of his children. His only regret, he said, was that he wanted to know them all better, and was not ready to leave them alone to take care of Mama. Tears streamed down his cheeks as he spoke. His life story was coming to a close. He was not certain that he was ready.
The next morning, Good Friday, Gene had a long and poignant discussion with his cardiologist. He was ready to go home, though the medical team wasn't quite ready to give up. He explained that he wanted to be at his home, in his bed, with friends and family around him for the event that he knew loomed just over the horizon. After a passionate argument, Gene's Cardiologist, who had grown quite fond of him, acquiesced and discharged him.
Later that morning, nurses came to the room, discontinued his defibrillator, contacted the hospice, and arranged for transport home. After returning to his hometown, to his home, family, and bed, the visitors began to come. At first a trickle, then a torrent of his friends, his coworkers, people he had gone to school with 75 yr ago, his grandchildren, his sister whom he adored, and neighbors who couldn't imagine life without seeing “Mr. Gene” walking up and down the road at 5:00 in the morning came to pay their respects.
On Saturday, the day before Easter, he occasionally slept, but spoke to those arrayed around his bed during brief periods of consciousness. Sometimes he would recognize someone that he had known years before. Mama sat by his side and tried to help him remember who he was talking to; the children and grandchildren were in and out. The neighbor women brought food because that is what women in the South do.
Late in the afternoon, he had been sleeping fitfully for a time. He awoke abruptly from what seemed to be an unconscious state and grabbed the hand of one of his friends sitting close to his side. “Hi, I'm Gene Brown! And I sure would appreciate your vote!” he exclaimed, as if in the middle of campaigning for the last election. He immediately fell back into deep sleep. Gene Brown, small-town public servant, had taken an atmosphere suffused with grief and gloom and with one amusing non sequitur, brought a smile to his assembled friends and family.
The next day, Easter Sunday, Gene fell into a coma and died late in the afternoon. A precious moment, his family at his side, he died the way he wanted to–in his town, in his home, in his bed. This good man, this dedicated servant, this humble, inquisitive son, father, brother and husband passed away having lived a life of service to the people of his hometown. He never quit giving of himself to the end of his very productive life. That was the only way that he knew to live.
If, by chance, you were to visit the cemetery where Gene is buried in the cold black dirt of southeastern North Carolina, Gene will likely not be there. You see he cannot be there when there is work that must be done. Knowing Gene, I would lay odds that he is out shaking the hands of all of the citizens that he has recently encountered in his new “home town”; listening to their needs, trying to understand their concerns, planning for a better future, and asking earnestly for their vote.