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My mind flashed back to the many times Ruth and I had talked about death and ways of dying. But even last month, except for her fading eyesight, she had appeared so alert and vital. It was a challenge to keep up with her long, strong legs when I accompanied her on her daily walk to the top of Signal Street. We had gossiped like two teenagers about the lighter side of my love life. Her final advice to me had been, “Outgrow the sex thing and get on with your life. You’ll feel so free!”

I could barely comprehend what Shirley was saying. “The problem is, she tries starving herself every time she feels like she can’t take care of herself anymore. This will be the third or fourth time she’s threatened to do this.”

“She’s never told me this. How long does she last?”

“About three or four days. And then she feels better and starts eating again. But this time I have a feeling she’ll go through with it.”

Ruth had always done things her own way. Most of her friends would have checked into a nursing home by now. But I knew Ruth would never give up her independence. Unmarried, no children, she had supported herself as a PE teacher before retiring in Ojai. A Theosophist and life-long student of esoteric and Eastern thought, she relished her autonomy and privacy.

I enter Ruth’s bedroom. Her head is perfectly centered on the pillow with the covers pulled up to her chin. “Hi, Ruth, it’s me, Suza.”

“Has Shirley told you about the trouble I’m making?”

“She didn’t put it like that!”

“You know how I feel. I want you to make everybody else understand. I don’t want to live like this!”

I bend down to give her a hug but she pushes me away. “I want you to help make the others understand. Tell them to leave me alone!”

Ruth was dead serious. Her courage was contagious. “Okay, Ruth, I’ll help you, I promise.”

Coaxing her to eat was out of the question. There were no nearby relatives to help out. And I did not want to sentence myself to endless days of adult diaper changing, catheter draining and spoon feeding someone who might eventually no longer recognize me.

The last person I had taken care of, Ada, had been a close friend of Ruth. We had both known Ada for many years, when she was still a vibrant, artistic person. But at some point in her late eighties, we began to see Ada slowly deteriorate. Ada did not want to move into a nursing home and she hired me to take care of her at home. The day came when her body was nothing more than a bag of skin and bones. She didn’t want to eat. It hurt to breathe. She wanted to die in her own bed. Unfortunately she did not have the energy or mental capacity to resist when well-meaning relatives checked her into the hospital. There she was miraculously revived and transferred to a nursing home where she spent three pitiful years strapped to a wheelchair before the end. Ruth and I both visited her regularly, but she didn’t know who she was or where she was.

While visiting Ada, I saw dying people force-fed chunks of steak and potatoes. Ruth was still sane enough to know that in a nursing home the social norms of death and dying would be imposed on her. It would be almost impossible to choose her own way of dying there.

As if reading my thoughts, Ruth repeats, “Be sure, be darned sure, that everybody knows exactly how I feel.” As if to emphasize her point, she takes out her dentures and plops them into the glass of water on her nightstand. “I won’t be needing these.”

Her face shrinks. Without dentures, she instantly looks much older. It doesn’t matter how she looks anymore.

“Can you still understand what I’m saying without my teeth in?”

“Yes, it’s just fine,” I reply. “Please, just take it day by day. Do what you feel like doing.”

“Ha!” she interrupts. “If I do what I feel like doing, I’ll eat like a glutton.”

Not knowing what else to do, I sit quietly by her bed. The room is warm, pleasant and familiar. It’s Ruth room, where she has slept for over twenty years. No nasty smells of urine and other people’s poop. After awhile I absorb what Ruth intends to do, and it starts to feel natural. I recover from the shock of it all. I hold her hand. It feels like holding the hand of a sick person when you try to encourage them to recover. Only we both understand that this will be a different sort of recovery. Our hands are warm and relaxed. We have begun the process of letting go.

Day Four

Three days go by before I have time to visit Ruth again. She is already so thin from a lifetime of frugal vegetarian living and her spirit is so stoic and serene that I entertain the romantic notion that she will take a pleasant leave of her body in just a few days. I envision myself holding her hand, just like in the movies. She will give me one last smile, then exhale and enter the great beyond.

When I arrive, a well-fed, oblivious attendant sits guard in the living room, engrossed in the TV and a pile of knitting. Shirley has posted a sign on the refrigerator saying, “Ms. Doak does not wish to be disturbed. Do not offer food or water. Only if she asks for it.”

Ruth is flat on her back in exactly the same position, the white sheets pulled tight up to her chin. Her eyes are closed but I can tell she’s not asleep.

“Ruth, it’s me, Suza.”

“Oh, good, I’m glad you’ve come.”

