The Last Weeks of Elka’s Life (.pdf)
Things Elka loved the last weeks of her life:
– Knowing that Paul and I were helping her together and were supporting what she wanted
– The Girl Brigade
– The story of the Mystery Man
– The story of losing her hearing aid and finding it in her diaper
– The visit from her beloved doctor, Serge Lindner
– The outpouring of love in phone calls and emails and visits from a community that she nurtured and felt nurtured by for many of her 93 years
– The taste of water
– Being cozy in her own bedroom, first in her own bed and then in a snazzy hospital bed, with her own sheets and her own pillows (“I love this bed. It’s wonderful. Is it mine?”)
– From her bed, looking at the pastels on the walls of her mother and herself as a young girl; then once in the hospital bed oriented towards the window, looking at the light and guessing the time and wanting the blinds closed when it got dark, with the slats up please
– Being alone in silence in her bedroom
– Our kisses on her cheeks and hands
– Kissing us on our cheeks and hands
– Thinking about the idea that she might get to see my dad again
– Saying “I don’t give a shit!”
The Timeline of Elka’s Last Weeks
(personal details and general information and education about Palliative Care, in the spirit of Elka the social worker and hospice volunteer, tributes to Elka, and some personal reflections about end of life issues)
From the time I first let her community know that my mom’s health was declining until she died was only 18 days.
This timeline might feel very sudden for many.
I decided to describe this process here rather than repeat myself to people who have expressed surprise about this and ask me many questions. In letters from her friends, I received many versions of “Elka is a role model for me of how to be in charge of one’s life and one’s death / how to die well / Elka is dying the way she lived — with integrity, thoughtfulness, gentleness and determination. She continues to teach and guide us.” It seems like the way my mom chose to die was out of the ordinary, and I think she would like everyone to know what she did and to be assured that she felt very comfortable doing it this way. This is in keeping with how she was a social worker to the end (and also trained as a hospice volunteer years ago here in Bellingham). She was comfortable talking about hard topics, wanted to offer resources, and told everyone who called, “It’s okay if you call or don’t call or if you can’t get through. Whatever happens, it’s okay. If we talk again, fine, and if we don’t, fine. I really feel that way.” She did really feel that way, and I was struck by how she was also thinking about how they might feel, and to the very end she wanted to do all she could to assure everyone that she was OK with what was happening, felt their love, and didn’t want them to have regrets.
In December 2021, my mom had a very nice few weeks with Paul visiting. They were snowed in, watched TV and movies, and shared beautiful meals. She was also very intent on reading old journals, and in retrospect I can see that over the last few years she was doing what the psychology literature calls a “life review.” During the end of that visit with Paul, my mom lost her appetite and frequently felt nauseous. Within two weeks, she decided to accept this state as her body’s way of communicating that it might be done with this business of being alive.
It may be that most people in that situation would go to the doctor to find out what was wrong: why the nausea and lack of appetite? My mom would not have judged anyone for making that choice. She made a different decision: she felt that whatever she might learn about what was going on with her physically was not going to change the fact that she was ready to die; she knew that, whatever she learned, she would not choose to have medical treatment to fix it. We had all been talking for years about this idea of comfort care, otherwise called palliative care, when you get very old, and my mom was comfortable with this approach.
I was influenced by the writings of Katy Butler and shared her work with my mom years ago when we were making decisions for my dad. We recommend these two books of hers:
My mom had been committed to caring for my dad until he died. Ever since then, she frequently said that she felt tired of being alive and wouldn’t mind if she didn’t wake up in the morning. When her close friend Anne ended her life using physician aid-in-dying, allowed by Washington’s Death With Dignity act, my mom felt very supportive of Anne’s decision and said that she wished she had that option also (that option is only available if you have a terminal diagnosis).
My mom wanted to be clear in her communication with people, maybe educating some, maybe pushing the comfort zone for some, but intentionally modeling her acceptance of and comfort discussing death and dying issues. She had the idea that some people felt she had “chosen” to end her life by not eating and drinking (a process some people choose called VSED). While she wanted everyone to know that such a decision is one she would support someone else making, it’s not what she was doing. She dictated this to me on 1/28/2022:
“I want to make sure people understand that I am not choosing to end this way. My body started it off, and it ended up this way. I stopped being interested in food many weeks ago. And that’s how this all started — it’s not that I started it consciously thinking that I would come to an end. It’s clearly my body that decided to stop functioning, and when that happened, I decided that it was time to end my 93 years of life. I just want people to understand that it was my body that gave me the message.”
