David was handsome by anyone’s standards. He had a strong jaw, a prominent brow and hairline, a broad-shouldered and muscular body. Had I met him as someone who was not in the healthcare profession, I might not have noticed that he covered his mouth when he talked. This was because the radiation given to his face had caused some of his teeth to fall out. David was losing weight when he was admitted to the nursing home, in part because he could not swallow enough food to nourish his body.
He needed some physical therapy to strengthen his limbs. It was during that time that I got to know David. Women from his church visited David to pray with him. He had a very strong belief in God. He declined the use of antidepressants to help to boost his spirits. In fact, David had already signed a DNR (Do Not Resuscitate order), which meant that he was refusing chest compressions or other life-sustaining measures, should his heart stop beating.
I was utterly stunned when I saw David’s signature on the bottom of his DNR sheet. In nursing homes, it is uncommon to see an individual sign this order themselves. Perhaps this is because most people in nursing homes are in their eighties and nineties. Never before in history have people lived this long. Nor have we had the technology to keep people alive as long as we can today. These days, what many workers in nursing homes often witness are patients with terminal illnesses and advanced dementia being kept alive. This is accomplished with feeding tubes, which supply artificial nutrition to patients when they can no longer eat. A plastic device is implanted in the stomach and nutrient-rich liquid is delivered directly to the stomach to keep someone alive. This is called a G tube. Most DNR’s of the elderly are signed by their next of kin. People of advanced age have not been educated on what artificial nutrition actually means or how it will impact their lives. By the time one of these patients would require a feeding tube, he or she is often confused and unable to sign any such form or make this type of decision.
Somehow, this 34 year old man named David, born in the Dominican Republic, had been clever and spiritually aware enough to acknowledge that this would not be the picture of his end of life story. David would not be kept alive on a feeding tube. He was brave in a way that I had never seen before. There was bold intent in his signature on the bottom of his DNR form. David was going to die well, and on his own terms.
David was released from the nursing home. A year went by. And then, like the flutter of a hummingbird’s wing, I heard from him again via email. David had met a woman named Marija. She lived in Finland, but had been flying into the Newark Liberty Airport to see him. David and Marija had fallen in love.
As David and Marija’s romance progressed, David did the unthinkable. He rescinded his DNR. He went to a local hospital and had a G tube implanted. (The G is for Gangsta, David said). I remember hearing of this and rescinding my own ideas about feeding tubes. I had previously believed them to fall into the category of cruel to the elderly with dementia. But as David was of sound mind, able to make his own decisions and newly in love, I was overjoyed. He wanted to stay alive for Marija. This was David’s fearless new step. He did not want to die.
Christmas is important to many people, in many cultures, for many various reasons. I knew that for Marija, Christmas was usually cold and snow covered the ground in her town, just outside Helsinki. Due to climate changes, Marija said that when it did not snow, the locals referred to this as a ‘Black Christmas’. The people of Finland got very upset when they had Black Christmases. As for David, his family usually cooked pernil (pig) and green plantains. His mother and younger brothers relied on him to create the feast, drive them to a local midnight mass, and buy and wrap presents to ensure a wondrous holiday.
Throughout the entire day of Christmas in the year 2015, Marija prepared fish roe and herring, rutabaga casserole and rice porridge (the porridge was her favorite thing). She wrapped presents for her children. She called David from Finland and sent him pictures and videos of her kids. Marija was delighted that snow was falling during her daily jog. In New Jersey, David lay on the couch in his mother’s sala (Spanish for living room), as he smelled the pig from the oven and watched his family dance to music. He was too weak to get to Christmas mass, but strong enough to sit up for a few minutes and watch his brothers open presents.
It was on the very next morning, the day after Christmas, when David’s heart stopped beating. I remember working in the very same nursing home where I met him, passing the room where he stayed, when I heard the news. I reached out to Marija. It was a horrible day, a day that seemed to last far too long, a day when we wished we could fall asleep at noon and hope that this had been something that was not true.
As the years have worn on, we have a different perspective. I still talk to Marija in Scandinavia. It is David’s true love, the one for whom he finally agreed on a feeding tube, who helps me to see the victory in David’s death. “David did not want me to have a Black Christmas,” Marija tells me. “He chose to wait until the day after Christmas to leave.”
These are the words that I needed. I did not know David all that well. But when I think of David’s family, I can imagine the sounds of their voices around the Christmas tree. I can smell the ham roasting in the oven. This smell of food must have brought up a round of nausea within David’s throat, due to his chemotherapy during that time. He could not eat at all towards the end. But he did not allow himself to lie down completely, he willed himself to keep breathing for that entire day, so that his family would have a good Christmas.
Like Saint Ignatius, David was sent many sufferings. He suffered so beautifully, so quietly, without a complaint or concern for himself. Rather, David worried about all of us. That is why he chose to spare his people such a great loss on Christmas Day. David chose to die on the day after Christmas. I sometimes go to his grave and try to talk to him. I ask him how he could have endured the length of time he spent on this planet, in pain, without teeth, with so many people to worry about, and with the knowledge that he was going to die so young.
I know what he would say, as I stand on the frozen ground where he is buried: Have a Merry Christmas. Do not think for a second that God is not with us, in every moment. Tell my girl that I love her.