She opens her eyes and pulls down the covers. Already her face and arms are visibly thinner. We chat about everything under the sun just like old times. Eventually the subject comes around to her ‘fast’. I put my thumb and index finger around her wrist. “Ruth, you are definitely thinner.”

“Good!”

“Are you comfortable?”

“I’m very comfortable.”

Her sole request is that I wipe the dead skin from her dried parched lips. The water by her bedside stands untouched.

“Well, what do you think of my little project?” she says, flashing a toothless grin.

“You mean dying?”

“Yes.”

What can I say? That she is brave, sensible, courageous? That she is crazy?

“Ruth, have you read about other people who’ve done this?”

“Yes.”

We discuss certain Zen monks and other people who reportedly refuse all food, water and medical attention when they feel ready to leave this world. “Most people don’t realize they have that option. Some spiritual teachers gather their family and disciples around them and just leave. Some of them even predict the exact moment of departure,” I add.

Neither of us has the faintest idea how long the process will take. “Just make sure those attendants Shirley has hired know not to feed me.”

I look at the calendar and count eighteen more days till Christmas.

I promise Ruth that I will take off work so that I can be with her fulltime the whole week before Christmas. Yet even as I promise this, I doubt she will survive until then. I also assure her that in a few more days I’ll start spending the night and that she can call me anytime.

“This is a good time of year to die. It’s winter. I’m glad we’ll be together for Christmas. Christmas would be a good day to die,” she says softly.

“What if you change your mind?”

She shakes her grey head and looks at me like I’m five years old.

“Why would I change my mind? Why would I want to live like this?”

Day Five

I visit Ruth again on her fifth day without food or water. The scene is always exactly the same. She is perfectly still in her bed, with the covers pulled up to her chin. Shirley changes the sheets as often as necessary and helps her take a shower almost every day. Then she puts a clean T-shirt and diapers on her. The room is immaculate with freshly cut roses on the dresser.

Ruth constantly assures us that she is very comfortable and there is nothing that she wants. She has called up the few friends that would understand and told them goodbye. She leaves it up to Shirley to deal with the few out-of-state relatives who haven’t visited her in years.

“What shall we talk about, Ruth?”

“It’s such a long wait…Reading would help pass the time. Could you read to me from Kim?”

As I read, she occasionally interrupts and corrects my pronunciation. It is during this hour that she loses her voice. By the time I leave, she can barely whisper her request to have the dead skin wiped from her parched, caked mouth.

The warm winter sunlight feels so good as I head home. It is a relief to step out of her house and back into the stream of life. Only the fifth day, and already I am weary of Ruth’s dying.

Day Seven

A whole week has gone by. Ruth lies motionless like an empty shell. I take her bony hand. “How do you feel, Ruth?” I ask.

For several minutes there is silence. I think she hasn’t heard me. Then, with great effort, she whispers, “I’ve looked forward to this for years.” I sit on her bed with my eyes closed and allow myself to relax. Shirley interrupts our reverie. I offer to take Ruth to the shower while she changes the sheets. Ruth clutches my arms and strains to a sitting position. It takes a while for her to swing her legs over the side of the bed. I help her remove her T-shirt and diapers. I try not to stare at her emaciated body.

“These disposable diapers are great,” she whispers as she grabs the portable potty at her bedside and lifts herself up to an upright position. I put my arm around her and support her down the hallway to the bathroom.

I shampoo her hair and armpits while she lathers her lower body. She likes the water full blast, very hot. “Oh, the water feels so good. It feels so good to be clean…”

It occurs to me that she’s been drinking water in the shower all this time and that’s why she hasn’t died of thirst yet. But I never see her swallow a single drop. I dry her with her favorite pink towel and ease her skeleton back into a clean T-shirt and diapers. The shower has completely exhausted her. She thanks Shirley for the crisp feel of the clean sheets. Even with my ear right up to her lips I can barely hear her.

“I’m so lucky to have friends like you.” She asks us to pull the covers right up to her chin, then adds, “You can leave anytime you want.”

We kiss goodbye several times.

“Goodbye, Ruth. I love you very much.”

“And I love you.”

Day Eight

I return late that night and sleep in Ruth’s living room.

When I check her in the morning, she is in an unusually happy mood.

Perhaps she feels her “little project” is nearly over. However, I still have doubts whether she can see it through to the end. I worry about her becoming disoriented. In a moment of weakness and hunger she might ask an attendant for breakfast.

“What day is it now?” she whispers.

“It’s Friday.”