I alerted my mom’s community (of over 100 people across the US and also in Holland, Israel, Germany, Mexico, and South Africa) to her new situation on 1/25. There was a week with a flurry of emails and phone calls and visits with many people she loved, and she was still eating a bit and walking to the bathroom. By that weekend she no longer left her bed. Her second week was quieter but still full of visitors and phone calls. That next weekend she mostly wanted to sleep, had no more interest in food, and really enjoyed drinking water (she had never particularly liked water before, and when she drank it at this point she talked about how delicious it was!). By the beginning of the third week, she mostly wanted to be alone and sleep. When asked, she said she felt “peaceful.”
It’s still hard to reconcile this decision. “But she was so loved! But she was still healthy!”
Here are some pieces to consider:
– She was preoccupied ever since her strokes (September 2018) and when she broke her hip and fell (August 2019) with worries that one of these things would happen again; her specific fears were that she’d be in a lot of pain and that she’d have no control over what happened and would die in a hospital.
– After her strokes, even though they were small and we didn’t experience her as being very impaired, Elka found no more pleasure in writing letters, both because it was hard to write and she felt that her brain wasn’t working as well, and this was a huge loss for her.
– After she came home from hip surgery with a walker, she was no longer independent: no longer could she drive or shop or easily have lunch with friends at restaurants or cook and bake with energy (in fact, on a Health Care Directive she was filling out some time ago, she told me that she wanted to put, on the line asking under what conditions she would not want to be revived, something like, “If I am not able to make an apple cake“). Being able to stand in her kitchen and bake something felt essential to being Elka. Baking was one way of loving people: that, and then inviting someone over to share what was baked. (She would call me and say, “Can you come over? I made some apple cake and there’s much too much for me.”)
– Once COVID happened, she felt extremely isolated socially and was mostly homebound.
– She was lonely for my dad, many of her closest friends had died or were dying, and she felt burdened by an ongoing family conflict.
– She often said that she felt very boring (“I’m sorry, but I have nothing to say“).
– As Paul wrote to me some days after she died:
“She was so appalled and saddened by the state of the world that she was more and more tuning it all out this last year. It was definitely a factor in her deciding to die. Just too much pain in the world for her to bear these days. And likely, her witnessing increasing attacks against Jews and synagogues in the US really shook her sense of safety as a Jew, all over again. I think she feared the worst for these next years/decades in this country.”
(What is happening in Ukraine would have broken my mom’s heart. I’m glad she was spared that information. Her father’s family was all from Ukraine, and I found this rabbi’s sermon very lovely to reflect on when I think about her father’s family:
https://www.irwinkeller.com/itzikswell/2022/2/26/the-jewish-gifts-of-ukraine)
– I overheard her tell someone on the phone, “I don’t want to go back. There’s no advantage to being alive with a walker… not walking or driving, you can’t do what you really want to do.”
– I’m not sure where this fits, but my mom loved (and I do mean loved) eating. For her to lose her appetite and decide to let her body stop eating is really telling. She was truly done if she did not have any more interest in food.
I give all these details to make the point that to focus on how my mom seemed to “let go of living so quickly” is to miss the bigger picture. Many of us might not have been ready to say goodbye to my mom, but she had been ready for a long time.
After she lost her appetite and Paul arrived and Hospice agreed to accept her, my mom perked up and had a very pleasant last few weeks. There was no longer a shadow over her of worrying that something might happen over which she had no control. She knew that she would be able to stay in her own home and in her own bed, if she wanted to, even if she had another stroke or broke another bone. She knew that Paul was going to be with her until the end. I think she felt lighter because of this knowledge: relieved and able to bask in the love pouring in. This didn’t mean that she wasn’t dying, but it seemed like a pretty incredible way to end one’s life: on your own terms, in your own home, in your own bed. Her children were in the next bedroom over or just down the street, and people who had loved her for years were visiting a lot or calling her on the phone. And there were the most delightful little tastes of some of her favorite Thai food or oatmeal with toasted coconut and brown sugar, a few bites each day that were absolutely delicious.
