Lessons from Hospice

What Comes Next and How to Like It is a memoir by Abigail Thomas that’s not particularly about death or dying. But it is, without a doubt, about the inscrutable and unpredictable things that life delivers up to us, including plenty of change and not an insignificant amount of loss—something Thomas knows a thing or two about.

Below is an excerpt from her book, which made the New York Times Bestseller list. There are details some could find disturbing, so if today’s not the day for such plainspoken facts, please consider clicking to another story and returning to this one another time. If you do choose to read on, though, we promise you won’t finish without having experienced a shift in perspective.

We recommend you read the whole of Abigail Thomas’s What Comes Next and How to Like It, but for now, a taste:


I decided to take the training for becoming a hospice volunteer. …
I want to make Death a member of my family. I don’t want it to arrive as a stranger.

The Information

During the last seventy-two hours of a person’s life, there will be a discoloration of toes and kneecaps, a marked coolness of hands and feet. There will be mental confusion, and a mottling of the skin, which will start at the feet and progress up the legs. When mottling reaches the upper thighs, death is imminent. Two minutes after the heart stops beating, the person is still aware. This is what happens during the course of a natural death, an easy death.

There are other scenarios—a bleed-out, for instance. If there is bleeding from the mouth and nose, we are to cover the blood with dark towels. There will be a large quantity of blood, and we want to spare the family the sight of it. If there is an internal bleed-out from a tumor in the esophagus, say, or a tumor in the lungs, there will be no visible blood. The instructor says if this is happening, we hold the patient’s hand and wait. Death will take only a few minutes.

Hold the patient’s hand and wait. The simplicity is so moving. It strikes me that the physical details of the dying body are as intimate and predictable as those of the body making love.

The Training

Twelve of us sit around a big table. We are given a bad diagnosis and twelve squares of paper. On the first three we are to write the names of three people dear to us. On the next three, things we cherish. On the next three, stuff we enjoy. On the last three, things about ourselves we value. We spread the squares in front of us neatly on the table. Then we are given six months to live.

The instructor describes the disease’s progress month by month. As each month passes, and our condition worsens, we must tear up two pieces of paper. The instructor comes around the table and collects the torn pieces in a shopping bag. By the end of the six months, when we are too weak to sit up, too weak to eat, when we have lost so much weight that our clothes hang off our bodies, we each have two pieces of paper left. The instructor comes around the table and from us she takes one of the last two pieces, tears it up, and drops it in her shopping bag. The room is quiet. We are each left with one piece of paper. Then she tells us to tear that up too.

Tirade Against “He Passed Away”

You never hear it said, “he is passing away.” It is always a fait accompli. “He passed.” How I hate it. As if the body had nothing to do with it, as if the body hadn’t even been around at the time but off playing Scrabble somewhere, or having a drink while the tenant moved out. Dying is the body’s call, the shutting down of services is the body’s last bit of business. Give credit where credit is due. Honor the process. Consider the simple dignity of “She is dying.” Or “He died.”

It is interesting to think of it as a verb.

—from What Comes Next and How to Like It by Abigail Thomas


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