She looks puzzled. “It’s Friday morning,” I repeat. “It’s the beginning of your eighth day without food.”

It seems to take her a few minutes to understand, or is she finally feeling the full impact of her intent? “Oh, the waiting takes such a long time…I can live a long time without fat on my body…” she finally whispers.

I take a deep breath. “How much longer do you think it will take till you’re dead?”

“I don’t know. I try not to think about it. If I say four more days I might be wrong and still find myself here talking to you!”

Shirley rarely hires strangers for the night vigil, but several different women “baby sit” during daytime hours when she or I can’t be there. The note forbidding any food or drinks remains posted on the refrigerator. Since Ruth sleeps most of the time, I don’t think any of the attendants actually realizes she is starving herself to death.

On Friday night my boyfriend, Paul, comes over. Her emaciated form does not faze him. Ruth is pleased to see him and motions for him to put his ear by her lips.

“Aren’t you a chiropractor?” she whispers.

“Yes,” he replies, unsuspecting.

“Well, then,” she responds with a knowing, naughty look, “isn’t there something you can do to my neck to hurry things along?”

“I can’t do that!”

“Sure you can! I won’t tell!”

“That’s easy for you to say! You’ll be free and happy. I’ll be in jail!”

Day Nine

I always knew Ruth had the right to change her mind, yet I am shocked when she confides on the ninth morning, “Shirley and I talked about my fast again yesterday. Tomorrow I’m going to make a decision.”
Then she adds wearily, “I’ve come this far, maybe I can see it through…”

Part of me resents that I might be going through this whole ordeal for nothing. Not that I want her to die, but if she begins eating and then changes her mind about living a month from now, I doubt that Shirley and I will have the patience to help her again.

When I return the next day, the look on Shirley’s face startles me. She informs me that the night nurse never told the daytime attendant that Ruth did not want any phone calls. Two out-of-state relatives had called. They begged Ruth to “eat a little something—sip some tea and try to hang on till Christmas so we can see you.”

Shirley is furious! She had consulted Ruth’s lawyer, who said that as long as Ruth is of sound mind she has the right to stop eating. “These relatives haven’t visited her in years! I told them that if they talk Ruth into eating, then we’ll put her in a rest home and they can just come and get her and take care of her themselves!”

Ruth had gotten upset and drank all of half a cup of chamomile tea. This turned out to be a blessing in disguise.

That night her urine smells of strong chamomile tea. She expels foul-smelling gas into the toilet. When I think she is finished, I half carry her back to bed. As we sit talking, I can hear her insides rumble. That should have warned me to grab some diapers. Suddenly she whispers, “I think I have to go!” I pull back the covers and frantically grab bunches of paper towels to clean her. I open every door and window to air out the house. As I wash her and change the bedding, I think, “If Ruth keeps on living, someone else will have to do this unpleasant job on a regular basis.” Just as I am about to put another diaper on her, it starts again. I grab more towels and bury everything, sheets and all, in a double garbage bag.

Cleaning her up the second time, I feel more convinced than every that Shirley and I should encourage her to see this through to the end.

Day Twelve

Ruth’s mind is definitely still intact. On the twelfth day she whispers, “Have you heard about the commotion my fast caused on Sunday?”

“Yes, I did!”

“Well, everything is all right now. At first my niece did not understand, but now there is peace in the family.”

That answers my next question. Ruth has had nothing but half a cup of chamomile tea in twelve days. Her withered face is serene as she whispers, “I’m so glad everyone understands.”

There is a full moon tonight. We hold hands for a long time.

Again, there is that feeling of letting go—a long unspoken goodbye. Late that night with the full moon shining on her shrunken face, she whispers clearly, “I feel the change is coming .”

About midnight she asks, “What day is it now?”

“It’s Tuesday…it’s been twelve days.”

“That’s a long time. I think it’s coming soon.”

I pray that she will die tonight.

Day Thirteen

I feel utterly naïve. I tell myself to stop anticipating that Ruth is going to die soon. This morning both her regular doctor and her osteopath are coming to see her. They’ve both known Ruth for years, and Shirley and I have great hope that they can give us some clue as to how much longer she’ll live.

“How’d you sleep, Ruth,” I ask.

“I sleep the sleep of the dead.” She laughs at her own joke and appears incredibly alert.

The osteopath, a tall, solemn-looking fellow, arrives first. I assume that Shirley has informed him of Ruth’s condition. After the long days of silence, his loud voice echoes in the room. Maybe he thinks she’s hard of hearing.

“How’s your appetite, Ruth?”