Even as my mom was detaching more from the things around her, she still wanted to talk with me about a Supreme Court Justice retiring and expressed great interest in a new documentary about Princess Diana (and asked me to forward the review I read her to several friends — always thinking about sharing!). She wondered whether she could get the movie on her TV; I said we would need to get her a subscription to Showtime. There she was, very much alive and present at that moment, possibly interested in a future pleasure she would experience if we subscribed to Showtime for a month to see a series… And then a little smile. “But it’s also okay if I don’t see that.” She could hold both: the desire to be done with living and the love of being alive at that moment.
It was like I was in the presence of the wisest teacher who had ever lived.
My mom was both going inward, saying goodbye, and alert and curious about the world she was still a part of, until just a few days before she died. Who gets lucky enough to have this kind of goodbye?! Someone expressed to me that she had never seen anything like it. People had time to say how they felt about her to her, not at a memorial service when she was already gone, and she had a chance to tell people how much she loved them.
People wrote incredible emails, and my mom asked me to share some of them here:
This one is from a close childhood friend of Paul’s:
Please give your mom my love, and please thank her for all she did for me, being a “second mom” growing up – and a safe place I could go to and be accepted. It’s a debt I can never repay, but I will always remember.
Each of these is from the son or daughter of a longtime friend of hers now dead:
On my mother’s behalf, I want to tell you again how much your friendship meant to her, how immeasurably you enriched her life. She loved you dearly, and from everything she told me about you through the years as well as the conversations you and I have had directly, I grew to love you, too.
She was a good friend to my mom and has been a lively correspondent with me in the past few years, always remembering my mom’s birthday and keeping her memory alive, which has been a great gift. I feel richer for having known her. She is dying as she lived, consciously and with greatness of heart.
Anji, For some reason, your words about your mother have hit me very hard. I am so touched and moved by her very beautiful way of leaving her body and leaving you…and all of the people in her life. Of course, I am crying about my mother and their extraordinary friendship and somehow, I am filled with a fresh flood of very real sadness about losing my mother almost 21 years ago. And deep appreciation of my mother and your mother’s very special friendship. My mother adored her, respected her, valued her from the bottom of her heart. Over the years your mom would remember my birthday on Christmas Day and mail me birthday cards. In many ways it was like getting a letter from my mom. She was so thoughtful and kind. Considerate and loving. I know she missed my mom a great deal. It meant so much to me. Please tell her that I am thinking about her with so much love. When she gets to the next world, please ask her to find my mother… undoubtedly they will find each other. Please ask her to tell my mother how much I love her. And how much I miss her – all of the time. I am heartened by the fact that they will be reunited. I know how hard this is… but your mom is leaving with the utmost integrity and courage… just like she lived her life.
Your mother had a significant influence on my life. When I was in grammar school, I would accompany your mother and my mother to clinics on the reservations. I made the decision early on that I would become a social worker, too. Your mother was truly a gift that kept on giving. I was a social worker in the field of child protective services for 30 years. Even as a young child, I admired your mother. She possessed a gentle and loving demeanor. She also had a great sense of humor. She modeled that even in times of great despair and difficulty, there is reason to hope, laugh, and be kind. I appreciated your mother’s ability to reign my mother in. Your mother was adept at reframing my mother’s situations so she would not get lost in her own despair. My mother’s friendship with your mother enriched her life.
It sounds like she is approaching the end of her wonderful life with remarkable honesty and intention, courage and grace. This is who she is, right? Our moms did truly have the best kind of friendship. They loved and respected and enjoyed each other so much. Brought so much to each other’s lives. After my mom died, Elka gave me a huge stack of letters that my mom had written to her. It was such a generous thing to do. My mom’s words in her handwriting are very precious to me. And the letters showed me the nature of their friendship – how much they loved sharing what was important to them with one another.
Elka, I pray for your continued serenity and comfort and ask you to give my mother all my love when you see her again. I am so sure there will be oodles of friends and loved ones to greet you but I know that long lasting childhood friendships are gifts.
