In the hospital where I work, people often come to my floor to die. Almost all of them have lived long lives, or at least their bodies have been used up to the very last drop.  The last breath occurs quietly, usually with a family member present (though not always) and then we wait for the next breath which never comes. I use my stethoscope to listen to their chest, trying to listen for any heartbeats or air moving in the lungs as the family waits to learn if their loved one is really gone. Sometimes I hear nothing. Sometimes I hear a low moan, the heart's last beat so slow that it can't make a "lub." During the hours and minutes before that last moan I do what I can to make the patient comfortable and ease the family's grief, explaining to them the dying process and what to expect next.

I spent the first 30+ years of my life living in fear of "old" people. My firsthand experience was not pleasant. All but one of my grandparents were dead by the time I was 10, and the one who survived lived seemingly only to emotionally torture me (and my father and sister) with every inadequacy and perceived slight. He was the type to lavish gifts and praise on his friends, but let the rain fall on his family. When he died in 1996, I stood in the funeral home with my father and sister, the three of us the last left in our bloodline: at once grieving, but also relieved to no longer suffer from the guilt and worry of offending someone who could never be pleased with us.

In nursing school, one of my first rotations was in a nursing home where my instructor, knowing my "fear" of the elderly, assigned me to care for a sweet little 96-year-old man with thick glasses and a big heart. His name was "Dale." After spending 5 minutes in his room the first morning, I knew exactly why we had been matched together. Dale talked nonstop and immediately put me at ease. He talked freely of his long life as a farmer, his preferences in tractors, of his grown children and their accomplishments, and of his life since his wife passed away. We took a walk to the opposite end of the nursing home and found an old organ, the kind you pump with your feet, which he sat down and played for 10 or 15 minutes. A social worker came out to see who was playing, and she was surprised to see Dale, so far from his room. She had no idea he could even play the organ, and was delighted to sit and listen to him share music that was locked up in his head for who knows how many years.

Dale had declined a throat surgery to improve his swallowing ability and had instead opted for a g-button, a short feeding tube through the abdomen wall to the stomach, through which he received nutritional shakes and medication. As I attempted to give him his tube feeding, Dale spoke of childhood events as though they happened only a few years ago, with amazing clarity and details cemented in place through his telling and retelling of these familiar stories. He told me it was a personal goal of his to live to be one hundred years old.  He told me a moving story surrounding his birth: the physician who delivered him could not coax him into taking his first breath. He was pronounced stillborn and placed on a table in the corner of the room while the doctor tended to Dale's mother's needs. Dale's grandmother was in the room and noticed the "stillborn" baby in the corner was moving and spoke up to the doctor. "This baby is alive!"

Dale's grandmother told him the miraculous story of his birth on his 21st birthday. From that moment, he knew he had a special purpose on this earth. It motivated him to succeed the rest of his life, but also haunted him. He told me he now wondered if his purpose was to help teach the many nursing students who were assigned to him each semester. He spent a lifetime trying to guess what that purpose was.

Dale put me at ease so well that I soon overcame my fears. The following week, I was assigned to a much less pleasant man who complained about everything, especially his fluid restriction, asking every passing person for a glass of water. His family rarely visited, and when they did, he didn't say much to them. Wheelchair bound from a combination of polio, obesity, diabetic neuropathy, and edema related to heart failure, his best days were surely behind him, and there were few joys left.

Six months before my grandfather died, he mailed a stack of photos back to me without any note or letter attached which was very confusing to me at the time. I drove to my father's house in tears, asking why my grandfather would mail back these memories to me without so much as a note to explain why he didn't want them anymore. My father threw up his hands.  I'm sure he was tired after 50 years of dealing with his histrionics. Now, having a little more perspective, I realize it was probably part of my grandfather's process of closure as he neared death, distributing his possessions among those he knew or cared about.  It still does not take away the hurt that I felt when I opened a pack of photos I had lovingly sent a man I never got to know very well.

Dale lived until just past his 97th birthday, which was during my second semester of nursing school. I wanted to see him one more time, the very first patient I had cared for on my own and who had been so patient with me as I was with him. He died from complications from pneumonia, in the hospital, peacefully during his sleep. I have never met anyone else who was so accepting of death and open about what his final hours would be like. He told me when his wife died, she was welcomed by family members who had died before her, and angels who would usher her to the next life. He was comforted knowing she passed so peacefully from this world to that one, and I think it made his own passing easier. At his viewing, I visited with one of his children and watched a video made at his 97th birthday party in which, one more time, he told a story about a stillborn baby who grew up to learn he had a very special purpose.