“You stupid fool,” I think. He’s probably asked that same question for the last ten years. I take him aside.

“Hasn’t Shirley told you that Ruth hasn’t eaten for two weeks?”

He shrugs and automatically continues his exam. He listens to her heart, takes her blood pressure and pronounces everything normal. I am relieved when he finally holds her hand and sits briefly by her bedside.

The doctor’s presence feels somewhat like the long-awaited arrival of the midwife at a home birth. “How much longer do you think Ruth will last?” I ask.

“It’s impossible to say. All her vital signs are normal. It could be tonight or it could be a long time still.”

The M.D. arrives just as the D.O. is leaving. He is well acquainted with Ruth’s philosophy and, in prior discussions concerning death, had agreed never to do anything to prolong her life against her wishes. His main concern was that she be kept comfortable.

“I won’t order any life-savings measures…Ruth and I discussed this a long time ago…If you have any problems with friends or relatives, have them speak to me. Our aim is to keep her comfortable. Give her chipped ice or water if she wants it.”

He checks her vital signs and confirms that there is nothing unusual.

“Do you want water?” he asks her.

“No.”

“Do you feel hungry?”

“No.”

“Are you comfortable?”

“Yes. Very comfortable.”

Shirley is in the kitchen baking Christmas cookies. It doesn’t seem quite right to be baking goodies with someone starving to death in the next room! I worry that the sweet, spicy aromas will arouse Ruth’s appetite.

A neighbor knocks on the door and asks if she can visit. She’s heard that Ruth is ill and might be dying. I go into the bedroom and ask Ruth if Mrs. Perry can come in. She motions for me to wipe her lips, which now are completely shrunken inside her mouth.

“Tell her she can come in.”

Like the doctor, this neighbor assumes that Ruth is hard of hearing. As soon as she shouts, “I came to say goodbye,” I regret allowing her to invade Ruth’s sanctuary. But Ruth whispers back, with all the spunk she can muster, “I may be here a long time yet!”

The neighbor bursts into tears and sobs, “You’ve known happier times, haven’t you?”

Mortified, I pull her aside and tell her not to say things like that! No wonder Ruth doesn’t want visitors. I push Mrs. Perry back into the kitchen and leave it up to Shirley to get rid of her.

I close my eyes and wait for the room to feel peaceful again. “Ruth, I think we better post a sign over your bed that says I CAN HEAR YOU PERFECTLY. I AM NOT DEAF.”

“They mean well.”

Day Fourteen

Like a midwife checking on a laboring mother long overdue, I peek in on Ruth briefly the evening of the fourteenth day. She lies so still, the spark of life in her dehydrated body seems so faint that I place my face close to hers to be sure she is still breathing. She is deep asleep and I leave the room without disturbing her.

A new attendant is watching TV. “How has Ruth been today?” I ask.

“Oh, she just sleeps all the time. She never wants to eat.”

None of the attendants seem to notice how close to death Ruth is.

When I return later that night, Ruth is still sleeping. I really believe that tonight she will die. The house is deathly still and for the first time I start to get "the creeps.” Shirley has decorated a Christmas tree, but even the blinking lights fail to dispel my sense of foreboding.

Close to midnight, Ruth wakes briefly. I reassure her I’m spending the night. She clutches my hand and then sinks back into her death-like state. But sleep eludes me. I hear her fidgeting.

Around 2 a.m. she struggles to get out of bed to use the potty chair.

I lift her skeleton into an upright position. She moves so slowly I fear she will collapse. She slumps over on the potty but insists on waiting until a bit of urine finally dribbles out. I can’t comprehend how her kidneys continue to function.

Now I really get the creeps. Ruth’s eyes are glassy and unfocused. Her body continues to endure, but her spirit seems to be ebbing in and out. It’s 3 a.m. before I get her bones settled back under the sheets. Finally I too lose consciousness.

Day Fifteen

Christmas is only six days away. We have all grown weary waiting for Ruth to die, especially Ruth herself. Her body is unusually restless tonight, and I wish we’d rented a hospital bed with rails. Instead we barricade her into the bed with six chairs.

Again at midnight she begins to fidget as if her spirit is fighting to fly out of her body. I check on her frequently. Fear grips me. Why can’t her flesh release her spirit? Why can’t she relax and let go?

The house feels cold and eerie and is filled with a foul, musty odor. We have invited death but my instinct is to let life flow into the house. I open all the windows and let the fresh air in. Ruth doesn’t care how cold it is. I bury my own body deeper under the blankets.