This is from my oldest friend from third grade, my equivalent of Elka’s Betty (the four of us spent an afternoon together years ago in Elka’s kitchen making flensjes, and we called ourselves the Flensjes Sisters):
I want to say THANK YOU to you Elka. I have so many fond memories of you – your home, your cards over all these years and of course your flenches (did I spell that right?) OH MY GOD DID I LOVE YOUR FLENCHES!!!…all that powdered sugar – Yummy :o) It is interesting to me at almost 62 now the things I remember and how they touched my life and contributed to my being. You have been a contributor to my being, Elka, and I am so grateful to you for your thoughtfulness, your kindness. And maybe one of the most profound impacts you have had on my life is that I always felt like you saw me, in a childhood where I think I sometimes felt not always very seen. When going through some of my father’s things recently I found a card you had sent to him with a picture of me in it from Anji’s wedding and it said some lovely things about me. Thank you for seeing me, Elka. I still have the necklace that you bought for me for a birthday, maybe third grade? – you, me and Anji went to Old Town and you let me pick a necklace out, very special and very treasured even still. And the pictures in my head, still so vivid, of being in Old Town with you and Anji buying it – little me feeling very seen, feeling very special. You came to my wedding!!!! My own mother didn’t come to my wedding – but you came to my wedding. Thank you for always seeing me and making room for me in your life. I’m sad you won’t let us send flowers as I am guessing your room would look like a floral shop and I love the idea of you surrounded by the beauty of the flowers that always graced the front of the cards you sent to me. Instead I send all the energy I can muster from my heart to you, to be joined by all the other heart energy from all the other lovely people who have known you, cared about you and been touched by you, who you have loved and who have loved you back. Please know I have loved you and feel so very fortunate to have been loved by you.
And these are a few of the emails her friends wrote:
I have long admired that rare quality in you that I can only call a deep “inner knowing” about what is true, what is right, and what really matters.
Your life has been an extraordinary blessing to all who know and love you—and to the world. Even from afar, I am humbly grateful for the gift of your light.
You showed me the benefits of kindness, honest communication, frankness plus the wonderful advantages gained through sharing cookies and a cup of tea. How I treasure the times I had with you both in your lovely garden, meeting at the symphony or a garden lecture and also having time with you and Myron to relax and enjoy viewing my own garden. Thank you so much for all you have shared and taught me about life as even now you are showing the beautiful way to go along towards the end.
I think back to wonderful times we spent together; your kindness; and the fact that thinking of you has always had a calming, reassuring effect on me.
Elka is a remarkable person. Her death will impact so many people. She’s been the glue bringing people together.
You have blessed my life and provided me also a wonderful model for living your life thoroughly.
Elka, I’m so moved by your calm and conscious path at this place in your life. I’ve always been impressed with your pragmatism and I see some of that same energy evident in your current decisions. I wish you a smooth and peaceful death.
How many people would love to have lived like your mother and then be so coherent 2 weeks before she started sleeping a lot and wasn’t interested in eating or drinking. What a wonderful life and wonderful time to pass away with her family by her side and not be in any pain and having so many people who love her.
I am so grateful for the time I shared with you. It always felt like a gift.
It does not surprise me that you have known that it is time to prepare for your journey onward… you have the wisdom that is earned through sorrows, joys, curiosity and love of those around you. By accepting the whole mix of life.
You lived your life with courage and integrity. You walked your talk and you followed through with what you knew was important and you shared all that with me and with others. I am a better person for having known you.
Your intellect, wit, curiosity, compassion and ability to articulate so well come to mind as qualities I greatly admire in you. However, I am perhaps most impressed with and fond of the rare quality you possess in being direct, particularly in a part of the world where directness is quite elusive. It is so refreshing! The world is an exponentially better place because of you and your ability to share your wonderful traits with those who’ve been blessed to have you in our lives. I am so happy you are at peace with the end of your life and hope I will meet my demise with the same sense of gratitude, serenity and dignity.
Anji has let us know that we must soon say goodbye to you. Your earthly journey is drawing to a close, and in searching for words of farewell, the image came to mind of being with you and all of our collective families at the platform of the cosmic train station while you, smartly dressed and radiant, prepare to step on board as we all wave, blow kisses, and thank you for the lovely visit we’ve had with you. You wave back at us and blow a kiss, then step on board, eager to catch up with Myron and join him in the infinite. So, thank you for the visit! Thank you too for being—along with Myron—the tree that Anji fell from, that lured Todd, that led to the Citron kids, and their spouses and children, and a vast forest of friendships. Our lives are wonderfully richer for knowing the Citron family, and that never would have been without you. Thank you too for just being Elka, a woman of immense intellect, kindness, practicality, and calm, even as you step from this earthly platform on to that train whose destination is unknown. The bright sun of your being shows us the way. We love you, dear Elka, and wish you a great journey~
Dictated to me by my mom in late January:
“I wish I could thank every person individually who sent me those incredibly kind, warm, and loving messages over Anji’s email. The words you chose to describe me are beyond anything I would have considered using.”
