Life Is a Marketplace

As health care professionals we spend much time teaching our patients. Similarly, we can learn from our patients about life and about death. I met Abigail, aged 69, when I was working as an oncology nurse. She had been coming for chemotherapy for three months, so we nurses got to know her well. One particular day Abigail was in a lot of pain but had refused to take her pain medication; earlier she had signed the paperwork to discharge herself against medical advice in order to attend a relative's funeral. As the head nurse I was notified by her nurse and her daughter, who was visibly upset; both had pleaded with her to no avail. I sat beside Abigail's bed and asked why she had refused pain medication despite being in pain.

She told me that she knew she was dying, and that it did not bother her. She said she needed to limit pain medication in order to have a clear mind as she played her life over. As a Yoruba woman, she sees this earth as a marketplace, and the other world is home. Just as anyone who goes to the market must go back home, everyone must go home (die) one day. As I listened to her, I saw respect of autonomy in relation to patient care develop a broader meaning than respect for personal choice; it covers respect for beliefs and life choice that a person makes—whether choosing life over death or death over life, especially if the choice is made with a clear mind.

Abigail left later that evening to attend her relative's funeral, and we did not hear from her again until four months later, when her daughter brought her back. She was in a lot of pain but looked calm as we tried to stabilize her. The following day I could not wait to see her and hear how she had fared through the night. I headed for her room as I got to the floor. Her very loyal daughter sat by her, weeping quietly. Abigail looked at me and smiled weakly as I drew a chair to her bedside. She could smile, despite all the pain?

“Hi, I have been waiting to see you. Thank you for not trying to dissuade me when I discharged myself against medical advice the other time.” She was glad we had supported her autonomy as a competent patient. I asked her if she found what she was looking for. I will never forget the look of satisfaction on her face as she related to me how attending the funeral helped her to realize how she needed to clean up and make amends if she had issues with anyone. And the funeral, being a family occasion, allowed her to meet many family members she had not seen or talked to in a long time. So, in essence, she had tried to pack up her trade as best as she could and finish her shopping, hoping to die in peace per chance the cancer take her life. Abigail continued to fight her cancer with her newfound strength, and her courage as she faced each day still amazes me.

On the day she died, her daughter, as well as the nieces and nephews she had recently made peace with, were present when she coded; they waited in the family room while we resuscitated her. When she came to, she reached for my hand and said, “It's time for me to go home, and I go in peace. No fear.” She removed her hand and smiled. She asked for her relatives, and we called them in to see her. One hour later, Abigail was gone. For her, the market is closed.

Note: No actual names have been used in this narrative.