At almost the exact moment as the previous night, I hear her struggling to get out of bed. The sight of her skin dangling off the bones is unnerving. She no longer has the strength to sit upright, and doubles over on the potty chair.

As I help her to lie down, I pray over and over, “Release this woman from her body.” But her body continues its innate task of surviving. Even her hair and nails continue to grow. Her heart continues its endless repetitions—the almost insane, mad task of pumping the life force through her dying body. I feel that the time has come to give her an injection but I have no idea what or how to get it.

I don’t understand why she doesn’t just die in her sleep. Is there something worrying her, something unsaid? Several times I ask her, “Is there anything else you want to tell me?” She always shakes her head, “No. No. No.” She is as perplexed to find herself still living as I am.

Day Sixteen

It’s now been sixteen days. Tonight I am so exhausted that I nap at home before going over for the night shift. Shirley called earlier to say she has to leave by 9:00 p.m. When I wake up it’s past 9:00, and by the time Paul drives me over I’m half an hour late and still half asleep.

As I walk in the door I try to assure myself that Ruth is asleep as usual and probably hasn’t even noticed that no one has been home. When I walk into her room her bed is empty. My mind goes blank. In panic I quickly search the bathroom. My worst fears of someone “rescuing” Ruth and rushing her to the emergency room have come true! As I scream for Paul I see that Ruth has fallen off the far side of her bed and is hanging face down, half on, half off the floor. She is tangled up in her bedding and it looks like she’s bumped her forehead on the nightstand.

Shaken, we maneuver her back on the mattress. Paul checks her pulse. Ruth is still in this world. I place a cold compress on her head while Paul rearranges the covers. We have no way of knowing whether she fell just after Shirley left or just before we arrived. She could have been hanging off the bed like that for more than half an hour!

Ruth begins to fidget and move in a state of frustrated agitation. She coughs and spits, then motions frantically for a Kleenex. She spits up globs of mucous several times, being very careful to spit only in the Kleenex and not make any messes. I don’t know if she is coughing and spitting because she has been lying face down or if this is the death rattle I have heard about.

Then she wets her diaper. I think, “If she is dying, why change it? Why disturb her?” But being uncertain, I ask her to lift up her bottom, while I arrange a new diaper underneath. She seems to understand everything. I hope she isn’t angry that no one was here when she fell out of bed.

She remains restless. I feel how sick and tired she is of still being alive. I curse myself for not getting rails as we make another barricade of chairs around her bed. We have to keep moving her back to the center of the bed. Later on I realize that we were witnessing the final moments of her spirit wrestling with her body for release.

Then Paul takes charge. Like a labor coach, he holds her hand. “Let go,” he whispers. “Let go.” She purses her lips and motions for the Vaseline. I ask if she wants me to clean her mouth with a wet cloth. She shakes her head vigorously. Absolutely not. For the last time I wipe her lips. I have done all I can. Once more I say goodbye and then leave her alone with Paul. I can hear him softly talking. “Be at peace, Ruth. You are going somewhere beautiful…” Later he tells me that she had stared intently at him for a long time. She had squeezed his hand as much as she had strength to and then turned her head away. He had the strong impression that she wanted him to leave, that she wanted to die alone.

Winter Solstice Liberation

When I wake up it’s Sunday, 4 a.m., the morning of the Winter Solstice. Ruth must be dead. But then, I had thought that so many times before. I examine her closely in the dim light of her night-light. Still I’m not sure and wake up Paul. He turns on the overhead light. Her head is perfectly centered on the pillow. Already she is turning yellow. Ruth is dead. This time she is really dead.

Paul checks her pulse. He closes her eyes and covers her face with the sheet. I call Shirley. Upon hearing the news she tells me that Ruth was unusually alert and talkative yesterday afternoon and that they had a wonderful, warm, final visit.

Her doctor arrives to sign the death certificate. The ambulance arrives and takes the body to be cremated. Ruth did not want a funeral. I walk up Signal Street in time to see the sun rising above the snowcapped Topa Topas. It’s an incredible relief to be free, back in the stream of life.

Now, years later, I think about everything that I experienced helping Ruth to leave her body, awake, aware, alert. I close my eyes and clearly see Ruth’s image in my mind’s eye. I can still see her striding vigorously up Signal Street with her long, strong independent legs, a smile on her face. Looking back, I see that spiritually I was just a child. I did not fully grasp the great gift Ruth gave me by asking me to be her guardian on her last days on Earth.

Adaped from Suza's forthcoming book: http://www.suzafrancina.com/autobiography_of_a_yogini_inno.shtml