The Pronouncement

Carl V. Tyler

I knew from last night's house call that my patient Bessie's time was near. All day long I'd felt the familiar churning inside, the sickly sweet combination of anticipated dread and anticipated relief. So when the phone rang while I was exercising at home, I wasn't surprised. I quickly dropped the barbell weights to answer the call before it went to voice mail.

It was Bessie's daughter, Susan.

"Mom is gone," she said, her tone controlled and calm.

Thus began the final chapter in my decade-long relationship with Bessie and her family. We had initially met when I assumed the care of Bessie's husband, who'd lived and died in a nursing home where I was medical director. Somewhere along the way, Bessie became my patient as well.

For years, helped by her daughters and daughter-in-law, we'd battled her heart failure. Fragile and chronically breathless, Bessie had a manner that always made me pause and slow down a bit. Perhaps her Southern gentility and courtesy reminded me of my own grandmother, also a transplant from the South.

"Please accept my deepest sympathies," I told Susan, feeling irritated at how awkward my words of condolence sounded.

After a quick shower, I donned my black suit, worn thin from weddings, baptisms and funerals.

As I drove to Bessie's home, the wind and snow blew furiously. It seemed ironic that whenever Bessie, who absolutely loathed our cold Northern winters, was in crisis, and I needed to see her urgently, I had to drive through a snow squall.

Yet there was never any question that I would go. Years before, Susan had asked that, when Bessie's time came, I would make the pronouncement. I knew from Susan's voice that my carrying out this final act meant so much to the family. The promise, once made, was the kind you keep.

At Bessie's home the front door was ajar, its thin, glass outer door offering poor protection against the cold and wind. I assumed this was an invitation for me to enter without knocking, but I later learned that it was a tradition--no one knew its origins--whereby after a death a door or window is left open in order to let the soul out.

A single lit candle burned on the dining table. Bessie was lying in her recliner chair, between the kitchen and the dining table. For a split second, I felt a sense--call it hoping against hope--that maybe she was still alive after all.

My senses took in the larger landscape around Bessie, in a delayed, almost mechanical adjustment. Around Bessie sat her two daughters, her son, her daughter-in-law and grandson.

Over the years, I've learned that in situations such as these, the words I say aren't as important as my presence, a tolerance for silence and an open, listening ear. I acknowledged each person there, then turned to Bessie herself.

In the two hours since her passing, her face had already taken on the characteristic high-cheekboned mask of death. Still, I felt compelled to check for a pulse and to auscultate her heart. It seemed such a peculiar but inescapable act, a fusing of necessity, futility and formality--as if Bessie weren't dead till I said she was. Still, I didn't see any need to state the obvious.