Overheard on a phone call:
“It feels wonderful to have all that love behind me. The children keep reading me emails from people that are so gorgeous.”
“I have constant care and companions and I have everything I need and I’m very lucky.”
What I see more clearly now as I have put all of these words together is that Elka built the kind of life that allowed her to have this kind of death.
Thank You
There are too many people to thank for all the support my mother got in her life. Please forgive me for leaving out most of you. Briefly, heartfelt thanks to:
– Shelli, for years and years of service to and love for both my parents
– Serge, my mom’s beloved doctor for many years who made a special visit to her bedroom (and took off his mask for a moment because she asked him to please do that for her) to say goodbye
– Everyone who called or emailed or visited my mom in her last weeks, constantly reminding her she was important and loved
– Simar from Hospice, who helped my mom’s body feel yummy
– Janet, a nurse we got so lucky to find to accompany us for the last two weeks of my mom’s life, who made my mom a custom sippy cup with metal straw because my mom hated the plastic, who helped my mom and us with her expert nursing, emotional support, and sometimes much more than the hour a day we hired her for in the beginning (a precious Hello-Goodbye)
– These folks from Hospice: Daniel, Nancy, Carolina, Kristine, Debbie, and Becky
Elka’s body
Elka had hoped her body could go to the UW Willed Body program (where my dad’s body went).
“I hope UW will take my body. I think they will. I think I’m interesting enough.”
Sadly, there were some medical reasons that UW declined to accept her body (but I’m sure they would have found her to be very interesting if they had been willing to take her). So we chose to have her body taken care of by a Seattle organization called Recompose.
As of March 11, after a brief ceremony with what is called the “laying in,” Elka’s body will begin to become soil using a process called “Natural Organic Reduction.” This process has very little negative environmental impact, and we believe (as do many rabbis) that it honors Jewish tradition.
If you’d like to read about this process, this is the website of the Seattle organization taking care of handling her body:
This organization spearheaded the recent campaign to make this process legal in Washington State. We have been watching this initiative over the last several years and very much support their work.
Elka had requested that her ashes (after the medical school program was done using her body, which she assumed would be the case) be mixed with my dad’s ashes (which the medical school had sent Elka last year). To honor her request, the Recompose folks will be adding my dad’s ashes to the vessel holding her body at some point during the decomposition process, so their remains will be mixed in the soil by the time the process is complete.
Elka’s body (plus wood chips, alfalfa, and straw) will transform into one cubic yard of rich, beautiful soil. Sometime this spring, we plan to pick up the soil in Kent (south of Seattle) and bring it back to Bellingham. Anyone who would like to have a bit of this “Elka/Myron soil” can let us know; we’ll be in touch when it’s ready to pick up.
And please note: If you have plans to travel to Holland and you are willing to take a very small baggie of soil to leave in a garden or tulip field or park, please contact me. I will gladly mail you a bit! I plan to bring soil to Holland at some point in the future, but in the meantime I would love to know that Elka is back home as soon as that can be arranged.
Articles that may be of interest:
— “Human Composting: A Reconstructionist Rabbi’s View”
Evolve – Human Composting: A Reconstructionist Rabbi’s View (reconstructingjudaism.org)
— NOR / Recompose FAQ’s
Recompose-In-A-Nutshell.update06012020.pdf (jewish-funerals.org)
Gloria Mundi
Come to my funeral dressed as you
would for an autumn walk in the woods.
Arrive on your schedule; I give you permission
to be late, even without good cause.
If my day arrives when you had other plans, please
proceed with them instead. Celebrate me
there—keep dancing. Tend your gardens. Live
well. Don’t stop. Think of me forever assigned
to a period, a place, a people. Remember me
in stories—not the first time we met, not the last,
a time in between. Our moment here is small.
I am too—a worldly thing among worldly things—
one part per seven billion. Make me smaller still.
Repurpose my body. Mix me with soil and seed,
compost for a sapling. Make my remains useful,
wondrous. Let me bloom and recede, grow
and decay, let me be lovely yet
temporal, like memories, like mahogany.
~ Michael Kleber-Diggs