Reflections on a Final Farewell

It hit me suddenly, this wave of guilt and regret—I should have brought something for Mrs. MacNeil, perhaps a bouquet or a small teddy bear. Just a little token to show my appreciation, you know? This was our last goodbye.

I was visiting my favorite 93-year-old patient at a seniors’ residence in Toronto. Over the years, we had formed a bond that felt more like a friendship than a clinical relationship.

Our conversations were filled with laughter and discussions about the simple beauties of life, the stunning places around the world, and the kindhearted individuals we had met. We often reminisced about Nova Scotia, the place we both once called home.

This visit was especially significant. Mrs. MacNeil was set to receive medical assistance in dying, known as MAID in Canada.

When our pets get old and suffer, we put them to rest—a process called euthanasia, derived from the Greek word meaning “a good death.” We do this to prevent their suffering, allowing them to leave this world with dignity.

In 2016, Canada legalized medical assistance in dying for eligible adults, allowing the option for a dignified exit when suffering becomes unbearable. It acknowledged that death is a natural part of life, deserving thoughtful discussion and even acceptance at the right time. The law provided adults with the choice to reject the idea of fighting against the inevitable, as expressed in Dylan Thomas’ poignant poem.

Mrs. MacNeil was a fiercely independent woman who wanted to have control over her life, as well as her death. She was sharp and knowledgeable and fully aware of her medical condition.

Her health had been on a steep decline due to severe, incurable ailments like cancer. She had been unwell for over a year, and the prospect of continuing in that state was unbearable. With support from her healthcare team, friends, and family, she made the deeply personal decision to end her life on her own terms.

“She had no regrets whatsoever and was ready to disembark from her fantastic journey on this earth.”

Mrs. MacNeil reflected on her life as long and rich, filled with travel and friendships. Her husband had passed long ago, and while she had no children, her nieces and nephews held her dear. She expressed that she had no regrets and felt ready to leave this world. It was evident she was capable of making such a significant choice.

During our last encounter, she paused for a moment, looked at me intently, and asked, “Will you be there to hold my hand?”

How could I say no? It felt like an honor, but I also found myself a bit apprehensive. I had never been present for such a moment, partly due to my own fears and partly from scheduling conflicts. Perhaps it was mainly my own cowardice, to be honest. Yet, Mrs. MacNeil was extraordinary, and above all, I wanted to honor her wish.

As I entered her suite, I took a deep breath. There she was, poised and radiant in her living room, looking beautiful and composed. It was a powerful sight. Her eyes lit up when she saw me, and I realized how meaningful my presence in this moment really was.

She looked so content—almost victorious. We embraced, and she thanked me for being there. Others had gathered, including her family and the physician who would be assisting with the MAID process. Meeting them eased my worries; they were all calm and compassionate.

With a warm smile, Mrs. MacNeil handed me a thoughtful gift—a seagull carved from wood, wearing rubber boots. “I’ve had this for ages! I chose you to have it,” she said.

Holding the seagull, I felt another pang of guilt for not bringing her something. She managed to surprise me with her kindness, and I promised to cherish it and always remember her.

As preparations for the MAID procedure began, I wondered how she would feel in those final moments. I sensed a mix of emotions in her—nervousness, excitement, relief. Everyone gathered in her bedroom, and as she lay down for the last time, a sense of calm settled around us. Were we really ready for what was about to happen? I felt like a child, wide-eyed and curious about this unknown experience.

We reviewed the MAID process once more. Then came the crucial question: “Are you sure you want to go through with this? There’s no turning back.”

“Yes,” she replied without hesitation.

She was resolute, knowing what she wanted.

I sat beside her, holding her hand. Looking into her clear, focused eyes, I whispered, “I have a gift for you, but it’s not something physical. I think you’ll recognize it…”

I began to sing “Farewell to Nova Scotia,” a beloved traditional song from our home province.

The sun was setting in the west
The birds were singing on every tree
All nature seemed inclined for rest
But still, there was no rest for me
So farewell to Nova Scotia, the seabound coast
Let your mountains dark and dreary be
For when I’m far away on the briny ocean tossed
Will you ever heave a sigh or a wish for me?

A serene smile adorned Mrs. MacNeil’s face as she fixated on me during the song. I felt this was likely the most fitting farewell I could offer her.

The medications began to flow through her IV. She closed her eyes, still smiling, and peacefully drifted away.

The room fell silent as everyone absorbed the profound moment we had just witnessed. I had to grab a tissue to wipe away the tears I couldn’t control. It felt strange yet completely right.

There are those who believe it is wrong for healthcare professionals to “play God”—to choose who lives and dies. But maybe it’s more complicated than right or wrong. It’s about honoring an individual’s autonomy and their personal choices regarding their existence. What is deemed “right” or “wrong” is often a matter of perspective. Ultimately, the most vital viewpoint belongs to the person confronting their mortality. It’s a sacred perspective.

Mrs. MacNeil was acutely aware of her condition and what awaited her. She made a decision rooted in clarity and autonomy, knowing exactly what she wanted and, importantly, what she didn’t want. She found tremendous comfort in reclaiming control over her suffering.

It made me reflect on my own eventual leaving. Would I resist against death? For how long would that last? I would hope for comfort, but if it were not available, would I choose to take control of my own departure? After witnessing Mrs. MacNeil’s serene exit, I found that thought more comforting.

From this experience with MAID, I didn’t just receive a wooden seagull from a remarkable woman; I also gained a profound understanding of what it means to have a good death.

Mrs. MacNeil experienced a dignified end to her rich life, surrounded by those she loved. It was her choice, and it was a beautiful farewell.

Note: Some names and details have been altered to respect the privacy of individuals mentioned in this reflection.